Vol 34, No 12 (2023)

The article is devoted to a new hospital-replacing technology – outpatient parenteral antibacterial therapy (APAT). The indications, contraindications, techniques and clinical effectiveness of APAT are discussed in detail. The benefits of APAT are realized when time-dependent antimicrobial agents are prescribed. Consistent drug delivery is achieved through the use of elastomeric pumps. The use of APAT increases patients' motivation for treatment and reduces the burden on medical staff. The introduction of APAT, in addition to clinical benefits, contributes to significant savings in the financial resources of a medical institution.

One of the significant modern problems of geriatrics is cognitive impairment. Moderate cognitive deficits are observed in 20% of older age groups. Ergotherapy, a multidisciplinary practice-oriented approach aimed at ensuring daily activity and meeting human needs in conditions of limitations of his psychophysiological capabilities that have arisen as a result of diseases and injuries, occupies an increasing place in geriatric medical and social technologies in our country.

Objective. To assess the possibilities of occupational therapy in the system of providing medical and social assistance to elderly and senile people with cognitive impairments based on the analysis of Russian and foreign practice.

Results. Ergotherapy is recommended in treatment and rehabilitation programs for patients of older age groups and, according to various authors, contributes to improving mood, cognitive abilities, physical condition and quality of life. For further development ergotherapy and the introduction of its approaches into the practice of providing geriatric medical and social care, scientific justification and development of differential diagnostic and therapeutic programs and algorithms, comparison of diagnostic data with other valid methods of assessing the functional status of older age groups; study of the possibility of optimal combination with traditional methods of physical and rehabilitation medicine, development of a methodology for individual satisfaction in the need for work and social activity in general, an assessment of its effectiveness from the standpoint of evidence-based medicine.

The annual increase in the number of patients with diabetes mellitus (DM) requires additional attention to the issue of improving the quality of life of patients and reducing the risks of developing complications in the long term.

Purpose. To study changes in ultrasound parameters of peripheral nerves in patients with type 1 diabetes mellitus (T1DM) of varying duration in childhood and adolescence.

Material and methods. The study included data from 190 children aged 5–18 years, including 139 children with an established diagnosis of T1DM of varying duration and 51 children from the control group. All patients underwent ultrasound of the peripheral nerves of the lower extremities using B-mode, color Doppler mapping, preppler microvascularization, and shear wave elastography mode.

Results. The data obtained indicate the promise of using ultrasound for diagnosis and dynamic monitoring of the condition of peripheral nerves in patients with T1DM in childhood and adolescence. The combination of increased stiffness and increased size of peripheral nerves of the lower extremities is a sign of nerve changes in T1DM in childhood and adolescence.

Selenium protects cells and tissues at the cellular level from damage caused by oxidative stress; This is especially true for heart disease, which remains the leading cause of death worldwide.

We examined 77 women with metabolically healthy obesity (MHO) during the menopausal transition (MT), and established a connection between hypoestrogenemia and psychovegetative disorders, hypersympathicotonia, and cardialgia. It has been established that the natural non-hormonal drug SELENBIO for women has a positive effect on the psychovegetative status and episodes of cardialgia during MHO in women with estrogen deficiency during the MT. The drug SELENBIO for women has a complex, versatile effect on the female body, helps normalize hormonal levels and ovarian function, neutralizes clinical manifestations, has a general strengthening and immunomodulatory effect, and, thanks to its antioxidant effect at the cellular level, slows down the aging process. All components of the drug are physiologically close to the human body and do not disrupt the natural processes occurring in it. The drug SELENBIO for women is highly effective with low toxicity, has a wide spectrum of action, and has a complex harmonizing effect on the body.

Osteoporosis (OP) is one of the important problems of modern medicine. OP significantly increases the risk of bone fractures. This implies the need to organize an integrated system of prevention, diagnosis and treatment of this disease. The main link in the fight against OP should be a comprehensive and systematic program to prevent and inform people about this problem. In most developed countries, various centers for the prevention of repeated fractures are organized and successfully operate. The article describes the principles of the organization of the work of the centers for the prevention of repeated fractures. The creation of these centers will make it possible to detect OP before complications develop, reduce the risk of fractures and improve the quality of life. Innovative Russian developments are discussed, which can be successfully applied in the work of such centers by specialists in various areas of medical activity.

Objective. To study the indicators of hemostasis and fibrinolysis systems, as well as the systemic inflammatory response in patients with newly diagnosed sarcoidosis after infection caused by SARS-CoV-2.

Material and methods. A prospective analysis of the indicators of hemostasis and fibrinolysis systems, as well as the systemic inflammatory response of 20 patients with sarcoidosis, after COVID-19, who were on inpatient treatment in Central TB Research Institute. The patients were divided into 2 groups. The first group included 10 patients with sarcoidosis, who had suffered COVID-19 (the main group). The comparison group consisted of 10 patients with sarcoidosis without a history of COVID-19.

Results. It was found, that in patients with newly diagnosed sarcoidosis, who underwent COVID-19, there is a hypercoagulation shift in the hemostasis and fibrinolysis system. This was evidenced by a significant shortening of the indicators of APTT, PT and an increase in the level of D-dimer compared to both healthy and patients, who had not undergone COVID-19. In addition, laboratory manifestations of systemic inflammation were most pronounced in patients with sarcoidosis who underwent COVID-19. Probably, changes in the hemostasis and fibrinolysis system occurred within the framework of a systemic inflammatory response.

Objective. To study clinical and laboratory features of the course of terminal ischemic stroke (IS) associated with COVID-19.

Material and methods. We analyzed 23 protocols of pathological examination of patients with IS who died in 2019 (group 1), and 24 protocols of patients with IS who died in 2020–2021. from complications caused by SARS-CoV-2 (group 2).

Results. In group 2, a change in the pathogenetic structure of cerebral infarction was revealed, with a predominance of its unspecified variant. In addition, in group 2, males predominated. The average hospitalization time in group 2 was significantly longer compared to group 1. In addition to concomitant diseases (arterial hypertension, chronic heart failure), in group 2 there was a significant increase in both thrombosis of various vascular systems, pneumonia of varying localization and severity, as well as anemia. The general infectious syndrome in patients with IS is a criterion for an unfavorable prognosis, especially if the process of acute-phase inflammation is accompanied by suppression of red blood cells, which can be considered as a marker of an unfavorable course of IS.

Conclusion. The combination of IS and COVID-19 forms a new pathogenetic subtype of cerebral infarction with deeper systemic manifestations. It can be assumed that this combination of clinical and laboratory changes is caused not only by massive hypoxia of internal organs, but also by the direct neuropathogenic effect of the virus.

The development of protein-energy malnutrition (PEM) in patients on program hemodialysis is one of the significant problems of modern hemodialysis. Despite the relevance of this problem, there is no single point of view on the mechanisms of development of PEM in this cohort of patients.

Objective. To assess the change in the level of interleukin-6 (IL6) in the blood of patients on program hemodialysis, and also to study the relationship between the level of IL6 in the blood serum and PEM indicators in this group of patients.

Material and methods. The study involved 645 patients receiving treatment with program hemodialysis (300 men and 345 women; mean age – 56.8±12.8 years). All patients underwent a traditional clinical and laboratory examination.

Results. In 66% of patients on hemodialysis, a significant increase in the level of IL6 in the blood was detected. Moreover, in patients with signs of PEM, the level of IL6 in the blood was statistically significantly higher compared to patients without signs of PEM. Also, patients with elevated IL6 levels had statistically significantly lower values of total protein, albumin, prealbumin, total cholesterol, transferrin and blood lymphocyte levels compared to patients with normal IL6 levels.

Also, patients with elevated IL6 levels had statistically significantly lower values of body mass index, skeletal muscle mass and body fat mass compared to patients with normal IL6 levels.

Conclusion. The data obtained suggest that an increase in the level of IL6 in the blood may be an important pathogenetic link in the development of PEM in patients receiving treatment with program hemodialysis.

The spectrum of fatty acids (FA) in erythrocytes and blood plasma reflects the characteristics of lipid metabolism in diseases of vascular origin, including cephalalgia associated with arterial hypertension (AH). Timely diagnosis and correction of violations of this spectrum is important for the prevention of diseases of the cardiovascular and nervous system in subsequent age periods of life.

Objective. To study the characteristics of the FA spectrum of erythrocyte membranes and blood plasma in adolescents with recurrent cephalalgia associated with AH.

Material and methods. The composition of FA of erythrocytes and blood plasma was studied in 51 adolescents aged 12–18 years with recurrent cephalgia associated with AH and without AH. Determination of the FA composition of erythrocytes and blood plasma was carried out by gas-liquid chromatography-mass spectrometry with preliminary lipid extraction according to the Folch method. The analysis of FA methyl esters was carried out on a gas chromatograph with a GCD Plus mass spectrometric detector (Hewlett-Packard, USA).

Results. The features of the structural redistribution of individual FA in adolescents with cephalgia and AH in the form of a predominance of saturated and monoenic FA in erythrocytes with a simultaneous decrease in their content in blood plasma, as well as a tendency to a decrease in the concentration of polyunsaturated FA in erythrocytes and their increase in plasma.

Conclusion. Early detection and timely correction of disorders of the FA spectrum of erythrocyte membranes and blood plasma is necessary, starting from childhood and adolescence, in order to subsequently reduce the risk of developing diseases of the cardiovascular and nervous system associated with these disorders.

In the course of this study, an analysis was made of the current foreign and domestic literature on the problem of the toxic effect of local anesthetics on the human body. Literature search was carried out in such databases as PubMed, eLibrary, CyberLeninka. Local anesthetics are widely used in modern clinical practice to anesthetize the area of surgical intervention, as well as symptomatic treatment of some pathologies that are characterized by severe pain. In today's world, an average of 10% of patients develop adverse reactions when using drugs. The level of toxicity of a particular compound is determined by the level of its toxic dose – the amount of a substance that causes some toxic effect. Thus, the greater the toxicity of a chemical, the lower its toxic dose will be. At present, a wide range of drugs for local anesthesia has been developed that have minimal side effects, despite this, we must not forget about the toxic effect on the body of this group of drugs, and therefore it is necessary to apply a personalized approach to each specific patient when performing local anesthesia, regardless of complexity. performed surgical intervention.

The review includes the analysis of modern data about prevalence, clinical picture, endoscopic, morphological, immunological diagnosis and treatment of autoimmune gastritis (AIG). The incidence of AIG is 2–12% of all cases of chronic gastritis. The leading factor in pathogenesis is the formation of autoantibodies to parietal cells and intrinsic Castle factor. AIG is a significant risk factor for vitamin C, B₁₂, and D deficiency. The clinical picture of AIG is nonspecific and may include gastroenterologic, hematologic, and neuropsychiatric syndromes. Morphological diagnosis is the most reliable method for assessing atrophic gastritis, allowing the assessment of the three dynamic stages of AIG. Immunological diagnostics include antibodies to parietal cells and are highly specific. There is no etiotropic and pathogenetic therapy for AIG. Cyanocobalamin replacement therapy is approved in clinical practice.