Vol 35, No 6 (2024)

Diabetes mellitus (DM) and lower extremity injuries are one of the global health problems. These conditions require rehabilitation measures to restore maximum functionality and quality of life of the patients. The presence of DM aggravates the recovery period after injuries, and also serves as an independent factor in poor outcomes, death, development of early and late trauma complications. In DM patients with injuries of the lower extremities it is required special attention, an integrated approach and the participation of a multidisciplinary team to create an optimal rehabilitation program aimed at prevention of the progression and development of complications, achieving a prompt and complete restoration of functions. Personalized treatment decisions, individually selected therapy methods and the use of modern technologies will help achieve the best results in the rehabilitation of patients with DM and lower extremity injuries. Basic rehabilitation strategies in DM patients with injuries of the lower extremities include: control of glucose levels and metabolic disorders; inspection and care of damaged tissues to prevent the development of ulcers and infections; gradual increase in physical activity; rehabilitation goals must be realistic and take into account the individual characteristics of the patient; the use of physiotherapy methods to improve microcirculation and activate tissue regeneration (transcutaneous electrical nerve stimulation, electrophoresis, magnetic fields, ultratonotherapy, cryotherapy, laser therapy, darsonvalization, pulsed electric fields, ultrasound therapy, ozokerite therapy and peloid therapy); the use of mechanotherapy with biofeedback and robotic systems to increase endurance, strength, improve balance function and form the correct walking stereotype (rehabilitation track with visual feedback about walking C-Mill).

The review is devoted to the analysis of current data on the prevalence, clinical picture, differential, instrumental diagnosis of psoriatic arthritis (PsA). The incidence rate PsA is 6–42% of all patients with psoriasis. In recent years, there has been a significant increase in the incidence of PsA. The main clinical manifestations of PsA are: peripheral arthritis, enteritis, dactyl, spondylitis. Timely diagnosis of PsA is an urgent and unresolved healthcare task. Interdisciplinary interaction of a dermatologist, a general practitioner, a rheumatologist and an in-depth examination based on the results of mPEST screening is necessary in order to detect this pathology early.

An original hydraulic theory of the pathogenesis of osteoarthritis of the knee joints is proposed. The hydraulic theory suggests the presence of an initial traumatic or domestic injury to the menisci, cruciate ligaments, and synovial membrane, followed by a post-traumatic increase in the volume of synovial fluid and, accordingly, hydrostatic pressure inside the synovial cavity. Damage to the cell layer of synovial macrophages, which form the basis of the intima and synovial barrier, leads to the leakage of synovial fluid into the subintima with the development of cellular alteration and the subsequent growth of fibrosis and the growth of uncontrolled hyperplasia, cellular hypertrophy and neoplasm of vessels and nerve endings. Later damage to the thick bone and cartilage barrier leads to intrusion of synovial fluid into the bone tissue with the formation of bone cysts and osteoarthritic damage/edema of the bone marrow. Restoration of barriers through the use of repair, including cellular, technologies in the near future is impossible due to the lack of regenerative potential in synovial macrophages and chondrocytes. Damage to the synovial and osteocartilage barrier suggests different medical tactics for the management of patients with osteoarthritis of the knee joints. The authors substantiate the undesirability of any type of analgesic therapy in case of damage to the synovial barrier and preservation of the integrity of the bone-cartilage barrier. The only effective and safe method of treatment at all stages of the disease is therapeutic exercise with an emphasis on exercises that accelerate lymphatic and venous outflow in order to achieve antifibrotic and antihypoxic effects.

There is variability in the frequency of autopsies and place of death among countries around the world.

Purpose. To conduct a comparative analysis of the place of death and the frequency of autopsies of the urban and rural population depending on the class of diseases in the regions of the Central Federal District (CFD) of the Russian Federation.

Materials and methods. The Rosstat table “Distribution of the deceased by source of information about the deceased and place of death in 2022”, urban and rural population were used. 11 of 22 classes of diseases according to the ICD-10 were selected for analysis, since their share in regional mortality is more than 95%.

Results. The frequency of autopsies in the event of death of urban residents of the CFD from any cause (70.64±14.79%) is higher than that of rural residents (61.69±15.49%; p=0.09). The largest proportion of autopsies was observed in cases of death from infectious diseases (ID) (on average 87.6±21.1% urban population and 82.3±26.6% rural; maximum 100%; minimum 53.5%) and external causes (EC) (more than 99% in all regions of the CFD). The minimum proportion of autopsies was registered in class R “imprecisely identified causes” (31.29 ± 27.47; minimum 4% and maximum 95%), and in class G “Diseases of the nervous system” (DNS) (35.51±29.77; minimum 32.25%; maximum 97.5%). The regional average proportion of deaths in hospital (from all causes 39.19±5.37% urban and 32.38±5.04% rural; p<0.0001) was the highest in the case of death from ID (79.14±10. 8% urban population, 76.32±11.25% rural) and minimum in three classes: DNS, R and EC. Regional average proportion of deaths at home (from all causes 45.04±6.64% urban and 52.38±6.04% rural population: p=0.002) The highest proportion of deaths at home was registered in the class of DNS (rural population 77.51±7.99%; maximum 88% and minimum 13%).

In case of death from external causes, the “scene of the incident” was the place of death, with a maximum in the Kostroma region (58.8%; rural population) and a minimum in the Lipetsk region (14.3%; urban population) and in Moscow (16.2%).

Conclusions. Significant interregional variability in the frequency of autopsies and place of death was revealed depending on the specified class of cause of death and place of residence (urban/rural).

Metastatic lesions of the heart can occur in various oncological diseases, but are more often observed in malignant neoplasms of nearby organs. A clinical case of a patient with kidney cancer and cardiac metastases occurring under the guise of acute myocardial infarction (AMI) is presented. In this case, metastases were detected only during a pathological autopsy of the patient. Thus, in a patient with cancer and the clinical picture of AMI, it is necessary to exclude the presence of metastases in the heart, as well as non-coronary causes of increased troponin levels. Correct diagnosis of cardiac metastases plays a decisive role in choosing optimal therapy and improving the prognosis for the patient.

Endovascular thrombectomy is an effective and safe method for the treatment of ischemic stroke, but this method is poorly studied in elderly patients.

A clinical case of successful endovascular thrombectomy in a patient aged 90 years with ischemic stroke and middle cerebral artery occlusion is presented.

Sarcopenic obesity, either alone or in combination with ophthalmopathology, has a negative impact on the resilience of the elderly.

Objective. Study the effect of sarcopenic obesity and cataracts on the resilience of elderly patients.

Materials and methods. The study involved 168 patients aged 60–74 years with age-related cataract and 172 patients of the same age with cataract and sarcopenic obesity. All patients underwent a comprehensive clinical and instrumental ophthalmological examination. The appropriate criteria presented in the clinical guidelines were used in the diagnosis of cataract. Sarcopenia was determined by the European Working Group on Sarcopenia in older people scale, supplemented by carpal dynamometry, and obesity was determined by body mass index.

Results. There was a distinct deterioration in the parameters of the resilience of the examined patients in both cohorts, but more significant among patients with combined sarcopenic obesity and cataract than among representatives with only the discussed ophthalmology. When analyzing the domains of resilience separately for patients with cataract and patients of the same age with sarcopenic obesity and cataract, statistically significant differences were found for all the selected parameters.

Conclusion. Sarcopenic obesity in combination with age-related cataracts statistically significantly and to a greater extent reduce the resilience of patients than age-related cataract alone. Among the domains under consideration, in patients with sarcopenic obesity and cataract, resilience deteriorates in the domains of resistance to adverse influences and trust in personal instincts, the spiritual sphere and the level of control.

The high prevalence of smartphone-dependent behavior (SDB) and associated functional disorders among adolescent users is a pressing problem of modern medicine and psychology.

Purpose. To study the incidence of recurrent pain syndromes and other functional disorders in students with SDB.

Material and methods. Using an online survey, random samples of 1st and 2nd year university students were surveyed. 256 people took part in the survey; median age – 21 (19; 22) years; boys – 52 (20.3%), girls – 204 (79.71%). SDB was assessed using the questionnaire The Smartphone Addiction Scale: Development and Validation of a Short Version for Adolescents (SAS-SV). The type of recurrent pain syndromes was determined using a screening questionnaire. The indicators were compared in 2 groups – with and without SDB.

Results. 83 (28.9%) of the examined were diagnosed with SDB, of which 15 (18.1%) were boys and 68 (89.9%) girls. Students with SDB had a higher frequency of generalized Internet addiction compared to students without SDB (42.0 and 15.1%, respectively; p<0.0001), longer time during the day (>6 hours/day) using a smartphone ( 65.1 and 26.0%, respectively; p<0.0001) with a predominance of watching videos (50.6 and 37.6%, respectively; p=0.0487), they also showed a correlation with frequent cephalgia (27.7 and 11.0%, respectively; p=0.0007), pain in the cervical spine (31.6 and 17.7%, respectively; p=0.0372), pain in muscles and joints (52.5 and 27.4 %, respectively; p=0.0047), unstable blood pressure (30.0 and 15.7%, respectively; p=0.0538), asthenia (61.4 and 28.3%, respectively; p<0.0001) were observed more often. ), dizziness (57.8 and 42.8%, respectively; p=0.0240), memory loss (41.0 and 21.4%, respectively; p=0.0007), severe irritability (42.2 and 23, 7% respectively; p=0.0025). Students with SDB were less likely to engage in sports (36.1 and 52.0%, respectively; p=0.0172), and spent little time outdoors (39.8 and 25.4%, respectively; p=0.0319).

Conclusion. A closer association of recurrent pain with SDB indicates the adverse impact of uncontrolled smartphone use on the body of addicted users and substantiates the need for correction of associated functional disorders, a personalized approach to these populations to reduce the risk of them developing chronic psychosomatic pathology in the future.

A negative trend in recent years is the high proportion of HIV infection in women of childbearing age, which increases the risk of HIV infection in the child. Prevention of tuberculosis, including vaccination, is of great importance. A clinical case of a combined course of tuberculosis and HIV infection in a preschool child immunized against tuberculosis is presented. Immunization against tuberculosis allowed to form antitubercular immunity and promoted favorable course of tuberculosis: absence of disease generalization; calcinates that started to form at the moment of detection; achievement of clinical cure on the background of antitubercular chemotherapy.

Purpose. To study the clinical and biochemical features of the course of coronavirus infection (COVID-19) in patients with arterial hypertension (AH).

Material and methods. The retrospective study included 74 patients with COVID-19 treated in hospital (37 men and 37 women; median age: 55.0 [45.0, 59.0] years). The patients were divided into 2 groups: 1st (n=48) – patients with hypertension who had COVID-19; 2nd (n=26) – patients without concomitant cardiovascular pathology who had COVID-19. Patients were assessed daily (for 7 days) for the clinical symptoms of the disease with an assessment of complaints, respiratory rate, heart rate, SpO₂. A study of the level of C-reactive protein (CRP), D-dimer, and ferritin was carried out initially, on the 3-5th and 8-10th days in the hospital.

Results. In group 1, compared with group 2, cough, shortness of breath, myalgia (with minimization of symptoms during treatment), as well as significantly higher values of CRP and D-dimer were statistically significantly more common. At the same time, cough, shortness of breath and myalgia in patients with COVID-19 and hypertension were more pronounced at the onset of the disease, in contrast to patients without hypertension. An increase in CRP and D-dimer indicators determines the severity of the condition of patients with comorbid pathology at the onset of the disease and requires timely hospitalization of this category of patients.