Open Access
Access granted
Subscription or Fee Access
Vol 35, No 8 (2024)
Topical Subject
HIV-associated oral diseases in children
Abstract
The article reviews the literature about HIV manifestations in the children’s oral cavity. The data of domestic and foreign authors on HIV-associated salivary gland disease, which is characteristic of HIV-infected children and rarely occurs in adults, are presented. The connection of the pathogenetic factor of HIV-associated salivary gland disease with the development of dental caries is considered. Additional factors influencing the risk of dental caries in HIV-positive patients are described: a decrease of the level of CD4+-lymphocytes, abundance of carbohydrate food in the diet, taking antiretroviral therapy drugs containing sucrose. The obtained data are necessary for dentists, infectious disease specialists and pediatricians to diagnose HIV-associated disease and undetected HIV infection (salivary gland disease is an early clinical indicator of immunosuppression), as well as for planning further treatment.
5-8
Identifying genomic variations in metabolic syndrome as a research strategy
Abstract
A review of modern Russian and foreign literature devoted to the genetic determinants of metabolic syndrome, mainly in young men, was carried out. When searching for information, the RSCI, Best Evidence, PubMed, Clinical Evidence, and Cochrane Library databases were used.
It has been determined that the clinical manifestations of metabolic syndrome in young people are caused by complex intergenic interactions of polymorphisms of a number of genes (FTO, ACE, TCF7L2, ITGA2B, CSK, MTHFR). Among them, the CSK, FTO and TCF7L2 genes play a significant role. Timely identification of genetic predictors of metabolic disorders is of great clinical importance. The long-term consequences of risk factors such as excess body weight, insulin resistance and the resulting hypertension can accumulate exponentially. In this regard, it is necessary to conduct large cohort studies not to study the consequences of metabolic syndrome, but to identify the genetic factors in the formation of this syndrome for the possibility of targeted treatment for this category of people.
9-13
Lecture
Prevention and treatment of osteoporosis in comorbid patients
Abstract
The article analyzes the effectiveness of existing drugs for the treatment and prevention of osteoporosis. The role of calcium and vitamin D in bone tissue homeostasis is shown. Special attention is paid to one of the urgent pharmacological and therapeutic problems – polypragmasia associated with comorbidity. Research data demonstrate that drugs for the basic therapy of cardiovascular diseases do not have undesirable interactions with drugs for the treatment of osteoporosis and, in general, many of them have a positive effect on bone metabolism and bone strength. One of the solutions to the problems associated with the treatment of osteoporosis may be the use of biologically active additives Osteomed, Osteo-Vit D3, Osteomed Forte.
13-21
Spinal stenosis at the cervical level: clinic, diagnosis and treatment
Abstract
The article analyzes in detail the modern data on spinal canal stenosis in the cervical spine. The cause of its development may be various degenerative changes in the cervical spine that affect one or more anatomical structures, including vertebrae, intervertebral discs, joints and ligaments of the spine. The clinical forms are considered and the available data on the pathogenesis, diagnosis and treatment of cervical spinal stenosis are analyzed. The differential diagnosis of cervical myelopathy is complex, but a detailed clinical analysis, the use of modern neuroimaging methods make it possible to make a nosological diagnosis, assess the severity of the lesion, choose the appropriate therapy, the scope of surgical treatment and determine the prognosis of the disease. The differentiated nature of surgical decompression operations makes it possible to achieve the best results of neurological recovery of patients and compliance with the principles of minimal invasiveness.
22-29
For Diagnosis
A comprehensive method for determining stress and emotional disorders in stroke patients
Abstract
Stroke is a social problem, is the leading cause of disability in the population and is often accompanied by emotional disorders, which are often difficult to diagnose. The development of effective methods of objectification of stress and emotional disorders for stroke patients is still very relevant.
Objective. To evaluate the effectiveness of a comprehensive methodology for determining stress and emotional disorders in stroke patients.
Materials and methods. 2 groups of 30 stroke patients, comparable in gender, age and clinical parameters, were studied. Patients in Group 1 received a basic rehabilitation complex (BC) aimed at correcting motor disorders; in Group 2 – BC + a course of cognitive behavioral psychotherapy (CBP). A comprehensive methodology for determining stress and emotional disorders (evaluating indices of subjective comfort and chronic fatigue, situational and personal anxiety, and the degree of emotional distress) was used at the beginning and at the end of rehabilitation. The statistical analysis was carried out using the program Statistica 10.
Results. Initially, in patients of both groups, the medians of the studied indicators corresponded to a low level of subjective comfort, severe chronic fatigue, and high levels of situational and personal anxiety. At the end of rehabilitation, significant intergroup differences (p<0.05) were revealed, indicating a statistically significant regression effect of emotional disorders in Group 2 (BC+CBP).
Conclusion. The complex technique makes it possible to objectify stress and emotional disorders in patients with acute cerebrovascular accidents, reflects the intergroup difference in their dynamics after the use of BC and its combination with CBP.
30-34
From Practice
Comorbidity of asthenic syndrome and primary headaches in students of a medical university
Abstract
Headache is one of the most frequent complaints in asthenic syndrome. The article presents the results of a study involving students of a medical university, the purpose of which was to assess the incidence of headaches and identify the main provoking factors of this condition. Adaptogens of plant origin are considered as a means of supportive therapy of asthenic syndrome. The prospects of domestic preparation of adaptogenic action in the prevention and overcoming of asthenic conditions are evaluated.
35-40
Peripheral nervous system damage in coronavirus infection: research results
Abstract
SARS-CoV-2 coronavirus has the ability to affect the nervous system and cause various neurologic disorders, both in the acute period and after recovery or during the development of post-coital syndrome. Among the nosologic forms of peripheral nervous system lesions after a new coronavirus infection are mononeuropathies, multineuropathies, multiple neuropathies, and noninflammatory polyneuropathies. Both the debut of neurological disease with varying degrees of severity of symptoms, including disabling, and progression of the existing pathology, requiring a change in treatment tactics, are possible. The article presents the results of a prospective study evaluating the effect of COVID-19 on the peripheral nervous system. Recommendations for physicians on the management of patients with peripheral nervous system damage against the background of coronavirus infection developed on the basis of the obtained information are presented.
40-44
Disorders of postural balance and spinal biomechanics in patients with operated spine syndrome
Abstract
Objective. To study the peculiarities of postural balance disorders and spine biomechanics, as well as their correlation with the severity of pain syndrome in patients with operated spine syndrome (OSS).
Material and methods. The study involved 86 patients aged from 27 to 65 years, who were divided into 3 groups: 1st (main; n=35) – patients with OSS who underwent microdiscectomy at the lumbar level, after which the pain syndrome persisted; 2nd (n=35) – patients with radiculopathy without surgical intervention in the anamnesis; 3rd (n=16) – patients without OSS who underwent microdiscectomy at the lumbar spine. The groups were comparable in age and gender. The study groups were analyzed for the clinical characteristics of pain syndrome, the myotatic reflex of muscles under load using manual muscle testing, as well as postural balance.
Results. In group 1, there was a dependence of the intensity of pain syndrome on the presence of myofascial pain trigger zones in the piriformis muscles contralateral to the affected leg and in the quadratus lumborum muscle ipsilaterally. In addition, pain intensity in in group 1 was strongly correlated with decreased bilateral rectus femoris strength. In group 1 a stabilometric study revealed a dependence of the pain syndrome on the presence of frontal asymmetry. In group 2, during manual muscle testing and stabilometric studies, a correlation was observed between a decrease in calf strength on the affected leg and the presence of myofascial pain syndrome in the piriformis muscle ipsilateral to the affected leg. In group 3, biomechanical disorders were revealed in the form of moderate frontal and sagittal asymmetry, as well as hypotonia of the rectus abdominis muscle, iliopsoas muscles, rectus femoris muscles, calf flexor muscles, and calf muscles. However, the severity of these data differs significantly from those in groups 1 and 2.
Conclusion. The formation and maintenance of pain in patients with OSS is influenced not only by degenerative-dystrophic changes at the level of the affected intervertebral disc with compression of the spinal roots and arthrosis of the facet joints, but also by disturbances in postural balance and biomechanics of the spine. An imbalance of muscle tone in the postural muscles is the cause of the development of postural myoadaptive overload syndromes in the muscles of the lower back and legs. Therefore, it is very important to include manual muscle testing in the examination of patients with back pain to determine the causes of biomechanical muscle overload. Treatment and rehabilitation should include, in addition to drug treatment, sets of individual exercises aimed at restoring muscle tone and strength and post-isometric relaxation to inactivate trigger points.
44-49
Manifestations of marfan syndrome in maxillofacial pathology in children
Abstract
Marfan syndrome (SM) is a multisystem disease transmitted in an autosomal dominant manner with incomplete penetrance. Classic manifestations of SM include a triangular-shaped face with a sharp chin (bird-face syndrome), dolichostenomelia, aortic dilatation, prolapsed heart valves, lens subluxation, scoliosis, and in many cases joint hypermobility. At the same time, the dental system is a concentrate of connective tissue. But there is not enough information about the condition of orofacial structures.
Purpose. To assess the oral phenotype in children and adolescents with SM.
Material and methods. 28 children and adolescents with SM were examined. The median age is 12.6 years, the range of fluctuations is 10–17 years. The diagnosis of SM was made according to the Ghent criteria. Along with the general clinical and instrumental picture, dolichocephaly, retrognathia, malocclusion, “Gothic palate”, temporomandibular joint disorder, and dental caries were determined. A comparison group without signs of SM was formed according to the “case-control” principle.
Results. Patients with SM, compared with children and adolescents without this syndrome, were characterized by pathology of the temporomandibular joint (p<0.001), multiple enamel defects (p=0.019) and caries (p<0.001), retrognathia (p<0.001), malocclusion (p<0.001), defects in the shape and location of teeth (p<0.001). In a number of cases, familial cases of dental pathology were noted.
Conclusion. Dental pathology is often recorded in patients with SM, which can be considered as one of the manifestations of the systemic nature of the syndrome. The presence of SM in a patient requires consultation with a dentist.
49-51
Expression of miсrorna-34, microrna-130, microrna-194 in the saliva of children with obesity
Abstract
Obesity is a global issue increasingly affecting the pediatric population. Excess adipose tissue raises the risk of developing cardiovascular, oncological, metabolic, and immunological disorders. Beyond social, hormonal, and genetic causes, scientists are particularly focused on cellular and molecular aspects of the disease's development. Currently, there is an active search for new promising markers to predict the risk of obesity, with an emphasis on non-invasive methods, forming a basis for effective preventive medicine. Key factors in the development of obesity include intracellular protein kinases, inflammation mediators, oxidative stress components, gastrointestinal hormones, adipokines, angiopoietin-like proteins, and microRNAs.
Objective. To study the features of microRNA-34a, microRNA-130, and microRNA-194 expression in the serum of children with obesity and identify the relationship with clinical and laboratory parameters of the disease.
Materials and methods. A total of 90 children, aged 10 to 17 years, were examined. The primary group consisted of 60 children with overweight and obesity, while the comparison group included 30 healthy children. Anthropometric measurements were taken for all participants, calculating the standard deviation of the body mass index using WHO Anthro Plus. Blood analysis was conducted to determine levels of glucose, alanine aminotransferase, aspartate aminotransferase, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, insulin, and leptin. Additionally, saliva analysis was performed to study microRNA. Body composition was assessed using the InBody 770 device. Statistical data processing was carried out using IBM SPSS Statistics 19.0.0, Russian version (USA).
Results. The study revealed a decrease in microRNA-130 expression in the saliva of children with obesity, 1.1 (0.01; 2.93), compared to the control group, 72.6 (0.07; 215.7) (p=0.005). This expression level was associated with serum cholesterol levels (r=-0.87; p<0.05). Notably, microRNA-130 expression increased 19.3 times in the group of boys with obesity, 1.37 (1.37; 1.37), compared to the control group, 0.07 (0.07; 1.07) (p=0.005). Conversely, in girls with obesity, this indicator decreased 105.8 times compared to girls of normal weight (p=0.0001). Additionally, microRNA-194 expression increased 3.4 times in girls with obesity, 156.04 (156.04; 156.04), compared to the control group, 46.4 (46.4; 46.4) (p=0.004).
Conclusions. The study of microRNA-34, microRNA-130, and microRNA-194 expression in the saliva of children with obesity revealed a decrease in microRNA-130 expression in children with obesity, differences in microRNA-130 expression between boys and girls with obesity, and an increase in microRNA-194 expression in girls with obesity. These findings suggest that changes in microRNA expression may be associated with the development of obesity in children, and the observed differences between boys and girls may indicate gender-specific regulation of microRNA expression in the context of obesity. These data highlight the importance of microRNAs as potential biomarkers that reflect changes occurring in pediatric obesity. Changes in microRNA-130 and microRNA-194 expression can serve as biomarkers of metabolic disorders and be used for early diagnosis and risk assessment of obesity and related diseases. Further research in this area may contribute to the development of new strategies for preventing and treating childhood obesity based on epigenetic regulatory mechanisms.
52-56
Degree of compliance with doctors recommendations and its effect on compensation of the disease among children and adolescents with congenital adrenal hyperplasia
Abstract
Purpose. To determine the effect of the degree of compliance of patients on the level of compensation for the disease in children and adolescents with congenital adrenal hyperplasia (CAH).
Material and methods. A survey was conducted, a retrospective study of the medical histories of 80 patients with CAH aged 1 to 17 years inclusive, who were observed at the Russian Children's Clinical Hospital.
Results. Based on the analysis of surveys and laboratory statuses, a high degree of compliance was found in 70% of the surveyed patients. It was found that there is a strong relationship between the degree of consent and the 17-ONR indicator. All this confirms the high level of responsibility of patients for their health, but also indicates that there is still a need to better inform patients about their disease, as well as the importance of following the doctor's prescriptions and being in a trusting relationship.
56-60
The course of pregnancy and perinatal complications in pregnant women with newly diagnosed urinary tract infection
Abstract
Purpose. To analyze the course of pregnancy and perinatal complications in pregnant women with newly diagnosed urinary tract infection.
Material and methods. Complications of pregnancy and early perinatal complications were analyzed in 97 pregnant women (main group) with newly diagnosed asymptomatic bacteriuria. The control group consisted of 50 pregnant women without clinical and laboratory signs of urinary tract infections.
Results. In the main group, in most cases, a monoinfection was isolated from the urine; Enterobacteriaceae were the predominant uropathogens. In the main group, mild iron deficiency anemia was detected significantly more often than in the control group (p<0.05) – in 43 (44.3%) women, vaginitis – in 45 (46.4%), changes in the structure of the placenta according to ultrasound diagnosis – in 18 (18.5%). In the main group, there was a tendency towards a decrease in fetal adaptation according to cardiotocography, as well as a higher risk of intrauterine infection, umbilical cord entanglement and the formation of intrauterine malformations.
Conclusion. Pregnant women with newly diagnosed asymptomatic bacteriuria of the tract are at risk of developing anemia, vaginitis, and also require additional diagnostics of the state of the fetoplacental system.
61-64
On the issue of diagnosing cutaneous forms of lupus erythematosus
Abstract
Cutaneous lupus erythematosus (CLE) is an autoimmune skin disease characterized by a variety of clinical manifestations and the possibility of progression to systemic lupus erythematosus.
Purpose. To study clinical and diagnostic features, as well as trigger factors of CLE to improve diagnosis, treatment and prevention of disease progression.
Material and methods. A retrospective analysis of the medical records of 60 patients with CLE who were treated at the Moscow Scientific and Practical Center for Dermatovenereology and Cosmetology of the Moscow City Health Department in 2017–2023 was carried out.
Results. Discoid lupus erythematosus was detected in 90% of patients. In 51.67% of cases, an incorrect diagnosis was made at the prehospital stage, which led to untimely initiation of therapy. The diagnosis of CLE was pathomorphologically confirmed in 60% of patients, of which in 38.33% the clinical and pathological diagnoses coincided. The most common skin lesions were observed on the face (75%), scalp (50%) and upper extremities (46.67%). The main trigger factors were insolation (18.33%) and psycho-emotional stress (13.33%).
Conclusion. The study highlights the need for dermatologists and rheumatologists to work together to more effectively diagnose and treat CLE. It was revealed that a significant number of cases of CLE were incorrectly diagnosed at the prehospital stage, which led to untimely initiation of therapy. Pathological examination plays a key role in confirming the diagnosis and correctness of therapeutic measures. An integrated approach to the diagnosis and treatment of patients with CLE can significantly improve the quality of medical care and reduce the risk of disease progression and complications.
64-67
Differential diagnosis of exanthems in infectious mononucleosis (clinical case)
Abstract
The article presents a description of a clinical case of infectious mononucleosis with pronounced exanthema in an 18-year-old female patient. The patient's clinical status is analyzed, and a detailed differential diagnosis is conducted with syndrome-similar diseases. The most significant clinical symptoms present in the typical picture of infectious mononucleosis are highlighted. The article discusses the significance of determining antibody avidity for diagnosing the stage of the infectious process. Particular attention is paid to the importance of determining this parameter in pregnant women, where diagnostic accuracy and assessment of disease severity are crucial for making decisions about patient management.
68-72
Peculiarities of blood cell composition depending on the sequence of manifestation of a number of diseases
Abstract
Aging is a process affecting various organ and tissue systems. The development of age-related changes occurs at the molecular, genetic, cellular, organ and organizational levels. At the population level, accelerated aging can manifest itself as an unfavorable upward dynamics of the incidence of age-associated diseases, an early manifestation of pathology.
Рurpose. To study the features of the cellular composition of the blood depending on the sequence of manifestation of a number of diseases.
Materials and methods. Statistical collections for 2015–2019 acted as materials, clinical blood test (cellular composition of blood) of 17 957 patients hospitalized in Saint-Petersburg City Hospital No 2 from 01.01.2015 to 31.12.2019 with the following diagnoses (ICD-10 codes) is also analyzed: E05, E10, E11, G20, H25, H40, I10, I10–I15, I20, M80–M81, N20–N23.
Results. The analysis established a significant correlation with the priority of disease manifestation for only two indicators: lymphocyte count (r=-0.675; p=0.022) and red blood cells (r=-0.639; p=0.033). Correlation analysis demonstrated a significant association between age-specific incidence index (ASII) and absolute lymphocyte and erythrocyte counts. The sequence of manifestation of the considered diseases, compiled on the basis of ASII ranking, is closely related to the age characteristics of the cellular composition of the blood.
Conclusion. Thus, features of the cellular composition of the blood were found depending on the manifestation of diseases. The identified patterns corresponding to age-related changes will allow the development of new approaches in the study of the pathophysiological gerontological continuum.
73-76
Atypical hemolytic-uremic syndrome: etiopathogenesis, diagnosis and therapy
Abstract
Atypical hemolytic-uremic syndrome (aHUS) is one of the variants of primary thrombotic microangiopathies (TMA). It is based on chronic uncontrolled activation of the complement system due to mutations in the genes of regulatory proteins of the alternative pathway of the complement system of hereditary or acquired nature. The result of this is endothelial damage leading to generalized thrombus formation in the microvasculature (so-called complement-mediated TMA). The main manifestations are thrombocytopenia, microangiopathic hemolytic anemia and organ damage, making up the classic triad of TMA. The diagnosis of aHUS is a diagnosis of exclusion. It is established on the basis of the characteristic clinical picture after excluding all other forms of TMA, both primary and secondary. The treatment of aHUS is based on the use of plasma exchange and anti-C5 monoclonal antibodies.
76-84
System of course application of transcutaneous electrical neurostimulation in therapeutic and rehabilitation complexes for dorsopathies
Abstract
The article is devoted to the disclosure of some mechanisms and the actual effectiveness of sequential courses of transcutaneous electrical neurostimulation (TENS) as part of complex therapy for lumbosacral dorsopathy.
Materials and methods. A total of 60 patients of both sexes under the age of 60 who were hospitalized due to a protracted exacerbation of the vertebrogenic process were monitored. The results of the neurological examination were compared with the data of pathopsychological and electrophysiological analysis. Patients were randomly divided into two groups: 1st (comparison group) – patients received basic therapy; 2nd (main group) – patients received TENS of the lumbosacral region and lower extremities in addition to basic therapy. The treatment course in this case consisted of 15 procedures. In addition, over the next two months, both groups underwent a maintenance cycle of local electrical stimulation (7 procedures).
Results. Immediately at the end of therapy, a slight (beyond the scope of confidence) advantage of the main one over the comparison group in terms of therapeutic efficacy was revealed. This was expressed in a relatively more distinct regression of the main symptoms, including the dynamics of algias, as well as in the form of a tendency to normalize the mental and vascular background. However, after a six-month period, including the implementation of a short cycle of TENS, the main group was characterized by a much greater stability of the results achieved, which was combined with a significantly lower number of exacerbations of the process.
Conclusion. The advantage, precisely in terms of therapeutic reliability, of a complex of two consecutive cycles of local electrical stimulation can be explained by the accumulation of effects characteristic of such types of exposure. In turn, the work performed opens up prospects for further optimization of treatment and rehabilitation programs for vertebrogenic pathology.
84-87