Vrach

Objective. The research goal was to substantiate the optimal choice of multimodal anesthesia of patients in the early recovery period after operative delivery to improve rehabilitation, reduce complications and improve the quality of life of parturient women and newborns.

Materials and methods. An open-label prospective randomized research was held, during which the data of clinical examination, the results of laboratory and instrumental methods of diagnosis and dynamic observation of 310 parturient women and newborns were analyzed. Patients and newborns were divided into three groups. In the main group (n=112), cesarean section was performed for parturient women under epidural anesthesia, which was prolonged in the first three days of the postoperative period. In the comparison group (n=95), the operation was performed under combined spinal-epidural anesthesia, and prolonged epidural anesthesia was used in the first three days of the postoperative period. In the control group (n=103), the operation was performed under epidural anesthesia, and in the postoperative period, nonsteroidal anti-inflammatory drugs (NSAIDs) were used for anesthesia.

Results. It was found that the combination of epidural anesthesia during labor and prolonged epidural anesthesia with ropivocaine in the first three days after cesarean section has a stronger analgesic effect compared to the combination of combined spinal-epidural anesthesia of bipuvacaine during labor and prolonged anesthesia of ropivocaine in the postpartum period, as well as in comparison with the combination of epidural anesthesia of ropivocaine in labor and NSAIDs in the first three days of the postoperative period. Prolonged epidural anesthesia significantly reduced stress hormone levels in both the mother and the newborn during the first 24 hours after surgery and had no negative effects on the newborn.

Infertility affects up to 17.5% of couples of reproductive age, which significantly increases the demand for assisted reproductive technologies (ART). Despite various transformations and modernisation of programmes, the live birth rate with in vitro fertilisation (IVF) remains low, resulting in the need for several protocols to achieve live births. An important factor in the success of IVF is the qualification of specialists, but despite its high level, the human factor and a certain amount of subjectivity in the work of reproductologists and embryologists cannot be avoided. Artificial Intelligence (AI) offers significant opportunities to improve various aspects of IVF, for example, AI models can accurately predict hormone doses, and automate ultrasound monitoring, reducing examination time. AI also improves sperm selection for intracytoplasmic injection and helps select embryos with the best chance of implantation, improving accuracy and reducing subjective evaluation. In addition, AI can play an important role in training professionals, improving their skills and increasing the accuracy of decision-making. The introduction of AI into clinical practice is a promising area for improving IVF outcomes.

At present, the medical and social problem of stroke prevalence among young patients has increased. Despite the fact that young stroke occurs much less frequently than in the elderly, it has a number of features - a complex pathogenesis and a variety of etiologic causes. Considering correctable risk factors among young population, consumption of nicotine-containing products and alcohol are singled out, as they are not only independent risk factors of vascular pathology development, but also aggravate the course of other risk factors. To the uncorrectable factors many scientists include male gender and gene polymorphism, the study of which has recently become more and more accessible and promising. Thus, the relevance of analyzing the prevalence of early stroke risk factors becomes more and more important every year.

Analysis of the literature data demonstrated unidirectional trends in relation to the risks of developing cardiovascular disease (CVD) associated with depression and anxiety, as well as a significant prevalence of factors of psycho-emotional stress, mainly in female populations. It has been shown that such trends are likely associated with both the physiological characteristics of the female body and variations in the expression of depression/anxiety, which in turn affect cardiovascular risks. In accordance with this paradigm, in order to improve the prevention of CVD in various regions, it is necessary to create an infrastructure capable of providing for all categories of the population, depending on regional characteristics, the availability of information and educational technologies, appropriate counseling on the identification and monitoring of psychosocial risk factors.

Objective. To study the effect of a topical cosmetic product obtained by deep enzymatic processing of brown seaweed on the skin of the face and neck, as well as the hair growth zone.

Materials and methods. Sixty women (30 – main group, 30 – control group) took part in the study. Clinical, biochemical and morphological parameters of the facial skin and scalp before and after a 28-day course were evaluated. The list of techniques - non-invasive diagnostics (transepidermal moisture loss – TEWL, hydration level, pH, skin temperature balance), photo-documentation, spectral-confocal microscopy, immunohistochemistry of proliferation (Ki-67) and inflammation markers (CD33) in skin biopsy specimens, phototrichogram for hair growth analysis.

Results. As a result of the study the data indicating a reliable improvement of the skin condition of the face and neck against the background of application of a topical cosmetic based on the product of deep enzymatic processing of brown seaweed were obtained, which is caused by a decrease in transepidermal water loss, normalization of elasticity and hydration, increased proliferation of epidermal cells with simultaneous reduction of signs of chronic inflammation in the dermis. In the scalp there was an improvement of hair growth indicators: hair density and the proportion of hair follicles in the active phase (anagen) increased, while in the control group the indicators remained without significant dynamics.

Conclusion. The obtained data indicate a pronounced positive effect of the new product on skin and hair condition, which is attributed to the unique composition of bioactive molecules formed as a result of enzymatic processing of carbohydrate fraction of brown seaweed.

Objective. To identify the peculiarities of Dopplerometric indices of blood flow in the interlobular renal and ophthalmic arteries in pregnant women at 11–14 weeks of gestation at low and high risk of pre-eclampsia development, calculated in the Astrea software.

Material and methods. The study included 353 pregnant women who were divided into 2 groups: those at high risk of preeclampsia (n=44) and those at low risk of preeclampsia (n=309). The results of clinical, laboratory and instrumental examinations (Doppler parameters in the ocular and renal arteries) were compared in patients of the two groups.

Results. There were no statistically significant differences in Dopplerometric parameters of ophthalmic and renal blood flow in patients with high and low risk of preeclampsia.

Conclusions. Ophthalmic and renal blood flow doppler parameters assessed during early prenatal screening cannot serve as additional prognostic markers. We plan to study these parameters in the II trimester of pregnancy, and perform the final analysis of the results after the implementation of pregnancy complications and obtaining information on perinatal outcomes.

Objective. To study the developed complications in the acute period of ischemic stroke (IS), as well as the prognosis of further course of the disease.

Material and methods. The study included 113 patients with IS in the acute period; mean age – 58,3±17,8 years. There were 2 observation groups: the 1^st (n=45) – patients with infectious complications in the acute period of IS; the 2^nd (n=68) – patients without infectious complications in the acute period.

Results. The patients' anamnesis revealed a long course of hypertension, inadequate hypotensive therapy, type 2 diabetes mellitus, frequent fluctuations of glycemic profile, heart rhythm disorders. Among complications, infectious diseases, mainly of the bronchopulmonary system, thrombotic and acute cardiac disorders were significantly more frequent in the acute period of IS. Atherosclerotic pathogenetic mechanism of IS development with complications in the acute period with the presence of cerebral artery stenoses was revealed more often during the examination. Other unfavorable prognostic signs were extensive areas of brain damage, deep disturbances of consciousness, severe neurological deficit, immobility of the patient.

Patients after massive surgical interventions on the lower extremities need rehabilitation to restore the function of the injured limb and restore daily activity. VR rehabilitation is a promising direction in the recovery of patients after interventions on the femur, hip or knee joint, especially in osteoporosis. Given the predicted increase in the incidence of osteoporosis over the next decade, preventive measures should be taken as early as possible. The effectiveness of this method is reflected in the world literature, and is also confirmed by our observation of the results of rehabilitation of patients after surgical treatment of the lower extremities.

Objective. To study the relationship between arterial hypertension (AH) and age-associated conditions within the domain approach.

Material and methods. 100 female patients with AH at the age of 70 years were examined. The studied parameters included the characteristics of somatic health (anthropometry, blood pressure [BP], pulse, general blood analysis, ratio of neutrophils to lymphocytes, platelets to lymphocytes, blood biochemical parameters, glomerular filtration rate, echocardiography, electrocardiography, drug therapy), parameters of the musculoskeletal system (FRAIL, Katz scales, SARC-F questionnaire, hand compression force, bioimpedanceometry), indicators of the sensory (ophthalmologic examination), cognitive (MMSE test), psychological (Beck scale, asthenic state scale [ASAS]), nutritional (MNA scale) systems.

Results. Patients with AH (systolic BP – 175 mm Hg, diastolic BP – 94 mm Hg), excessive body weight (body mass index – 37.1 kg/m²) and abdominal obesity (waist-to-hip ratio – 0.91) were revealed, elevated inflammatory markers (C-reactive protein – 4.5 mmol/L), reduced functional capacity (FRAIL – 2.0 points, SARC-F – 4.0 points), relatively preserved cognitive abilities (MMSE – 27.0 points, ASAS – 75.0 points) and vitamin D deficiency (25.50 mmol/L). The analysis showed that hypodynamia (p < 0.001), smoking (p = 0.014) and obesity (p < 0.001) were statistically significant predictors of elevated systolic BP. Moreover, elevated systolic BP was a predictor of chronic heart failure (p < 0.001), presarcopenia (p < 0.001), diabetes mellitus (p < 0.001) and age-related forgetfulness (p < 0.001).

Conclusion. The obtained data indicate the presence of pre-disease and disease states of cardiovascular nosology, metabolic disorders and reduced functional capacity in the examined patients. Further studies are needed for more detailed analysis of the revealed features and development of individualized prevention and treatment strategies.

The use of digital twins to predict the values of leading indicators of patients' health status, as well as the consequences of events and their outcomes, is one of the most promising areas of modern healthcare. The widespread use of such digital technologies contributes to the modernization of medicine at all stages, which makes it possible to optimize algorithms for diagnosis, treatment, rehabilitation and prevention. This opens a new path to personalized medicine, where the risks of developing diseases and complications are identified long before their clinical manifestation.