Том 31, № 6 (2024)

Background. The problem of finding reliable markers of bronchial asthma (BA) severity in children is relevant. It is of interest to evaluate the production of TGF-β1 (transforming growth factor β1) in induced sputum and nasal secretion in predicting the BA severity in children.

Objective. Investigation of the TGF-β1 level in induced sputum and nasal secretion in children with allergic bronchial asthma of varying severity.

Methods. The concentration of TGF-β1 in induced sputum and nasal secretion was determined using enzyme-linked immunosorbent assay.

Results. The production of TGF-β1 in induced sputum significantly differed in the groups of children with bronchial asthma compared to the control group (Kruskal-Wallis test, p<0.05) and between themselves (Kruskal-Wallis test, p<0.05). No dependence of the TGF-β1 level in nasal secretion on the severity of bronchial asthma was found.

Conclusion. The TGF-β1 level in induced sputum correlates with the severity of bronchial asthma in children, which reflects the intensity of inflammation in the lower respiratory tract and the dynamics of progressive bronchial remodeling. Investigation of TGF-β1 in induced sputum for identifying the severity of bronchial asthma in children is promising area.

Background. According to literature data, more than 3 million children die from sepsis every year in the world, and the total number of diagnoses of «sepsis» in the pediatric population exceeds 25 million. Sepsis in childhood has significant differences from adult patients in clinical symptoms, course of the disease, severity of the condition and management tactics.

Objective. Evaluation of the epidemiology and etiology of septic conditions in children of different ages in a hospital setting.

Methods. A retrospective study of the risk factors, etiology and routing of 28 children of different age groups with an established diagnosis of «sepsis» who were treated in a 3rd level children’s hospital was conducted.

Results. It was shown that among the groups of pathogens, the dominant position remains with gram-negative flora, and the leading place among individual microorganisms belongs to Staphylococcus aureus. Considering that Staphylococcus aureus was also the dominant pathogen in children with respiratory infections hospitalized in the isolation and diagnostic department, the authors suggest its influence not only on the prevalence, but also on the severity of the infectious process. In 23% of cases, the diagnosis of sepsis was made on the basis of culturing one pathogen from 2 or more loci. It was also demonstrated that children of younger age groups are more prone to the development of generalized forms of the infectious process: all 28 children were under 12 years old.

Conclusions. Further study of various clinical and epidemiological aspects of the development of septic conditions will reveal the current mechanisms of infection, as well as variants of the body’s response to generalized infection, which will serve as the basis for a personalized approach to the treatment of sepsis in children.

Atrial fibrillation (AF) is the most common heart rhythm disorder requiring treatment, the prevalence of which increases with age. Pharmacological drugs are the first-line therapy for AF treatment. Antiarrhythmic drugs (AADs) are used as emergency therapy to terminate recently developed AF and to maintain sinus rhythm as a planned therapy to prevent recurrence of arrhythmia. The review presents data on the most commonly used AAD in clinical practice for the treatment of AF, propafenone. A distinctive feature of propafenone is the possibility of its use at all stages of medical care: outpatient, emergency, inpatient, both orally and intravenously. The drug can be used both to interrupt paroxysmal AF and to maintain sinus rhythm in planned therapy.

The literature review is devoted to the problems of treating arterial hypertension (AH) in elderly and old patients. The features of examination of elderly patients, goals and strategy of treatment are considered. The literature data on groups of antihypertensive drugs recommended for the treatment of older age groups and the available evidence base are analyzed. The review focuses on the use of indapamide as a drug from the diuretic group, which has an optimal ratio of efficacy and safety. This drug has the optimal class of recommendations for the treatment of the elderly according to the FORTA system. According to meta-analyses, indapamide is characterized by a higher efficiency in reducing systolic blood pressure (SBP; -5.1 mm Hg compared to hypothiazide) and a lower risk of electrolyte disturbances, especially in non-retarded form. The cardio-, nephro- and angioprotective properties of indapamide are described in detail. The possibilities of dementia prevention and possible mechanisms of neuroprotection during treatment with indapamide are discussed.

The issues of secondary prevention of venous thrombosis have not yet been fully resolved. The need for prevention, its duration and the choice of drug remain controversial. The probability of relapse of the disease after discontinuation of anticoagulants, according to different authors, ranges from 2 to 30% depending on the interval after anticoagulant therapy and the localization of the primary thrombotic episode. The duration of long-term prevention varies. To resolve this issue, experts suggest assessing possible risk factors for relapse of venous thromboembolic complications (VTEC), which are usually divided into major and minor, transient (temporary) and persistent. If secondary prevention of VTEC is required in patients with high bleeding risk and the impossibility of prescribing anticoagulant drugs, Russian and foreign clinical guidelines suggest the use of sulodexide. The pharmacological action of the drug is not limited to anticoagulant action, it also has antiplatelet, angioprotective, fibrinolytic properties, there is evidence of a decrease in plasma lipid levels. The antithrombotic effect of sulodexide is associated with an endothelioprotective effect. Sulodexide is currently widely used in medical practice. Analysis of current sources of domestic and foreign literature on the use of sulodexide in venous pathology revealed a wide range of evidence base for this drug, including for secondary prevention of VTEC.

Background. The global spread of lipitension (syntropy of arterial hypertension – AH and dyslipidemia) with damage to target organs and the development of polymorbid pathology dictates the need for its early diagnosis and treatment at the stage of primary health care.

Objective. Evaluation of the effectiveness of combination therapy with antihypertensive drugs (AHDs) and statins in patients with lipitension and comorbid pathology, taking into account the rational use of multipurpose polypills at the outpatient stage.

Methods. Outpatient cards of 240 patients with insufficiently effective antihypertensive therapy were studied in the Kuban State Medical University. An analysis of data physical examination, anthropometry data, blood lipidogram, electrocardiography, therapy with AHDs and statins was carried out.

Results. The prevalence of separate prescription of antihypertensive drugs and lipid-lowering drugs with insufficient AH control (up to 66%) and low-density lipoproteins – LDL (up to 30%) should be accompanied not only by intensification of separate combination therapy, but also by the use of a strategy for treating outpatients with multi-target fixed triple combinations in polypills.

Conclusion. The control of hypertension in 82.1% and LDL-C in 57.1% of patients with lipitension achieved with the use of Equamer when using maximum doses of the components in the polypill (amlodipine, lisinopril, rosuvastatin) may be even more significant.

Background. The use of clopidogrel-based antithrombotic therapy represents an effective strategy for secondary prevention of ischemic events in patients with atherosclerotic cardiovascular disease, primarily acute coronary syndrome (ACS), but to date there is still uncertainty in the choice of optimal approaches to minimize the risks of hemorrhagic complications, including taking into account the possibilities of personalized medicine, especially when the patient additionally receives acetylsalicylic acid (ASC) or an oral anticoagulant (dual antithrombotic therapy).

Objective. To investigate the possible relationship between carriage of CYP2C19 genetic variants (rs4244285, rs4986893, rs12248560) and bleedings in patients receiving dual antithrombotic therapy with clopidogrel after ACS.

Methods. The retrospective study included 150 patients (women – 20%) who presented ACS 30 weeks ago. Patients with atrial fibrillation (AF) (n=73) received clopidogrel and rivaroxaban/apixaban, while patients without concomitant AF (n=77) received clopidogrel and ASC 75/100 mg/day. Pharmacogenetic (CYP2C19 rs4244285, rs4986893, rs12248560) and pharmacokinetic (Сmin,ss clopidogrel) tests were performed for all patients. Bleeding events were assessed retrospectively for the entire period of antithrombotic therapy, but no longer than 6 months. Information about hemorrhagic events was obtained using the MCMDM-1 questionnaire.

Results. Bleeding occurred in 45 (30%) patients. The most frequent bleeding events were nosebleeds – 23 (15.3%) patients, bruising – 21 (14%), and oral bleeding – 11 (7.3%) patients,. Among patients with hemorrhagic events, there was a trend (p=0.25) toward a higher frequency of TT and CT genotype carriers CYP2C19 rs12248560 compared to patients without bleeding (48.9% vs 37.1%, respectively). Depending on the CYP2C19 genotype, all patients were divided into three subgroups in which hemorrhagic events were also analyzed: 1) carriers of gain-of-function (GOF) allele but without loss-of-function alleles (LOF) (n=50); 2) LOF and GOF carriers (n=11); 3) LOF carriers without GOF allele (n=28). Subgroup 1 had a bleeding rate – 36.0%, subgroup 2 – 36.4%, and subgroup 3 – 21.4% (p>0.05).

Conclusion. According to the retrospective analysis the presence of hemorrhagic events in patients with ACS receiving dual antithrombotic therapy with clopidogrel may be associated with carriage of the T allele (genotypes TT and CT) CYP2C19 rs12248560, while carriage of LOF alleles in the absence of GOF alleles, on the contrary, may be associated with a lower incidence of bleeding. Further prospective studies are required to confirm the identified trends.

Background. Thoracic surgical interventions in some patients are associated with a high risk of complications and mortality in the postoperative period, and may also be contraindicated due to functional limitations. Circumstances dictate the need to focus on methods of local impact on cavities in the lungs and residual cavities in the pleural space in order to quickly eliminate them, in particular, on endoscopic valvular broncoblockation (EVBB).

Objective. Assessment of the possibility of using endoscopic valvular broncoblockation in patients with pulmonary pathologies of various etiologies.

Methods. Radiological (radiography, fluoroscopy, multislice computed tomography) and endoscopic (tracheobronchoscopy, exploratory broncho-occlusion) methods, as well as their combination (selective bronchography) were used.

Results. In 110 cases, EVBB was performed to treat patients with destructive pulmonary tuberculosis, including in 58 cases with infiltrative tuberculosis, in 38 patients with disseminated tuberculosis and in 14 cases with fibrous-cavernous tuberculosis.

Conclusion. The use of an endobronchial valve in combination with PTCT is an effective non-drug method of treating patients with destructive pulmonary tuberculosis, which improves the results of their treatment and reduces the number of patients for whom surgical intervention is indicated.

Background. More than half of the patients registered with the antituberculosis dispensary for pulmonary tuberculosis undergo examination and treatment in the general medical network of the republic before hospitalization in the dispensary. Often, similar clinical and radiological picture of pulmonary tuberculosis and other lung diseases is the cause of frequent diagnostic errors.

Objective. Analysis of the situation in the Kabardino-Balkarian Republic on the diagnosis and surgical treatment of pulmonary tuberculosis in the antituberculosis and general medical network.

Methods. The results of the examination of 1318 patients with pulmonary tuberculosis in the antituberculosis and general medical network of the Kabardino-Balkarian Republic in the period from January 2018 to December 2022 were analyzed.

Results. When analyzing the results of the examination of tuberculosis patients, it was found that more than half of them (59.9%) received an average of 23.3 ± 6.8 kcal/day during inpatient treatment in the general medical network (GMN) before admission to the dispensary; half of them (46.5%) were found to have bacterial excretion during examination in the antituberculosis dispensary. In addition, bacillary pulmonary tuberculosis patients remained in the GMN somewhat longer (26.6±6.9 bed-days), which led to a destructive course, as well as an increase in the frequency of errors in the differential diagnosis of infiltrative pulmonary tuberculosis and community-acquired pneumonia, which reached 30–68%, and the time to establish a diagnosis exceeded 1–3 months.

Conclusion. In order to quickly diagnose patients with pulmonary tuberculosis and reduce «unjustified» lung surgeries in patients with tuberculosis in GMN, it is necessary to properly organize the work of the GMN, namely, to introduce modern methods of etiological diagnosis of tuberculosis, organize a consultation with a phthisiatrician or an analysis of a specific clinical case at pulmonology commissions before thoracic surgery for an unspecified lung disease.

Background. Prevention of both infectious and non-infectious diseases is the priority area of modern healthcare. Prevention of tuberculosis (TB) in individuals with comorbid somatic pathology (SP) is one of the ways to improve the quality and duration of life.

Objective. Identification of risk factors for the development of TB in patients with comorbid SP and evaluation of the effectiveness of classes in the health school (online) as a method of working with correctable risk factors (RF).

Methods. A simple retrospective study included 99 patients with newly diagnosed TB and various comorbid SP who were treated at the Omsk Central District Hospital from 2018 to 2022. To identify RF, the factor analysis method with subsequent correction of the identified RF by training patients in online health schools was used.

Results. Of the 99 patients with newly diagnosed TB, 54 had cardiovascular diseases, 44 had bronchopulmonary pathology, and 48 had gastrointestinal tract pathology. From 29 social and demographic parameters, using the factor loading matrix, 9 factors that increase the likelihood of developing TB in rural residents with comorbid SP, with a total variance of 65.76% were formed. The leading place among them was occupied by correctable RF (bad habits, living conditions, stove heating, low social status). Online health schools included 4 classes that rural residents could remotely attend repeatedly during the year. After a year, there was a decrease in the degree of alcohol and nicotine addiction, an increase in the number of people with normal body weight and a decrease in people with underweight, a decrease in the number of people with low physical activity, i.e. factors that increased the likelihood of developing TB and people with comorbid pathology in rural areas were eliminated.

Asthenia is a pathological condition that can accompany various diseases and also develop in healthy individuals under certain circumstances. Unlike ordinary fatigue, which, as a rule, occurs as a result of intense mobilization of the body and is a physiological condition, asthenia does not disappear after rest and requires medical assistance. Correction of asthenia symptoms is an urgent task in the clinical practice of outpatient doctors. The article discusses the main clinical manifestations of asthenic syndrome and its features, pathogenetic mechanisms of development, and the possibilities of non-drug and drug treatment. A promising treatment strategy for patients is the use of the phenylpiracetam.

Background. Chemotherapy (CT)-induced peripheral neurotoxicity is one of the main dose-dependent side effects of many antitumor agents, including taxane and platinum agents. Symptoms of chemotherapy-induced peripheral neuropathy (CIPN) often persist after completion of treatment and affect the quality of life of patients who have undergone drug therapy for malignant tumors.

Objective. Identification of clinical and subclinical disorders in cancer patients with CIPN by studying the dynamics of neuromyographic parameters during antitumor treatment.

Material and methods. The study included 93 cancer patients with CIPN who underwent drug antitumor treatment. The mean age was 54.7±10.5 years. All patients underwent electroneuromyography (ENMG) using the Neuromag-EMG-micro electroneuromyograph (Neurosoft LLC, Russia) at the time of diagnosis of CIPN and 10 patients – 6 months after completion of chemotherapy.

Results. When evaluating the ENMG data during the initial examination of patients, a decrease in the amplitude of the sensory response of the median and sural nerves was recorded, which indicates a predominantly axonal-demyelinating lesion of the peripheral nerves. Repeated examination revealed worsening of nerve fiber conductivity, as evidenced by a decrease in the excitation propagation velocity (EPV) of the sensory response of the median and sural nerves, as well as a tendency to decrease in the EPV of the motor response of the median and tibial nerves.

Conclusion. Neurophysiological methods for assessing CIPN provide objective markers for the early diagnosis of toxicity, and the data obtained from patients help to assess the significance of symptoms in the context of the individual characteristics of each patient. However, given the small number of studies devoted to the study of the role of ENMG in patients with CIPN, further research is required.

Atopic dermatitis is a common chronic genetically determined skin disease with complex pathogenesis. Due to the high prevalence of dermatosis and its progression to severe forms, the issue of new treatment options for this disease is relevant. This review discusses new current treatment options for atopic dermatitis, targeted drugs that allow patients with poorly controlled moderate to severe atopic dermatitis to achieve disease control.

Background. Foreign and domestic clinical guidelines do not describe approaches to the personalized selection of antihistamines (AH) in the treatment of allergic rhinitis (AR). The comparative efficacy of AHs in patients with different phenotypes of AR has not been adequately studied.

Objective. Comparative assessment of the clinical efficacy of initial pharmacotherapy with rupatadine, bilastine, or cetirizine for persistent seasonal moderate AR in children.

Methods. A 4-week open, prospective, randomized, comparative study in parallel groups (n=32 – rupatadine, 10 mg; n=32 – bilastine, 20 mg; n=31 – cetirizine 10 mg, 1 tablet once a day) among children over 12 years old with persistent seasonal AR of moderate severity was conducted. Therapy was initiated within 48 hours after the onset of the first symptoms of exacerbation of the disease with a total severity of symptoms according to VAS <5 points. Clinical efficacy was assessed using the r-TNSS and VAS scales on the day of patient inclusion in the study (initial), as well as on the 3rd, 7th, 14th, 21st, and 28th days of therapy or until exclusion from the study due to therapy inefficiency.

Results. No significant differences were found in the assessment of clinical parameters between the groups initially and during the study. They were identified only among patients with concomitant bronchial asthma (BA): when comparing the assessment of the severity of symptoms on the VAS scale depending on the AHs, statistically significant differences were found between patients receiving rupatadine and cetirizine on the 21st day: rupatadine – 3.25 (3.10–6.68) points, cetirizine – 7.50 (4.20–8.05) (P=0.038), and on the 28th day: rupatadine – 3.15 (2.55–6.68), cetirizine – 7.50 (4.60–8.05) points (p=0.034). When assessing the dynamics of maintaining AR monotherapy without the need for STEP-UP therapy during the study, statistically significant differences were noted on the 7th day of the study (rupatadine and cetirizine – 100% of patients, bilastine – 58.3% (7/12) (P=0.006).

Conclusion. No differences in the effectiveness of antihistamines were found among all patients, while the advantage of rupatadine compared to bilastine and cetirizine as a starting therapy at the onset of the first symptoms of AR in children over 12 years old with polymorbid AR (AR + BA) can be noted.

Allergic rhinitis, despite its high prevalence in the population, causes certain difficulties in diagnosis, since in children its clinical symptoms resemble those of an acute respiratory viral infection. In the presented clinical case, the diagnosis of allergic rhinitis was made 4 years late, and therefore the patient did not receive antiallergic treatment, which significantly complicated the course of the disease. To diagnose allergic rhinitis, a complex of anamnestic, clinical and laboratory research methods was used. The examination revealed a positive allergy history, early manifestations of atopy in the form of atopic dermatitis, living in an “allergenic” environment, and high levels of specific IgE antibodies to pollen and mite allergens. These data allow doctors to suspect the disease in children at an early age, verify the diagnosis together with an allergist, prescribe therapy and prevent the progression of the disease.

Background. One of the urgent problems in women of reproductive age is pelvic floor diseases (PFD), leading to deterioration of not only physiological and psychoemotional, but also social life of women of any age and status. Recent studies of causal relationships show the versatility of pathological processes of connective tissue (CT), which cannot be corrected only by surgery. The review presents evidence of the relationship between dysplastic processes, their hereditary predisposition to pelvic organ prolapse, as well as options for conservative treatment methods and their effectiveness in aesthetic gynecology. In our opinion, this can serve as a recommendation for doctors to select correction methods and choose further tactics for patient management.

Conclusions. Taking into account the latest research in medicine, the pathology of pelvic floor CT covers a range of conditions associated with abnormalities in the genes of collagen, elastin and matrix proteins, combining them into undifferentiated dysplasia of connective tissue with a hereditary predisposition. However, genomic markers require further study. The introduction of various physiotherapy methods along with subsequent imitation of pelvic floor models as an assessment of the effectiveness of the treatment is becoming increasingly relevant in clinical practice. In this case, modelling can be used to correct conservative treatment with exercises as a first-line therapy, and in women with advanced cases as a recommendation for prevention and monitoring of the dynamics of invasive treatment.

Background. The absence of connection between the results of clinical assessment and urodynamic instrumental diagnostics in women with urinary incontinence is relevant problem.

Objective. Objectification of lower urinary tract urodynamic measurements when prescribing M-anticholinergics to women with mixed urinary incontinence.

Methods. Due to the lack of sufficient accuracy of recording using urination diaries, the assessment was based only on the results of home uroflow monitoring. The choice of the indicator of the mean effective volume (MEV) of the bladder is attributable to the fact that it determines the severity of pollakiuria, nocturia, the intensity of imperative urges and the number of cases of urgent urinary incontinence. The material was obtained as a result of a retrospective analysis of data from a non-invasive urodynamic examination of a group of patients (80 cases) with a mixed form of urinary incontinence aged from 31 to 78 years (average age – 54 years). In 36 patients included in the 1st subgroup, the MEV value during home uroflow monitoring was in the range from 43 to 150 ml. In the remaining 44 cases (2nd subgroup), the MEV was 213 ml. After the examination, an M-anticholinergic was prescribed during the preparation for surgery. After the performing trocar synthetic sling (TSS) according to the Danilov-Volnykh method, 48-hour home uroflow monitoring was repeated in the period from 3 months to 1 year.

Results. The effectiveness of the therapy during the period of M-anticholinergic prescription was no more than 76%. In a quarter (20 women) of patients, taking the drug did not have an effect in the form of an increase in the MEV of the bladder (P<0.1). The average values of the maximum emptying rate (Qmax) of the bladder in the general group initially amounted to 28.5 ml/s, and after the appointment of therapy and the implementation of TSS, they decreased to 20.3 ml/s. In the general group, an increase in the MEV was noted, but at the same time, a significant increase in the minimum released volumes from 35 to 57 ml was observed (P<0.01), while the maximum capacities, on the contrary, decreased from 454 to 432 ml. The volumetric micturition profile almost normalized, and in the range of volumes up to 100 ml, the occurrence decreased by 1.5 times (P<0.01). In the area of 101–200 ml, the percentage of occurrence of volume values did not change, and the volume profile in areas over 200 ml radically changed for the better.

Conclusion. Conservative therapy in the preoperative period allows to level out the urgent component of the disease. In this case, the specific weight of the stress component increases, and accordingly, the manifestations of urinary incontinence during physical exertion become more contrasting, and the functional state of the lower urinary tract changes. Trospium chloride can be easily dosed when prescribed, which ensures personalization of therapy. In addition, this drug is well combined with nootropics, α1-adrenergic blockers and can be prescribed for a long time.

The basis of treatment for luminal HER2-negative breast cancer (BC), the most common subtype of BC, is hormonal therapy, which is prescribed for 5–10 years after radical treatment. Despite such long-term treatment, one in 3–4 patients with stage II and one in 2–3 patients with stage III experience a relapse, which can occur within 20 years after the initial diagnosis. The risk of recurrence depends on such tumor characteristics as the degree of malignancy, the level of proliferative activity, the extent of regional lymph node involvement, etc. In order to reduce this risk, several strategies for intensifying adjuvant hormonal therapy are currently used. These include ovarian suppression, prolonged hormonal therapy, and the use of CDK4/6 inhibitors. This article provides an overview of the risk factors for recurrence and currently available strategies for adjuvant hormonal therapy.

Background. Adherence to adjuvant hormonal therapy for patients with hormone-dependent HER2-negative breast cancer is of fundamental importance and affects the treatment outcomes.

Objective. Assessment of the adherence to AHT among patients with hormone-dependent HER2-negative breast cancer after radical treatment, as well as possible reasons for its decline.

Methods. In order to study compliance, we initiated a survey among patients with luminal HER2-negative breast cancer who were receiving or had previously received adjuvant hormonal therapy. The study involved 420 patients. 64.5% of patients took the drug without fail, and 19% of patients occasionally (up to 5 times a month) missed doses. A decrease in compliance was noted with an increase in the duration of therapy. The most common reasons for interrupting therapy before the prescribed time were adverse events (10%), lack of the drug in the pharmacy (10%), forgetfulness (5%), and some patients did not consider it necessary to take the prescribed drugs (2.4%). Every second patient did not have the necessary amount of information about the treatment.

Results. The results of the study emphasize the need to develop solutions to inform patients about the importance of therapy, the risks associated with refusing treatment, as well as side effects and ways to correct them. Such tools will increase patient adherence to therapy, and therefore improve treatment results and reduce the likelihood of relapse.

Background. Diabetic macro- and microvascular complications are the most important chronic complications of type 2 diabetes mellitus (DM2), many features of which require further study. Continued research in this area can help improve the quality of diagnostics of these complications, including at the early stages of their development.

Objective. Evaluation of the features of macro- and microvascular complications in DM2 patients.

Methods. A total of 122 DM2 patients at an average age of 62.3±9.5 years were examined. The control group consisted of 40 practically healthy individuals. All patients underwent standard examinations, including determination of glycated hemoglobin, blood lipids, creatinine, uric acid, insulin, cystatin C levels, daily proteinuria, and urine albumin-creatinine ratio. Neurological status with assessment of pain, tactile, and vibration sensitivity was examined. Echocardiography, ultrasound examination of the brachiocephalic arteries, reactive hyperemia test, and ultrasound of the peroneal nerves (PN) were performed.

Results. The patients included in the study had a fairly long duration of diabetes, were characterized by poor glycemic control, and the presence of multiple vascular risk factors; therefore, most of them developed a wide range of microvascular complications, which were often presented in various combinations. Among these patients, there was a high proportion of individuals with various macrovascular DM2 complications, as well as with associated comorbid conditions. Clinical and laboratory data of diabetic patients were characterized by numerous differences from healthy individuals, including higher levels of blood pressure, glycemia, insulin resistance, lipidemia, uricemia, azotemia, albuminuria; a number of clinical and laboratory features were noted in patients with various microvascular complications of diabetes. DM2 patients demonstrated distinct manifestations of cardiovascular remodeling. Clinical features of diabetic polyneuropathy (DPN) and sonographic characteristics of PN demonstrated a close relationship, which allows to consider PN ultrasound as one of the possible accessible and informative methods for diagnosing (including at early, asymptomatic or low-symptom stages) and predicting the course of DPN in DM2.

Conclusion. The diagnostic approaches used allow to evaluate the features of diabetes-associated microvascular and macrovascular complications at the modern stage, to study their relationships with each other and with the nature of the course of DM2. The close relationships between the sonographic characteristics of PN and the clinical features of DPN established in this work allow to consider PN ultrasound as one of the possible accessible and informative methods for diagnosing DPN in DM2.

текст

Objective. Comprehensively review the history of the study of scapular fractures, starting from the first mention of the term «scapula» and ending with the present time; tracking the development of diagnostic methods and methods of conservative and surgical treatment of scapular fractures throughout history.

An analysis of various domestic and foreign medical literary sources including articles, monographs and journals containing data from different studies on the history of scapular fractures was carried out. Vesalius (1514-1564) was the first to use the term «scapula». Probably the oldest scapula fractured about 250 million years ago, was described by Chinese authors during the study of the skeleton of the fossilized remains of the dinosaur «Yangchuanosaurus hepingensis». The oldest recorded fractures of the human scapula date back to prehistoric and early historical times. Thus, acromial fracture was described in the treatises of Hippocrates. The early history of the treatment of scapular fractures is closely related to the history of French surgery. Petit, Du Verney and Desault in the 18th century were the first to point out the existence of these fractures. The first study devoted exclusively to scapular fractures was published by Traugott Karl August Vogt in 1799. Thomas Callaway published an extensive dissertation on shoulder girdle injuries in 1849, in which he reviewed a number of cases known at that time. The first radiograph of a scapular fracture was published by Petty in 1907. Mayo Robson (1884), Lambotte (1913) and Lane (1914) were pioneers in the surgical treatment of these fractures, followed by the French surgeons Lenormat, Dujarrier and Basset in 1923. The first results of internal fixation of the glenoid fossa, including a radiograph, were published by Fischer in 1939.

Conclusion. The initial interest in the study of scapular fractures was associated with incidence of this injury in military situations. The first discoveries in the areas of scapular anatomy, diagnosis and treatment of scapular fractures were made thanks to the work of French military field surgeons. The invention of more sophisticated methods for diagnosing musculoskeletal injuries helped to deepen existing knowledge, and the increased availability of instrumental methods for examining patients made it possible to diagnose scapular injuries in everyday life in peacetime. Along with the development of world traumatology in general, less traumatic and more high-tech methods of surgical treatment of scapular fractures have developed.