I.P. Pavlov Russian Medical Biological Herald

BACKGROUND: Adolescent patients with type 1 diabetes mellitus (T1DM) report dry mouth in 95% of cases. Xerostomia syndrome may be associated with impaired metabolic control with the result of decreased salivary gland function.

AIM: To determine the relationship of clinical manifestations of xerostomia syndrome and the degree of periodontal damage in adolescents with T1DM with different level of metabolic control.

METHODS: The study included 122 adolescents aged 14 (13; 16) years. The participants were divided into groups: the study group (n = 61) with the diagnosis ‘Insulin-dependent diabetes mellitus', and the comparison group (n = 61) without metabolic diseases, but with the diagnosis ‘Chronic catarrhal gingivitis'. All subjects underwent evaluation of the Papillary-Marginal-Alveolar Index (PMA), Sulcus Bleeding Index (SBI). Xerostomia syndrome was evaluated by a survey on XI scale (Xerostomia Inventory), oral dryness was evaluated using Clinical Oral Dryness Score (CODS), sialometry, salivation flow rate measurement; pH-metry.

RESULTS: The SBI index was 0.33 (0.16; 0.66) in the study group with glycated hemoglobin (HbA1c) < 7% (study group 1) and 0.50 (0.33; 0.92) in the group with HbA1c ≥ 7% (study group 2), and 0.10 (0.00; 0.40) in the comparison group (p = 0.001). PMA was 19.50% (11.75%; 31.50%) in study group 1, 35.00% (22.50%; 44.50%) in study group 2, and 10.00% (0.00%; 15.00%) in the comparison group. Differences in PMA were statistically significant both between all the groups (p < 0.001) and in pairwise comparisons (p < 0.05). The mean pH of saliva was 6 (5; 6) in study group 1, 5 (5; 6) in study group 2, and 7 (6; 7) in the comparison group (p < 0.001). The salivation flow rate was lower in patients with type 1 diabetes: 0.22 (0.14; 0.26) ml/min in study group 1, 0.13 (0.06; 0.24) ml/min in study group 2, and 0.56 (0.30; 0.60) ml/min in the comparison group (p < 0.001). CODS achieved 4 (3; 4) points in study group 1, 5 (5; 6) points in study group 2, and 1 (0; 2) point in the comparison group (p < 0.001). The saliva volume measured by sialometry was 1.10 (0.73; 1.30) ml in study group 1, 0.60 (0.28; 1.20) ml in study group 2, and 2.80 (1.50; 3.00) ml in the comparison group (p < 0.001).

CONCLUSION: Xerostomia syndrome should be considered an important clinical sign indicating the development of periodontal diseases in T1DM. Metabolic control influences the condition of the oral cavity in adolescents with T1DM, which confirms the importance of maintaining normal blood glucose level for dental and gingival health in this category of patients.

BACKGROUND: The evaluation of liver function and the extent of liver damage can be of high diagnostic significance in predicting outcomes of acute pancreatitis (AP).

AIM: To evaluate the impact of the concomitant liver damage on the dynamics of laboratory parameters and outcomes in patients with acute pancreatitis.

METHODS: A retrospective, cohort, single-center study involved 94 patients hospitalized in a surgical hospital for AP. The patients were divided into 2 groups: the main group with a significant liver damage (n = 48; mean age 51.7 ± 15.7 years; 57.0% men and 43.0% women), and the control group without such damage (n = 46; mean age 52.6 ± 16.2 years; 54.3% men and 45.7% women).

RESULTS: On day 3 and 5, higher transaminase activity was recorded in the main group compared to the control group (a more pronounced cytolysis syndrome). On day 3, both groups were clinically comparable in bilirubin level (43.13 ± 6.93 µmol/l and 42.13 ± 6.55 µmol/l), despite the statistical significance of differences (p < 0.001). By day 5, the bilirubin level in the control group significantly decreased (22.37 ± 3.82 µmol/l), but remained at higher level in the main group (30.27 ± 9.39 µmol/l, p < 0.001). The levels of total serum protein, total serum cholesterol, and serum triglycerides did not show differences at the studied time points (for all comparisons p > 0.05). Plasma fibrinogen in patients with AP showed no differences between the groups on day 1 of hospitalization, with the mean values within the reference range (200–400 mg/dl); on day 3, an increase was noted in both groups with the mean value exceeding the upper limit of the reference range and a tendency to forming difference between the groups. However, on day 5, a significant increase in fibrinogen level was noted in the main group — up to 647.86 ± 143.09 mg/dl, and up to 455.48 ± 147.00 mg/dl in the control group (p = 0.001). In 14 (29.16%) patients in the main group and 5 (10.87%) patients in the control group, moderate AP developed into severe. In addition, one case of death was recorded in each group.

CONCLUSION: In some patients with AP, the underlying disease is complicated by hepatocytolysis and cholestasis syndromes. In these patients, the moderate-to-severe acute pancreatitis more often progresses to severe forms. The study confirmed the hypothesis that evaluation of the liver function and of the extent of liver damage may be of a high diagnostic significance in predicting the outcome of acute pancreatitis and can be used for studying the effectiveness of various treatment strategies for pancreatitis.

BACKGROUND: Lower extremity varicose vein disease is a common condition among people of working age, leading to serious complications and impairment of quality of life. Modern minimally invasive techniques, such as endovenous laser coagulation (EVLC) and radiofrequency ablation, are effective and safe; however, complications such as thrombosis, heat-induced lesions, recanalization and recurrence are possible. Steam thermal ablation (STA) is a promising technique that minimizes the risk of tissue damage via the use of the energy of condensing steam.

AIM: To evaluate comparative characteristics of EVLC and STA in vitro: energy and temperature characteristics of impact on the vein and surrounding tissues, effectiveness and safety.

METHODS: Experimental studies were performed on 38 veins removed during phlebectomy. The veins were randomly divided into groups depending on the obliteration method: STA in different modes and EVLC. An Acrovein steam-generating prototype complex (Russia) and a Lakhta Milon diode laser (Russia) were used. A system with continuous liquid circulation was used to simulate physiological conditions. Temperature distribution was modeled in MATLAB R2017b (Mathworks, USA). The technical characteristics of the catheters, including the minimum bending radius, were compared; after the procedure, a histological examination of the veins was performed to assess morphological changes.

RESULTS: The maximum catheter temperature during EVLC (1470 nm) was 58 [48–69]°C, during STA in 1 pulse/cm mode — 36 [32–40]°C, STA in 3 pulse/cm mode — 44 [34–54]°C (p < 0.05). During STA, after 4 pulses, the temperature reached a maximum of 58 [49–67]°C, further temperature increase was insignificant (p > 0.05). The catheter for STA (Acrovein, Russia) withstood a bend of 0.5 mm in diameter, maintaining functionality, whereas the light guide for EVLC (Lakhta-Milon, Russia) fragmented at a radius of 3.0 mm. Modeling confirmed the safety of STA. During EVLC, vein perforation was noted in 57.1% of cases (n = 4; p < 0.05), while during STA no perforations occurred.

CONCLUSION: The results of the experimental study demonstrated the effectiveness of STA of varicose veins in vitro with a lower incidence of vessel perforation cases compared to EVLC.

BACKGROUND: One most modern method to correct telangiectasias is percutaneous coagulation. A large number of available devices, lack of optimized protocols and predictable results of procedures, make studying the effectiveness and safety of methods for correcting facial vascular pathologies a pressing issue today.

AIM: To conduct a comparative analysis of the effectiveness and safety of removing facial telangiectasias using a neodymium laser with 1064 nm wavelength and 650 μs pulse width, and using a device based on E-Light technology (E-Light device), which represents the synergy of intense pulsed light (IPL) and radiofrequency (RF).

METHODS: A prospective experimental randomized study was conducted. Each patient (n = 79) of two study groups underwent two sessions of laser obliteration of telangiectasias. The interval between procedures was 1 month. In group 1 (n = 39), obliteration was performed using a solid-state laser with neodymium-doped yttrium aluminum garnet as an active medium (Nd:YAG laser), in group 2 (n = 40), an E-Light device was used. The study groups were comparable in gender (р = 0.818), age (р = 0.147) and the initial number of telangiectasias (р = 0.062). The patients were conducted macrophotography and dermatoscopy of facial vascular lesions. After each obliteration session, pain sensations of patients were assessed on Visual Analogue Scale (VAS).

RESULTS: The results of subjective pain assessment on VAS after each procedure showed a statistically significant differences between the groups: after the first and second obliteration sessions (р < 0.0001), pain sensations were weaker in patients of group 1. Despite the absence of a statistically significant difference in the results in terms of the number of obliterated telangiectasias in the two groups (after the first obliteration session — р = 0.994, after the second obliteration session — р = 0.208), in group 1, 19.2% more telangiectasias have been cleared than in group 2. One patient (2.5%) of group 2 had hypopigmentation in the treated area 1 month after the second obliteration session.

CONCLUSION: The effectiveness of obliteration of facial telangiectasias with Nd:YAG laser in terms of reducing vascular malformations was 19.2% greater than when using a E-Light device. The use of a Nd:YAG laser for two sessions of facial telangiectasia obliteration was safer than that of E-Light device.

BACKGROUND: Currently, much attention is given to the problem of emotional burnout among medical workers, since the psychological state of medical personnel has a key impact on the quality of medical care provided and patients’ satisfaction with their interaction with the healthcare system.

AIM: To study the prevalence of emotional burnout syndrome (EBS) among medical personnel of a medical rehabilitation department and a probability of its Influence on the implementation of a patient-oriented model of medical care.

METHODS: To achieve the set goal, an analysis of the development of EBS was conducted in a 24-hour inpatient medical rehabilitation department. Using V.V. Boyko's questionnaire, an anonymous survey of healthcare workers (n = 64) was conducted: 7 physicians, 45 mid-level and 12 junior medical workers.

RESULTS: Analysis of the survey results revealed that 75.0% of healthcare workers had not yet developed EBS, 23.4% were in the stage of development, and 1.6% had developed it. Eighteen-point eight percent of healthcare workers had reached the resistance stage, characterized by inappropriate, selective emotional responses and a reduction in professional responsibilities. EBS was most evident (2.2%) among mid-level medical personnel, while physicians and junior medical personnel were more often in the stage of its development. The resistance stage was also more common (22.2%) among mid-level medical personnel.

CONCLUSIONS: Manifestation of EBS in medical workers in the form of such symptoms as inappropriate selective emotional response, emotional withdrawal, partial reduction of professional responsibilities, can negatively affect the implementation of a patient-oriented model of medical care, and requires the development of measures aimed to provide psychological support primarily to the mid-level medical personnel, and EBS prophylaxis among all medical medical professionals of a medical rehabilitation department.

BACKGROUND: A key step in drug pharmacokinetic analysis is testing the linearity hypothesis, as it allows one to judge how predictably the concentration of a substance changes when its dose is corrected.

AIM: To evaluate the linearity of the pharmacokinetics of the compound GIZh-298 (4-benzoylpyridine O-(2-morpholinoethyl) oxime oxalate) in blood plasma of rats after a single intragastric administration at doses of 60, 90 and 120 mg/kg.

METHODS: The study was performed on outbred, sexually mature male white rats. The test compound was administered intragastrically once at doses of 60, 90, and 120 mg/kg. Plasma GIZh-298 concentrations were determined by high-performance liquid chromatography with mass spectrometric detection. Dose proportionality was assessed by normalizing the area under the drug concentration-time curve (AUC) and the maximum plasma drug concentration after extravascular administration (C_max) to the drug dose.

RESULTS: The pharmacokinetics of GIZh-298 in rats in the dose range of 60–120 mg/kg is nonlinear, as evidenced by the calculated proportionality constant (b), which is significantly greater than unity. The interception points of the function described by the linear regression equation, with the abscissa (a) of the linear regression equations was close to zero (-0.32 for AUC_0→∞ and 0.34 for C_max), meaning the regression lines originated almost from the reference center and thus demonstrated a linear portion of the curve that included the 60 and 90 mg/kg points. In the portion from the minimum detectable dose to 90 mg/kg, the dose dependence of AUC and C_max was linear. A sharp deviation from proportionality was observed upon transition to a dose of 120 mg/kg, leading to an overestimated mean b value when analyzing all the three points.

CONCLUSION: The pharmacokinetics of GIZh-298 in rats is linear over a dose range of up to 90 mg/kg. A further increase in the dose to 120 mg/kg resulted in a disruption of linear proportionality, which may be due to saturation of absorption or elimination processes.

BACKGROUND: Aortoduodenal fistula (ADF) is an extremely rare pathology encountered in 0.04–0.07% of cases, according to published data. This pathological communication between the aorta and duodenum results from topographic and anatomic peculiarities of the mutual arrangement of the abdominal aorta and duodenum. The most common complication of ADF is massive gastrointestinal bleeding with extremely high mortality rate (up to 100% without treatment and 30–40% with surgical treatment).

This article describes a case of treatment of ADF complicated with bleeding using a developed method of endoscopic hemostasis, which consists in a combined use of two powdered hemostatic agents and a granulated cytoprotective sorbent.

CONCLUSION: The proposed method of endoscopic stopping of gastroduodenal bleeding provided reliable hemostasis, prevented recurrent hemorrhage, gained time for diagnostic search and successful performance of radical surgery at a specialized vascular center.

INTRODUCTION: Electronic cigarettes (e-cigarettes) are battery-powered inhalation delivery systems for nicotine or other psychoactive aerosols, which also contain flavorings and other components of nicotine-containing liquid. Use of e-cigarettes poses a significant public health threat. Currently, the lifetime prevalence of e-cigarette smoking reaches 43.7%. Recently, the use of electronic nicotine delivery means is associated with a growing number of respiratory complications most pressing being e-cigarette and vaping use-associated lung injury (EVALI).

AIM: To present the operating principle of electronic nicotine delivery systems, their types, to suggest the trigger components of e-cigarette liquid and their effect on the respiratory system.

This review presents Information on currently available methods and devices for inhaled nicotine delivery proposed as a more modern way to quit traditional tobacco smoking. Information on prevalence of e-cigarette smoking among adults and adolescents is presented. The article discusses the reasons and trends for active spread of e-cigarettes as a means of quitting traditional tobacco smoking, and fallacy of this concept when comparing potential harm for smokers’ health. The history of the creation and development of the existing electronic smoking devices is separately described, and characteristics of the current generations of electronic nicotine delivery systems are given. The article discusses the public health problems arising from the spread of e-cigarette smoking, as well as characteristics of smoking devices and liquids, their components and potential toxic effects of their metabolites, potential health risks for smokers, and possible outcomes.

CONCLUSION: The use of electronic nicotine delivery systems threatens with the development of severe respiratory system pathologies due to the presence of various components in smoking liquids, which trigger toxic reactions and enhance addictive effect, thereby worsening lung damage.

This Letter to the editor raises the need for a comprehensive approach to screening and treatment of noncommunicable diseases and common mental disorders, using the situation in India as an example. The authors discuss the prevalence and comorbidity of these disease groups as a prerequisite for changing the concept of primary care, propose a framework for an integrative approach, discuss the benefits of its implementation for healthcare, and discuss future developments in addressing this organizational challenge.