Vol 33, No 2 (2025)

INTRODUCTION: The epidemiology of multiple myeloma (MM) in Russia has not been sufficiently studied, however, it is important for understanding its prevalence in connection with increase in life expectancy of the population and the projected increase in morbidity MM.

AIM: To study the main epidemiological and clinical-demographic indicators of MM in the Republic of Crimea for 2019–2022.

MATERIALS AND METHODS: A prospective analysis of medical records of 173 patients with MM, who were undergoing outpatient and inpatient treatment in the hematology and chemotherapy department of Efetov Crimean Republican Oncological Clinical Dispensary was conducted. Statistical analysis of the data was conducted using the Microsoft Office application package and descriptive and parametric statistical methods.

RESULTS: Of the 713 patients MM were diagnosed of 91 women (66.5±11.1) years and 82 men (59.7±10.0) years. The men-to-women ratio was 0.9:1, which does not correspond to the global trends in MM development. The average incidence during the study period was 1.4 per 100 thousand, the average prevalence was 3.92 per 100 thousand, with the prevalence rate increased by 67.0% from the baseline. Patients with stage III of the disease according to the Durie–Salmon classification predominated — 97 (56.0%) patients. Mortality was 8.5 per 100 thousand among men and 6.0 per 100 thousand among women. The 5-year survival rate of patents with MM was 45.0%, the median survival was 38 months.

CONCLUSION: The prevalence of MM in the Republic of Crimea almost twice exceeds that in other regions of Russia. A steady increase in the incidence rate has been detected, which is probably due to improvement of the MM detectability as a result of regular prophylactic medical examinations of the population.

INTRODUCTION: Today, laparoscopic appendectomy (LAE) is the ‘golden standard’ of the treatment for acute appendicitis. However, the choice of the method of management of the appendix stump (AS) causes much debate.

AIM: Comparative analysis of invagination and ligation methods of management of the appendix stump in LAE.

MATERIALS AND METHODS: The analysis included data from 130 patients who underwent LAE. An analysis and comparison of the invagination and ligation methods of management of AS are presented.

RESULTS: There were no significant differences in the frequency of mild postoperative complications of LAE, severity of pain syndrome and length of hospital treatment. The difference was in the time of the surgical intervention, which was longer in the group of patients with AS managed using the invagination method. The frequency of infiltrates of the right iliac fossa was lower in the group of AS management using invagination method.

CONCLUSION: This clinical study demonstrated the effectiveness, safety and availability of the invagination method of AS management compared to the ligation method. A disadvantage of the invagination method is the requirements to the surgeon’s practical skills and a significant increase in the length of the operation. The management of the AS by immersing it with the intracorporal suture into the cecum cupula can be recommended for use in the everyday surgical practice.

INTRODUCTION: Extracorporeal perfusion of transplants is a promising area that is actively studied to eliminate the existing shortage of donor organs. However, the optimal parameters and duration of extracorporeal perfusion that would not lead to impairment of the morphofunctional condition of transplants, have not been sufficiently studied.

AIM: To present the results of development and experimental testing of an original device for perfusion preservation of an isolated heart on the biomodel.

MATERIALS AND METHODS: An original perfusion device for preserving donor hearts has been developed and experimentally tested on mature outbred male rats. During 15-hour normothermic extracorporeal perfusion of the heart in the proposed device, its rhythmic and contractile function, temperature, pH of the perfusate, pressure in the aorta, hematocrit, рО₂ and рСО₂ in the perfusate were studied, the content of glucose, lactate, and creatine phosphokinase (CPK) activity in perfusate samples were determined.

RESULTS: During perfusion of isolated hearts, sinus rhythm was observed at a sufficient rate. Perfusate pH stayed within 7.3–7.4. Hearts were perfused at constant pressure in the aorta of 70 mm Hg in normothermic conditions (t=37°С). After stabilization of the heart function, the systolic pressure in the left ventricle was 96.0 [93.7; 98.5] mm Hg and remained without significant changes during 12 hours of perfusion; at 15 hours of perfusion, the parameter decreased by 15.0% to 82.0 [79.5; 84.2] mm Hg, p=0.01208. After stabilization of the heart function, diastolic pressure in the left ventricle was 4.0 [3.0; 5.0] mm Hg and remained without significant changes during 12 hours of perfusion; by 15 hours of perfusion, it increased 1.5 times to 6.0 [5.0; 7.0] mm Hg, p=0.0164. During the experiment, biochemical markers in the perfusate after 30 min of perfusion and stabilization were at the level of physiological values without significant dynamics within 12 hours of perfusion: glucose consumption was 80.5 [70.2; 85.5] μmol/(kg×min×mm Hg); lactate excretion — 35.7 [32.5; 44.2] μmol/(kg×min×mm Hg); CPK leakage — 95.8 [93.7; 111.3] IU/l. After 15 hours of perfusion, the level of glucose consumption by isolated hearts per unit of performed function increased significantly to 136.8 [130.5; 145.7] μmol/(kg×min×mm Hg), p=0.01208; lactate excretion and CPK leakage into the perfusate increased to 58.2 [55.7; 67.4] μmol/(kg×min×mm Hg), p=0.02144, and 229.7 [215.8; 242.4] IU/L respectively, p=0.01208.

CONCLUSION: The study showed that extracorporeal perfusion of the heart in the developed device allows maintaining its viability for 12 hours in conditions maximally close to physiological ones, and also conducting dynamic assessment of the functional and metabolic state of the organ.

INTRODUCTION: Hyperglycemia causes glucotoxicity of neurons via different mechanisms, and, in combination with obesity, is a strong predictor of cognitive dysfunction. Free fatty acids and circulating cytokines cross the blood-brain barrier leading to neuroinflammation and proliferation of microglia. These alterations can be detected using neuroimaging methods. Thus, evaluation of cognitive functions and glycemic profile seems relevant in children with disorders of carbohydrate metabolism and different weights.

AIM: To analyze clinical and metabolic profile and cognitive functions in children and adolescents with carbohydrate metabolism disorders depending on body weight.

MATERIALS AND METHODS: A prospective, open, controlled study was conducted in 2022–2023. The study included 53 children aged from 7 to 18 years with carbohydrate metabolism disorders with duration of the disease of 1 to 7 years: group 1 — children with excessive body weight or obesity (n=33) and group 2 (n=20) — children with normal body weight. The work included evaluation of anthropometric parameters, carbohydrate metabolism disorders (glycemia and its variability, determination of glycated hemoglobin, immunoreactive insulin, and C-peptide), lipid spectrum, verification of non-alcoholic fatty liver disease, and testing using children’s version of Wechsler questionnaire.

RESULTS: Children with carbohydrate metabolism disorders and overweight or obesity more often had relatives with overweight (p=0.04), or diabetes mellitus (p=0.03) and were more often diagnosed with lipidemia (p=0.048) and fatty hepatosis (p=0.031). Children with carbohydrate metabolism disorders, both normal and overweight, showed statistically significant differences in the immunoreactive insulin index: among boys (p=0.030, p=0.001) and girls (р=0.020, р=0.002). Glycemia before bedtime and the time of glycemia above the target range were higher in overweight children (p=0.029, p=0.002). In Wechsler test, children with overweight or obesity and normal body weight children differed in the following parameters: vocabulary (speech function), letter-digit test, Kohs Block Design Test (constructional-spatial praxis; p=0.043, p=0.008 and p=0.005 respectively).

CONCLUSIONS: Children with carbohydrate metabolism disorders in combination with excessive body weight and obesity are characterized by impairment of some cognitive functions associated with asymptomatic glycemic variability.

INTRODUCTION: Motivation of the young people is a key condition for a full coverage with medical examinations and for a high active detection of sexually transmitted infections (STIs). Modern medical and social conditions dictate the need to update the approaches to educational activities in the prevention of STI.

AIM: To determine the effectiveness of preventive measures aimed at motivation to undergo annual screening for detection of STIs and screening in preparation for conception.

MATERIALS AND METHODS: A survey of 1,165 students studying in the humanities and technical specialties was conducted. The relationship between preventive measures and the presence of an attitude to undergo examinations was assessed using the relative risk (RR) indicator.

RESULTS: The positive influence on motivation for examinations to identify STIs, in the form of routine annual screening and medical preparation for conception was established as a statistically significant direct relationship (RR >1, p ≤0.05) for individual medical consultations, thematic video materials and distance learning on social and psychological aspects. Activities with a statistically significant positive effect in terms of motivation for annual screening (RR >1, p ≤0.05) and a potential effect of explaining medical preparation for parenthood (RR >1, p >0.05) are the inclusion of relevant topics in the educational process and students' educational research work. To note, such forms of preventive work as distant lectures and personal consultations with doctors have a potentially positive effect if the format of their implementation is improved. A negative effect (RR <1) was established in relation to discussion forms of work and existing websites of medical organizations.

CONCLUSION: Of priority significance in motivating to STIs screening is direct interaction of young people with employees of medical organizations in the form of individual and group counseling. An important component of effective education is educational and research work. The need to review approaches to presenting information on official websites of medical organizations and limit discussion events has been proven.

INTRODUCTION: Currently, a large amount of data has been accumulated on the dimensions of the auricle (AU), in particular, in the area of the location of the intertragal notch (ITN). The results of the conducted studies provide information mainly on the metric characteristics of AU. Methods of geometric morphometry (GM) permit to make conclusions about the shape of the anatomical structure. There are no data in the literature on the study of the shape of ITN using GM methods, and the authors’ conclusions about the shape of individual parts of the AU are based on the use of only the descriptive method.

AIM: To study the shape of ITN of auricle of girls using GM methods.

MATERIALS AND METHODS: The study included 140 girls aged (18.99±0.47) years. The somatotype and cephalotype of the girls were determined, and the right and left AU were photographed. Marks were applied on the digitized images along the margins of the ITN using the screen digitizer tpsDіg2 2.31. The GM methods were realized using MorphoJ 1.06d program. The strength of influence of the cephalotype and somatotype of the girls on the ITN shape was determined. The critical significance level of Goodall’s F-criterion was determined at 0.05. The variability of the ITN shape was determined using the ‘thin-plate’ method. The obtained data were subjected to the discriminant analysis.

RESULTS: The influence of cephalotype on the shape of the ITN of the left AU showed low values of Goodall’s F-criterion — 0.82 (p=0.900). The deformation grids of the ITN of the left AU demonstrated the greatest changes of the ITN shape in the antitragus area and posterior-inferior part of the ITN. ANOVA of the Procrustes coordinates of the ITN of the right AU showed that the influence of the somatotype on the shape of the ITN was not statistically significant. The distribution of the shapes of the ITN of both the right and left AU in the coordinates of the first and second canonical variables looked more disjointed when grouping data by somatotypes. The Mahalanobis distance between the ITN shapes of the right and left AU was 0.025 (p <0.0001), and the classification accuracy of this model was determined at the level of 78.93%.

CONCLUSION: The study results show that the somatotype of girls compared to their cephalotype has a greater influence of the ITN shape of both the left and right auricles.

INTRODUCTION: At the present time, the importance of the problem of co-infection of tuberculosis and coronavirus disease-19, COVID-19, has already been recognized and is being studied systematically, and the significance of the combination of pulmonary mycobacteriosis and COVID-19 is only being recognized, as evidenced by descriptions of single cases.

AIM: To demonstrate the influence of COVID-19 on the clinical course of pulmonary mycobacteriosis.

A clinical case of a 38-year-old female patient is presented with oligosymptomatic progression of pulmonary mycobacteriosis caused by M. avium, at 6 months after recovery from COVID-19. Mycobacteriosis developed with the underlying anomaly in the form of the right-sided aortic arch complicated by compression stenosis of trachea and bronchiectasis of S₄, S₅ segments of the left lung.

CONCLUSION: Patients with mycobacteriosis require active follow-up after recovery from COVID-19 for at least a year, for timely diagnosis of reactivation and treatment of pulmonary mycobacteriosis.

INTRODUCTION: The knowledge of the main variants of blood supply to the thyroid gland is of practical interest for both morphologists and surgeons, since understanding of the peculiarities of the arrangement and the type of branching of arteries often determines the course of surgical intervention in this area. The thyroid arteries are in the zone of close attention of specialists due to the abundance of their anatomical variants.

The presented case illustrates peculiarities of the origin and branching of the superior and inferior thyroid arteries in an 82-year-old female patient. The detailed preparation of injected vessels revealed an atypical arrangement of the thyroid arteries and their branches on the right: the superior thyroid artery emerged in a single trunk with the lingual artery, and the inferior thyroid artery emerged directly from the subclavian artery. Upon that, the arteries had classic arrangement on the left.

CONCLUSION: In the studied variant, of interest was the fact that the abnormally located inferior thyroid artery was combined with a single arterial trunk for the superior and lingual artery on one side of the body, with the ‘classic’ architecture of branches of the external carotid artery and thyrocervical arterial trunk on the other side. The frequency of occurrence of this variant, according to the literature, is 3.5% of cases. The main difference from the cases described in the literature is location of the thyrocervical trunk above the bifurcation of the common carotid artery and shorter length of the thyrocervical trunk and the superior thyroid artery.

INTRODUCTION: Mitochondria are targets for virtually all damaging agents. However, the dependence of the type of ultrastructural alterations on the chemical nature of the toxicant has not been established.

AIM: To study functional and ultrastructural alterations in mitochondria mediated by exposure to environmental pollutants.

The conducted analysis showed that toxic environmental pollutants realize their effect through the following mechanisms: oxidative stress, disruption of membrane protein balance, reduction of membrane potential, disruption of calcium homeostasis, release of cytochrome C into the cytoplasm, reduction of adenosine triphosphate synthesis and activation of mitochondrial apoptosis. Ultrastructural alterations can be classified as follows: disorders in the distribution of mitochondria in the cell cytoplasm and general decrease in their number, modification of the general morphology of the organelle, including disorganization and loss of cristae, alteration of matrix density and its vacuolization, breakage of the integrity of the membrane, deposition of toxic agents within the organelle.

CONCLUSION: No dependence of the type of functional or ultrastructural alterations of mitochondria on the chemical nature of the damaging agent was found.