卷 32, 编号 2 (2024)

INTRODUCTION: Caring of reproductive health of children and adolescents in the society, especially of adolescent girls as a group most vulnerable to risks in the reproductive sphere, continues to be of high importance. The studies confirm that education and awareness about reproductive health can reduce the probability of problems occurring. The existing legal regulations emphasize the importance of providing accurate and timely information of reproductive health.

AIM: Scientific justification of the strategy of forming safe reproductive behavior of adolescent girls on the basis of the peculiarities of their current reproductive behavior taking into account the opinion of specialists in the fields of education and healthcare.

MATERIALS AND METHODS: To assess the peculiarities of reproductive behavior of adolescent girls, an anonymous questionnaire survey of 400 adolescent girls was conducted. To determine the expectations of the participants of the sex education process, as well as the main directions of preventive work and education, a survey of 400 parents of adolescent girls, 86 pediatricians, 34 obstetricians-gynecologists and 420 teachers was conducted. For all groups of participants, author’s questionnaires were developed.

RESULTS: The reproductive behavior of adolescent girls living in the territory of the Novosibirsk region, is characterized by early start of sex life (15.90 ± 0.14 years), promiscuity (1.70 ± 1.10 partners), refusal to use effective means of contraception. Parents of adolescent girls emphasize the leading role of the family in sex education, suggesting participation of doctors and teachers in the process, but remain dissatisfied with the intensity of preventive measures. A similar problem is emphasized by specialists in the healthcare and education systems who indicate the possibility of conducting preventive work with adolescent girls remotely. In the opinion of pediatricians and obstetricians-gynecologists, providing preventive information on the reproductive health and behavior, will not only create safe reproductive behavior for modern adolescents, but is also an effective strategy of improving the system of reproductive health protection.

CONCLUSION: The study identified features of the reproductive behavior of adolescent girls that characterize it as risky. The results emphasize the need for an integrated approach to assessing and maintaining the health of adolescent girls, and also focus attention on the importance of educational work in this age group. The study serves as a basis for further preventive strategies in the field of reproductive health and education.

INTRODUCTION: In 2020, humanity faced a pandemic of a new infection a Severe Acute Respiratory Syndrome-related Corona Virus 2 (SARS-CoV-2) that had a significant impact on the economic, social, including medical, aspects of our life. Against the background of these changes, oncological diseases, like many other comorbid pathologies, seemed to fade into insignificance. But, as we understand, they have not lost their relevance, but only ‘retreated to the shadow’ for a while. Study of the basic statistical indicators used for evaluating the prevalence of cancer pathology and the results of the work of oncological service, helps analyze and understand the processes occurring in conditions of reorientation of medical measures for combating the pandemic.

AIM: To study changes in the main indicators of the oncology service of the Ryazan region during the COronaVIrus Disease 2019 (COVID-2019) epidemic.

MATERIALS AND METHODS: The main statistical indicators of morbidity, detestability and mortality from malignant neoplasms (MNs) in the Ryazan region were analyzed on the basis of statistical forms of federal statistical observation No. 7 (Form No. 7) ‘Record of MNs’, reports and data of cancer registry for 2012–2022. The most relevant statistical indicators were analyzed, data on most common and relevant tumor localizations were separately considered.

RESULTS: At the height of COVID-19 pandemics in 2020–2021, a sharp reduction of the total number of identified MN cases was observed a seeming decline of ‘mortality’. At the same time, there was an increase in the proportion of patients with advanced IV stage pathology of lungs, stomach, and colorectal cancer, which, in turn, led in some cases to increase in one-year mortality, and to general increase in mortality among cancer patients. To note, despite a complicated situation associated with non-observance of the terms of the periodic medical examinations, reprofiling of a number of medical organizations and increased load on the primary medical care organizations, the oncology service of the Ryazan region showed a not that catastrophic impairment of the main statistical indicators, and of some of them a proportion of detection of early stages, results of treatment of tumors of visual localization even a positive dynamics. In 2022, officially registered cancer incidence rates in our region returned to previous values comparable to 2019.

CONCLUSION: The experience of recent years should help in developing measures to prevent both the spread of similar epidemiological diseases and measures to prevent a decline of the quality of specialized medical care, in particular, in the field of oncology.

INTRODUCTION: The relevance of improving algorithms of surgical correction of lesser toes (SCLT) is due to a high incidence of hammertoe deformity syndrome, its negative impact on the working capacity and quality of life, and to a considerable degree of dissatisfaction of patients with the results of surgical treatment.

AIM: To evaluate the effectiveness of an improved SCLT algorithm using a modified fixed B. Helal osteotomy and combined plantar plate (PP) and toe flexor tendon repair.

MATERIALS AND METHODS: The prospective study included 167 female patients with a severe deformity of the second lesser toe. In 83 patients of the control group, the stability of the metatarsophalangeal joint was restored through surgical PP repair. In the main group (n = 84), along with elimination of PP defect, the second toe flexor tendon repair was performed. The condition of the second lesser toe before and one year after its surgical correction was evaluated using clinical and X-ray methods and a questionnaire.

RESULTS: At the stage of assessing the long-term results of treatment in the main group, the integral score of ACFAS Module 2 scale increased by 63 points relative to the preoperative value, which appeared to be 22 points more (U_emp = 3687, U_cr = 4894, р ˂ 0.01) than a similar change in the control group. One year after surgery, the incidence of the floating toe syndrome and its residual hyperextension in the main group decreased by 10.8% (φ*_emp = 0.007, р ˂ 0.05) and 8.8% (φ*_emp = 0.016, р ˂ 0.05), respectively.

CONCLUSIONS: Application of the improved algorithm permitted to improve the SCLT effectiveness, which was confirmed by a statistically significant improvement of the long-term results of treatment of patients in the main group compared to the control group.

INTRODUCTION: Cardiac complications are leaders in the structure of mortality of patients after resection of abdominal aortic aneurysms (AAA). In recent years more data have been obtained on the possibility of performing invasive coronary angiography (CAG) as a method of preoperative assessment of the condition of the coronary arteries.

AIM: To assess the tactics of routine CAG and preventive revascularization of the myocardium in comparison with non-invasive functional tests in patients without clinical manifestations of coronary heart disease (CHD) from positions of the hospital outcomes of AAA resections.

MATERIALS AND METHODS: A retrospective study included 205 patients without clinical and instrumental signs of CHD who underwent AAA resection at National Medical Research Center of Surgery named after A. Vishnevsky in 2001–2021. Patients of the first group (n = 55) underwent CAG before AAA resection and, if significant stenosis of coronary arteries was detected, revascularization of the myocardium was performed. In patients of the second group (n = 71), only functional cardiac tests were conducted before the operation. Patients of the third group were operated on without additional evaluation of cardiac status.

RESULTS: In 30.9% of patients of the first group, significant coronary lesions were detected, in 29.5% of them with the involvement of the left main coronary artery. This required 10 percutaneous coronary interventions and 5 coronary artery bypass surgeries, which made 27.0% of patients in this group. No cases of myocardial infarction were recorded in this group. In the second and third groups, one case of myocardial infarction in each group was recorded (p = 0.688). There was no significant difference in the postoperative mortality in all the groups (1.8%; 4.2%; 2.5%, respectively; p = 0.704). To this end, maximally invasive diagnostic tactics increased the average waiting time for AAA resection: 52.2 ± 6.0 days in groups without coronary angiography and myocardial revascularization versus 99.2 ± 13.0 days in the first group.

CONCLUSION: In a cohort of patients without anamnestic and clinical manifestations of coronary artery disease, the tactics of routine coronary angiography followed by prophylactic myocardial revascularization did not improve the short-term results of AAA resection, while the waiting period for intervention on the abdominal aorta increased. Preoperative tactics with functional cardiac tests also did not affect the treatment results.

INTRODUCTION: The publication is devoted to studying the rehabilitative effect of the Walkbot innovative training system on restoring the walking function in Paralympic athletes diagnosed with cerebral palsy (CP). The novelty of the developed Walkbot robot-assisted training system (TS) and insufficient experience of its use in rehabilitation practice require investigations on contingents of patients with musculoskeletal disorders in CP to develop protocols and programs of the rehabilitation use of the Walkbot TS.

AIM: Study of effectiveness of rehabilitation use of the Walkbot robotic TS to restore the walking function in Paralympic athletes with spastic cerebral palsy.

MATERIALS AND METHODS: The study was conducted at the Medical Rehabilitation Center ‘Sergievskie Mineral Waters’ in 2023. Forty Paralympic athletes (all men) aged 30-35 years were examined. The experimental group (EG) and control group (CG) included 20 Paralympic athletes each with standardization of the groups by the main parameters. The classes were conducted for 60 minutes according to the rehabilitation program. In the experimental group, besides exercise therapy (ET), the participants also exercised on the robotic Walkbot TS to restore the walking function, namely, they used Go world game with the known tasks symbolizing counties of the world, Go palace game that permits to take a walk around the palace, when patients move to the right or left as they choose; Go undersea game occurring against the background of a fairy sea world where they must go through the route controlling the direction of movement. The Paralympians of the control group used the standard rehabilitation program including ET with no training and gaming technologies.

RESULTS: The obtained results showed a pronounced improvement in the parameters of motor actions in Paralympians of the EG, while in the CG, positive rehabilitation changes were 2–3 times less expressed. At the initial and final rehabilitation stages, an increase of the tolerated duration of classes was recorded: by 5 times in the EG and 3 times in the CG, post-rehabilitation increase in the EG was 23.4% compared to that in CG. After training on the Walkbot TS, the volume of the performed load increased 5.9 times in the EG and 2.1 times in the CG. The increase in the EG made 64.5% compared to the CG, which indicated an increase in speed-strength qualities and endurance of para-athletes. At the end of rehabilitation, the amount of steps on the Walkbot TS in the EG increased 5.9 times (in the CG — 2.9 times), increase in the EG made 48.3% compared to the CG.

CONCLUSION: The experiment established a complex multisided positive effect of training sessions on the Walkbot TS in the EG versus the effect of only exercise therapy in the CG. The obtained data suggest that training on the Walkbot TS confer a significant restorative and normalizing effect on the neurophysiological mechanisms of functioning of the central parts of the motor cortex.

INTRODUCTION: The existence of foreign bodies in a human organism often creates difficulties in differential diagnosis and diagnosis verification.

A clinical case of a 45-year-old female patient is presented. On examination, the patient complained of pain in the knee joints, restricted range of active movements, more on the left. Pain syndrome in the joints has been present for several years intensifying on exertion; a week before the current consultation, the patient fell down from her height on the left knee and felt a sharp enhancement of pain in it. X-ray of the left knee joint showed a fragmented foreign body in the surrounding soft tissues. The patient denied a history of trauma with a foreign body getting into the wound; she cannot give the data and mechanism of appearance of a foreign body in the soft tissues.

CONCLUSION: The peculiarities of the given clinical case include the absence of data on the fact of entry of a foreign body, its prolonged presence in the soft tissues without significant clinical symptoms. A relative rarity of a foreign body in soft tissues, however, does not exclude it being a cause of pain syndrome, the primary care physicians should have diagnostic alertness. A thorough history taking and instrumental examinations are required to exclude, among other things, the presence of an X-ray negative foreign body. Not a single method of examination can be considered ideal for diagnosis of all types of foreign bodies.

INTRODUCTION: There exist several approaches to treatment of rosacea: systemic, external or complex therapy. Many practitioners note the effectiveness of using intense pulsed light in treatment of rosacea acne. Along with hardware techniques, azelaic acid-based gel is actively used in treatment. Despite the growing popularity of phototherapy, there is insufficient scientific literature on the study of optimal parameters of intense pulsed light for patients using azelaic acid.

AIM: To describe the experience of application of a combination of intense pulsed light and azelaic acid in erythematotelangiectatic subtype of rosacea.

A clinical case of a 52-year-old female patient with severe erythematotelangiectatic rosacea. Phototherapy was conducted in a course of 7 procedures with an interval of 3 weeks; azelaic-based gel was prescribed twice a day for 5 months, sunscreen cream with protection factor 50 for daily use. For the first procedure, a filter with 640 nm wave length was used, fluence 22 J/cm², pulse duration 3.5 ms, number of subpulses — 3; filter with 590 n wavelength, fluence 22 J/cm², pulse duration 3.5 ms, number of subpulses — 3; filter with 560 nm wavelength, fluence 20 J/cm², pulse duration 3.5 ms, number of subpulses — 3; filter with 515 nm wavelength, fluence 16 J/cm², pulse duration 3.5 ms, number of subpulses — 3. After 3 weeks, a second phototherapy procedure was conducted according to the same protocol. In the third procedure, the energy flow on each filter was increased by 1 J, pulse duration and number of subpulses did not change. On examination in 3 weeks, there was a reduction of the number of small and large telangiectasias, significant reduction of redness, no disturbing subjective sensations. In the subsequent procedures it was decided not to increase the energy flow on filters to avoid recurrent undesired phenomena.

CONCLUSION: Clinical observation demonstrated the effectiveness of using a combination of intense pulsed light and azelaic acid in erythematotelangiectatic rosacea when selecting the maximum permissible parameters of phototherapy. When treating with intense pulsed light it is permissible to increase the energy flow by 1 J/cm²–2 J/cm² on condition of normal tolerance. In case edema and hyperemia are present for more than 3 days, it is necessary to reduce the energy flow.

INTRODUCTION: Currently, investigation of efflux transport systems of an organism is an important scientific and practical task permitting to more deeply investigate the pharmacokinetics of medical drugs and to optimize pharmacotherapy of a number of diseases. The super family of ABC transporters plays a significant role in transport of biobiotics, the processes of absorption, distribution and excretion of medical drugs from an organism, in realization of undesired drug-drug interactions and development of pharmacoresistance. An important representative of this super family is breast cancer resistance protein (BCRP).

AIM: Systematization of the data on BCRP structure, localization, functions, substrates and modulators of its activity.

This literature review presents modern data on the molecular and spatial structure of BCRP, its localization in the cell, in organs and tissues. The data from studies of the functions of BCRP in an organism, of its role in the development of undesired drug-drug interactions at different stages of pharmacokinetics are summarized. An up-to-date list of medicinal drugs that are substrates and inhibitors of BCRP is given. Modern approaches to testing medical drugs for belonging to BCRP substrates or modulators of its activity are disclosed.

CONCLUSION: The significance of BCRP consists in the existence of a wide range of drugs that are its substrates or modulators of its activity. Upon that, of increasing significance is the investigation both of new and long-known medicinal substances for their belonging to substrates, inducers or inhibitors of breast cancer resistance protein, in order to increase the effectiveness of pharmacotherapy and reduce the risk of undesired drug interactions. Search for non-drug substrates and modulators of BCRP activity permits to obtain new markers for conducting effective studies of safe pharmacokinetics both in vitro and in vivo.

INTRODUCTION: In modern conditions of social development, there is a change of emphasis in definitions concerning not only public, but also individual health. Preserving and strengthening the health of the population is a complex task that implies the interaction of various specialists. This integration, the complexity of interaction in issues concerning preserving and strengthening the health of the population, should undoubtedly be reflected in the training of specialists, and, first of all, in higher medical education.

AIM: To determine the role of the discipline ‘Public Health and Healthcare’ (PHH) in teaching population health issues and in the integration of departments of various profiles in the study of individual, group and population health in modern conditions.

The article presents a discussion about modern trends in the development of the educational and scientific PHH discipline based on the opinions of students, teachers and the experience of Sechenovskiy University. Thus, students of profiles ‘General Medicine’, ‘Pediatrics’, ‘Medical and Preventive Care’ think that studying public health issues is the task of doctors of all clinical specialties (69.4%–76.7%), of hygienists (< 60.0%), of epidemiologists (< 30.0%). Integration in the teaching of PHH issues, according to teachers of PHH departments, in such types of activities as academic work, educational work, general scientific projects, joint printed works, textbooks and teaching aids, joint innovative projects, is mainly carried out with teachers of preventive educational disciplines, to a much lesser extent with teachers of clinical and fundamental disciplines.

CONCLUSION: An integrative approach to definitions, terms, and concepts is needed in the study of the health of individuals, population groups and population with a significant variety of disciplines and departments teaching them. The methodological role in teaching these issues is the prerogative of the PHH discipline.