Vol 13, No 3 (2022)

The basis of the modern industrial revolution is digitalization and artificial intelligence due to the influence of the digitalization process on all aspects of the economy, public life, including healthcare and education. The creation of a modernized healthcare system that would meet world standards implies an increase in both the quality and accessibility of medical care, which requires new technological solutions. The development of any new technology relies on digitalization, which has led to the creation of the Internet, robots, and artificial intelligence. Digital health is a new format for the medical industry to improve the efficiency and quality of medical care. The training of modern specialists provides for a significant change in teaching methods. The dependence of the quality of medical education on the multicomponent and increasingly digital nature of social reality is obvious. Additional special training of doctors for remote work is needed, the development of curricula taking into account the digitalization of healthcare. The relevance of the problem of digitalization of higher medical education involves an analysis of the state of modernization processes in medical universities, regulations on the electronic information educational environment of the university, including electronic information and educational resources, a set of information, telecommunication technologies and technological tools. The necessity of systematizing the social effects of the digitalization of higher education and conducting appropriate prolonged studies is substantiated.

BACKGROUND: In patients with a constitutional delay of puberty starts and ends completely without any medical intervention. In adolescents with hypogonadotropic hypogonadism puberty is absent or does not continue its development. Differential diagnosis of the conditions is complicated due to lack of standard recommendations for the selection, conducting and assessment of stimulation tests.

AIM: To assess the information content and find ways to increase the specificity of stimulation tests with triptorelin and corionic gonadotropin in relation to hypogonadotropic hypogonadism.

MATERIALS AND METHODS: We examined 44 adolescent boys aged 13.5–17 years with delayed puberty. Sexual development was assessed according to Tanner scale, bone age (X-ray of the non-dominant hand according to the Greulich atlas). All boys were tested with triptorelin. The test with one- and three-day intramuscular injection of human chorionic gonadotropin was performed in 26 and 35 patients, respectively. Statistical analysis was performed using the StatTech v. 2.6.1 (developer — Stattech LLC, Russia). To assess the diagnostic significance of quantitative signs in predicting a certain outcome the ROC-curve analysis was performed.

RESULTS: It was revealed that a negative test with triptorelin was observed in some patients with constitutional delay of puberty. Threshold stimulated luteinizing hormone and follicle stimulating hormone levels were set (8.90 and 5.90 IU/l respectively). Gonadotropins values equal to or lower than selected thresholds allow diagnosing of hypogonadotropic hypogonadism with high sensitivity and specificity. Threshold testosterone levels stimulated by one- and three-day administration of human chorionic gonadotropin were determined (2.11 and 5.84 nmol/l respectively). Testosterone values equal to or lower than selected thresholds allow diagnosing of hypogonadotropic hypogonadism with high sensitivity and specificity. A high degree of positive correlation was found between stimulated luteinizing hormone levels and stimulated testosterone levels during a three-day test with human chorionic gonadotropin.

CONCLUSIONS: A negative test with triptorelin is observed in some patients with constitutional delay of puberty. The specificity of the test can be improved by using threshold stimulated levels of luteinizing hormone and follicle stimulating hormone (8.90 and 5.90 IU/L, respectively). The use of the threshold levels of testosterone (2.11 and 5.84 nmol/l within the one- and three-day functional tests of the testicles respectively) can help to increase the specificity of the considered outdated stimulation tests with human chorionic gonadotropin.

BACKGROUND: Duchenne muscular dystrophy is the most severe and common form among childhood muscular dystrophies, characterized by a progressive course. One of the main measures to slow down the rate of progression of the disease is physiotherapy, but now there are no recommendations to identify the optimal motor regimen, which is effective and safe for patients with Duchenne muscular dystrophy.

AIM: The aim of the study was to evaluate the effectiveness of regular dynamic aerobic exercise in patients with Duchenne muscular dystrophy who are capable of independent movement.

MATERIALS AND METHODS: We examined 15 patients with genetically confirmed Duchenne muscular dystrophy aged 4,9 to 9,0 years (mean age 6,9 years) who did not participate in rehabilitation programs with exercise therapy for >6 months prior to inclusion in the study. All patients underwent a course of physical therapy, the duration of the course was 4 months, the course was divided into 2 stages: preparatory stage (individual cardiac functional reserve 51–60% with the number of repetitions of each exercise 6–8 times) and training stage (individual cardiac functional reserve 61–70% with the number of repetitions each exercise 10–12 times) The duration of the training was 60 minutes. At the baseline and during dynamic observation after 2 and 4 months, the following were evaluated: 6-minute walk test, timed function test (time to stand from supine, running 10 m, time to climb and descent 4 stairs).

RESULTS: Statistically significant positive dynamics was revealed: the average values of the distance of the 6-minute walk at the baseline were 478,2 ± 10,1 m, then 489,5 ± 11,4 m (p < 0.05) after 2 months and 502,6 ± 10,7 m (p < 0.005) after 4 months. The average values of the time to stand from supine at the baseline was 3,7 ± 0,2 sec., after 2 months — 3,5 ± 0,2 sec. (p < 0.08), after 4 months — 3,5 ± 0,2 sec. (p < 0.05). Mean values of time to run 10 m at baseline 4,3 ± 0,1 sec., after 2 months — 4,1 ± 0,2 sec. (p < 0,05), and after 4 months — 4,1 ± 0,1 sec. (p < 0.005).

CONCLUSIONS: Thus, the regular performance of aerobic physical therapy exercises without weights in combination with training on an exercise bike can increase endurance and speed in ambulant patients with Duchenne muscular dystrophy.

The liver is a unique and complex functioning organ, which is central in the metabolism of proteins, carbohydrates, fats and plays an important role in digestion, hematopoiesis, hemocoagulation, and detoxification processes. The pathology of the liver is complex and diverse, often accompanied by the pathology of other organs. Liver diseases are often encountered by doctors of various specialties, and for the clinician, knowledge of this pathology of this organ is essential. Currently, there is a steady increase in the number of patients with liver diseases, mostly people of working age. The development of acute and chronic liver pathology in the vast majority of cases is accompanied by the occurrence of various complications, up to the appearance of liver failure.

The lecture contains up-to-date information about the etiology and pathogenesis of hepatic pathology. Pathological processes in the liver are considered taking into account the complexity of its structural and functional organization. The main symptoms and syndromes of liver pathology are described, their pathophysiological assessment is given. Modern classifications of jaundice, hepatitis, liver failurea regiven.

Uterine adnexa torsion is an urgent surgical condition defined as total or partial twisting of an ovary and/or a fallopian tube on its vascular axis, causing circulatory failure. The diagnosis establishing before the operation is difficult due to absence of pathognomonic features of the clinical picture and instrumental diagnostics. In case of torsion the ovary is usually rotating around the infundibular-pelvic and uterine-ovarian ligaments, which causes vascular compression; ischemia and necrosis are progressing, leading to such complications as pelvithrombophlebitis, bleeding, infections, peritonitis, as well as calcification and autoamputation. Classical clinical picture of the uterine adnexa torsion is a sudden onset of continuous/intermittent pelvic or abdominal pain varying from moderate to severe, diffuse or isolated on one side. Pain syndrome could be of various duration, from several days to several months, and there could be such temporal episodes of pain in past history indicating prior partial torsion. This state can be accompanied by nausea, vomiting, fever, painful and frequent urination. The most precise instrumental diagnostics method in case of uterine adnexa torsion is colour Doppler ultrasonography, however, the final diagnosis is established only during the surgery. If the ovary is ischemic, adnexal detorsion is recommended, in case of necrosis adnexectomy is performed. When examining ultrasound of the pelvic organs, the left ovary is not visualized.

In our clinical case, according to the results of MRI of pelvic organs, the 38-year old patient had a cyst in posterior cul-de-sac with hemorrhagic or high-protein contents, and also the left ovary was not visible. During the laparoscopy an autoamputation of the left uterine adnexa due to torsion was found, as well as presence of necrotizing lesion in posterior cul-de-sac. Thus, laparoscopy is the only reliable method for diagnosing and treating adnexal torsion.

This article focuses on the problem of intraventricular hemorrhage in preterm infants with low and extremely low body weight. Premature newborns are most susceptible to this pathology due to the morpho-functional immaturity of brain tissues and blood vessels. Pathological factors lead to lesion of the vessel wall and a massive hemorrhage in the cavity of the ventricles, sometimes with a breakthrough into the white matter. The morphological findings of hemorrhage in the lateral ventricles of the brain in a child born with extremely low body weight are presented on an example of a clinical case. The article presents a description of the morphology of damage to the germinal matrix and choroid plexus as one of the most common sources of hemorrhage. The main attention is paid to the state of the blood vessels: arterioles, venules, capillaries. Possible causes and consequences of vascular injury in the periventricular region are indicated here. According to the recent studies, intraventricular hemorrhage appears more often due to damage to the choroid plexus in children born at 37 weeks of gestation and later. In this report we consider the problem of hemorrhage from the reducing germinal matrix’s vessels into the subependymal region with spreading into the white matter and lateral ventricles.