R. A. Gudkov, A. Dmitriyev, Natal'ya V. Fedina, Valeriya I. Petrova, Tat'yana A. Teryokhina, Alina E. Sologub
INTRODUCTION: Conjugated hyperbilirubinemia in newborns may evidence prognostically dangerous diseases. However, the variety of causes and rarity of some of them makes differential diagnosis challenging. AIM: To determine the order of diagnostic actions to exclude, first of all, the most probable causes of conjugated hyperbilirubinemia. The review presents relevant information on diseases of newborns and children, running with elevation of the serum level of conjugated bilirubin. The search was carried out in PubMed, MEDLINE, eLibrary.ru databases for 2016–2023. The issues of terminology, etiology and risk factors are briefly covered. The presented pathologies include biliary atresia and Alagille syndrome, infectious and iatrogenic hepatopathies, various forms (including the new ones) of progressive familial intrahepatic cholestasis, disorders in synthesis of the primary bile acids, α1-antitrypsin deficiency, galactosemia, tyrosinemia type 1, cystic malformations, mitochondrial diseases and some other rare diseases accompanied by conjugated hyperbilirubinemia. Brief diagnostic characteristics of the presented diseases are given. CONCLUSION: The differential diagnosis of conjugated hyperbilirubinemia in newborns and children is a complex problem requiring immediate solution by successive exclusion of the most probable diseases, first of all, biliary atresia, Alagille syndrome, infectious and iatrogenic causes.
{"title":"Differential Diagnosis of Conjugated Hyperbilirubinemia in Infancy (Literature Review)","authors":"R. A. Gudkov, A. Dmitriyev, Natal'ya V. Fedina, Valeriya I. Petrova, Tat'yana A. Teryokhina, Alina E. Sologub","doi":"10.17816/pavlovj188846","DOIUrl":"https://doi.org/10.17816/pavlovj188846","url":null,"abstract":"INTRODUCTION: Conjugated hyperbilirubinemia in newborns may evidence prognostically dangerous diseases. However, the variety of causes and rarity of some of them makes differential diagnosis challenging. \u0000AIM: To determine the order of diagnostic actions to exclude, first of all, the most probable causes of conjugated hyperbilirubinemia. \u0000The review presents relevant information on diseases of newborns and children, running with elevation of the serum level of conjugated bilirubin. The search was carried out in PubMed, MEDLINE, eLibrary.ru databases for 2016–2023. The issues of terminology, etiology and risk factors are briefly covered. The presented pathologies include biliary atresia and Alagille syndrome, infectious and iatrogenic hepatopathies, various forms (including the new ones) of progressive familial intrahepatic cholestasis, disorders in synthesis of the primary bile acids, α1-antitrypsin deficiency, galactosemia, tyrosinemia type 1, cystic malformations, mitochondrial diseases and some other rare diseases accompanied by conjugated hyperbilirubinemia. Brief diagnostic characteristics of the presented diseases are given. \u0000CONCLUSION: The differential diagnosis of conjugated hyperbilirubinemia in newborns and children is a complex problem requiring immediate solution by successive exclusion of the most probable diseases, first of all, biliary atresia, Alagille syndrome, infectious and iatrogenic causes.","PeriodicalId":113364,"journal":{"name":"I.P. Pavlov Russian Medical Biological Herald","volume":"20 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141662521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. V. Abrosimov, A. V. Chupin, A. F. Kharazov, Evgeniy M. Troshin, N. R. Masalimov
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.
{"title":"Routine Coronary Angiography and Functional Cardiac Tests before Resection of Abdominal Aortic Aneurysm in Patients without Symptoms of Myocardial Infarction","authors":"A. V. Abrosimov, A. V. Chupin, A. F. Kharazov, Evgeniy M. Troshin, N. R. Masalimov","doi":"10.17816/pavlovj595860","DOIUrl":"https://doi.org/10.17816/pavlovj595860","url":null,"abstract":"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. \u0000AIM: 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. \u0000MATERIALS 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. \u0000RESULTS: 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. \u0000CONCLUSION: 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.","PeriodicalId":113364,"journal":{"name":"I.P. Pavlov Russian Medical Biological Herald","volume":"29 51","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141659470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sergey I. Kireyev, V. G. Protcko, Vladimir S. Kireyev, E. S. Olenko
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 (Uemp = 3687, Ucr = 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.
{"title":"Comparative Evaluation of Effectiveness of Lesser Toe Surgical Correction","authors":"Sergey I. Kireyev, V. G. Protcko, Vladimir S. Kireyev, E. S. Olenko","doi":"10.17816/pavlovj375356","DOIUrl":"https://doi.org/10.17816/pavlovj375356","url":null,"abstract":"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. \u0000AIM: 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. \u0000MATERIALS 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. \u0000RESULTS: 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 (Uemp = 3687, Ucr = 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. \u0000CONCLUSIONS: 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.","PeriodicalId":113364,"journal":{"name":"I.P. Pavlov Russian Medical Biological Herald","volume":"3 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141658638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mihail V. Bykov, V. V. Lazarev, A. Mayorov, M.S. Tsesareva, V. S. Nafikov, Anna S. Koroleva, V. V. Sytkov, D. Severinov, Dmitriy A. Smirnov, Nikolay S. Frolov, D.V. Chernyshev
INTRODUCTION: Currently, various approaches to the treatment of intestinal failure (IF) are considered. In search for pathogenetically justified therapy, it is possible to use oxygenated saline enteral solution (OSES). АIM: To demonstrate, by gas analysis of the introduced oxygenated saline enteral solution and the excreted intestinal fluid, the possibility of gas exchange in the intestine with increased oxygen extraction under hypoxic conditions. An 8-year-old child with burdened premorbid history and severe community–acquired bilateral pleuropneumonia kept on mechanical ventilation, had signs of IF (disorder in passage, absence of independent defecation for more than two days). During treatment and observation of the child, enteral feeding was attempted with pharmacological stimulation with prokinetics, and introduction of laxative sorbent with prebiotic effect (lactulose). Because of non-effectiveness of these measures, it was decided to perform intestinal lavage with OSES introduced through the nasogastral tube. In 30 minites after start of OSES introduction, the gastrointestinal tract motility notably enhanced, in 1.5 hour from the beginning of the procedure, fractional passage of a significant amount of thick fecal masses was noted, after which intestinate — liquid stool stained yellow with bile, was obtained. During the procedure, a comparative analysis of the gas composition of the introduced OSES and excreted intestinate was done. In the excreted solution, 97-fold decrease of рО2 from 659 to 6.8 mm Hg, and 3.6-fold increase in CO2 tension from 23 to 85.7 mm Hg, were noted. CONCLUSION: Oxygenation of the enteral environment by barbotage of a saline enteral solution introduced through a tube is an effective component of intensive therapy for intestinal failure syndrome, taking into account the ability of the gastrointestinal tract tissues to actively participate in gas exchange: extract oxygen and release carbon dioxide.
{"title":"Elimination of Intestinal Hypoxia in Complex Treatment of Intestinal Failure (Case Report)","authors":"Mihail V. Bykov, V. V. Lazarev, A. Mayorov, M.S. Tsesareva, V. S. Nafikov, Anna S. Koroleva, V. V. Sytkov, D. Severinov, Dmitriy A. Smirnov, Nikolay S. Frolov, D.V. Chernyshev","doi":"10.17816/pavlovj321911","DOIUrl":"https://doi.org/10.17816/pavlovj321911","url":null,"abstract":"INTRODUCTION: Currently, various approaches to the treatment of intestinal failure (IF) are considered. In search for pathogenetically justified therapy, it is possible to use oxygenated saline enteral solution (OSES). \u0000АIM: To demonstrate, by gas analysis of the introduced oxygenated saline enteral solution and the excreted intestinal fluid, the possibility of gas exchange in the intestine with increased oxygen extraction under hypoxic conditions. \u0000An 8-year-old child with burdened premorbid history and severe community–acquired bilateral pleuropneumonia kept on mechanical ventilation, had signs of IF (disorder in passage, absence of independent defecation for more than two days). During treatment and observation of the child, enteral feeding was attempted with pharmacological stimulation with prokinetics, and introduction of laxative sorbent with prebiotic effect (lactulose). Because of non-effectiveness of these measures, it was decided to perform intestinal lavage with OSES introduced through the nasogastral tube. In 30 minites after start of OSES introduction, the gastrointestinal tract motility notably enhanced, in 1.5 hour from the beginning of the procedure, fractional passage of a significant amount of thick fecal masses was noted, after which intestinate — liquid stool stained yellow with bile, was obtained. During the procedure, a comparative analysis of the gas composition of the introduced OSES and excreted intestinate was done. In the excreted solution, 97-fold decrease of рО2 from 659 to 6.8 mm Hg, and 3.6-fold increase in CO2 tension from 23 to 85.7 mm Hg, were noted. \u0000CONCLUSION: Oxygenation of the enteral environment by barbotage of a saline enteral solution introduced through a tube is an effective component of intensive therapy for intestinal failure syndrome, taking into account the ability of the gastrointestinal tract tissues to actively participate in gas exchange: extract oxygen and release carbon dioxide.","PeriodicalId":113364,"journal":{"name":"I.P. Pavlov Russian Medical Biological Herald","volume":"19 25","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141659541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Igor’ N. Kagramanyan, Vladimir A. Reshetnikov, O. Manerova, I. Yakushina, Elena A. Shustikova, Nazim T. ogly Ismail-zade
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.
{"title":"Modern Trends in Development of Educational and Scientific Discipline ‘Public Health and Healthcare’: Its Methodological Role and Integrative Function","authors":"Igor’ N. Kagramanyan, Vladimir A. Reshetnikov, O. Manerova, I. Yakushina, Elena A. Shustikova, Nazim T. ogly Ismail-zade","doi":"10.17816/pavlovj630115","DOIUrl":"https://doi.org/10.17816/pavlovj630115","url":null,"abstract":"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. \u0000AIM: 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. \u0000The 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. \u0000CONCLUSION: 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.","PeriodicalId":113364,"journal":{"name":"I.P. Pavlov Russian Medical Biological Herald","volume":"8 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141662572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
V. Gorelik, Svetlana N. Filippova, Oleg S. Smentyna, L. S. Revchuk, Ya. V. Davydova
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.
{"title":"Change in Walking Parameters of Paralympic Athletes Diagnosed with Cerebral Palsy Using WALKBOT Training System at Recovery Stage of Rehabilitation","authors":"V. Gorelik, Svetlana N. Filippova, Oleg S. Smentyna, L. S. Revchuk, Ya. V. Davydova","doi":"10.17816/pavlovj611555","DOIUrl":"https://doi.org/10.17816/pavlovj611555","url":null,"abstract":"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. \u0000AIM: Study of effectiveness of rehabilitation use of the Walkbot robotic TS to restore the walking function in Paralympic athletes with spastic cerebral palsy. \u0000MATERIALS 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. \u0000RESULTS: 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. \u0000CONCLUSION: 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.","PeriodicalId":113364,"journal":{"name":"I.P. Pavlov Russian Medical Biological Herald","volume":"21 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141661111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natal’ya M. Popova, A. V. Shchulkin, Yu. S. Tranova, M. I. Povetko, Aleksandr S. Polupanov, S. K. Pravkin, A. A. Slepnev, E. Yakusheva
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.
{"title":"Breast Cancer Resistance Protein: Structure, Localization, Functions, Significance for Rational Pharmacotherapy","authors":"Natal’ya M. Popova, A. V. Shchulkin, Yu. S. Tranova, M. I. Povetko, Aleksandr S. Polupanov, S. K. Pravkin, A. A. Slepnev, E. Yakusheva","doi":"10.17816/pavlovj384999","DOIUrl":"https://doi.org/10.17816/pavlovj384999","url":null,"abstract":"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). \u0000AIM: Systematization of the data on BCRP structure, localization, functions, substrates and modulators of its activity. \u0000This 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. \u0000CONCLUSION: 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.","PeriodicalId":113364,"journal":{"name":"I.P. Pavlov Russian Medical Biological Herald","volume":"14 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141660031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
简介：人体器官中存在异物往往会给鉴别诊断和诊断验证带来困难。本文介绍了一例 45 岁女性患者的临床病例。经检查，患者主诉膝关节疼痛，活动范围受限，以左侧为重。关节疼痛综合征已存在数年，劳累时疼痛加剧；就诊前一周，患者从高处摔下，左膝关节感到剧烈疼痛。左膝关节的 X 光片显示，周围软组织中有碎裂的异物。患者否认有异物进入伤口的外伤史；她无法提供软组织中出现异物的数据和机制。结论：该临床病例的特殊之处在于没有关于异物进入伤口的数据，异物长期存在于软组织中，但没有明显的临床症状。然而，软组织中异物的相对罕见性并不排除它是疼痛综合征的病因，初级保健医生在诊断时应保持警惕。需要通过全面的病史采集和仪器检查来排除 X 光阴性异物的存在。没有一种检查方法可以被认为是诊断所有类型异物的理想方法。
{"title":"Clinical Case of a Foreign Body in the Soft Tissues surrounding the Knee Joint: to Help the Practitione","authors":"Aleksey V. Kosyakov","doi":"10.17816/pavlovj111003","DOIUrl":"https://doi.org/10.17816/pavlovj111003","url":null,"abstract":"INTRODUCTION: The existence of foreign bodies in a human organism often creates difficulties in differential diagnosis and diagnosis verification. \u0000A 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. \u0000CONCLUSION: 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.","PeriodicalId":113364,"journal":{"name":"I.P. Pavlov Russian Medical Biological Herald","volume":"28 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141659616","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. V. Yurina, E. V. Manukhina, I. Uspenskaya, Pavel P. Yurin, L. Tishkina
INTRODUCTION: Identification of morbidity (based on requests) and the population’s need for dental care optimizes the planning and distribution of compulsory health insurance (CHI) funds between medical organizations at the regional level. However, due to a decrease in the population’s demand for medical care in the context of the new coronavirus infection (Corona Virus Disease 2019, COVID-19), the dynamics of the provision of dental care and the structure of dental morbidity taken into account in the compulsory medical insurance system, have changed. AIM: To study the structure and dynamics of the provision of dental care in the period 2018–2021 (pre-pandemic and COVID-19 pandemic period) based on the volume of dental care paid for in the compulsory medical insurance system provided to citizens of the Ryazan region (RR). MATERIALS AND METHODS: The analysis was carried out on the basis of registers of bills accepted for payment submitted by medical organizations, taking into account the results of control and expert measures. All completed cases of treatment of insured persons with dental diseases in medical organizations of the Ryazan Region for 2018–2021 were selected for study according to territorial compulsory medical insurance programs. RESULTS: In the structure of outpatient primary health care in 2021, cases of its provision in the ‘Dentistry’ profile amounted to 7.40 ± 0.10%, taking 3rd place; the total number of cases of providing medical care to patients with this pathology decreased by 5.60% compared to 2018. Despite the reduction in the volume of primary dental care, the volume of dental examinations of the population of the RR increased by 30.46%. There was also a 34.08% reduction in completed cases of treatment of chronic periodontitis (p 0.02). For the 2018–2021 period 73,049 medical and economic examinations (MEE) and 1,626 examinations of medical care quality (EMCQ) were carried out, and 1,966 violations were identified (1,316 based on the results of the MEE and 650 based on the results of the EMСQ). The vast majority of these concerned non-compliance with standards of care and clinical guidelines. CONCLUSION: The results of the study indicate a reduction in the number of cases of insured persons seeking medical care for dental diseases during the COVID-19 pandemic. Owing to the approval of Order No. 231n of the Ministry of Health of Russia of March 19, 2021, obliging medical insurance organizations to carry out control and expert measures in each medical organization in a certain amount of dental care cases accepted for payment, the number of examinations has increased, and, as a result, the identification of violations in the provision of dental care.
{"title":"Dynamics of Dental Care for the Population of the Ryazan Region in COVID-19 Pandemic","authors":"S. V. Yurina, E. V. Manukhina, I. Uspenskaya, Pavel P. Yurin, L. Tishkina","doi":"10.17816/pavlovj245794","DOIUrl":"https://doi.org/10.17816/pavlovj245794","url":null,"abstract":"INTRODUCTION: Identification of morbidity (based on requests) and the population’s need for dental care optimizes the planning and distribution of compulsory health insurance (CHI) funds between medical organizations at the regional level. However, due to a decrease in the population’s demand for medical care in the context of the new coronavirus infection (Corona Virus Disease 2019, COVID-19), the dynamics of the provision of dental care and the structure of dental morbidity taken into account in the compulsory medical insurance system, have changed. \u0000AIM: To study the structure and dynamics of the provision of dental care in the period 2018–2021 (pre-pandemic and COVID-19 pandemic period) based on the volume of dental care paid for in the compulsory medical insurance system provided to citizens of the Ryazan region (RR). \u0000MATERIALS AND METHODS: The analysis was carried out on the basis of registers of bills accepted for payment submitted by medical organizations, taking into account the results of control and expert measures. All completed cases of treatment of insured persons with dental diseases in medical organizations of the Ryazan Region for 2018–2021 were selected for study according to territorial compulsory medical insurance programs. \u0000RESULTS: In the structure of outpatient primary health care in 2021, cases of its provision in the ‘Dentistry’ profile amounted to 7.40 ± 0.10%, taking 3rd place; the total number of cases of providing medical care to patients with this pathology decreased by 5.60% compared to 2018. Despite the reduction in the volume of primary dental care, the volume of dental examinations of the population of the RR increased by 30.46%. There was also a 34.08% reduction in completed cases of treatment of chronic periodontitis (p 0.02). For the 2018–2021 period 73,049 medical and economic examinations (MEE) and 1,626 examinations of medical care quality (EMCQ) were carried out, and 1,966 violations were identified (1,316 based on the results of the MEE and 650 based on the results of the EMСQ). The vast majority of these concerned non-compliance with standards of care and clinical guidelines. \u0000CONCLUSION: The results of the study indicate a reduction in the number of cases of insured persons seeking medical care for dental diseases during the COVID-19 pandemic. Owing to the approval of Order No. 231n of the Ministry of Health of Russia of March 19, 2021, obliging medical insurance organizations to carry out control and expert measures in each medical organization in a certain amount of dental care cases accepted for payment, the number of examinations has increased, and, as a result, the identification of violations in the provision of dental care.","PeriodicalId":113364,"journal":{"name":"I.P. Pavlov Russian Medical Biological Herald","volume":"72 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141662821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Tactics for Choosing Optimal Parameters of Intense Pulsed Light in Treatment of Erythematotelangiectatic Subtype of Rosacea","authors":"E. E. Zhiltsova, Kseniya V. Mezhevaya","doi":"10.17816/pavlovj321689","DOIUrl":"https://doi.org/10.17816/pavlovj321689","url":null,"abstract":"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. \u0000AIM: To describe the experience of application of a combination of intense pulsed light and azelaic acid in erythematotelangiectatic subtype of rosacea. \u0000A 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. \u0000CONCLUSION: 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.","PeriodicalId":113364,"journal":{"name":"I.P. Pavlov Russian Medical Biological Herald","volume":"23 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141661959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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