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Modern approaches to the management of pregnancy in uterine myoma 子宫肌瘤妊娠处理的现代方法
Pub Date : 2023-05-26 DOI: 10.21886/2219-8075-2023-14-2-44-51
I. Fatkullin, Y. V. Orlov, F. Fatkullin
   The presented review summarizes current data on the tactics of accompanying patients with uterine myoma at various stages of their reproductive potential realization: the stage of pregravid preparation, the stage of pregnancy management, the moment of delivery and the postpartum period. Based on the analysis of domestic and foreign special scientific and practical literature, various methods of childbirth are proposed, from more preferable delivery through the natural birth canal, to the necessary caesarean section, performed strictly according to indications. Data are presented on the options for elective and emergency myomectomy during pregnancy, during operative delivery and in the postpartum period. Based on the results of systematization of the information received, the authors raise the question of the need for further research in the field of developing methods for optimal management of patients during pregnancy and childbirth complicated by uterine myoma, due to the relevance of the problems discussed.
本文综述了子宫肌瘤患者生殖潜能实现的各个阶段(孕前准备阶段、妊娠管理阶段、分娩时刻和产后)的陪伴策略。在对国内外特殊科学实用文献进行分析的基础上,提出了多种分娩方法,从较理想的顺产到必要的剖宫产,严格按指征进行。数据提出了选择性和紧急子宫肌瘤切除术在怀孕期间,在手术分娩和产后期间的选择。根据所收到的信息的系统化结果,由于所讨论的问题的相关性,作者提出了需要进一步研究开发子宫肌瘤合并妊娠和分娩患者的最佳管理方法的问题。
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引用次数: 0
Challenges for occupational medicine during the pandemic of a new coronavirus infectious disease (COVID-19) 新型冠状病毒传染病(COVID-19)流行期间职业医学面临的挑战
Pub Date : 2023-03-28 DOI: 10.21886/2219-8075-2023-14-1-101-111
Y. Gorblyansky, E. R. Ramazanova, E. Kontorovich, O. Ponamareva
The article describes the current issues in occupational medicine and the ways to resolve them in the context of the spread of a new coronavirus infection COVID-19. The risks of COVID-19 infection in medical and non-medical workers are considered. Modern approaches to establishment of COVID-19 causal relationship with occupation and medical examinations in patients with COVID-19 are presented. The main provisions of the National concept of healthcare-associated infections relevant in the context of COVID-19 pandemic are presented. Problems in public health care related to restructuring of work of medical organizations in conditions of COVID-19 spread are shown. Attention is paid to mental health disorders in medical workers providing medical care to patients with COVID-19. The prospects of development and implementation of measures for prevention of COVID-19, its complications and adverse outcomes taking into account complex assessment of working environment and professional health of workers are considered from the position of occupational medicine.
本文介绍了在新型冠状病毒感染COVID-19蔓延的背景下,职业医学当前存在的问题及其解决方法。考虑医务人员和非医务人员感染COVID-19的风险。提出了建立COVID-19与职业和医学检查之间因果关系的现代方法。介绍了与COVID-19大流行相关的国家卫生保健相关感染概念的主要规定。指出了新冠肺炎疫情传播条件下,医疗机构工作重组在公共卫生领域存在的问题。为COVID-19患者提供医疗服务的医务工作者的精神健康障碍受到重视。考虑到工作环境和工人职业健康的复杂评估,从职业医学的角度考虑了COVID-19预防措施的制定和实施前景、并发症和不良后果。
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引用次数: 0
The role of nerve growth factor (NGF) in the pathogenesis of leprosy The神经生长因子(NGF)在麻风病发病中的作用
Pub Date : 2023-03-28 DOI: 10.21886/2219-8075-2023-14-1-119-124
A. Lutsenko, L. Saroyants
Leprosy is a chronic infectious disease caused by M. leprae with a primary lesion of the skin and peripheral nervous system. Currently, clinicians using bacterioscopic studies of scarification and skin biopsy mainly diagnose leprosy. However, the development and application of new diagnostic criteria, especially those associated with damage to nerve fibers, remains an urgent task of modern leprology. This review considers the important role of neurotrophic factor (nerve growth factor, NGF) in the pathogenesis of nervous system damage in leprosy and establishes the relationship between NGF levels and forms of the disease. The review includes data from foreign and domestic articles; the search was carried out using the “Scopus”, “PubMed”, “Web of Science”, “elIBRARY” databases.
麻风病是一种由麻风分枝杆菌引起的慢性传染病,原发损害皮肤和周围神经系统。目前,临床医生主要使用细菌学检查和皮肤活检来诊断麻风病。然而,制定和应用新的诊断标准,特别是与神经纤维损伤有关的诊断标准,仍然是现代麻风学的一项紧迫任务。本文综述了神经营养因子(神经生长因子,NGF)在麻风病神经系统损伤发病机制中的重要作用,并建立了NGF水平与麻风病形式之间的关系。综述数据来自国内外文献;使用“Scopus”、“PubMed”、“Web of Science”、“elIBRARY”等数据库进行搜索。
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引用次数: 0
Molecular epidemiological and clinical aspects of enterovirus infection in the south of Russia 俄罗斯南部肠病毒感染的分子流行病学和临床方面
Pub Date : 2023-03-28 DOI: 10.21886/2219-8075-2023-14-1-83-92
E. Kovalev, T. Tverdokhlebova, E. N. Simovanyan
Objective: the study of molecular epidemiological and clinical aspects of EVI in the Rostov region for the period 2006-2020. to improve the disease surveillance system. Research methods: epidemiological, virological, molecular biological (PCR, sequencing, phylogenetic analysis), microbiological, statistical. Materials and methods: the analysis of medical records of 139 patients with EVI was carried out. Samples of biomaterial (feces, throat swab) from 17293 people, samples from environmental objects (2710 samples), strains of enteroviruses (EV) in the amount of 142 specimens were studied. Results: in the Rostov region until 2013. sporadic incidence of EVI prevailed with registration from 1 to 38 cases per year. June 2013 there was a sharp increase in the incidence of EVI with the formation of local foci in organized groups, associated with the circulation of a new genotype — EV 71 type of subgenotype C4 of “Chinese” origin (622 patients with EVI were registered, one death). The clinical features of the disease were determined: acute onset with manifestations of intoxication, foot and mouth disease-like syndromes, followed by the development of CNS pathology in 37.4% of patients. According to the results of sequencing of biomaterial samples from patients and virus carriers for the period 2006-2020. EVs of 22 types were detected. Conclusions: EVs are subject to intense genetic variability, due to which new genovariants pathogenic for humans may appear. The change in EV genotypes, which dominated the circulation among the population of the Rostov region, determined the rise in the incidence of EVI in 2013. A significant diversity of non-polio EV genotypes was revealed, while the structure of EV genovariants changed in different years.
目的:研究2006-2020年罗斯托夫地区EVI的分子流行病学和临床方面。完善疾病监测体系。研究方法:流行病学、病毒学、分子生物学(PCR、测序、系统发育分析)、微生物学、统计学。材料与方法:对139例EVI患者的病历资料进行分析。对17293人的生物材料(粪便、咽拭子)、环境物样本(2710份)和142份肠病毒(EV)菌株进行了研究。结果:在罗斯托夫地区直到2013年。散发的EVI发病率普遍存在,每年登记1至38例。2013年6月,随着有组织群体中局部疫源地的形成,EVI的发病率急剧增加,这与一种新的基因型——“中国”源性C4亚基因型ev71型的传播有关(登记了622例EVI患者,1例死亡)。确定了该病的临床特征:37.4%的患者急性起病,表现为中毒、手足口病样综合征,随后出现中枢神经系统病理。根据2006-2020年期间患者和病毒携带者生物材料样本的测序结果。共检出22种电动汽车。结论:EVs具有强烈的遗传变异性,因此可能出现新的人类致病性基因变异。在罗斯托夫地区人群中占主导地位的EV基因型的变化决定了2013年EVI发病率的上升。非脊髓灰质炎型EV基因型具有显著的多样性,但不同年份EV基因变异的结构发生了变化。
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引用次数: 0
Balneotherapy of epigastric pain syndrome: the meaning of motilin in the implementation of the therapeutic effect balne疗法治疗胃脘痛综合征:胃动素在实施治疗效果中的意义
Pub Date : 2023-03-28 DOI: 10.21886/2219-8075-2023-14-1-24-30
A. E. Shklyaev, D. Kazarin, O. A. Grigoreva
Objective: to study the mechanism of action of low-mineralized sulfate-chloride-sodium mineral water on the clinical picture and motor function of the stomach in patients with epigastric pain syndrome using the regulatory peptide motilin as an example. Materials and methods: 113 people of both sexes were examined, the average age was 22.3±0.21 years. The observation group (57 people) included individuals with functional dyspepsia in the variant of epigastric pain syndrome, the comparison group included practically healthy individuals (56 people). The questionnaire method was used according to the Gastrointestinal Symptom Rating Scale questionnaire; ELISA method for determining the concentration of motilin in the blood. Mineral water in a volume of 200 ml was taken once by both groups of patients, patients with EPS additionally received a course. Results: in persons with epigastric pain syndrome, abdominal pain prevails. The course intake of mineral water provides a positive clinical trend, confirmed by a decrease in the syndromes of lesions of the upper gastrointestinal tract. A single and course intake of mineral water provides a stable increase in the level of motilin in functional dyspepsia. Conclusion: patients suffering from functional dyspepsia in the variant of epigastric pain syndrome have persistent disorders of motilin secretion compared with healthy individuals. Stimulation of the stomach on a drinking test model showed inadequacy of changes in the level of this hormone. Both a single and a course intake of low-mineralized sulfate-chloride-sodium mineral water contributes to an increase in the concentration of motilin, which should be considered as a physical adaptogenic factor leading to a stable ordering of the body’s functional relationships.
目的:以胃动素调节肽为例,探讨低矿化硫酸盐-氯化物-钠矿泉水对胃脘痛综合征患者临床表现及胃运动功能的作用机制。材料与方法:共检查男女113例,平均年龄22.3±0.21岁。观察组(57人)包括患有上腹痛综合征变型的功能性消化不良的个体,对照组包括实际健康的个体(56人)。采用问卷调查法,参照《胃肠症状评定量表》;ELISA法测定血液中胃动素的浓度。两组患者均服用200 ml矿泉水1次,EPS患者加服1个疗程。结果:上腹疼痛综合征患者以腹痛为主。饮用矿泉水的过程提供了积极的临床趋势,证实了上胃肠道病变综合征的减少。在功能性消化不良患者中,单次和长期饮用矿泉水可稳定地提高胃动素水平。结论:变异型胃脘痛综合征的功能性消化不良患者与健康人相比存在持续性胃动素分泌障碍。在饮酒试验模型上刺激胃显示这种激素水平的变化不足。低矿化度的硫酸盐-氯化物-钠矿泉水的单次和连续摄入都有助于胃动素浓度的增加,这应该被认为是一种物理适应因子,导致身体功能关系的稳定秩序。
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引用次数: 0
On some issues of medical semiotics 论医学符号学的若干问题
Pub Date : 2023-03-28 DOI: 10.21886/2219-8075-2023-14-1-31-37
N. Volkova, A. Volkov
Very few works are devoted to the problem of medical semiotics, meanwhile, modern medical science, having received new research methods, expanding knowledge about diseases and the human body, continuously introduces new concepts, terms, indicators. Their integration into the general context of medical semiotics is an important problem. A significant difficulty is the large volume of symptoms, syndromes currently accumulated in medicine. This article is devoted to the transformation of empirical medical semiotics into analytical one. The authors, relying on the apparatus of theoretical semiotics, proposed a new classification of symptoms and the concept of the meaning of symptoms. These approaches make it possible to make all the array of medical symptoms available for use by a doctor and to diagnose diseases based on a logically consistent and modeling human thinking algorithm. The article outlines a further program for the improvement and development of medical semiotics.
医学符号学的研究很少,而现代医学的研究方法不断更新,对疾病和人体的认识不断扩大,不断引入新的概念、术语、指标。将它们整合到医学符号学的大背景中是一个重要的问题。一个显著的困难是目前医学上积累的大量症状、证候。本文致力于从经验医学符号学向分析符号学的转变。作者借助理论符号学的工具,提出了新的症状分类和症状意义的概念。这些方法使医生可以使用所有医学症状,并根据逻辑一致和建模的人类思维算法诊断疾病成为可能。文章概述了进一步改进和发展医学符号学的方案。
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引用次数: 1
Adaptive immune response in patients with atherosclerosis before and after coronary bypass surgery 动脉粥样硬化患者冠状动脉搭桥手术前后的适应性免疫反应
Pub Date : 2023-03-28 DOI: 10.21886/2219-8075-2023-14-1-125-134
I. F. Shlyk, L. Sizyakina, I. Evsegneeva, S. Shlyk, D. Besedina, I. V. Makarchuk
Objective: to assess changes in the immune status before and after coronary bypass surgery. Materials and methods: included 70 male patients with coronary atherosclerosis (group 1) and 30 volunteers (group 2) without signs of coronary artery disease comparable in age to group 1. Immunity parameters were studied before surgery, after 4–5, 9–10 and 28–30 days by the method of phenotyping of CD3+ populations; CD3+CD4+; CD3+CD8+; CD3+CD25+; CD3+CD45+; CD3+CD95+; CD4+CD25+; CD4+CD154+; CD19+, CD19+CD40+. The levels of Ig A, M, G were assessed by the method of radial immunodiffusion in the gel. Serum precipitation in polyethylene glycol was used to determine circulating immune complexes. Statistical analysis of the study results was performed using the Statistica 12.0 program (StatSoft, USA). Statistical significance was considered significant at p<0.05. Results: in patients of the IHD group, uncoupling of the processes of T-lymphocyte activation, their maturation and apoptosis was noted; suppression of immunoregulation and activation of intercellular cooperation. After CABG, in dynamics, these processes reflect the multidirectional changes. Conclusions: in patients with coronary atherosclerosis, there is a discoordination of the processes of T-lymphocyte activation, their maturation and apoptosis. Suppression of immunoregulation and activation of intercellular cooperation. In the dynamics after CABG, immunity parameters differ in different directions in different periods of observation and demonstrate different degrees of involvement of adaptive mechanisms of immune defense.
目的:探讨冠状动脉搭桥术前后免疫状态的变化。材料与方法:纳入男性冠状动脉粥样硬化患者70例(第一组)和无冠状动脉疾病征象的志愿者30例(第二组),年龄与第一组相当。术前、术后4 ~ 5天、9 ~ 10天和28 ~ 30天采用CD3+群体表型法研究免疫参数;CD3 + CD4 +;CD3 + CD8 +;CD3 + CD25 +;CD3 + CD45 +;CD3 + CD95 +;CD4 + CD25 +;CD4 + CD154 +;CD19 +、CD19 + CD40 +。采用径向免疫扩散法测定凝胶中Ig A、M、G的水平。聚乙二醇血清沉淀测定循环免疫复合物。使用Statistica 12.0程序(StatSoft, USA)对研究结果进行统计分析。统计学意义被认为是显著的,p<0.05。结果:IHD组患者t淋巴细胞活化、成熟和凋亡过程发生解耦;抑制免疫调节和激活细胞间合作。CABG后,在动力学上,这些过程反映了多向变化。结论:冠状动脉粥样硬化患者存在t淋巴细胞活化、成熟和凋亡过程失调。抑制免疫调节和激活细胞间合作。在CABG后的动态中,不同观察时期的免疫参数在不同方向上存在差异,表现出不同程度的免疫防御适应性机制参与。
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引用次数: 0
Optimization of scientifico-practical aspects of West Nile fever causative agent’s monitoring (by the example of the Volgograd region) 西尼罗热病原体监测的科学实用优化(以伏尔加格勒地区为例)
Pub Date : 2023-03-28 DOI: 10.21886/2219-8075-2023-14-1-93-100
D. Nikitin, S. K. Udovichenko, E. Putintseva, N. Borodai, A. Toporkov
Objective: to assess the quality and effectiveness of West Nile fever (WNF) causative agent’s monitoring in the Volgograd region and to develop a set of measures to its optimization. Materials and methods: data on the detection of WNV cases, results of serological and zooentomological monitoring in 2009–2021. A comprehensive methodological approach was applied, including statistical and epidemiological methods. Results: based on the assessment of WNF causative agent’s monitoring key aspects in the Volgograd region, it was shown that one of the priority problems is the insufficient and untimely detection of cases among the population. Among the urgent problems of serological monitoring are the lack of a clearly established frequency of serological examination in the population of the region’s administrative territories and the termination of one of the indicator population groups examination, regulated by the current regulatory and methodological documents. An assessment of the parameters of monitoring studies of the external environment indicates an insufficient territorial coverage and a decrease in the volume of studies, primarily in relation to the main carriers of the West Nile virus, which determines the overall low detection rate of West Nile virus markers. Conclusion: recommendations are proposed for optimizing monitoring, which will enhance the efficiency of WNF epidemiological surveillance and develop a scientifically based forecast of the development of the epidemiological situation.
目的:评价伏尔加格勒地区西尼罗热病原体监测的质量和效果,并制定一套优化监测的措施。材料和方法:2009-2021年西尼罗河病毒病例检测数据、血清学和动物昆虫学监测结果。采用了综合方法,包括统计和流行病学方法。结果:通过对伏尔加格勒地区WNF病原体监测重点方面的评估,发现人群中病例发现不足和不及时是重点问题之一。血清学监测的紧迫问题包括,在本区域行政领土人口中缺乏明确确定的血清学检查频率,以及终止了目前监管和方法学文件规定的一个指标人群检查。对外部环境监测研究参数的评估表明,领土覆盖范围不足,研究数量减少,主要涉及西尼罗河病毒的主要携带者,这决定了西尼罗河病毒标记物的总体检出率较低。结论:提出了优化监测的建议,有助于提高WNF流行病学监测的效率,科学预测流行病学形势的发展。
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引用次数: 0
Etiology and risk factors for non-suicidal self-injurious behavior 非自杀性自伤行为的病因和危险因素
Pub Date : 2023-03-28 DOI: 10.21886/2219-8075-2023-14-1-13-23
E. Darin, O. Zaitseva
The article presents a review of the literature on the subject of non-suicidal self-injurious behavior (NSSI), the study of which attracts the attention of authors, both in the Russian Federation and around the world. Large meta-analyses of NSSP studies, proposed models, probable causes and mechanisms of occurrence, neurobiological factors, social factors, as well as the influence of modern means of communication and social networks are considered. Objective is to study, summarize and present data on the causes and risk factors of non-suicidal self-injurious behavior. Research method — articles in the “MEDLINE/PubMed”, “Scopus” databases in international medical journals were selected and analyzed. Articles were searched by keywords: “Self-Injurious Behavior”, “Non-Suicidal Self Injury”, “Deliberate Self-Harm”, “Self-Harm”, “Risk Factors”. Inclusion criteria: publication date from 2017 to 2022, clinical studies, meta-analyses and systematic reviews, randomized controlled trials, availability of the full text in the public domain or abstract. Exclusion criteria: abstracts; monographs, study guides; publication date until 2017, inconsistency with the research topic. A total of 94 publications were found. The review included 61 publications from 2017 to 2022 that corresponded to the topic and purpose of the study, and also added 19 sources older than 2017 that are significant for disclosing the subject of the study from references in the reference lists of the analyzed sources.
本文综述了非自杀性自伤行为(NSSI)这一主题的文献,该研究在俄罗斯联邦和世界各地都引起了作者的关注。对NSSP研究的大型荟萃分析,提出的模型,发生的可能原因和机制,神经生物学因素,社会因素,以及现代通信手段和社会网络的影响进行了考虑。目的是研究、总结和展示非自杀性自伤行为的原因和危险因素。研究方法:选取国际医学期刊“MEDLINE/PubMed”、“Scopus”数据库中的文章进行分析。文章按关键词搜索:“自残行为”、“非自杀性自残”、“故意自残”、“自残”、“危险因素”。纳入标准:发表日期为2017年至2022年,临床研究,荟萃分析和系统评价,随机对照试验,公共领域全文或摘要的可用性。排除标准:摘要;专著、学习指南;发表日期至2017年,与研究课题不一致。共发现94份出版物。该综述纳入了2017年至2022年与研究主题和目的相对应的61篇出版物,并增加了19篇2017年之前的文献,这些文献对于从分析来源的参考文献列表中披露研究主题具有重要意义。
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引用次数: 0
A clinical case of a familial form of hereditary metabolic disease from the group of peroxisomal diseases (D-bifunctional protein deficiency) in the neonatal period 新生儿期过氧化物酶体疾病(d -双功能蛋白缺乏症)组家族性遗传性代谢疾病的临床病例
Pub Date : 2023-03-28 DOI: 10.21886/2219-8075-2023-14-1-56-65
S. B. Berezhanskaya, A. Afonin, N. N. Vostrikh, K. I. Lazareva, I. Loginova, L. Kravchenko, A. V. Medoyan, L. I. Monat
A clinical case of a familial form of peroxisomal D-bifunctional protein (DBP) deficiency (OMIM 261515) with an unfavorable (fatal) outcome caused by a mutation in type 4 17ß-hydroxysteroid dehydrogenase (HSD17B4) with a nucleotide replacement of chr5:118788316G>A in the homozygous state is presented. (D-bifunctional protein deficiency or 17-beta-hydroxysteroid dehydrogenase IV deficiency). Bifunctional protein deficiency is an autosomal recessive birth defect of peroxisomal fatty acid oxidation. The total incidence of morbidity is one case per 50,000 newborns. Most peroxisomal disorders manifest in the early neonatal period with an extremely severe course and phenotypic features, which facilitates their diagnosis. This is the difference between them and diseases with a milder and prolonged course, which debuted at different age periods, often had no neonatal or infantile symptoms and were accompanied, in some cases, by satisfactory cognitive functions. The purpose of the report was to highlight the clinical manifestations, variants of the course and complexity of the diagnosis of peroxisomal disorders to a wide range of doctors of different specialization: in the field of perinatology, pediatrics, neurology, genetics, endocrinology.
一个家族型过氧化物酶体d -双功能蛋白(DBP)缺乏症(OMIM 261515)的临床病例,其不利的(致命的)结果是由4型17ß-羟基类固醇脱氢酶(HSD17B4)突变引起的,在纯合子状态下,chr5:118788316G>A核苷酸替代。(d -双功能蛋白缺乏或17- β -羟基类固醇脱氢酶IV缺乏)。双功能蛋白缺乏症是一种常染色体隐性出生缺陷的过氧化物酶体脂肪酸氧化。总发病率为每5万名新生儿1例。大多数过氧化物酶体疾病表现在新生儿早期,具有极其严重的病程和表型特征,这有利于其诊断。这是它们与病程较轻、病程较长的疾病之间的区别,后者在不同年龄阶段出现,通常没有新生儿或婴儿症状,在某些情况下伴有令人满意的认知功能。该报告的目的是向各种不同专业的医生强调过氧化物酶体疾病的临床表现、病程的变化和诊断的复杂性:围产期、儿科、神经病学、遗传学、内分泌学。
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引用次数: 0
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Medical Herald of the South of Russia
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