Pub Date : 2023-11-09DOI: 10.33667/2078-5631-2023-24-79-83
R. A. Ravodin, L. S. Kruglova, A. V. Nikitina
This article provides a review of the literature on the prevalence of Merkel carcinoma, the features of its clinical, dermoscopic, pathomorphological diagnosis and therapy. In the light of the presented data, two of our own clinical observations of Merkel carcinoma are described: a clinical and dermoscopic description, a pathomorphological and immunohistochemical picture, the treatment performed and its long-term results are given. In the presented clinical observations, Merkel carcinoma was detected in two women aged 70 and 83 years at stage I, which determined a favorable prognosis. Clinically, the tumor was presented in the form of a dense, non-ulcerated nodule or a pink-red nodule; all neoplasms were localized on the head. The dermoscopic picture was different, in one case it was represented by globules and dots of red color against a background of milky pink and white areas, individual linear and convoluted vessels, there were white structures (like chrysalids), and in another case – structureless areas of pink color with tree-like vessels and white structures in the form of chrysalids. Histologically, the small round cell type of structure predominated. An IHC study in both cases revealed a pronounced expression of cytokeratin 20 and chromogranin A, the Ki‑67 index was above 70 %.
{"title":"Merkel cell carcinoma as rare malignant skin tumor (two clinical cases)","authors":"R. A. Ravodin, L. S. Kruglova, A. V. Nikitina","doi":"10.33667/2078-5631-2023-24-79-83","DOIUrl":"https://doi.org/10.33667/2078-5631-2023-24-79-83","url":null,"abstract":"This article provides a review of the literature on the prevalence of Merkel carcinoma, the features of its clinical, dermoscopic, pathomorphological diagnosis and therapy. In the light of the presented data, two of our own clinical observations of Merkel carcinoma are described: a clinical and dermoscopic description, a pathomorphological and immunohistochemical picture, the treatment performed and its long-term results are given. In the presented clinical observations, Merkel carcinoma was detected in two women aged 70 and 83 years at stage I, which determined a favorable prognosis. Clinically, the tumor was presented in the form of a dense, non-ulcerated nodule or a pink-red nodule; all neoplasms were localized on the head. The dermoscopic picture was different, in one case it was represented by globules and dots of red color against a background of milky pink and white areas, individual linear and convoluted vessels, there were white structures (like chrysalids), and in another case – structureless areas of pink color with tree-like vessels and white structures in the form of chrysalids. Histologically, the small round cell type of structure predominated. An IHC study in both cases revealed a pronounced expression of cytokeratin 20 and chromogranin A, the Ki‑67 index was above 70 %.","PeriodicalId":499576,"journal":{"name":"Medicinskij alfavit","volume":" 16","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135192577","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}
Pub Date : 2023-11-09DOI: 10.33667/2078-5631-2023-24-65-70
S. Yu. Dolgikh, A. G. Stenko, N. V. Gryazeva
Striae distensae, commonly known as stretch marks, are visible linear atrophic scars. Despite quite numerous studies, the lack of a unified approachto the problem of treating atrophic scars, a detailed clinical and morphological classification leads to the fact that doctors empirically choosepatient management tactics, which leads to unreliability or even lack of effect, the need for numerous repeated courses of therapy, and significanteconomic costs. The article presents data on studying the effectiveness of various methods of therapy. Depending on the method of therapy,patients were divided into three groups by simple randomization. The study used a visual analogue scale (VAS) to assess the clinical symptomsof AR. The combined use of fractional ablative laser and PDT with the topical photosensitizer chlorin e6 is highly effective in the treatment ofatrophic scars lasting more than a year (VAS dynamics – 74.9 %), fractional ablative laser is moderately effective in long-term atrophic scars (VASdynamics – 65.6 %), while PDT in the form of monotherapy is insufficiently effective (VAS dynamics – 45.6 %).
{"title":"New comprehensive method for treatment of atrophic skin scars","authors":"S. Yu. Dolgikh, A. G. Stenko, N. V. Gryazeva","doi":"10.33667/2078-5631-2023-24-65-70","DOIUrl":"https://doi.org/10.33667/2078-5631-2023-24-65-70","url":null,"abstract":"Striae distensae, commonly known as stretch marks, are visible linear atrophic scars. Despite quite numerous studies, the lack of a unified approachto the problem of treating atrophic scars, a detailed clinical and morphological classification leads to the fact that doctors empirically choosepatient management tactics, which leads to unreliability or even lack of effect, the need for numerous repeated courses of therapy, and significanteconomic costs. The article presents data on studying the effectiveness of various methods of therapy. Depending on the method of therapy,patients were divided into three groups by simple randomization. The study used a visual analogue scale (VAS) to assess the clinical symptomsof AR. The combined use of fractional ablative laser and PDT with the topical photosensitizer chlorin e6 is highly effective in the treatment ofatrophic scars lasting more than a year (VAS dynamics – 74.9 %), fractional ablative laser is moderately effective in long-term atrophic scars (VASdynamics – 65.6 %), while PDT in the form of monotherapy is insufficiently effective (VAS dynamics – 45.6 %).","PeriodicalId":499576,"journal":{"name":"Medicinskij alfavit","volume":" 18","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135192779","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}
Pub Date : 2023-11-09DOI: 10.33667/2078-5631-2023-28-44-49
P. V. Seliverstov, V. V. Shapovalov, O. V. Aleshko
To date, the main focus in the implementation of medical activities is focused on the organization of outpatient care for the population. It is at the level of primary health care, where it is possible to carry out primary prevention measures and the formation of a healthy lifestyle, these issues should be given special attention when providing medical care to the population. One of the main tasks of modern healthcare is to reduce the number of chronic non-communicable diseases of the adult population using modern tools of early preclinical diagnostics. To date, one of the most promising areas that have a significant impact on modern healthcare is digital telemedicine technologies based on artificial intelligence. They can be confidently attributed to the most popular and rapidly developing groups of services developed for primary health care for the purpose of primary diagnostics. Nevertheless, no matter how fast information technologies develop, the opinions of experts in the subject area remain relevant, which significantly enrich the results of the expert opinion.
{"title":"Introduction of telemedicine technologies based on artificial intelligence into practice of providing outpatient care for medical examination","authors":"P. V. Seliverstov, V. V. Shapovalov, O. V. Aleshko","doi":"10.33667/2078-5631-2023-28-44-49","DOIUrl":"https://doi.org/10.33667/2078-5631-2023-28-44-49","url":null,"abstract":"To date, the main focus in the implementation of medical activities is focused on the organization of outpatient care for the population. It is at the level of primary health care, where it is possible to carry out primary prevention measures and the formation of a healthy lifestyle, these issues should be given special attention when providing medical care to the population. One of the main tasks of modern healthcare is to reduce the number of chronic non-communicable diseases of the adult population using modern tools of early preclinical diagnostics. To date, one of the most promising areas that have a significant impact on modern healthcare is digital telemedicine technologies based on artificial intelligence. They can be confidently attributed to the most popular and rapidly developing groups of services developed for primary health care for the purpose of primary diagnostics. Nevertheless, no matter how fast information technologies develop, the opinions of experts in the subject area remain relevant, which significantly enrich the results of the expert opinion.","PeriodicalId":499576,"journal":{"name":"Medicinskij alfavit","volume":" 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135286435","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}
Pub Date : 2023-11-09DOI: 10.33667/2078-5631-2023-24-74-78
I. M. Khismatulina
The aim of the study. A retrospective analysis of the results of complex therapy of moderate papulo-pustular acne with minocycline 50 mg per day orally and 15 % azelaic acid gel topically under natural ultraviolet irradiation. Materials and methods. In a retrospective study, data from outpatient charts and the results of studying the morpho-functional parameters of the facial skin of 61 people (31 acne patients and 30 healthy individuals) were analyzed. Patients received oral minocycline (Minolexin®) 50 mg per day for 6 weeks and topically 15 % azelaic acid gel 2 times a day for 12 weeks in the period from April to September. Results and discussion. The therapy was effective: clinical cure occurred in 90.3 % (n = 28), clinical remission – in 9.7 % (n = 3) patients. Rapid regression of papulo-pustules was achieved through the use of minocycline, which had antibacterial and anti-inflammatory effects. After treatment, elevated values of sebumetry, skin relief, pore size, and pigmentation were normalized in the group of patients with acne, due to the action of a topical gel, as well as the absence of photosensitizing effect in minocycline. Systemic and local adverse events registered in outpatient records were of a temporary nature and did not require discontinuation of therapy.
{"title":"Minolexin® in complex therapy of papulo-pustular acne of moderate severity (results of own research)","authors":"I. M. Khismatulina","doi":"10.33667/2078-5631-2023-24-74-78","DOIUrl":"https://doi.org/10.33667/2078-5631-2023-24-74-78","url":null,"abstract":"The aim of the study. A retrospective analysis of the results of complex therapy of moderate papulo-pustular acne with minocycline 50 mg per day orally and 15 % azelaic acid gel topically under natural ultraviolet irradiation. Materials and methods. In a retrospective study, data from outpatient charts and the results of studying the morpho-functional parameters of the facial skin of 61 people (31 acne patients and 30 healthy individuals) were analyzed. Patients received oral minocycline (Minolexin®) 50 mg per day for 6 weeks and topically 15 % azelaic acid gel 2 times a day for 12 weeks in the period from April to September. Results and discussion. The therapy was effective: clinical cure occurred in 90.3 % (n = 28), clinical remission – in 9.7 % (n = 3) patients. Rapid regression of papulo-pustules was achieved through the use of minocycline, which had antibacterial and anti-inflammatory effects. After treatment, elevated values of sebumetry, skin relief, pore size, and pigmentation were normalized in the group of patients with acne, due to the action of a topical gel, as well as the absence of photosensitizing effect in minocycline. Systemic and local adverse events registered in outpatient records were of a temporary nature and did not require discontinuation of therapy.","PeriodicalId":499576,"journal":{"name":"Medicinskij alfavit","volume":" 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135192787","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}
Pub Date : 2023-11-08DOI: 10.33667/2078-5631-2023-22-44-49
S. N. Bogomolov, V. N. Solntsev, A. N. Kulikov, A. N. Kuchmin
We provided historical aspects and some features of different ultrasound diagnostic methods of left ventricular hypertrophy, their advantages and disadvantages. Using some methods of statistical analysis, we tried to assess the sensitivity, specificity, accuracy and consistency of the two most commonly used methods of left ventricular mass indexations (to the body surface area and to the height 2.7) among patients with different body mass indexes. According to our results, among patients with body mass index less than 25.0 kg/m2, both left ventricular myocardial mass indexations have good consistency with each other and can be effectively used in the diagnostic of left ventricular hypertrophy. Fairly good consistency between the studied criteria among patients with a body mass index of 25.0–29.9 also, theoretically, allows to use both methods of indexation for the diagnosing of this pathology. According to the poor consistency of the studied criteria, in case of body mass index more than 30.0 kg/m2, left ventricular myocardial mass indexation to height 2,7 should be used only.
{"title":"Ultrasound diagnostics of left ventricular hypertrophy: once more about the indexation of myocardial mass","authors":"S. N. Bogomolov, V. N. Solntsev, A. N. Kulikov, A. N. Kuchmin","doi":"10.33667/2078-5631-2023-22-44-49","DOIUrl":"https://doi.org/10.33667/2078-5631-2023-22-44-49","url":null,"abstract":"We provided historical aspects and some features of different ultrasound diagnostic methods of left ventricular hypertrophy, their advantages and disadvantages. Using some methods of statistical analysis, we tried to assess the sensitivity, specificity, accuracy and consistency of the two most commonly used methods of left ventricular mass indexations (to the body surface area and to the height 2.7) among patients with different body mass indexes. According to our results, among patients with body mass index less than 25.0 kg/m2, both left ventricular myocardial mass indexations have good consistency with each other and can be effectively used in the diagnostic of left ventricular hypertrophy. Fairly good consistency between the studied criteria among patients with a body mass index of 25.0–29.9 also, theoretically, allows to use both methods of indexation for the diagnosing of this pathology. According to the poor consistency of the studied criteria, in case of body mass index more than 30.0 kg/m2, left ventricular myocardial mass indexation to height 2,7 should be used only.","PeriodicalId":499576,"journal":{"name":"Medicinskij alfavit","volume":"4 12","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135391535","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}
Pub Date : 2023-11-08DOI: 10.33667/2078-5631-2023-25-7-13
G. A. Gazaryan, G. A. Nefedova, G. G. Gazaryan, M. U. Keshtova, L. G. Tyurina, I. V. Zakharov, S. Yu. Kambarov, K. A. Popugaev
The aim of the study was to estimate the significance of delayed percutaneous coronary interventions (PCIs) in the treatment of ST-segment elevation myocardial infarction (STEMI), to weigh the initial mortality risk (MR) while determining the indications for their use and the time window for the use of mechanical reperfusion in late hospital admission. Total 2226 patients admitted to the Institute with STEMI for the period 2008–2017 were studied. Emergency coronary angiography was performed in 945 admitted patients in the initial 12 hours and in 834 patients after 12–72 hours of STEMI onset; PCI was performed in 784 and 619 patients, respectively. In all patients, MR was scored by TIMI; angiographic success was assessed as TIMI 3 coronary flow and compared to ECG signs of reperfusion. The baseline MR score averaged 5 or 12.5%, being corresponded to score 4.2 or 8% in patients with PCI performed in the initial 12 hours, score 5 or 12.5% in those with PCI performed after 12–72 hours, and score 6 or 16% in patients without PCI; or with respect to the patient age, MR scored 3.7 or 7%, 6 or 16%, and 7.5 or 25%, for those under the age of 65 years, those from 65–75 years, and those over 75 years old, respectively. Mortality in patients with an early and delayed PCI was 5.2% and 4.2%, respectively, and 15.6% in patients without PCI; after patient distribution by age under 65, 65–75, and over 75 years old, the respective mortality rates were 3.8%, 4.9%, and 10.8% after an early PCI; 2.6%, 5.8%, and 8.2% after a delayed PCI; and 8.4%, 19.4%, and 28% among those without PCI. For 10 years, the number of primary PCIs had increased from 39% to 78%. The ratio of early to delayed PCI made 56% to 44%. Of 195 deaths (67 patients with PCI and 128 without PCI), 90% of patients had a three-vessel disease; 83% of patients had the MI area over 30%; and the cause of death in 84% was pulmonary edema. The presented data suggest a high practical significance of delayed PCI in patients with initially high MR, its most weighty components being the age over 75 years and severe manifestations of acute heart failure (AHF). Unlike early PCIs, the delayed PCIs are used less frequently, the initial MR is not taken into account, and they are abstained from in respect to people over 75 years of age. The reduction in mortality, proportional to the baseline MR, suggests their correlation to PCI results and the feasibility of PCI use without age restrictions. The use of primary PCIs in late hospital admissions, by analogy with early ones or selectively in high MR, will help to optimize the treatment tactics and minimize mortality.
{"title":"Baseline risk, time window, and indications for delayed percutaneous coronary interventions, their significance in treatment of ST-segment elevation myocardial infarction","authors":"G. A. Gazaryan, G. A. Nefedova, G. G. Gazaryan, M. U. Keshtova, L. G. Tyurina, I. V. Zakharov, S. Yu. Kambarov, K. A. Popugaev","doi":"10.33667/2078-5631-2023-25-7-13","DOIUrl":"https://doi.org/10.33667/2078-5631-2023-25-7-13","url":null,"abstract":"The aim of the study was to estimate the significance of delayed percutaneous coronary interventions (PCIs) in the treatment of ST-segment elevation myocardial infarction (STEMI), to weigh the initial mortality risk (MR) while determining the indications for their use and the time window for the use of mechanical reperfusion in late hospital admission. Total 2226 patients admitted to the Institute with STEMI for the period 2008–2017 were studied. Emergency coronary angiography was performed in 945 admitted patients in the initial 12 hours and in 834 patients after 12–72 hours of STEMI onset; PCI was performed in 784 and 619 patients, respectively. In all patients, MR was scored by TIMI; angiographic success was assessed as TIMI 3 coronary flow and compared to ECG signs of reperfusion. The baseline MR score averaged 5 or 12.5%, being corresponded to score 4.2 or 8% in patients with PCI performed in the initial 12 hours, score 5 or 12.5% in those with PCI performed after 12–72 hours, and score 6 or 16% in patients without PCI; or with respect to the patient age, MR scored 3.7 or 7%, 6 or 16%, and 7.5 or 25%, for those under the age of 65 years, those from 65–75 years, and those over 75 years old, respectively. Mortality in patients with an early and delayed PCI was 5.2% and 4.2%, respectively, and 15.6% in patients without PCI; after patient distribution by age under 65, 65–75, and over 75 years old, the respective mortality rates were 3.8%, 4.9%, and 10.8% after an early PCI; 2.6%, 5.8%, and 8.2% after a delayed PCI; and 8.4%, 19.4%, and 28% among those without PCI. For 10 years, the number of primary PCIs had increased from 39% to 78%. The ratio of early to delayed PCI made 56% to 44%. Of 195 deaths (67 patients with PCI and 128 without PCI), 90% of patients had a three-vessel disease; 83% of patients had the MI area over 30%; and the cause of death in 84% was pulmonary edema. The presented data suggest a high practical significance of delayed PCI in patients with initially high MR, its most weighty components being the age over 75 years and severe manifestations of acute heart failure (AHF). Unlike early PCIs, the delayed PCIs are used less frequently, the initial MR is not taken into account, and they are abstained from in respect to people over 75 years of age. The reduction in mortality, proportional to the baseline MR, suggests their correlation to PCI results and the feasibility of PCI use without age restrictions. The use of primary PCIs in late hospital admissions, by analogy with early ones or selectively in high MR, will help to optimize the treatment tactics and minimize mortality.","PeriodicalId":499576,"journal":{"name":"Medicinskij alfavit","volume":"59 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135431418","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}
Pub Date : 2023-11-08DOI: 10.33667/2078-5631-2023-26-21-26
S. V. Topolyanskaya, L. I. Bubman, D. S. Koshurnikov, V. V. Karpov, A. I. Nechaev, S. O. Khan, K. A. Lytkina, G. G. Melkonyan, L. I. Dvoretskyi, S. A. Ratchina
The study aim was to investigate bone mineral density (BMD) and body composition in old patients with amputated lower limbs. Materials and methods . This work is a cross-sectional study, which enrolled 31 patients, who underwent amputation of one of the lower extremities. The mean age of the study patients was 73.4±9.0 years, ranging from 60 to 101 years. The majority of study patients were men (77.4%). 41.4% of patients underwent amputation of the left lower limb, 58.6% – right. The time from amputation to enrollment in the study ranged from 4 to 444 months, with a median of 30 months. Bone mineral density in the lumbar spine and proximal femurs was analyzed by dual energy x-ray absorptiometry. Results. Osteoporosis in the proximal part of the left femur was registered in 51.7% of patients, osteopenia – in 17.2%, normal BMD – in 31.1% of cases. Osteoporosis in the proximal part of the right femur was observed in 64.0% of patients. In the lumbar spine, osteoporosis was found only in 6.9% of patients. The mean T-score in the lumbar spine reached +0.38 SD, in the proximal left femur – -1.5 SD, in the left femur neck – -2.1 SD, in the proximal right femur – -2.0 SD, in the right femur neck – -2.1 SD. In the case of amputation of the left lower limb, the left femur BMD averaged 710.8±239 mg/cm3, the left femur T-score – -2.6±1.6SD, the T-score in the left femur neck – –3.0±1.3 SD, with the intact left leg – 980.1±194 mg/cm3,–0.8±1.5SD,–1.5±1.2SD, respectively (p=0.002, p=0.005 and p=0.006). In case of amputation of the right lower limb, the right femur BMD reached 743.8±268 mg/cm3, right femur T-score – -2.4±1.7SD, the T-score in the right femur neck – -2.4±1.7SD, with the intact right leg – 909.9±211.0 mg/cm3, -1.2±1.5SD, -1.5±1.5SD, respectively (p=0.09, p=0.06 and p=0.1). The likelihood of developing osteoporosis in the left femur with amputation of the left leg increased by 9.8 times, compared with patients who had a preserved left lower limb (odds ratio=9.8; 95% CI=1.1–93.5; p=0.02). In patients with amputation of the left leg, inverse correlation was registered between bone mineral density and the time from the moment of amputation to inclusion in the study (r= -0.65, p=0.03). Conclusion. Preliminary results of this study demonstrate a decrease in bone mineral density in the proximal femur of the amputated limb. Further studies are needed to study BMD in amputees and to elucidate the pathogenetic basis of the relationship between BMD and other clinical and laboratory parameters in this group of patients.
{"title":"Osteoporosis and body composition in old patients with amputated lower limbs","authors":"S. V. Topolyanskaya, L. I. Bubman, D. S. Koshurnikov, V. V. Karpov, A. I. Nechaev, S. O. Khan, K. A. Lytkina, G. G. Melkonyan, L. I. Dvoretskyi, S. A. Ratchina","doi":"10.33667/2078-5631-2023-26-21-26","DOIUrl":"https://doi.org/10.33667/2078-5631-2023-26-21-26","url":null,"abstract":"The study aim was to investigate bone mineral density (BMD) and body composition in old patients with amputated lower limbs. Materials and methods . This work is a cross-sectional study, which enrolled 31 patients, who underwent amputation of one of the lower extremities. The mean age of the study patients was 73.4±9.0 years, ranging from 60 to 101 years. The majority of study patients were men (77.4%). 41.4% of patients underwent amputation of the left lower limb, 58.6% – right. The time from amputation to enrollment in the study ranged from 4 to 444 months, with a median of 30 months. Bone mineral density in the lumbar spine and proximal femurs was analyzed by dual energy x-ray absorptiometry. Results. Osteoporosis in the proximal part of the left femur was registered in 51.7% of patients, osteopenia – in 17.2%, normal BMD – in 31.1% of cases. Osteoporosis in the proximal part of the right femur was observed in 64.0% of patients. In the lumbar spine, osteoporosis was found only in 6.9% of patients. The mean T-score in the lumbar spine reached +0.38 SD, in the proximal left femur – -1.5 SD, in the left femur neck – -2.1 SD, in the proximal right femur – -2.0 SD, in the right femur neck – -2.1 SD. In the case of amputation of the left lower limb, the left femur BMD averaged 710.8±239 mg/cm3, the left femur T-score – -2.6±1.6SD, the T-score in the left femur neck – –3.0±1.3 SD, with the intact left leg – 980.1±194 mg/cm3,–0.8±1.5SD,–1.5±1.2SD, respectively (p=0.002, p=0.005 and p=0.006). In case of amputation of the right lower limb, the right femur BMD reached 743.8±268 mg/cm3, right femur T-score – -2.4±1.7SD, the T-score in the right femur neck – -2.4±1.7SD, with the intact right leg – 909.9±211.0 mg/cm3, -1.2±1.5SD, -1.5±1.5SD, respectively (p=0.09, p=0.06 and p=0.1). The likelihood of developing osteoporosis in the left femur with amputation of the left leg increased by 9.8 times, compared with patients who had a preserved left lower limb (odds ratio=9.8; 95% CI=1.1–93.5; p=0.02). In patients with amputation of the left leg, inverse correlation was registered between bone mineral density and the time from the moment of amputation to inclusion in the study (r= -0.65, p=0.03). Conclusion. Preliminary results of this study demonstrate a decrease in bone mineral density in the proximal femur of the amputated limb. Further studies are needed to study BMD in amputees and to elucidate the pathogenetic basis of the relationship between BMD and other clinical and laboratory parameters in this group of patients.","PeriodicalId":499576,"journal":{"name":"Medicinskij alfavit","volume":"14 1‐2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135342022","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}
Pub Date : 2023-11-08DOI: 10.33667/2078-5631-2023-26-35-40
A. I. Lopatin, V. V. Andreev, N. A. Pasatetskaya, M. G. Sokolova, E. V. Lopatina
Retinopathy of prematurity is one of the most severe diseases that lead to permanent blindness from early childhood. The frequency of retinopathy of prematurity in neonatology closely correlates with the degree of maturity of the child’s body. Goal. To conduct a analysis of the correlation of the degree of oxygenation, the number of blood transfusions with the severity of progressive retinopathy in newborns. The study included 40 premature infants diagnosed with retinopathy of newborns who were being treated in the neonatal intensive care unit. Conducted: clinical and diagnostic examination of patients; analysis of the dependence of the degree of oxygenation, the number of blood transfusions, gestational age, inotropic support and the severity of retinopathy. Materials and methods . Out of 40 patients diagnosed with neonatal retinopathy, 6 children were operated on. Results and discussion . The study showed that all the operated children were born at a gestation period of less than 29 weeks, were treated with antibacterial and inotropic drugs. There was no direct relationship between the number of blood transfusions and the risk of developing a severe form of the disease with further surgical treatment. In 40% of cases, children who developed retinopathy of stages 1 and 2 did not receive transfusion of erythrocyte suspension at all. At the treatment stage, all operated patients received a gas-air mixture with an oxygen content above 45%, as well as inotropic and vasopressor support with epinephrine and norepinephrine. Statistical analysis has shown that the number of blood transfusions is not the leading factor in the decision to refer a child for surgery. Among children with a gestation period of less than 29 weeks, retinopathy of varying severity was found in all infants; in the group of children aged 30–35 weeks, the disease developed only in 45% of patients. Conclusion. The conducted studies have shown that the parameter number of hours spent using IVL (the parameter artificial lung ventilation) is informative, and parameters such as weight and gestational age are significant. It is necessary to note the importance of additional parameters. Among the operated children, the condition of severe asphyxia was suffered by 45.5% of children in group A, in Weight groups severe asphyxia was in 28% of cases. Statistical analysis showed that children who required surgical treatment received catecholamine therapy at the initial stages. The most unfavorable percentage of oxygen supplied with the air mixture starts from 40–45%. The children who required surgical treatment received catecholamine therapy at the initial stages.
{"title":"Analysis of the effect of intensive therapy of premature infants on the development of neonatal retinopathy","authors":"A. I. Lopatin, V. V. Andreev, N. A. Pasatetskaya, M. G. Sokolova, E. V. Lopatina","doi":"10.33667/2078-5631-2023-26-35-40","DOIUrl":"https://doi.org/10.33667/2078-5631-2023-26-35-40","url":null,"abstract":"Retinopathy of prematurity is one of the most severe diseases that lead to permanent blindness from early childhood. The frequency of retinopathy of prematurity in neonatology closely correlates with the degree of maturity of the child’s body. Goal. To conduct a analysis of the correlation of the degree of oxygenation, the number of blood transfusions with the severity of progressive retinopathy in newborns. The study included 40 premature infants diagnosed with retinopathy of newborns who were being treated in the neonatal intensive care unit. Conducted: clinical and diagnostic examination of patients; analysis of the dependence of the degree of oxygenation, the number of blood transfusions, gestational age, inotropic support and the severity of retinopathy. Materials and methods . Out of 40 patients diagnosed with neonatal retinopathy, 6 children were operated on. Results and discussion . The study showed that all the operated children were born at a gestation period of less than 29 weeks, were treated with antibacterial and inotropic drugs. There was no direct relationship between the number of blood transfusions and the risk of developing a severe form of the disease with further surgical treatment. In 40% of cases, children who developed retinopathy of stages 1 and 2 did not receive transfusion of erythrocyte suspension at all. At the treatment stage, all operated patients received a gas-air mixture with an oxygen content above 45%, as well as inotropic and vasopressor support with epinephrine and norepinephrine. Statistical analysis has shown that the number of blood transfusions is not the leading factor in the decision to refer a child for surgery. Among children with a gestation period of less than 29 weeks, retinopathy of varying severity was found in all infants; in the group of children aged 30–35 weeks, the disease developed only in 45% of patients. Conclusion. The conducted studies have shown that the parameter number of hours spent using IVL (the parameter artificial lung ventilation) is informative, and parameters such as weight and gestational age are significant. It is necessary to note the importance of additional parameters. Among the operated children, the condition of severe asphyxia was suffered by 45.5% of children in group A, in Weight groups severe asphyxia was in 28% of cases. Statistical analysis showed that children who required surgical treatment received catecholamine therapy at the initial stages. The most unfavorable percentage of oxygen supplied with the air mixture starts from 40–45%. The children who required surgical treatment received catecholamine therapy at the initial stages.","PeriodicalId":499576,"journal":{"name":"Medicinskij alfavit","volume":"5 19","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135390332","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}
Pub Date : 2023-11-08DOI: 10.33667/2078-5631-2023-26-31-34
N. V. Shchepetin, N. V. Orlova, Yu. N. Fedulaev, S. E. Arakelov, I. Yu. Titova
The flow of labor migrants to Russia is steadily growing. The rules for providing medical care to foreign citizens on the territory of the Russian Federation depend on their status. Among the morbidity of migrant workers, infectious diseases, venereal diseases, tuberculosis, injuries, intoxication are leading. This increases the risks to the health of Russians, and also puts an economic burden on the healthcare system of the Russian Federation. The purpose of our study was to study risk factors in migrant workers hospitalized with acute coronary syndrome. The study included 50 migrant workers and 107 Russian citizens hospitalized with acute coronary syndrome. Analysis of risk factors for cardiovascular diseases revealed that in migrant labor patients, the development of acute coronary syndrome occurred at a younger age. There were significantly more smokers among migrant labor patients, they had a lower body mass index, type 2 diabetes mellitus and a previous acute myocardial infarction were significantly less common in the anamnesis. Analysis of clinical and laboratory data of patients hospitalized with acute coronary syndrome revealed that the main risk factors for cardiovascular diseases among migrant workers are smoking and lipid metabolism disorders.
{"title":"Analysis of risk factors for cardiovascular diseases in migrant workers with acute coronary syndrome","authors":"N. V. Shchepetin, N. V. Orlova, Yu. N. Fedulaev, S. E. Arakelov, I. Yu. Titova","doi":"10.33667/2078-5631-2023-26-31-34","DOIUrl":"https://doi.org/10.33667/2078-5631-2023-26-31-34","url":null,"abstract":"The flow of labor migrants to Russia is steadily growing. The rules for providing medical care to foreign citizens on the territory of the Russian Federation depend on their status. Among the morbidity of migrant workers, infectious diseases, venereal diseases, tuberculosis, injuries, intoxication are leading. This increases the risks to the health of Russians, and also puts an economic burden on the healthcare system of the Russian Federation. The purpose of our study was to study risk factors in migrant workers hospitalized with acute coronary syndrome. The study included 50 migrant workers and 107 Russian citizens hospitalized with acute coronary syndrome. Analysis of risk factors for cardiovascular diseases revealed that in migrant labor patients, the development of acute coronary syndrome occurred at a younger age. There were significantly more smokers among migrant labor patients, they had a lower body mass index, type 2 diabetes mellitus and a previous acute myocardial infarction were significantly less common in the anamnesis. Analysis of clinical and laboratory data of patients hospitalized with acute coronary syndrome revealed that the main risk factors for cardiovascular diseases among migrant workers are smoking and lipid metabolism disorders.","PeriodicalId":499576,"journal":{"name":"Medicinskij alfavit","volume":"6 21","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135390665","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}
Pub Date : 2023-11-08DOI: 10.33667/2078-5631-2023-22-7-18
M. Yu. Kameneva, L. D. Kiryukhina, P. V. Struchkov
Improved approaches to quality assurance have led to the need to update the technical standards of spirometry taking into account modern technical capabilities. The aim of the study is to present updated recommendations on spirometry with explanations and additions that are important for everyday work in practical healthcare. Analysis of documents on technical standards of spirometry developed by an joint task force of specialists with expertise in conducting and analyzing lung function tests and ensuring laboratory quality, appointed by the Russian Respiratory Society, the Russian Association of Functional Diagnostics Specialists, the Russian Scientific Medical Society of Therapists, as well as a joint group of the American Thoracic Society and the European Respiratory Society. The 1st part presents sections on indications and contraindications to spirometry; technical conditions of the procedure, including infection control; methods of spirometry; describes the main indicators and criteria for the quality of the study. The implementation of the presented standards and consensus recommendations for clinicians, operators and researchers is necessary for improving the accuracy of spirometric measurements and the patient experience.
{"title":"Updated national guidelines for spirometry. Part 1. Test rules and quality criterias","authors":"M. Yu. Kameneva, L. D. Kiryukhina, P. V. Struchkov","doi":"10.33667/2078-5631-2023-22-7-18","DOIUrl":"https://doi.org/10.33667/2078-5631-2023-22-7-18","url":null,"abstract":"Improved approaches to quality assurance have led to the need to update the technical standards of spirometry taking into account modern technical capabilities. The aim of the study is to present updated recommendations on spirometry with explanations and additions that are important for everyday work in practical healthcare. Analysis of documents on technical standards of spirometry developed by an joint task force of specialists with expertise in conducting and analyzing lung function tests and ensuring laboratory quality, appointed by the Russian Respiratory Society, the Russian Association of Functional Diagnostics Specialists, the Russian Scientific Medical Society of Therapists, as well as a joint group of the American Thoracic Society and the European Respiratory Society. The 1st part presents sections on indications and contraindications to spirometry; technical conditions of the procedure, including infection control; methods of spirometry; describes the main indicators and criteria for the quality of the study. The implementation of the presented standards and consensus recommendations for clinicians, operators and researchers is necessary for improving the accuracy of spirometric measurements and the patient experience.","PeriodicalId":499576,"journal":{"name":"Medicinskij alfavit","volume":"2 11","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135391440","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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