Vol 42, No 1 (2025)

During the pandemic of the new coronavirus infection, the most common comorbid pathology in patients with laboratory confirmed cases of COVID-19 was arterial hypertension (AH) due to the participation of the renin-angiotensin-aldosterone system components in the penetration of the SARS-CoV-2 virus into the human body and the similarity of the pathogenesis of these diseases. One of the manifestations of post-Covid syndrome in АН is destabilization of blood pressure, insufficiency of antihypertensive therapy effectively conducted before, uncontrolled hypertension, requiring intensified therapy, the development of resistant hypertension in some cases, high incidence of target organs damage. The frequency of new cases of hypertension 3 and 4–6 months after COVID-19 was low.

Objective. To determine sex and age differences in dental preservation in diabetic patients.

Materials and Methods. 218 charts of patients with DM were selected from 4887 medical records of dental patients who visited the Republican Dental Polyclinic of Izhevsk in 2021–2023; the comparison group was formed according to the “case – control” principle. Subgroups were formed according to the WHO classification: middle, elderly and old age. The number of missing and preserved teeth, the location on the jaws, and the class of the denture defect were evaluated.

Results. The main contingent of the municipal dental polyclinic consisted of people of retirement age – 80.7 %, working patients – 16.0 % and non-working – 3.3 %. Patients with DM amounted to 5.5 %, 93.3 % of whom were elderly and senile persons, predominantly women (75.0 %, p≤0.001). The number of extracted teeth in diabetic patients was 13.7 ± 0.8 in middle age, 14.4 ± 0.6 in elderly and 15.5 ± 0.95 in old age, which was 1.5 times larger than in the comparison group, with higher rates in the middle age group in women and on the contrary lower rates in the old and elderly age groups (p≤0.01). Tooth preservation in patients with DM was 1.5 times lower and decreased with age: on an average – 23.8 ± 7.3 points, in elderly age – 26.6 ± 2.5 and in senile – 22.2 ± 2.5 (p≤0.01). The scores of women with diabetes were higher, especially in the elderly patients (p≤0.001). Complete absence of teeth was observed in 89.9 % of patients with DM, more frequently on the upper jaw (p≤0.001).

Conclusions. In patients with diabetes mellitus tooth loss occurs more quickly and is not associated with age-related changes, which is confirmed by the pronounced correlation between the absence and preservation of teeth, while in healthy patients a significant relationship between the age and the absence of teeth was established.

Objective. To analyze the risk factors for the development of preeclampsia and assess their role in predicting this complication on the basis of a retrospective analysis of medical records data.

Materials and methods. A retrospective analysis of the medical records of 55 patients who ended their pregnancy was carried out. The patients were divided into 2 groups: the first group consisted of 33 puerperal women diagnosed with preeclampsia, the second group included 22 patients without hypertensive complications. A comprehensive assessment of clinical and anamnestic risk factors, as well as the data analysis of the comprehensive screening of the first trimester were carried out.

Results. The analysis of the data obtained showed that an increase in the level of average blood pressure in the first trimester is an important risk factor for the development of hypertensive disorders in the second half of pregnancy (p<0.05). The analysis of clinical and anamnestic risk factors revealed that preeclampsia was significantly more common in the first pregnancies , and in patients with a history of antenatal fetal death (p<0.05). According to the results of routine risk calculation in the first trimester using software, a high risk for developing preeclampsia was determined only in 16% of cases of pregnant women from the first group,

Conclusions. Despite the widespread use of comprehensive screening programs for preeclampsia, the problem of predicting it currently remains unsolved. Particular attention should be paid to a multivariate approach based on the assessment of the combination of factors, since no single marker is able to provide high sensitivity screening when isolated.

Objective. To calculate the risk prediction of benign ovarian tumor (BOT) development in postmenopausal patients.

Materials and methods. 60 postmenopausal women participated in the prospective study. The patients were divided into 2 groups: the main group which included women with BOT and comparison group – patients with no neoplasms of the uterine appendages. The clinical and medical history data were assessed, laboratory tests (vitamin D level, insulin-like growth factor 1, leptin, zinc, estradiol, testosterone, sex steroid-binding globulin, cancer marker 125) were performed, results of instrumental methods of examination (pelvic ultrasound) were analyzed as well as surgical treatment protocols and histological studies. Regression analysis of the data obtained was carried out, statistically significant features were determined and the mathematical model for the risk prediction of the development of BOT in postmenopause was created.

Results. The investigation showed that an isolated assessment of the studied laboratory markers has no statistical significance for determining the risk of developing postmenopausal ovarian tumors; a multifactorial approach is relevant, that is assessing a combination of factors.

Conclusions. The developed mathematical model for predicting the development of postmenopausal ovarian tumors demonstrated an increase in the effectiveness of risk prognosis for developing postmenopausal ovarian tumors in postmenopausal patients, the sensitivity of the developed method was 95 %, specificity 85.7 %.

Objective. To assess the effect of coronavirus infection on the development of true arthritis in patients with post-COVID joint syndrome

Materials and methods. Factors contributing to the development of true rheumatic disease in patients with confirmed coronavirus infection were evaluated in a prospective cohort study. General clinical and immunological tests, including markers of rheumatoid arthritis were determined.

Results. On the basis of the results of this study, it was found out that COVID-19 may act as a trigger for autoimmune diseases.

Conclusions. The results of the study indicate the trigger role of COVID-19 in the development of autoimmune diseases. Preventive measures aimed at early detection of rheumatoid arthritis among patients with SARS-COV2 are control of leukocyte count and rheumatoid arthritis markers. A follow-up with a rheumatologist with a periodic monitoring of clinical and immunological parameters is recommended if joint syndrome is revealed.

Objective. To develop a method of predicting fibrosis risk in women with non-alcoholic fatty liver disease (NAFLD) and postmenopausal obesity.

Materials and methods. 70 patients with NAFLD and postmenopausal obesity with an average age of 51.0 (49.0–52.0) participated in the study. Hepatic steatosis signs were confirmed by ultrasound examination after other causes of its development had been excluded. The count of thrombocytes, glucose concentration, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) activity were determined and body mass index (BMI), steatosis index HSI and fibrosis indices APRI and FIB4 were calculated in all the patients.

Results. The patients with NAFLD and postmenopausal obesity were divided into 2 groups: with a high fibrosis risk and with a low one. Women with a high fibrosis risk were significantly older (р=0,044), had a lower number of thrombocytes (р<0,001), and a higher glucose concentration (р=0,046) and transaminase activity. We selected 4 signs that significantly affect the probability of fibrosis and calculated the predicted risk of its development using the formula:

Y = 0.4258 – 0.0038 · platelets + 0.0567 · glucose + 0.0350 · AST – 0.0110 · ALT, where Y (rounded to a whole) is a predicted risk of fibrosis formation in patients with NAFLD and postmenopausal obesity. With Y ≥ 1 the risk of fibrosis formation is predicted in this cohort, and there is no risk when Y value is < 1. The sensitivity and specificity indicators of this method were 100 % and 97.5 %.

Conclusions. The suggested method for predicting the risk of fibrosis in NAFLD includes available laboratory tests, has good diagnostic characteristics, no "grey area" and is developed for the risk group (postmenopausal women). Its use will expand the possibilities of minimally invasive diagnosis, ensure earlier detection of the risk of liver fibrosis in this risk group, which will help to determine the further tactics of these patients’ management.

Objective. To assess the state of the respiratory system of agricultural tractor drivers for the further substantiation of target programs for bronchopulmonary diseases prevention.

Materials and methods. During the medical examination of 168 agricultural tractor drivers, a spirometric functional assessment of the respiratory system state was carried out, medical and social aspects of life, anthropometric data with calculation of body mass index, allergic anamnesis, and the presence of confirmed respiratory diseases were studied. The median age of agricultural machine operators was 51 [41; 58] years, the median professional experience was 20 [10; 32] years. A hygienic assessment of work-related factors was carried out using Statistica 10 software package for statistical analysis.

Results. It has been determined that harmful production factors that negatively affect the respiratory system are silicate-containing dust, harmful chemicals of hazard classes I–IV, and unfavorable microclimatic conditions. 15.2 % of workers are registered at the dispensary with a confirmed respiratory disease of non-occupational genesis. 11.2 % of workers not diagnosed with any respiratory disease complained on some symptoms of this system. Chronic bronchitis significantly more often occurs in people with abdominal obesity than in people without it (16.1 and 4.0 %, respectively, p = 0.039) and in patients with allergies than in those with negative allergic history (25.0 and 9.6 % respectively, p = 0.033). Impaired respiratory function according to spirometry results was revealed in 36.3 % of workers. Statistically significant differences in spirometric readings and the proportion of persons with deviations in the results of spirometry depending on age, abdominal obesity, and allergies were not revealed (p>0.05). Statistically significant lower values of FEV₁ and FEV₁/VC and the proportion of persons with deviations in spirometric readings in the group of smoking agricultural tractor drivers were determined.

Conclusions. A large incidence of non-occupational bronchopulmonary diseases associated with abdominal obesity and positive allergy history, and a considerable proportion of workers with external respiratory function disorder according to spirometry readings, associated with smoking status, were revealed. The lowest spirometric indicators and the largest proportion of people with abnormal spirometry results were registered in the youngest age group and among workers with little work experience. Taking into account the regional limitation of the study and the small number of workers examined, further study in this field is required.

Objective. To study the problems of effective communication between the doctor and the patient at the outpatient stage of medical care and suggest some ways to solve them.

Materials and methods. An online survey of 309 people (119 doctors and 190 patients) was conducted. The questionnaires concerning the appearance of the doctor, his verbal and non-verbal skills contained 34 questions each. Such research methods as analysis, synthesis, questionnaires, as well as the statistical method are used in this study.

Results. Patients most often complain about doctors’ indifferent attitude to their problems, when communicating with medical staff. Many respondents are dissatisfied that the doctors do not emphasize the importance of a healthy lifestyle, which, in their opinion, is due to the fact that most doctors do not realize the significance of a lifestyle modification in disease prevention. Patients' responses also often noted a lack of nonverbal reinforcement of words during the consultation. It may seem an insignificant element of professional communication, but it turned to be of a great importance for many patients.

Conclusions. When providing medical care at the outpatient and polyclinic stage, the level of a primary healthcare physician’s communication competencies is of great importance. Physicians’ good communication skills not only allow to create comfortable and trusting relationships with patients, but also increase the quality of medical care significantly, which will improve the treatment results. 

A clinical case of a 67-year-old female patient with esophagogastric anastomotic leakage after proximal gastrectomy for cancer of the cardiac portion is presented. The complication manifested itself as acute right-sided pleural empyema on the 12th day after the surgery. After the pleural cavity drainage and primary sanitation of the empyema, endoscopic installation of a vacuum system equipped with an open-pore sponge was chosen as a technique for closing the anastomotic defect. This system was operating for 10 days, gradually reducing the amount of the exudate discharged. There was no need to replace the drainage, since endoscopic examination revealed good regeneration in the area of the anastomotic defect. Intensive therapy, along with drainage and sanitation of sources of inflammation, ensured stabilization of the patient’s general condition and healing of the anastomosis. This clinical observation demonstrates the effectiveness of endoscopic vacuum therapy in treatment of esophageal anastomotic leaks and the prospect of its use in difficult cases associated with defects and fistulas of the gastrointestinal tract.

Shwachman – Diamond syndrome is a hereditary ribosomopathy which is manifested by exocrine pancreatic insufficiency, hematological disorders, stunted growth and bone deformities. The pathology is caused by mutations in the SBDS gene. Early detection of the disease and timely treatment, including the use of enzyme preparations, specialized nutrition and granulocytic colony-stimulating factors, contribute to improving the patients' quality of life and prognosis.

A clinical case of a family manifestation of this syndrome is presented in the article. The diagnosis was made and confirmed by a genetic study only at the age of 1. From birth, the girl had clinical manifestations of atopic dermatitis, with a torpid course to therapy, characteristic stools, changes in the general blood test (GBT) in the form of leukopenia and neutropenia of varying severity, changes in the biochemical blood test (BCBT) in the form of increased liver enzymes. Also, the patient has an 8-year-old elder sister with similar changes in the GBT. To exclude the presence of pathogenic genetic variants of the SBDS gene in the cis-position, the girl's parents were examined.

A pathogenic variant of the SBDS gene C.258+2T>C in a heterozygous state was revealed in the girl's mother, while the father had the variant C.653G>A (p.Arg218Gln) in a heterozygous state. Taking into account the hereditary nature of the disease, the girl's elder sister underwent a genetic examination as well at the age of seven. The study also revealed two pathogenic variants of the SBDS gene C.653G>A (p.Arg218Gln) and C.258+2T>C in a compound heterozygous state. Thus, SDS in the child was confirmed by genetic methods of examination.

The case described in the article is aimed at attraction the pediatricians' attention to the correct assessment of GBT indicators (knowledge of age-related norms of the blood cells count and age-specific features of the leukoformula), the ability to count the absolute number of granulocytes. To clarify the nature of neutropenia (congenital, acquired), it is necessary to evaluate the GBT results in dynamics.

The article is dedicated to the 85th anniversary of Lyudmila Fedorovna Molchanova. Her life and scientific work at ISMA are described in the article.