Vol 39, No 6 (2022)

Menopause is a physiological period during which involutional processes in the reproductive system predominate in a woman's body. Vitamin D deficiency increases the risk of age-related diseases, so it is important to examine and, if necessary, adjust the level of vitamin D. Purpose of the study. To determine the relationship between vitamin D levels and the severity of menopausal syndrome in postmenopausal women. Materials and methods. A cross-sectional study was conducted, which included data on 150 patients who applied for a gynecological appointment with complaints of manifestations of menopausal syndrome (CS). Results. As a result of the study, it was revealed that out of 150 women with manifestations of menopausal syndrome, the average level of 25(OH)D in the blood serum was 25.3(7.5) ng/ml. At the same time, in 49 (33%) of the surveyed, the content of hydroxyvitamin D was normal, a deficiency was observed in 53 (35%), and in 48 (32%), the indicators corresponded to a deficiency. However, the correlation analysis of the relationship between the level of vitamin D and the severity of the climacteric syndrome did not reveal a statistically significant relationship between the studied parameters (p=0.317). Conclusions. The severity of menopausal syndrome does not depend on the level of vitamin D in the blood, which confirms the leading role of hypoestrogenism in the etiopathogenesis of this condition.

Objective. To study the clinical and laboratory features of the formation of a combination of arterial hypertension in patients with erosive and ulcerative lesions of the gastroduodenal zone and to develop a method for predicting the probability of developing this phenotype. Arterial hypertension and diseases of the gastrointestinal tract are among the common diseases, which are often observed in the same patients.

Materials and methods. Employees (n = 127, males only) of locomotive crews, who work for more than 10 years at Perm-II Railway Station of Sverdlovsk Branch of OJSC Russian Railways, were examined. The methods of examination included the analysis of anamnesis data, physical, laboratory and instrumental examinations of patients. Laboratory studies included the analysis of the results of a general blood test, the serum concentration of common biochemical parameters (glucose and cholesterol), as well as the concentration of individual proteins: endothelin-1, monocyte chemotactic protein-1 and C-reactive protein.

Results. The diagnostic value of determining a number of indicators for predicting the development of arterial hypertension in patients with erosive and ulcerative manifestations of the gastrointestinal tract was established. The greatest significance for the diagnosis of comorbidity was demonstrated by the level of endothelin-1, glucose and cholesterol as well as the content of white blood cells and platelets. The data obtained made it possible to develop a mathematical formula for calculating the risk of arterial hypertension in patients with erosive and ulcerative lesions of the gastroduodenal system.

Conclusions. Employees of locomotive crews have an increased risk for comorbid pathology formation – arterial hypertension against the background of erosive and ulcerative lesions of the gastroduodenal zone, which is accompanied by a change in a number of laboratory parameters that can be used to predict the risk of developing comorbid pathology.

Objective. To analyze and summarize the available literature data regarding the normogonadotropic menstrual function disorders in the reproductive period for identification of pathogenetic approaches to treatment of menstrual function disorders, sterility, miscarriage and pathological processes associated with them.  Most of menstrual function disorders (76 %) are caused by functional hypothalamic disorders, changes in the rhythm and gonadotropic hormone secretion amplitude, which are not accompanied by an altered level of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) – normogonadotropic menstrual function disorders (NMFD).

Materials and methods. Systematic review of native and foreign literature.

Results. The clinical lecture presents the current data on physiology of reproductive system regulation, characteristics of menstrual function in norm and pathology; it defines  normogonadotropic disorders, demonstrates their clinical forms, hypothalamic dysfunction-forming mechanisms as well as  predetermining, trigger, contributory factors, which  form the normogonadotropic disorders; describes clinical features of patients with the above pathology as well as algorithms for therapeutic approaches in the form of “step-type” tactics: elimination of contributory factors, prevention of trigger mechanisms, basic adaptogenic and situational  therapy that leads to restoration of ovulation, realization of reproductive plans and improvement of the quality of life among such patients in more than 90 % of cases.

Conclusions. It was stated, taking into account the variety of mechanisms forming normogonadotropic menstrual function disorders, that treatment of such patients is a complex goal, which requires a detailed studying of female health status, forming a proper clinical diagnosis, developing personified medical programs for a long period of time.

Objective. To optimize the treatment of pregnant women with a moderate form of COVID-19 by including a sorbent in complex therapy.

Materials and methods. Pregnant women (n = 87) with a gestational term of 30 weeks or more were divided into 2 groups. Group 1 (n = 42) received standard treatment for COVID-19. Group 2 (n = 45) received an additional preparation of colloidal silicon dioxide. The following endotoxemia indicators were assessed: concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), medium mass molecules (MМM). The course of pregnancy and complications of childbirth were evaluated.

Results. At the peak stage of the disease, in patients of group 2 the level of МММ was 0,43 opt. units lower, CRP – 7.1 mg / l lower, IL-6 – 2.3 ng / ml lower than in women of group 1.

Anemia, fetal growth retardation, threatening preterm birth, fetoplacental insufficiency, polyhydramnios and oligohydramnios was diagnosed rarely in group 2; the average fetal weight was 256 g more, the average fetal height was 2.4 cm more than in group 1. In group 2, there were fewer children with moderate and severe asphyxia.

Conclusions. The addition of colloidal silicon dioxide to the standard treatment of pregnant women with a moderate form of COVID-19 helps to reduce the level of endogenous intoxication, which is manifested by positive dynamics.

Objective. To study and describe the clinical and epidemiological aspects of pediculosis in residents of Astrakhan Region for 2016–2020.

Materials and methods. In total, 1202553 cases of human infection with infectious and parasitic diseases were registered in Astrakhan Region during the analyzed period, of which pediculosis accounted for 0.4 % of all infectious diseases and 35.1 % (5380 cases) of all parasitic infestations. Cases of pediculosis were recorded in all age groups including children, who accounted for 74.6 % (4015 cases).

Results. Considering the number of registered cases of pediculosis for the period of 2016–2020, the largest number of cases was noted in 2016–2019 and amounted to 89 % (4789 cases). Cases of pediculosis have been recorded in both urban and rural areas. In total, 41.3 % (2220) cases of pediculosis were registered in the rural areas of Astrakhan Region during the analyzed period, of which the proportion of children was 77.7 % (1724 cases) of all registered cases of pediculosis in the rural areas and 42.9 % of all cases of pediculosis registered in children. The incidence of the urban residents is 1.4 times higher than that of the rural ones and is 58.7 % (3160 cases), of which the child population is 72.5 % (2291 people) of all cases of pediculosis registered in the urban areas and 57.1 % of all cases of pediculosis in children.

Conclusions. The epidemiological situation regarding pediculosis in Astrakhan Region remains very tense, as evidenced by the above indicators. The incidence of the urban residents is 1.4 times higher than that of the rural in Astrakhan Region. The most frequent cases of pediculosis are registered in children due to a large crowding of patients in various educational institutions, or epidemic outbreak in the class or school.

The results of the study. Considering the number of registered cases of pediculosis for the period 2016-2020, the largest number of cases was noted in 2016-2019 and amounted to 89% (4789 cases).

Cases of pediculosis have been recorded in both urban and rural areas. In total, 41.3% (2,220) cases of pediculosis were registered in rural areas of the Astrakhan region during the analyzed period, of which the proportion of children was 77.7% (1,724 cases) of all registered cases of pediculosis in rural areas and 42.9% of all cases of pediculosis registered in children.

The incidence of urban residents is 1.4 times higher than that of rural residents and is 58.7% (3160 cases), of which the child population is 72.5% (2291 people) of all cases of pediculosis registered in urban areas and 57.1% of all cases of pediculosis in children.

Conclusions. The epidemiological situation of pediculosis in the Astrakhan region remains very tense, as evidenced by the above indicators. The incidence of urban residents is 1.4 times higher than that of residents of rural areas of the Astrakhan region. The most frequent cases of pediculosis are registered in children, which may be due to a large crowding of patients in various educational institutions, or there may be an epidemic outbreak in the classroom or school.

Objective. To analyze the work of the Republican Perinatal Council in the Republic of Sakha (Yakutia).

Materials and methods. A retrospective analysis of the work of the Republican Perinatal Council in the Republic of Sakha (Yakutia) for 2018–2021 was carried out.

Results. A total of 1553 women were sent to the RPC in 2018–2021. The proportion of group 2 women with changes in biochemical screening, chromosomal and hereditary fetal pathology increased. According to the results of RPC, the routing of pregnant woman is clearly worked out. The effectiveness of RPC can be estimated by the infant mortality rate in the Republic of Sakha (Yakutia) (2021 – 3.6 %).

Conclusions. The work of the Republican Perinatal Council, strict control over the observance of the stages of obstetric care, the introduction of routing sheets in the Republic of Sakha (Yakutia), the concentration of pregnant women and women at high risk for maternal and perinatal pathology in third-level institutions allowed to reduce an early neonatal mortality, infant mortality.

Objective. To determine the priority risk factors for maternal mortality (MM) and failed maternal mortality (FMM) on the basis of clinical and epidemiological features and to develop scientifically based patient-centered models for predicting severe obstetric conditions.

Materials and methods. Primary documentation of successful and dysfunctional maternal outcomes that occurred at the levels I, II, III of medical organizations in Perm and the territories of Perm Krai from 2007 to 2018. Using random sampling, two observation groups were formed: women with failed maternal mortality, deceased women and the control group. Analytical epidemiological "case-control" studies were carried out, which included the determination of confidence intervals, etiological accuracy using Epi Info and Excel ® 2016 MSO programs, a package of applied electronic tables Stat2015 of the author (© V.S. Sheludko, 2001–2016), the MedCalc ® 15.8 Portable program.

Results. Socio-behavioral, general somatic, obstetric-gynecological risk factors, the frequency of occurrence of which among women with failed maternal mortality was 1,4–4,3; 1,2–25,5; 1,1–7,6 times more often, and in the group of deceased mothers 1,9–9,0; 1,7–29,5; 2,8–9,0 times higher than in the group of healthy participants. The "indicators of maternal death" have been identified, which increase the risk of a failed maternal death turning into maternal death. Early clinical and laboratory signs of severe obstetric conditions are the following: high leukocyte intoxication index (LII), elevated levels of aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea and creatinine, decreased levels of fibrinogen, prothrombin index (PTI), prolongation of thrombin time (TT). Infectious-inflammatory, hypertensive complications, comorbidity, a high percentage of premature births and, accordingly, severe perinatal conditions are significantly more common in groups with unfavorable outcomes.

Conclusions. In the course of the study, reliably significant risk factors were identified, on the basis of which scientifically based models for assessing the probability of developing critical obstetric conditions were worked out.

Objective. To analyze the clinical picture of premature baby A. with persistent hyperglycemia, the patient's treatment tactics and approaches to differential diagnosis of the causes of this pathological condition. Glucose occupies one of the central positions in the processes of fetal growth and development, timely and normal development of the newborn brain. Disorders of its metabolism often lead to hypo- or hyperglycemia, especially common among premature infants, from isolated episodes to long-lasting persistent conditions. This article discusses a clinical case of a patient with registration of persistent hyperglycemia for two months.

Materials and methods. The article presents the analysis of the treatment of premature patient A. with a birth weight of 450 g. Medical documents with the results of clinical, instrumental and laboratory research methods were used. Informed consent of legal representatives for examination and treatment was obtained.

Results. A change in the condition of the child against the background of deep prematurity, septic process, accompanied by prolonged episodes of hyperglycemia, oxygen dependence, episodes of anemia, the formation of retinopathy and bronchopulmonary dysplasia, is described.

Conclusions. The analysis of the clinical case showed that hyperglycemia in premature infants is a polyetiological condition, it has different duration and outcomes, can be both the main disease as well as manifestation of many other serious pathologies of the neonatal period. The further search for effective and safe methods of diagnosis and correction of hyperglycemia is justified.

Objective. To study the effect of recombinant glycodelin (Mybiosource, Germany) on the morphofunctional state of the spleen in case of transplantation of the allogeneic red bone marrow cells to Wistar rats in dynamics of in vivo experiment. From the point of view of immunology, pregnancy is a physiologically conditioned state of the tolerance of mother’s immune system to genetically foreign embryo. Glycodelin is a protein associated with pregnancy; it has an immunosuppressive effect and is perspective for medicine.

Materials and methods. The morphological picture of the organ was assessed; the following immunohistochemical indicators were studied: monoclonal antibodies to 1) CD68 – for identification of macrophages, membrane staining; 2) Ki-67 – for cells divided with mitosis and being in different phases of cellular cycle; 3) determination of macrophage colony-stimulating factor (M-CSF).

Results. When studying the histological slices of the spleen, it was shown that glycodelin against the background of allogeneic transplantation of the bone marrow contributes to the activation of immune system cells in the spleen, stimulates the proliferation of immune cells (Ki-67) and their differentiation that was manifested by an increase in the number of plasmacytes. By the end of the study, macrophage content is essentially reduced; eosinophil infiltration is verified that is an indirect positive sign of reaction to the transplant. Against the background of the bone marrow cells allotransplantation, there was observed an increase in M-CSF level in animals on the day 21^st from the onset the experiment compared with the group of intact animals. Introduction of glycodelin against the background of BM cells allotransplantation caused the cancellation of this effect.

Conclusions. Thus, the action of glycodelin qualitatively determined the function of the spleen in direction of the development of a tolerant immune response to allogenate and excluded the development of severe post-transplantation complications.

The article describes the life, scientific and professional career of Vladimir Nikolayevich Shamov, an outstanding scientist-transfusiologist, neurosurgeon, talented health care organizer, founder of a scientific school, full member of the Academy of Medical Sciences of the Union of Soviet Socialist Republics, Honored Scientist of the Russian Soviet Federative Socialist Republic, Lenin Prize laureate, Lieutenant General of medical service. During the Civil War, V.N. Shamov became one of the first in our country to work on the new problem – blood transfusion. Together with his assistants I.R. Petrov, N.N. Elansky, S.V. Heinats and P.I. Stradyn, he conducted research on isolating four isoagglutination blood groups and obtaining standard sera for their determination. On June 20, 1919, the first blood transfusion in the country was performed taking into account isoagglutination groups of a donor and a recipient. The works on the use of cadaveric blood constituted a small part of the topic, which V.N. Shamov was interested in all his life: the problem of organ and tissue transplantation. In 1940, he published the fundamental "Manual on Blood Transfusion" and made a report at the meeting of Pirogov's Surgical Society of Leningrad on the results of treatment of cranial gunshot wounds. The formed principles of treatment became the basis of neurosurgical care rendered to the wounded people during the Great Patriotic War.  In 1961, he organized the  first in this country Artificial Kidney Laboratory and became the head of the newly established Leningrad Laboratory of Blood Fibrinolysis Preparation and Use. After the Civil War, V.N. Shamov became the Head of the Department of General Surgery of Perm Medical Institute.