Vol 40, No 5 (2023)

Objective. To assess the vascular endothelial function in the first trimester of pregnancy using the method of skin thermometry in the aspect of the development of hypertensive complications.

Materials and methods. One hundred women in the first trimester of pregnancy were examined. Based on the gestation outcomes they were divided into two groups: group 1 consisted of 80 patients without pregnancy complications, group 2 included 20 women whose pregnancy was complicated by hypertensive disorders. Clinical and anamnestic risk factors were evaluated; blood pressure level, uterine artery pulsation index, pregnancy-associated plasma protein A were measured; endothelial function was assessed using high-resolution skin thermometry.

Results. Analysis of the obtained data showed significant differences in the body mass index, systolic and diastolic blood pressure levels and values of pulsation index in the uterine arteries. An increase in the indicators during the first trimester of pregnancy was observed in patients from the group with hypertensive disorders. The results of measurements of blood flow fluctuations in the microcirculatory system showed no significant differences in the compared groups.

Conclusions. The obtained results of measuring the amplitudes of blood flow fluctuations in the microcirculatory system indicate the absence of initial endothelial dysfunction in the maternal body. However, an increase in the body weight, initial level of systolic and diastolic blood pressure, uterine artery pulsation index have an important role in predicting the development of hypertensive disorders in pregnancy.

Objective. To evaluate the efficiency of diagnostics and treatment in patients with microcarcinomas of the thyroid gland at the State Medical Institution "RCOD of the Ministry of Health of the Republic of Tatarstan named after Professor. M.Z. Sigal" for 2020-22.

Materials and methods. MIS "BARS. Healthcare – MIS" of oncological dispensary, outpatient charts and medical histories of patients operated on for thyroid microcarcinomas were used.

Results. In the study group, all patients had papillary microcarcinoma. Women over 45 years of age prevailed. Women of fertile age accounted for 41.7%. The combination of microcarcinoma with thyroid adenomas, colloidal goiter and AIT was detected in 78.6% of patients. The organ capsule invasion occurred in 35.7% of patients, metastases to regional lymph nodes – in 19%. Thyroidectomy was performed in 66.7% of patients; 12 (28.6%) patients underwent I-131 therapy.

Conclusions. Due to the fact that papillary microcarcinoma of the thyroid gland is often found in women of fertile age, and develops against the background of another thyroid pathology complicating diagnostics, it sprouts an organ capsule in 35.7% and gives metastases to regional lymph nodes in 19%, therefore requires a timely diagnostics and radical treatment.

Objective. To compare the incidence of COVID-19 among healthcare workers and the general population.

Materials and methods. A retrospective analysis of COVID-19 incidence among healthcare workers and the general population was conducted using official statistics from the Center of Hygiene and Epidemiology in Perm (Russia) for the period of 2020–2022. An epidemiological descriptive and analytical method was used.

Results. During the pre-vaccination period, the disease incidence among healthcare workers exceeded that of the general population by 3.4 times. During the mass immunization period against the background of Delta strain circulation, there was a reduction in the severity of the epidemic process in both groups, while maintaining a trend towards an illness increase. When the Omicron strain appeared, there was revealed an explosive growth in the sickness rate among both healthcare workers and the general population, which was followed by a subsequent decline. Female healthcare workers had an illness rate 1.3 times higher than males. Among the afflicted healthcare workers, those aged 36–59 constituted the largest proportion. The share of infected in the group of 18–36 years and those of 60 and above was 24.7 % and 20.0 %, respectively. A similar gender and age structure of the disease was observed in the general population. The disease rate among doctors exceeded that of nurses and other medical personnel.

Conclusions. It has been established that the severity of COVID-19 epidemic process among healthcare workers reliably exceeds that of the entire population with the similarity of qualitative manifestations of the epidemic process.

To analyze the data obtained from scientific papers on Internet resources and to track the characteristic changes in hemostasis with various types of rickettsiosis fevers, allowing a better understanding of the pathogenesis of rickettsiosis and, as a result, a more competent approach to the treatment of this pathology. In the course of the work, numerous scientific papers of foreign and domestic scientists from various Internet resources (PubMed, CyberLeninka, Elibrari, etc.) were used, which made it possible to analyze changes in hemostasis and summarize them while working.

At the end of the twentieth century, a rapid economic development of endemic zones caused changes in their nosology, significantly affecting an increase in the incidence of natural focal rickettsiosis from the group of tick-borne spotted fevers in many regions of the world. Geographical conditions of the Volga-Caspian floodplain have created optimal conditions for the formation of natural foci of some rickettsioses on the territory of the Astrakhan region. During the period of controlled epidemiological surveillance from 1983 to 2019, the incidence rate of Astrakhan rickettsia fever has increased several dozen times, the settlements located near the gas complex are hyperendemic. The results of numerous studies regarding infectious diseases of rickettsiosis etiology indicate the leading role of cellular structures in the imbalance of hemostasis suggesting a more detailed study of their functional activity and the determination of factors affecting their activity. Rickettsioses require a more thorough study of the clinical and epidemiological picture, pathogenetic aspects to identify criteria for early diagnosis of hemocoagulation disorders in the hemostasis system that formed the basis of this study.

Thus, summing up all of the above, rickettsioses require a more thorough study of the clinical and epidemiological picture, pathogenetic aspects to identify criteria for early diagnosis and appointment of adequate therapy. The features of hemocoagulation dynamics in rickettsia fevers deserve special attention, because this process is both a trigger mechanism of the infectious process and an important factor affecting other structures of this biological system.

Objective. To present biomechanical substantiation of the possibility of using a post-resection obturator prosthesis made of polyamide thermoinjection material, dispersion-reinforced with nanostructured titanium dioxide.

Materials and methods. The biomechanical method of mathematical modeling was applied in the work. The construction of the calculated finite element model included: determination of the mechanical properties of materials; construction of a geometric model; creation of a finite element grid; setting the boundary conditions of force effects.

Results. Preliminary studies of the physical and mechanical characteristics of reinforced polyamide showed an increase in maximum stresses and Ung's modulus by 8,4 % and 7,2 %, respectively, which corresponds to the standards of ISO 1567: 1999. The results of biomechanical calculations of the strength of the elements of the prosthesis-obturator are the following: the level of maximum stresses within the strength indicators under horizontal load is 45,25 MPa, under vertical load (equivalent stress value) – 30,88 MPa, maximum stresses in the contact area with the occlusal pad – 35,00 MPa, deformations determined in the load area – 0,001, and the presence of retaining clasps distributes stresses on the surface of the supporting tooth and reduces them by 11 %. These facts determine a sufficient stability and good fixation of the post-resection prosthesis.

Conclusions. Based on the results of physical and mechanical studies of the maxillary prosthesis-obturator made of thermo-injection polyamide reinforced with nanoscale titanium dioxide, the necessary strength characteristics and structures were determined, that indicates the prospects for its clinical application in the practice of an orthopedic dentist for the treatment of patients with acquired defects of the jaw bones.

Objective. To assess the effectiveness of health improvement during the vacation period of summer recreation campaign based on the assessment of the health status of children in a summer recreation center.

Materials and methods. A total of 377 children and adolescents aged 7 to 15 years (203 girls and 174 boys) were examined in conditions of a twenty-four-hour stay at the children's recreation center during the period of 21 days. The effectiveness of recreation was evaluated on the basis of an analysis of anthropometric, physiometric indicators, medical documentation of children’s health, and a survey of parents about the results of recreation.

Results. High efficiency of improvement of the health was revealed in 95 % of vacationers, low efficiency was noted in 4 %, no efficiency – in 1 % of children. The maximum dynamics of body weight indicators was observed in 1.8 % of children. A positive trend of transition to the group of average physical development was observed in 3 children with body weight deficiency and in 4 – with excess body weight. All the parents interviewed, positively assessed the form of activity of the health institution.

Conclusions. An active involvement of children of different age in children's recreation organizations will improve the level of health of schoolchildren. The participation of parents or legal representatives in the study of the effectiveness of summer recreation campaign will allow adjusting the principles of organization and long-term effects.

Objective. To study the features of providing a specialized care to gynecological patients in conditions of the pandemic of new coronavirus infection COVID-19 by the results of the work of Gynecological Unit of Samara Regional Clinical Hospital (SRCH) named after V.D. Seredavin.

Materials and methods. The results of the work of gynecological unit of SRCH for the period of 2019–2021 were analyzed. Annual reports on the work of this institution were used.

Results. The Gynecological Unit of SRCH named after V.D. Seredavin consists of 37 beds. Since 2017, on the basis of this unit Regional Urogynecological Center was organized. In 2021, the work of the unit was adapted to rendering medical care in pandemic conditions. The number of operations increased compared with 2020: in 2021–3134, in 2020–2782. The number of bed-days after the surgery reduced: in 2021–4.79 (in 2020–5.03), an average bed-day decreased: in 2021–5.96 (in 2020–6.18). The quantity of hospitalizations raised in 2021–1672 (in 2020–1591).

Conclusions. In the most severe conditions of pandemic, the gynecological unit managed to preserve its surgical activity; the volume of medical care corresponded to the plan. A proper organization of work with regard to all requirements of antiepidemic safety provided the absence of the postoperative complications.

The objective of the study was to analyze the clinical picture of hydatid echinococcosis with combined damage of the liver and lungs as well as tactics of management and treatment. A clinical observation of a patient with echinococcosis is presented. Information from the medical record of an inpatient with the results of clinical examination, instrumental and laboratory diagnostic methods was used. The clinical case is characterized by a delay in surgical intervention and a severe course of infection. The need for increased attention of practitioners to echinococcosis is indicated; an individual work with each patient to prevent a severe course, possible complications and a favorable outcome of the disease is required.

To assess the efficiency of using the methods of extracorporeal detoxification in the complex treatment of sepsis and septic shock so as to eliminate endotoxin, cytokines as well as to replace the function of organs. The article presents a successful experience of using two sessions of hemofiltration with an oXiris set for extrarenal indications in a patient with diffuse fecal peritonitis and severe comorbid background after surgery. The complex of therapeutic measures, dynamics of clinical and laboratory data before and after both sessions of oXiris therapy is presented. Positive effect of hemofiltration on the patient's condition using the oXiris set was noted 48–72 hours after the start of the procedure and 72 hours after its completion. The use of two sessions of oXiris therapy in the treatment of septic shock in a patient with diffuse fecal peritonitis and severe comorbid background allowed stabilizing hemodynamics 48–72 hours after the start of treatment; a significant improvement of a patient’s condition occurred 72 hours after the end of the second procedure.

Difficulties in the differential diagnostics of adrenocortical cancer (ACC) are due to its heterogeneous clinical and biological behavior, which is based on a complex histogenesis and molecular genetic landscape of adrenocortical cells. In this connection, the “postulate” in the diagnosis and treatment of ACC should be a multidisciplinary approach in centers with experience in adrenal surgery and pathomorphology. The presented own clinical observations of patients with ACC diagnosed during a multiple revision of histological slides and repeated immunohistochemistry including recurrent tumor, illustrates the complexity of differential diagnosis and shows the need for further study of the subcellular mechanisms of adrenocortical oncogenesis underlying its clinical picture, morphology, and expression of valuable specific markers.

Objective. To study the morphological consequences of severe acute post-manipulation pancreatitis (APP), the morphological features of its course and the result of the compound "L-17" exposure.

Materials and methods. Rats weighing 250–300 g were used. Forty operations were performed to create a model of APP on rats. The control group included 20 rats with APP without medication, the experimental group – 20 rats with AKI against the background of "L-17" introduced in the dose of 40 mg/kg once per day.

Results. In all cases of application of this APP model in rats, the development of acute pancreatitis was noted. The conducted morphological studies showed that APP in rats in the experiment met the criteria for a severe course of acute pancreatitis with the development of purulent peritonitis and necrotizing parapancreatitis with morphological manifestations of systemic inflammation in all the organs studied (with a lethality of 70 %). The use of a new "L-17" in APP in experimental rats showed a decrease in the risk for developing both purulent peritonitis and purulent-necrotic parapancreatitis as well as a 2-fold decrease in mortality (from 70 % to 30 %). A new effect of "L-17" was revealed, i.e. prevention of necrosis of Langerhans islets. The study of the cellular composition of the inflammatory infiltrate showed a decrease in the activity of inflammatory process.

Conclusions. The efficacy of a new rat model of APP, ranked by severity, was shown. "L-17" alleviates the severity of APP, reducing the risk for developing various purulent complications and systemic inflammation.