Vol 39, No 4 (2022)

Objective. To analyze the conditions and factors contributing to the development of acne recurrence after therapy with systemic retinoids. Acne is a chronic inflammatory dermatosis characterized by the formation of open and closed comedones, papules, pustules, nodes on skin areas rich in sebaceous glands, significantly disrupting the quality of life of patients. The most effective drugs for its treatment are systemic retinoids. They allow one to achieve complete cleansing of the skin, but even after their use relapses of the disease are possible.

Materials and methods. The study involved 65 women 1 year after the end of acne treatment with systemic retinoids, who were divided into two groups: group I was formed by 30 women with the development of acne relapses; group II included 35 women without acne relapses. The exclusion criteria were the following: severe endocrine pathology, the presence of cardiovascular diseases, liver disease, pregnancy and lactation, alcoholism, smoking. The study consisted of general clinical techniques and standard laboratory methods, including biochemical blood analysis with the determination of lipid and carbohydrate metabolism, the level of pituitary hormones and sex hormones. Methods of parametric and nonparametric statistics were used to account for and analyze the results.

Results. In half of the cases, acne relapses were observed after a new coronavirus infection; much less often, in equal proportions, they developed after stress and menstrual cycle failure, there were patients who could not identify the factors preceding the recurrence of acne. The average age of patients with acne relapses after treatment with systemic retinoids was 24.6 ± 2.4 years, patients without acne relapses after appropriate therapy – 17.3 ± 1.8 years (p = 0.028). Burdened heredity for acne, combination of acne with seborrheic dermatitis and/or menstrual dysfunction by the type of menstrual arrhythmia were significantly more often determined in patients with acne relapses after therapy with systemic retinoids. In the same group, lipid metabolism disorders and hormonal changes in the form of increased levels of progesterone and androgens were observed significantly more often.

Conclusions. Acne, even after the therapy with systemic retinoids, can have a recurrent course. The main external factor, preceding relapse is a new coronavirus infection. Relapses after acne treatment with systemic retinoids are developed against the background of burdened heredity for acne, changes in lipid metabolism, persistent imbalance of sex hormones, as well as when acne is combined with seborrheic dermatitis. For pubertal acne without pronounced metabolic and endocrine changes, relapses after therapy with systemic retinoids are not typical.

Objective. To conduct a study of cognitive functions in young people (18–44 years old) with arterial hypotension, to determine the prognostic significance of arterial hypotension in the development of cognitive impairment.

Materials and methods. A survey in patients aged 18–44 years with arterial hypotension was conducted in electronic format using the Google Forms service (Google Forms). The survey involved 100 persons with arterial hypotension, the control group consisted of 50 persons. Data processing was carried out using Microsoft Excel as well as statistical methods were used.

Results. Arterial hypotension is the result of a functional disorder of the nervous system and it leads to some unpleasant symptoms: loss of strength, weakness, lethargy, decreased concentration, memory impairment and many other signs that can reduce the quality of life of people. In general, arterial hypotension does not lead to significant impairment of cognitive functions at a young age, but in such patients, attention, concentration, working memory and speech function get worse to some extent.

Conclusions. Arterial hypotension can be a risk factor for the onset and progression of cognitive disorders, therefore, in all patients with this disease, close attention should be paid to the state of higher mental functions while conducting such simple clinical and psychological studies using cognitive function assessment scales to track dynamics.

Objective. To analyze the frequency of occurrence of a pathological karyotype during pregnancy that occurred naturally and through the use of ART.  Miscarriage (MC) is a significant problem for the medical community. There is a number of factors affecting the process of gestation. Currently, there is an opinion about the impact of assisted reproductive technologies (ART) methods on the fetal karyotype and an increase in the risk for MC when they are used.

Materials and methods. The study used the data of karyotyping of abortive material from 256 women diagnosed the “non-developing pregnancy” with indication of age and gestational age at the time of termination of pregnancy for the period from 2018 to 2020, provided by JSC "Center for Family Medicine" in Yekaterinburg. In the course of the work, a statistical analysis of the frequency of occurrence of pathological karyotypes in different groups, identified on the basis of the method of pregnancy, was carried out.

Results. To a greater extent, the problem of MC associated with a pathological fetal karyotype, occurs during natural pregnancy. This may be due to the lack of pregravid preparation. In addition, during ART, especially with the use of donor material, the cells without karyotype abnormalities are selected. The problem of MC after the use of ART may be associated with other somatic or functional risk factors.

Conclusions. The available data on the possible genetic causes of early MC draw attention to the need for preimplantation genetic testing to make a timely diagnosis of fetal chromosomal abnormalities. In order to improve the reproductive health of the population, such method as a pregnant woman genetic passport can be proposed.

The liver cirrhosis (LC) is a severe disease, the 11^th by the cause of death in the world, 50 % of patients die during 5 years. The most frequent etiological factors are alcoholic disease of the liver and chronic viral hepatitis. The following general pathological mechanisms are involved in LC pathogenesis: hepatocyte damage, endothelial dysfunction, oxidant stress, fibrosis activation, pathological regeneration, neoangiogenesis, architectonic impairment of the organ with the development of portal hypertension. Genetic factors contribute to the progression of the liver pathology. Depending on the LC etiology, there are the features of pathogenesis, clinical picture, morphology, diagnostics, treatment and prognosis for alcoholic liver disease, chronic viral hepatitis, nonalcoholic fat liver disease, autoimmune hepatitis, primary biliary LC, hemochromatosis, Wilson-Konovalov disease, A1-antitripcin deficiency disease. Among rare causes of LC, there are noted Budd-Chiari syndrome, cardiac cirrhosis, Indian childhood cirrhosis.

Objective. To study the effect of a new derivative of arylamides of aminocarboxylic acids, which has a high antiarrhythmic activity on the state of the cardiovascular system.

Materials and methods. To study the antiarrhythmic activity of the compound, the experiment was carried out on a model of arrhythmia caused by intravenous administration of aconitine. The effect was evaluated by its ability to prevent the occurrence of arrhythmia or to prolong the survival time of animals. In addition, an analysis of the electrocardiogram of awake rats and rabbits was carried out. The test compound and the comparison drug, lidocaine, were intravenously administered to animals in effective antiarrhythmic doses.

Results. Diethylaminoacetic acid ortho-toluidide nitrate under conditions of aconitine arrhythmia shows a pronounced antiarrhythmic effect; under its influence, there is a statistically significant reduction in the duration of arrhythmia attacks in animals by 2.4 times compared with the control as well as protection from death. The compound does not change the parameters of electrocardiogram of animals, no statistically significant differences from the control results were found.

Conclusions. 1. A new compound, diethylaminoacetic acid ortho-toluidide nitrate, exhibits a pronounced antiarrhythmic effect. Probably, it can be attributed to class IB antiarrhythmic drugs, since it exhibits high activity on calcium chloride and aconitine models of arrhythmia.

2. Given that the studied compound combines high antiarrhythmic activity with no negative effect on ECG parameters, a drug based on it can be used as an effective antiarrhythmic drug.

Objective. The postoperative wound complications are an integral part of the treatment process in any surgical practice. The aim of this work is to optimize the tactics of management and the choice of a method for reconstructing the anterior chest wall of cardiosurgical patients with postoperative sternomediastinitis.

Materials and methods. The development of sternomediastinitis in patients undergoing open heart surgery is the highest risk factor for life. According to many authors, it occurs in 0.5–11 % of patients, while the fatality of this complication can reach up to 40–50 %. This condition develops in a number of patients in a cardiac surgery hospital who have certain developmental predictors.

Results. Thus, in our work, we consider preoperative, intraoperative and postoperative risk factors for the development of sternomediastinitis. Based on all the data studied in the world literature and our own experience, we algorithmized the approach to choosing the tactics of anterior chest wall reconstruction, determined the time frame and gave specific recommendations based on clinical examples, which confirms the practical effectiveness of the proposed methods.

Conclusions. A differentiated approach to the choice of the method of plastic intervention is given, the tactical priority of using muscle flaps or segmental resection of the sternum is substantiated, and the importance of omentoplasty of a chest defect in severe purulent-septic lesions of a large scale is also updated.

Objective. To analyze the results of fat grafting in volume restoration, soft tissues and skin defects correction.

Materials and methods. Autologous fat grafting was performed for aesthetic soft tissues correction in 30 women, as well as in 3 patients with long-term non-healing trophic ulcers to obtain a regenerative effect. Subcutaneous fat aspiration was implemented using standard liposuction techniques, water jet, mechanical and syringe.

Results. The volume of fat graft varied depending on the area requiring correction, and averaged 90 (33–195) ml. The areas, most often subjected to fat grafting, were the mammary glands – 10 (33 %), shins – 8 (27 %), buttocks – 5 (17 %), hands – 2 (7 %), lips and nasolabial region – 2 (7 %), the outer surface of the thigh – 1 (3 %). Despite partial decrease of fat graft volume in the postoperative period, all patients were satisfied with the results; no complications of the procedure were noted. The preparation of fat graft for the correction of trophic defects included its washing with saline and filtering with 1.4 and 1.2 mm anaerobic fat transfers; the fat was grafted through a 2 mm cannula into the subcutaneous tissue directly under and around the ulcerative defects. It improved the regeneration of the epithelium around the trophic ulcers and reduced their size.

Conclusions. Thus, the efficiency and safety of using the technique of autologous fat grafting for volumizing and regenerative purposes has been clinically confirmed.

Objective. To carry out the retrospective and operative analysis of the epidemiological situation regarding human dirofilariosis in Astrakhan Region for the period from 1951 to 2019.

Materials and methods.  Eighty-one epidemiological maps of persons infected with dirofilaria as well as case histories of ambulatory patients of Helminthological Center were analyzed.

Results. In total, during the analyzed period (from 1951 to 2019), 81 local cases of human dirofilariae infection were registered in Astrakhan Region. The largest number of dirofilariasis cases was observed in the late 90s – early 2000s – 63 % (n = 51). The largest number of dirofilariasis cases was registered in 2000 and 2002 – 13.6 % (n = 11) and 11.1 % (n = 9), respectively. The age of the patients ranged from 11 months to 78 years. Thus, dirofilariasis was registered mainly in the adult population – 84 % (n = 68). Children aged 11 months to 17 years accounted for 16 % (n = 13) of all cases of dirofilariasis. Helminth was localized both in the eye area – 44.4 % (n = 36), and out of – 55.6 % (n = 45). At extra-ocular localization of the parasite, helminth was localized in the lower extremities – 11.1 % (n = 5), in the head – 42.2 % (n = 19), in the chest – 11.1 % (n = 5), in the abdomen and face – 2.2 % for each (n = 1), in the upper extremities – 17.8 % (n = 8). In most cases, incorrect diagnoses were made – 77.8 %. All the described cases were local – patients did not leave Astrakhan Region. The diagnosis of dirofilariasis was made based on the data of the clinical picture, epidemiological history and data from laboratory blood tests.

Conclusions. Thus, the problem of dirofilariasis remains relevant today, as evidenced by new cases of human disease; the main location is the area of the eyelids, orbit and scalp; dirofilariasis was more often observed in women due to the fact that, unlike men, they are more careful about their appearance; characteristic signs of dirofilariosis are hyperemia, edema, pain at the location of helminth as well as the migration of the parasite under the skin; in most cases, incorrect diagnoses are made.

Objective. To identify the potential epizootic and epidemiological risks arising from the development of the infrastructure of Platov Airport in the territory adjacent to the airport for the development, if necessary, of a set of anti-epidemic and preventive measures.

Materials and methods. Epizootological monitoring was carried out in the vicinity of Platov airport, as well as on the territory of the complex itself for three seasons (2019–2021). The capture of small mammals was carried out according to the standard method of trap-lines with Hero crushers; 1200 trap-days were accumulated. Route records of bats with the determination of their species were carried out. The species belonging of blood-sucking arthropods was determined using determinants. Regulatory support for the above monitoring was formed in accordance with the current normative and methodological documents: SanPiN 3.3686-21 "Sanitary and Epidemiological Requirements for the Prevention of Infectious Diseases"; MP 3.1.0211-20 "Trapping, Accounting and Forecasting the Number of Small Mammals and Birds in Natural Foci of Infectious Diseases"; MU 3.1.3012-12 "Collection, Accounting and Preparation for Laboratory Examination of Blood-sucking Arthropods in Natural Foci of Dangerous Infectious Diseases".

Laboratory studies of samples of extracted biomaterial for the search of markers of pathogens of natural focal infections were carried out taking into account the requirements of current regulatory documents. Samples for laboratory testing were formed in compliance with the principle of "one point of collection of material, one time of collection of material, one type of material".

Results. The results of epizootological monitoring of the territory of the Platov airport (Rostov-on-Don) are presented, according to which a real possibility of the development of epizootics of dangerous infectious diseases among small mammals living in the adjacent territory to the Platov airport has been established. In order to eliminate potential risks that can lead to complications of the epidemiological situation, it is necessary to carry out planned deratization and acaricide treatments on the territory of Platov airport. The continuation of regular epizootological monitoring of the airport territories and adjacent territories remains very relevant.

Conclusions. The results of epizootological monitoring of the territory of the Platov International Airport (Rostov-on-Don) revealed the presence of mouse-like rodents penetrating from the surrounding fields, including those belonging to groups I and II of infectious sensitivity to tularemia, which form potential epizootological risks. A comprehensive laboratory study of biological material obtained from mouse-like rodents captured during epizootological monitoring did not reveal markers of pathogens of natural focal infections. At the same time, systematic regular epizootological monitoring of the airport territory is necessary due to the presence in the territories surrounding the airport complex of natural foci of particularly dangerous infections common to humans and animals, where mouse-like rodents live and reproduce, including house mice and rats, capable of migrating and inhabiting residential and warehouse premises and in case of activation of epizootic process to introduce infection into the territory of the airport complex, especially in autumn and winter.

Objective.To study the peculiarities of morbidity and mortality from malignant neoplasms associated with the human papillomavirus among male and female population in a megalopolis. The International Agency for Research on Cancer relates cancer of the oral cavity, tonsils and oropharynx, larynx, anal canal and skin of the perianal region, vulva, vagina, cervix and penis to malignant neoplasms associated with the human papillomavirus.

Material and methods. The analysis of morbidity and mortality was carried out according to the Population Cancer Registry of St. Petersburg for the period 2011–2020. The structure of the localization of the tumor process, trends and levels of morbidity and mortality from neoplasia associated with papillomavirus infection were studied. The study included information on 13,117 cases of the disease and 7,257 deaths.

Research methods: epidemiological, clinical, statistical methods.

Results. Among all the malignant neoplasms, the proportion of HPV-associated neoplasias was 5.1 % in men and 5.8 % in women (p < 0.05). In the structure of morbidity and mortality from HPV-associated tumors, cancer of the oral cavity and larynx occupies the largest share among men, and cervical cancer among women. The incidence of oropharyngeal cancer among the male population is higher compared to the female, the incidence of anal cancer among women is 2.9 times higher and there is an upward trend with higher growth rates (p < 0.05).

Conclusions. The established gender differences of HPV-associated malignant neoplasms should be taken into account when justifying the directions for improving dispensary monitoring of patients and vaccination of papillomavirus infection.

Objective. Literature review of pseudomembranous colitis caused by pathogenic Clostridium difficile infection and description of a clinical case of pseudomembranous colitis.

Materials and methods. A clinical case of a patient with pseudomembranous colitis is presented.

Results. In a patient with multiple injuries and grade II shock, whose condition required numerous surgical interventions and intensive antibiotic therapy, after the completion of antibiotic therapy there appeared signs of pseudomembranous colitis – loose stools (up to 5 times a day), fever up to 39 ° C, signs of endogenous intoxication, A C. difficile toxin was found in faeces. Antibiotic-associated colitis was diagnosed; metronidazole 500 mg 3 times a day, activated charcoal, infusion therapy were prescribed – on the 12th day, the therapy led to recovery. During the subsequent reconstructive operation, lincomycin 600 mg was administered by infusion for prophylactic purposes, after which, 6 hours later, the patient developed a clinical picture of severe pseudomembranous colitis. A laboratory study of faeces again revealed toxin A C. difficile. The recurrence of the disease required a long-term treatment in the gastroenterology department.

Conclusions. Pseudomembranous colitis is certainly a complex pathology that is a serious hospital-acquired infection. Accurate diagnosis requires correct assessment of the patient’s condition through clinical and laboratory diagnostic methods, correct prescription of conservative treatment and choice of surgical intervention tactics.