Comprehensive Examination Of Patients Research Articles

THE STATE OF THE CORONARY BED IN CORONARY HEART DISEASE IN PATIENTS WITH HYPOTHYROIDISM

Hypothyroidism is a significant aggravating factor for coronary heart disease (CHD). However, there are no practical recommendations for the management of this group to date. The main method of assessing the severity of coronary artery disease is a morphological assessment of the condition of the coronary arteries. The aim. To carry out comparative assessment of clinical parameters, including the state of the coronary bed in patients with coronary artery disease with newly diagnosed (without hormone replacement therapy) and primary manifest hypothyroidism compared with patients with coronary artery disease without hypothyroidism. Materials and methods. Two hundred and forty patients with CHD were examined. The study group included 90 patients with coronary heart disease and hypothyroidism, the comparison group consisted of 150 patients with coronary artery disease without thyroid pathology. A comprehensive examination of patients, including coronary angiography, was performed. The frequency of cases and characteristics of lesions of the coronary bed, the volume of interventions were assessed. The analysis of the obtained data was carried out in Statistica 10.0 (StatSoft Inc., USA). Results. In the study group (CHD and hypothyroidism), a statistically significantly increased level of myoglobin, a change in lipid profile parameters in relation to patients with CHD without hypothyroidism was found. In the group of patients with coronary artery disease and hypothyroidism, a predominance of the frequency of multivessel lesions of the coronary bed was revealed. The volume of surgical interventions between the examined patients did not reveal significant differences. Conclusion. Patients with coronary heart disease and hypothyroidism should be considered as a group of additional cardiovascular risk and require a more careful approach. It is possible to prescribe higher dosages of statins.

The Result of the Treatment of Optic Nerve Edema after COVID-19

The neuro-ophthalmic symptoms and signs associated with COVID-19 infection are varied and span the course of the infection to the convalescent phase. In addition to the anterior segment of the eye, there is a possibility of damage to the posterior segment of the eyeball. The described cases are isolated and there are no results of treatment of patients who have undergone COVID-19.Purpose: To describe the outcome of treatment of bilateral optic nerve edema after COVID-19.Methods. A 59-year-old man with reduced visual functions in the post-surgical period was examined. A standard ophthalmological examination was performed. In addition, spectral optical coherence tomography (OCT) of the macular area of the retina and optic disc (OND) was performed using the RTVue XR Avanti apparatus (Optovue, USA). The patient underwent a laboratory study.Results. Bilateral papilledema was detected in a patient after COVID-19. According to OCT data, a thickening of the nerve fiber layer of the retina of both eyes was revealed, according to OCT angiography, a decrease in the density of the RPC. Conducted a course of conservative and physiotherapy treatment.Conclusion. The COVID-19 epidemic poses several challenges for the ophthalmological community: to determine algorithms for timely diagnosis and treatment, as well as to ensure the prevention of complications from the organ of vision in patients who have undergone COVID-19. It may make sense to screen for coronaviruses in patients with inflammatory diseases of the posterior segment of the eye of unknown etiology. The inclusion of spectral optical coherence tomography with the function of angiography in a comprehensive examination of patients is important for the early detection of microcirculatory and morphometric changes in the optic disc, macular and peripapillary retina. It is advisable to use physiotherapeutic methods of treatment in patients with visual impairment in the post-COVID period, which will reduce the long-term drug load and increase the effectiveness of treatment.

The role of molecular imaging in the comprehensive examination of HIV-patients with ischemic heart disease

Cardiovascular disease is one of the most frequent cause of death globally. The greatest part is occupied by ischemic heart disease. HIV patients are composed to a higher risk of coronary heart disease.The purpose of this work is to evaluate the possibility of using molecular imaging methods in a comprehensive examination of patients with HIV infection and ischemic heart disease.Materials and methods. The survey group includes 32 patients with HIV infection. The comparison group consists of 25 age-matched patients with coronary heart disease and without HIV Infection. All patients were underwent myocardial perfusion scintigraphy using single photon emission computed tomography. Positron emission tomography with FDG were performed if necessary to assess the viability of the myocardium. The patients of the main group undergo diagnostic coronary angiography and standard set of laboratory and institutional diagnostic methods.Results. The results of which confirm the high efficiency of radionuclide diagnostic methods for detecting perfusion disorders, contractility and myocardial viability in patients with HIV infection even at an early stage. They can be recommended for using in a comprehensive examination of patients with HIV infection.

Биомаркеры ишемии органа зрения как предикторы ишемического инсульта головного мозга

Purpose. To study biomarkers of ischemia of the organ of vision in patients with acute disorders of the arterial circulation of the retina and optic nerve. Material and methods. We observed 38 patients (38 eyes). The patients were divided into two groups, the first group consisted of 26 patients (26 eyes) with acute circulatory disorders of the optic nerve (anterior ischemic neuropathy), the second group consisted of 12 patients (12 eyes) with acute circulatory disorders of the retina (occlusion of the central artery retina and its branches). The control group consisted of 12 practically healthy individuals. Results. In a biochemical study in patients with anterior ischemic neuropathy (1st group), the level of NSE in the lacrimal fluid was increased compared to the control group and averaged 32.3 ± 0.85 ng/ml, although in the blood serum it remained within the normal range , which reflects the beginning of destructive processes in the nervous tissue. In patients with acute circulatory disorders of the retina (2nd group), the content of NSE in the lacrimal fluid was increased by 1.7 times compared with the control group. Conclusion. The NSE study can be used in a comprehensive examination of patients with acute circulatory disorders of the optic disc and retina as an additional marker of the neurodegenerative process. Since data from traditional methods of research do not always show the degree of damage to the visual pathways, the study of the level of NSE helps to make assumptions about the severity of the disease and predict the outcome. Keywords: visual organ ischemia, occlusion, anterior ischemic neuropathy, central retinal artery, diagnostics, NSE protein

Minimally invasive technologies for treatment of gallstone disease complicated by mechanical jaundice in patients of elderly and senior age

BACKGROUND: In recent years, there has been a significant increase in the number of patients of older age groups with cholelithiasis and its complications. Trans-light endoscopic and hybrid technologies for the treatment of cholelithiasis complicated by mechanical jaundice in such patients can reduce the proportion of traditional operations, the frequency of complications and mortality.
 AIM: To develop an algorithm for the treatment of cholelithiasis complicated by mechanical jaundice in elderly and senile patients based on the use of modern minimally invasive and hybrid technologies.
 MATERIALS AND METHODS: The analysis of the treatment of 116 elderly and senile patients with cholelithiasis complicated by mechanical jaundice from 2016 to 2021 has been carried out.
 RESULTS: After a comprehensive examination of patients, the following pathology has been diagnosed: choledocholithiasis (cholecystectomy in the anamnesis) in 7.8%; сholedocholithiasis (cholecystectomy in the anamnesis) + stricture of the distal choledochus in 9.5%; сholecystocholedocholithiasis in 82.7%, including choledocholithiasis without major duodenal papilla stricture in 7.3%, Mirizzi syndrome (including major duodenal papilla stenosis in 3.1%) in 5.2%, choledocholithiasis + stricture of the distal choledochus in 79.2% and choledocholithiasis + stricture of the distal choledochus + parafaterial diverticulum in 8.3% of the patients. The severity of the comorbidity index according to the Kaplan Feinstein scale in 2.6% of patients corresponded to a mild degree, in 70.7% to a moderate degree, in 26.7% to a severe degree. Trans-luminous endoscopic and hybrid technologies have been used to eliminate the stricture of the distal part of the bile duct and sanitation of the bile ducts. Traditional operations by endovideosurgical and mini-access as well as laparotomy have been performed in 5.2%, 13.8% and 2.6% of the patients, respectively. The mortality rate was 3.5%. Complications associated with endoscopic interventions have developed in 5 (4.3%) patients, including retrograde cholangiopancreatography-induced pancreatitis in 2, bleeding from the incision of the duodenal papilla in 3 patients.
 CONCLUSIONS: Trans-light endoscopic and hybrid technologies for the treatment of cholelithiasis complicated by mechanical jaundice in patients with severe comorbidity index can reduce the proportion of traditional operations, the frequency of complications and mortality.

The state of the immune system in patients with functional ovarian cysts

Conducting a qualitative and comprehensive examination of patients with functional ovarian cysts is fundamentally necessary to understand the treatment strategy of this pathological state.
 The objective of the work was to study the features of immune disorders in patients of reproductive age with functional ovarian cysts. 
 Methods. 50 patients of reproductive age with functional ovarian cysts were examined. General clinical, gynecological, ultrasound examination of the pelvic organs, a study of the state of the immune system were carried out.
 Results. In 70% of patients chronic inflammatory processes of the pelvic organs were detected. The findings revealed varying degrees of immune system disorders in women with ovarian cysts with different parity.
 In nulliparous and women who gave birth violations of cell immunity of the I degree were revealed, in the group with infertility - II degree.
 In the group of patients who gave birth and with infertility, the III degree of disorders of humoral immunity was diagnosed, and in nulliparous women - II degree.
 Conclusion. Determining the degree of disorders of the immune system already at the prehospital stage will allow individualizing the choice and dosing regimen of immunomodulatory drugs as part of the complex therapy of functional ovarian cysts.

MRI visualization of aortic recoarctation in the long-term period after surgery (case report)

Case study. Aortic coarctation refers to well-known and well-studied congenital malformations of the cardiovascular system. The success of cardiovascular surgery significantly increased the survival rate of patients, but, unfortunately, did not reduce the risks of serious cardiovascular complications in the long-term postoperative period. One of the significant complications remains recoarctation – repeated narrowing in the area of surgery, which can initiate other complications.The purpose of the study: to present the features of blood flow in the aorta in a patient with aortic coarctation in the long-term postoperative period on the clinical example of a complex MR examination.Material and methods. A 12-year-old patient, at the age of 6, she underwent balloon angioplasty of aortic coarctation. Echocardiographic data revealed a residual gradient at the isthmus of the aorta and expansion of the descending aorta. To clarify the diagnosis, MRI angiography of the heart was performed with intravenous contrast and the use of a cardiopackage for 4D flow analysis (4D flow).Results and discussion. According to the MRI study, a narrowing of the distal aortic arch with aortic dilation after the departure of the left subclavian artery was revealed, which is confirmed by the obtained absolute values of blood flow indicators. MR-angiography of the aortic arch made it possible to visually determine the “gothic” shape of the aortic arch and present 3D reconstructions. 4D flow maps showed acceleration of blood flow to the systole in the area of aortic narrowing, additional vortex flow below the area of aortic narrowing and spiral flow in the descending aorta, which persisted throughout the diastole.One explanation for the abnormal spiral flow in the descending thoracic aorta may be the presence of a “gothic” aortic arch. Also, residual hypoplasia of the aortic arch and narrowing of the isthmus are the leading parameters affecting the pathophysiology of changes in blood pressure during exercise.Conclusion. The 4D-flow MR package in vivo makes it possible to study the flow geometry and blood flow parameters in detail, to obtain a detailed picture of the aortic condition, which gives potential advantages in a comprehensive examination of patients with aortic coarctation under dynamic observation.

ЛЕЧЕНИЕ ОСТЕОПОРОТИЧЕСКИХ ПОВРЕЖДЕНИЙ ЗАДНЕГО ПОЛУКОЛЬЦА ТАЗА БЕЗ СУЩЕСТВЕННОГО СМЕЩЕНИЯ

Relevance. The prevalence of osteoporosis and, as a result, the risk of life-threatening pathological fractures increases. At the same time, the optimal treatment tactic for low-energy injuries of the posterior half-ring of the pelvis without significant displacement has not been determined, which actualizes further studies of this type of damage. The aim of the study was to analyze the experience of diagnosing and treating osteoporotic injuries of the posterior pelvic half-ring without significant displacement. Materials and methods. The prospective controlled study included 63 patients aged 60-93 years who were treated in 2018-2020 for osteoporotic fractures of the posterior half-ring of the pelvis without significant displacement. Comprehensive examination of patients was carried out, including standard radiography and X-ray computed tomography (CT) of the pelvis, correction of comorbid conditions, analgesia, prevention of thromboembolism. In one outpatient observation based on standard radiography, pelvic ring injury was not detected in a timely manner. In 57 patients hospitalized up to 5 days after injury, early functional conservative treatment was used. In 33 of them, this treatment led to restoration of function, fusion. In 24 of 57 patients, in the conditions of early functional conservative treatment, a significant pain syndrome persisted and pelvic ring instability was determined, they underwent prompt minimally invasive pelvic stabilization followed by early activation. Intensive therapy for advanced heart and renal failure was performed in 2 patients 86 and 82 years hospitalized up to 5 days after the injury. In 4 patients hospitalized within more than 5 days after injury with significant pain syndrome and pelvic ring instability, its urgent operative minimally invasive stabilization was carried out with subsequent early activation. For minimally invasive stabilization of the rear half-ring, cannulated screws were used, the front half-ring - cannulated screws, lockable rods, in two - plate osteosynthesis. The outcome was assessed using the S.A. Majeed scale 6 months after hospitalization. Results. Three patients (4.8%) died due to decompensation of severe comorbid somatic pathology. There were no nonunions, thromboembolic and infectious complications. The terms of restoration of motor activity of patients with conservative treatment amounted to 8-24 weeks, with operative - 8-16 weeks. One patient had a screw migration from the anterior pelvic half-ring under the skin. The results were evaluated in 52 patients (82.5%): excellent - 26 (50%), good - 22 (42%), satisfactory - 1 (2%), bad - 3 (6%). Conclusions. 1. post-traumatic pelvic pain, impaired motor activity, and no detection of bone traumatic changes with standard pelvic radiography should be an indication for performing pelvic computed tomography. 2. The low mortality rate - 4.8% - and the high level of excellent and good results - 92% - in the group of elderly, senile and long-lived patients with osteoporotic fractures of the posterior half-ring of the pelvis without significant displacement indicate the adequacy of the applied protocol of multidisciplinary, early functional treatment of these injuries. 3. Minimally invasive osteosynthesis using blockable rods and cannulated screws of the front and rear half-rings of the pelvis in case of their instability allows early activation of elderly, senile and long-lived patients, accompanied by a low risk of complications.

Analyzing a clinical case of married couple with combined infertility

Infertility is a disease of the reproductive system characterized by lacked clinical pregnancy after 12 or more months of regular unprotected sex. To diagnose the causes and choose the tactics of infertility treatment, a personalized approach to each patient is required, which is beneficial for both the doctor and the patient. A comprehensive examination of patients is important from the point of pharmacoeconomics and clinical efficiency view. Here, a comprehensive diagnostics of the spouses resulting in birth of a healthy child is discussed.

The Role of Scintigraphy and Hybrid Single-Photon Emission Tomography in Comparison with Laboratory Data in a Comprehensive Examination of Patients with Secondary Hyperparathyroidism

Objective:to estimate the possibilities and determine the diagnostic value of scintigraphy and single-photon emission computed tomography combined with computed tomography (SPECT/CT) in the assessment of the functional state of parathyroids in comparison with laboratory data in patients with secondary hyperparathyroidism (SHPT). Material and methods.The study consistently included 64 patients with the established diagnosis of SHPT due to the acquired vitamin D deficiency or with terminal chronic kidney disease (CKD), with the presence of ultrasound data and laboratory tests of calcium-phosphoric exchange indicators. Neck and mediastum nuclear study with 99mTc-methoxy-isobutyl-isonitrile (MIBI) was performed in the planar two-phase scintigraphy mode according to the standard protocol with an estimation of parathyroid visualization intensity, as well as in SPECT/CT performed 1 hour after MIBI injection. Results. In the group of patients with CKD as a cause of SHPT (n = 14), the most pronounced increase of parathyroid hormone (PTH) level (210.8 ± 103.0 vs. 107.0 ± 40.2 pg/ml in patients with vitamin D deficiency (n = 50, p < 0.001)) and phosphorus (mean 1.39 ± 0.51 mmol/l), as well as excess of normal levels of alkaline phosphatase (407.7 ± 338.1 units/l) were noted. In patients with vitamin D deficiency, impaired parathyroids according to SPECT/CT data was visualized in 8 % of cases, and in patients with CKD in 14.3 %. No significant differences in the mean levels of vitamin D in patients with (n = 46) and without (n = 4) modified parathyroids according to scintigraphy were detected: 26.06 ± 13.19 vs. 25.82 ± 18.80 ng/ml, respectively (p = 0.97). Differences in PTH and calcium levels were not observed: 91.3 ± 39.2 vs. 89.2 ± 29.5 pg/ml (p = 0.90), 2.53 ± 0.21 vs. 2.58 ± 0,15 mmol/l (p = 0.64), respectively. Conclusion.The neck SPECT/CT is a key method of topical imaging of impaired parathyroids in preoperative preparation of patients with SHPT caused by CKD. The method may have a diagnostic value in treatment-resistant patients with vitamin D deficiency and upper-normal PTH and calcium levels in terms of detection of the nodular form of parathyroid hyperplasia. The implementation of SPECT/CT after 1 hour after MIBI injection increases the sensitivity of the study.

КЛИНИЧЕСКИЕ МЕТОДЫ ОБСЛЕДОВАНИЯ ПАЦИЕНТОВ С ХРОНИЧЕСКИМИ ЗАБОЛЕВАНИЯМИ СЛИЗИСТОЙ ОБОЛОЧКИ ПОЛОСТИ РТА ПРИ ОКАЗАНИИ ОРТОПЕДИЧЕСКОГО ЛЕЧЕНИЯ

Chronic diseases of the oral mucosa are difficult for a dentist to diagnose and treat. The recurrent course of chronic diseases of the oral mucosa leads to the fact that patients are left without orthopedic dental care for a long time. Recent studies have shown that orthopedic treatment of patients with chronic diseases of the oral mucosa is not only possible, but also necessary. If a pathology of the oral mucosa is detected during orthopedic treatment, it is necessary to conduct a complete examination of the patient, obtain advice from specialist doctors: a dental surgeon, dermatologist, endocrinologist, infectious disease specialist, etc., and draw up a joint treatment plan. Under our supervision were 69 patients, of both sexes, aged 58 to 78 years, during the examination of which special attention was paid to the study of the oral mucosa. Particular attention was paid to the study of the oral mucosa, especially changes in the background of chronic diseases of the oral mucosa. During her examination, the color was noted (taking into account the patient's age and profession), the degree of moisture, swelling, the presence of pathological formations, their shape, size, quantity, localization, location of elements on the changed or normal color of the mucosa. The condition of the gums, the mucous membrane under the prosthesis was taken into account. Palpation determined the density of soft tissues, the sensitivity of pathological changes in the mucous membrane to pressure and friction, the presence of pain points. The general characteristics of the mucous membrane of the prosthetic bed were evaluated according to the Supple classification. After applying the prosthesis, the state of the mucous membrane of the prosthetic bed was assessed in dynamics: on the first, third, seventh and 21st day after prosthetics. Cytological and bacteriological studies were carried out. It was revealed that the erythrocyte sedimentation rate and leukocyte formula, blood test for vitamin D content, the content of immunoglobulins IgA, IgG, were changed compared to the norm.
 Prosthetics with removable orthopedic structures are started after a comprehensive examination of patients with an absolute absence of contraindications during the period of remission of chronic diseases of the oral mucosa or during the treatment of the underlying somatic disease.

Сроки проведения витрэктомии при проникающих ранениях глазного яблока

Purpose. Analysis of the results and identification of the optimal timing of vitrectomy for penetrating wounds of the eyeball. Material and methods. For the study, 15 patients with 15 eyes were selected with a diagnosis of penetration injury (scleral or corneoscleral) within the boundaries of the flat part of the ciliary body, hemophthalmos without retinal detachment and lens damage. All patients underwent vitrectomy for hemophthalmos. The patients were divided into 3 groups: 1 group of 5 people – vitrectomy was performed on the 2 nd day after admission to the ophthalmology department (primary surgical treatment of pan + vitrectomy); 2 group of 5 people – vitrectomy was performed 12-14 days after primary surgical treatment; 3 group of 5 people – vitrectomy was performed after 1 month or more after a penetrating wound. Results. The optimal timing of vitrectomy in penetrating wounds of the eyeball complicated by hemophthalmos, without the presence of retinal detachment and damage to the lens, has been determined. Conclusion. The analysis of the results of surgical treatment indicates the need for a comprehensive examination of patients with penetrating eye wounds. It is necessary to refrain from early vitrectomy, it is also dangerous to have a blood clot in the vitreal cavity for a long time due to the traction effect on the retina. Keywords: penetrating wound, vitrectomy, hemophthalmos, retinal detachment.

Особливості порушення біоелектричної активності головного мозку у пацієнтів з печінковою енцефалопатією

The purpose of the study was to determine the relationship between the bioelectrical activity of the brain and the severity of hepatic encephalopathy. Materials and methods. We examined 99 patients with hepatic encephalopathy due to chronic hepatitis (51 patients, including 26 men and 25 women) and liver cirrhosis (48 patients, including 32 men and 16 women). The age of patients is 51.2±9.5 years. According to outpatient cards, all patients were examined in the gastroenterology departments of clinics in Kharkiv, where chronic hepatitis and liver cirrhosis and their etiology, if necessary, were diagnosed based on clinical-laboratory and instrumental examination. The term of chronic hepatitis from diagnosis was 8.1±3.9 years, liver cirrhosis – 2.1±0.5 years. The bioelectrical activity of the brain was recorded on a 12-channel computer electroencephalographic complex DX-NT32 in a state of restful wakefulness and under functional loads. Results. The increase in the severity of hepatic encephalopathy was accompanied by a decrease in the frequency and percentage contribution of alpha rhythm in combination with an increase in the percentage contribution to slow wave activity. The presence of a number of pathological changes that were detected on the electroencephalogram in the studied group of patients with hepatic encephalopathy is also noteworthy. Thus, in patients with stage II hepatic encephalopathy, bilateral synchronous acute "three-phase waves" were registered, mainly in the front-temporal leads. To determine the relationship between impaired bioelectrical activity of the brain and impaired liver function, a correlation was made between the indicators of electroencephalogram and the content of ammonia in the blood in groups of patients with chronic hepatitis and cirrhosis. The correlation analysis revealed a negative relationship between the content of ammonia in the blood and the frequency of the alpha rhythm (r = -0.58; r = -0.69; p <0.05), a direct relationship between the content of ammonia and the percentage contribution of slow wave activity (r = + 0.61; r = + 0.63, p <0.05) in groups of patients with chronic hepatitis and liver cirrhosis, respectively. The data obtained support the link between impaired brain bioelectrical activity and liver dysfunction due to chronic hepatitis and liver cirrhosis. Conclusion. Thus, electroencephalogram in a comprehensive examination of patients with chronic liver disease can track the dynamics of the clinical course of hepatic encephalopathy, and the changes on the electroencephalogram can serve as an additional marker of the severity of hepatic encephalopathy, which is especially important in detecting hepatic encephalopathy in the latent stage

Clinical manifestations of polycystic ovary syndrome: a modern view

INTRODUCTION: Polycystic ovary syndrome (PCOS) is one of the urgent problems of gynecological endocrinology. The main signs of PCOS include a violation of menstrual and/or ovulatory function and clinical and/or biochemical hyperandrogenism, as well as polycystic ovarian morphology according to the ultrasound results. PCOS leads to infertility, obesity, and cardiovascular system diseases. PCOS is an important symptom complex in the diagnosis, which directly affects the reproductive function of females, hence the percentage of fertility. This study aimed to analyze the features of clinical, laboratory, and instrumental parameters in females with a previously established PCOS diagnosis referred for surgical treatment. The obtained results were studied from the point of view of the clinical guidelines of the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology (2003), International PCOS Network (2018), and the Ministry of Health of the Russian Federation (2021).
 MATERIALS AND METHODS: The study included 121 females who were admitted to hospitals in Moscow for surgical treatment. Among the gynecological surgical hospitals, the following medical institutions were allocated: the city clinical hospital, the research center, and the commercial clinic we conditionally divided into three levels.
 The city clinical hospital had 54 females (1st group) aged 2137 years, the research center with 48 females (2nd group) aged 2242 years, and the commercial clinic with 19 females (3rd group) aged 2541. Before the ovarian surgery for PCOS, all patients underwent an additional examination, including the collection of anamnesis, particularly, features of menstrual and generative function, anthropometric indicators, body weight, and height study. Based on these parameters, the body mass index (BMI) was calculated, the clinical signs of hyperandrogenism (acne, excessive hair growth on the body and face, and the degree of hirsutism) were assessed, and the hormonal profile was determined to detect biochemical hyperandrogenism (free testosterone). Additionally, the level of glucose and insulin in the blood plasma was determined in all patients, and a pelvic ultrasound examination (ultrasound) was performed.
 RESULTS: Menstrual irregularities were revealed, of which complaints were presented by a total of 49.5% of patients. The results of the preliminary selection of patients with PCOS for surgical treatment revealed that 108 (89.2%) had primary and secondary infertility, of whom 64 (52.9%) had BMI within the normative values, 29 (23.9%) were overweight, and 25 (20.6%) were obese. Clinical manifestations of hyperandrogenism were present in 61 (50.4%) patients included in the study. The level of free testosterone above the normative values (2.85 pg/ml) was diagnosed only in 9 (7.4%) patients out of 121 who are included in the study. Additionally, this parameter was within the upper limit of the norm (average value of 2.780.36 pg/ml) in 112 females but was combined with clinical manifestations of hyperandrogenism. Black acanthosis was noted in 6 (5.0%) patients with free testosterone levels in 3.013.64 pg/ml. Increased blood glucose levels were combined with obesity in 3 (5.5%) patients of 1st group and 1 (2.1%) in 2nd group. Insulin levels significantly exceeded the upper limit of the norm in 6 (5.0%) patients. The ultrasound result in all patients (n=121) revealed the presence of echographic signs of PCOS in PCOS was confirmed by ultrasound in 54 females in 1st group, 48 females in 2nd group, and 19 females in 3rd group.
 CONCLUSION: Our results suggest an unreasonably broad interpretation of PCOS diagnosis. Therefore, PCOS diagnosis should be primarily remembered as a diagnosis-exception. Only repeated, extended, thorough, and comprehensive examination of patients with a presumed PCOS diagnosis will allow you to better navigate the individual characteristics of patients and offer adequate methods for correcting the symptom complex to improve the overall health, fertility, and quality of life.

Успешное хирургическое лечение расслаивающей аневризмы брюшного отдела аорты

The article considers a clinical case of surgical treatment of a patient with a giant complicated abdominalaortic aneurysm. Comprehensive examination of patients using modern diagnostic methods (contrast MSCTangiography, ultrasound) improves the diagnosis of a complicated form of abdominal aortic aneurysm. Timelysurgical treatment - resection of the abdominal aorta, aorto-femoral bifurcation prosthetics in the complextreatment of the patient allowed to prevent fatal consequences. The patient was discharged in a satisfactorycondition on the 8th day after the operation, therefore, the tactics used were effective and justified.

Ретинопротективная терапия глаукомы

Background: a fluctuating blood pressure (BP) and particularly an overnight hypotension is the key adverse factor leading to the progression of glaucomatous optic neuropathy. Aim: to study the effectiveness of a neuroprotective drug (a complex of water-soluble polypeptide fractions) in patients with unstable primary open-angle glaucoma and normalized ophthalmotonus by monitoring the morphological and functional parameters of the retina and optic nerve. Patients and Methods: this six-month study included 30 patients (60 eyes) with primary open-angle stage 2 or 3 compensated glaucoma and unstable course. At the first stage of the study, a daily blood pressure monitoring (DBPM) was used for all patients to assess changes in systemic hemodynamics. The patients were split into 2 groups, each group consisting of 15 individuals, who received a different number of intramuscular (IM) injections of a neuroprotective drug, 5.0 mg: 10 injections in group 1 and 20 injections group 2. A comprehensive examination of patients was carried out at the beginning of the follow-up period, and at 3 and 6 months after the completion of the course of treatment with the drug. It included visometry, tonometry, static perimetry and optical coherence tomography of the retina and optic nerve. Results: based on the DBPM, the normal circadian BP pattern was disturbed in 27 (90%) patients. During the entire follow-up period, both groups demonstrated an improvement in visual acuity. The results of static perimetry indicated the stabilization of the glaucoma process in group 1 patients, while in group 2 where the treatment course with the neuroprotective drug lasted twice longer, it was possible to achieve an improvement in photosensitivity of the retina, as proven by the positive trends in MD and PSD indices. The results of the functional studies fully correlated with the morphological findings as demonstrated by a reliable stabilization of the status of the retinal nerve fiber layer and ganglion complex, as well as the volume of the optic nerve head. At the same time, a longer course of therapy with the drug was accompanied not only by a significant increase in the above parameters, but also by a decline in the volume of excavation of the optic nerve disc. Conclusions: the use of the neuroprotective drug in patients with the progression of primary open-angle glaucoma co-occurring with the changes in systemic hemodynamics enabled to achieve stabilization and improvement of the visual functions. Keywords: glaucoma, systemic blood pressure, peptide preparation, retinal ganglion cells, neuroprotection, retinoprotection. For citation: Makarova A.S. Retinoprotective therapy of glaucoma. Russian Journal of Clinical Ophthalmology. 2022;22(4):210–215 (in Russ.). DOI: 10.32364/2311-7729-2022-22-4-210-215.

Результаты неинтервенционного клинического исследования «Колибри» по оценке эффективности и безопасности применения препарата АМБЕНЕ® БИО у пациентов с первичным и вторичным остеоартритом различной локализации

Aim: to evaluate the efficacy and safety of therapy with AMBENE® BIO (in two courses for 48 weeks with a pause of 24 weeks) in patients with osteoarthritis of large and small joints of various localization. Patients and Methods: 118 patients with the established diagnosis of gonarthrosis or hand osteoarthritis of the hands were included in the study. Patients received AMBENE® BIO 1 ml once a day for 20 days according to the patient information leaflet. In gonarthrosis, intra-articular injection 1–2 ml into the target joint with an interval of 3–4 days during a course of 5–6 injections was prescribed. The therapy was conducted in two courses; the second course was conducted 6 months after. Before and after 30±7, 210±7 and 330±14 days from the treatment initiation, a comprehensive examination of patients was performed with an assessment of the pain severity on a 100 mm visual analog scale (VAS), the WOMAC index. The primary criterion for the analysis of efficacy was the degree of control over pain on movement, assessed by the subjects with the VAS 30±7 days after the treatment initiation (after the end of the first course in 10 days) versus the baseline. Results: initially, the pain on movement was 64.7 mm. After 30±7 days from the treatment initiation, the pain decreased to 41.6 mm (p < 0.05). Among patients with gonarthrosis, there was a significant positive trend on all scales of the WOMAC index (pain, stiffness, dysfunction, general indicator), and a significant decrease in pain was recorded on a 100 mm VAS, in particular, immediately after the end of the 20-day therapy course. Evaluation results of pain, stiffness and small joints function indicated that therapy with AMBENE® BIO had a significant positive effect in patients with hand osteoarthritis. No cases of severe adverse events were recorded. Conclusions: therapy with AMBENE®BIO in patients with osteoarthritis of small and large joints allows to achieve a statistically significant reduction in the pain syndrome severity and an improvement in the functional state of the joint in most patients. AMBENE®BIO therapy is characterized by a high safety profile and good tolerability. KEYWORDS: osteoarthritis, SYSADOA, chondroprotector, gonarthrosis, hand osteoarthritis, comorbidity. FOR CITATION: Feklistov A.Yu., Vorobieva L.D., Alekseeva O.G. et al. Results of a non-interventional study "Colibri" to evaluate the efficacy and safety of AMBENE® BIO in patients with primary and secondary osteoarthritis of various localization. Russian Medical Inquiry. 2022;6(3):126–132 (in Russ.). DOI: 10.32364/2587-6821-2022-6-3-126-132.

Кардиальные проявления постковидного синдрома у детей и подростков

The aim of the research. To study the features of cardiovascular system disorders in post-covid syndrome (PCS) in children and adolescents after a mild form of coronavirus infection (COVID-19). Material and methods. From 260 children and adolescents after a mild form of COVID-19, a total of 30 patients aged 7–17 years with cardiac manifestations of PCS were selected. Therewith, 32 patients with an uncomplicated form of the disease were selected to form a comparison group. In 3 and 6 months after disease onset, a comprehensive examination of patients was performed with a questionnaire on the subjective scale for MFI-20 assessment asthenia (Multidimensional Fatigue Inventory-20), electrocardiography (ECG), echocardiography; daily monitoring of ECG and blood pressure. The biochemical blood test included assay of creatine phosphokinase-MB (CPK-MB), troponin I and lactate dehydrogenase (LDH). Results. The incidence of PCS with cardiac manifestations amounted to 11.5 %. After 3 months from the disease onset, complaints of pain and discomfort in the chest, palpitations, fatigue, and poor exercise tolerance persisted. Asthenic syndrome was diagnosed in 70 % of patients. The “general asthenia” indicator totalled14 [12; 16] points (p<0.001) and was associated with the age of patients (r=+0.5; p<0.05). Arrhythmic syndrome and conduction disorders were detected in 67% of children. Labile arterial hypertension and hypotension occurred in 23 % of the adolescents. The increase in CPK-MB remained in 17% of the children, LDH – in 10%. In the sixth month after the onset of the disease, there were no significant differences in the results of the examination in the observation groups. However, a decrease in the level of resistance within 6 months was recorded in 43.3% of the schoolchildren with PCS (p<0.001). Conclusion. The data obtained indicate the need for early verification of cardiopathies in children with COVID-19, determination of a set of therapeutic and rehabilitation measures as well as ECG monitoring.

СОВРЕМЕННЫЕ АСПЕКТЫ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ЛИМФЕДЕМЫ КОНЕЧНОСТЕЙ

The article provides the literature overview on various current methods of surgical treatment of patients with limb lymphedema. Despite the fact that the basis of the treatment of this pathology is a complex antiedema therapy, the possibilities of conservative therapeutic measures for lymphedema leave much to be desired and cannot often satisfy either patients or clinicians. The use of surgical methods in the treatment of lymphedema has a long history and has gone from various types of resection to reconstructive interventions. The analysis of current literature data has shown that the choice of the volume and method of surgical correction in lymphedema requires a difficult and individual assessment of the pathological changes developing in the disease, which should be identified only with a comprehensive examination of patients. Operations of lymphovenous anastomosis, transplantation of lymph nodes are considered to be the most effective in the prevention or initial stages of lymphedema. With pronounced manifestations of the disease, optimal results are achieved with a reasonable combination of methods improving lymph drainage and operations reducing the excess volume of the affected limb, thereby provided patients with potentially improved functional outcomes and quality of life. The limitations in improvement despite multimodality treatment are consided to be at the level of satisfactory values. The experience of the most lymphedema professionals has to besuggesteda reasonable balance between basic conservative therapy and surgical treatment. Undoubtedly, the results of evaluating these methods will improve the choice of the optimal method for treating patients with limb lymphedema.

Особливості перебігу цукрового діабету 2-го типу у поєднанні з гіпотиреозом

Вступ. Останні десятиліття характеризуються значним збільшенням частоти захворювань органів ендокринної системи зі зміною структури, насамперед випадків поліендокринопатій, особливе місце серед яких займають поєднання цукрового діабету (ЦД) і тиреопатій. Збільшення частоти поєднання ЦД 2-го типу з гіпотиреозом впливає на особливості клінічного перебігу такої патології, залишається актуальною проблемою сучасної медичної науки. Мета дослідження: вивчення частоти гіпотиреозу у хворих на ЦД 2-го типу та встановлення клінічних особливостей перебігу ЦД 2-го типу у поєднанні з гіпотиреозом. Матеріали і методи. Проведено обстеження 179 хворих на ЦД у поєднанні з первинним гіпотиреозом, у тому числі 64 хворих на ЦД 1-го типу і 115 хворих на ЦД 2-го типу. Групу порівняння становили 62 хворі на ЦД без гіпотиреозу (з них 27 — із ЦД 1-го типу, 35 — із ЦД 2-го типу). Функціональний стан щитоподібної залози (ЩЗ) оцінювали за допомогою визначення базальних концентрацій тиреотропного гормона і вільної фракції тироксину. Результати. Встановлено, що пацієнти із ЦД 2-го типу та гіпотиреозом належали до більш старшої вікової категорії, ніж пацієнти з ЦД 1-го типу та гіпотиреозом. Так, вік пацієнтів у групі хворих на ЦД 1-го типу з гіпотиреозом становив 35,3 ± 9,5 року та у групі хворих на ЦД 2-го типу з гіпотиреозом — 47,6 ± 11,0 року. В усіх групах хворих відсоток жінок був значно вищим за чоловіків. Виявлено вірогідні відмінності щодо показника амплітуди глікемії — його збільшення у хворих на ЦД 1-го типу з гіпотиреозом. При поєднанні ЦД 2-го типу з гіпотиреозом показники ліпідного обміну були вищими, ніж при ЦД 2-го типу без тиреоїдної патології. Це підтверджує вплив гіпотиреозу на ліпідний обмін та обумовлює підвищення ризику прогресування серцево-судинних ускладнень за наявності двох захворювань. Висновки. Серед обстежених хворих гіпотиреоз траплявся у 2,4 раза частіше при ЦД 2-го типу, ніж при ЦД 1-го типу, що свідчить про більше число чинників ризику розвитку супутньої автоімунної патології за умов метаболічних порушень при ЦД 2-го типу. Інсулінорезистентність та гіперінсулінемія, що відзначаються при ЦД 2-го типу, сприяють проліферативним процесам, у тому числі й у тканині ЩЗ, а більш старший вік хворих на ЦД 2-го типу сприяє прогресуванню інволютивних змін і подальшому розвитку гіпофункції ЩЗ. Рекомендується обов’язкове комплексне обстеження хворих на ЦД 2-го типу щодо наявності супутньої тиреоїдної патології.