Concomitant Somatic Pathology Research Articles

Clinical and laboratory peculiarities in postmenopausal patients with benign ovarian tumors

Objective. To assess clinical and laboratory peculiarities of postmenopausal patients with benign ovarian tumors. Materials and methods. The data of a prospective study of concomitant somatic and gynecological pathology in postmenopausal patients with benign ovarian tumors (basic group, n = 40) and patients without pathologies (comparison group, n = 15) are presented. Clinical and laboratory data were evaluated in both groups as well. Results. Postmenopausal patients with benign ovarian tumors were frequently exposed to myomas, chronic salpingitis and chronic cervicitis, when women with no ovarian neoplasms did not have these pathologies. Patients of the main group had higher levels of FSG, leptin, GBP and lower levels of vitamin D, than patients of the comparison group. Conclusions. Postmenopausal patients with benign ovarian tumors frequently have concomitant gynecological pathology, pronounced vitamin D insufficiency and high levels of FSG, leptin and GBP in serum samples.

Fisher – Evans syndrome: rare cause of cytopenias in children

Interested in the problem of cytopenic conditions in children is associated with a various causes of them. The spectrum of differential diagnostic search is very wide: hemoblastoses, myelodysplastic and paraneoplastic syndromes, aplastic anemia. It is necessary for assessment of the main cause of cytopenia to pay attention on the patient’ common status (his complaints, anamnestic data — features of the start of the disease, previous diseases, concomitant somatic pathology, constant medication). Also on the complex and features of the clinical manifestations, the functional state of organs and systems, and in particular the liver, hematological changes in peripheral blood and bone the brain. The combination of immune thrombocytopenic purpura with autoimmune hemolytic anemia are named Fisher — Evans syndrome (FES). The article presents a clinical case of the combination Fisher — Evans syndrome and preceding B-lymphoma in a preschool child, and also reflects the main etiopathogenetic mechanisms of development this pathology. Fisher — Evans syndrome (SFE) is a rare autoimmune disease characterized by the immune thrombocytopenia (ITP) and Coombs–positive autoimmune hemolytic anemia (AIGA), which can develop simultaneously or sequentially, and in some cases are combined with immune neutropenia. The primary and secondary variants of Fisher — Evans syndrome are described. The secondary is the background of the following pathology: Epstein — Barr viral, cytomegalovirus, immunodeficiency virus, hepatitis C, parvovirus, varicella zoster virus, mycoplasma infection, tuberculosis), immunodeficiency and lymphoproliferative conditions, rheumatoid, autoimmune and malignant diseases such as systemic lupus erythematosus (SLE), antiphospholipid syndrome (AFLS), Sjogren’s syndrome, immunoglobulin A deficiency (IgA), autoimmune lymphoproliferative syndrome (ALPS), general variable immune deficiency (OVIN), lymphogranulomatosis (LGM), chronic lymphoblastic leukemia (CLL), autoimmune thyroiditis, autoimmune hepatitis, Takayasu arteritis, systemic sclerosis. The difficulties of searching causes are and indicated this diagnosis of exclusion. The question remains: is B-lymphoma the cause or accomplice of SFE in a child?

Neurofunctional and microstructural features of the brain in patients with nutritional obesity according to special magnetic resonance imaging techniques (literature review)

Background. Obesity is a chronic disease characterized by excessive accumulation of adipose tissue in the body, manifested by an increase in body weight by 20 percent or more of the average values. Obesity is becoming an increasingly significant public health problem. Assessment of the functional pathology of the brain provides more information about the pathogenetic changes leading to metabolic disorders. Modern methods of neuroimaging make it possible to obtain information about the initial functional changes in the brain according to the data of intracerebral connectivity - functional connectivity between its individual structures.Objective. The study of modern literature data on functional disorders of brain connectivity in patients with obesity, including those with eating disorders.Materials and methods. A systematic review of studies published in foreign and domestic literature has been carried out. Articles were searched using the PubMed database and Elibrary.Results. The problem of functional and microstructural studies of the brain in obesity is covered in sufficient detail in Western English-language literature. Nevertheless, it must be stated that at the moment there are practically no articles on the subject under study in domestic scientific publications. However, it should be noted that in the foreign literature there are rare data on neuroimaging of the brain in the aspect of neural network connectivity, studies in obesity with concomitant somatic pathology, for example, in type II diabetes, and other disorders of the endocrine system. There are relatively few data where correlations would be made with the age and gender of patients, concomitant mental disorders, which emphasizes the relevance of the issue.At the subsequent stages of the joint development of endocrinology, psychiatry and radiation diagnostics, the use of modern MRI techniques will help with the choice of target structures for stereotaxic correction of the described pathology. The clinical application of functional MRI will help to reveal the pathogenesis of various types of obesity at the neurofunctional levels with further prediction and analysis of the development of the disease, while the inconsistency and inconsistency of the currently obtained results of studies of the pathogenesis of alimentary obesity in terms of the pathology of functional connectivity based on fMRI, the absence clinical application of special MRI techniques substantiate the need to continue scientific research in this direction

КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ ГАНГРЕНОЗНОЙ ПИОДЕРМИИ У ДЕВУШКИ-ПОДРОСТКА

Pyoderma gangrenosum (PG) is the most severe type of pyoderma and is extremely rare among children and adolescents. Authors represent a clinical case of PG in a 14 years old female adolescent characterized by multiple sharply painful ulcerative defects with a pronounced tendency to peripheral growth. PG had arisen and proceeded further during the postoperative period against the background of iron deficiency anemia, chronic nonspecific nonulcerative colitis and a dysfunctional state of humoral immunity. Making a diagnosis, conducting differential diagnostics, identifying provoking factors, searching for concomitant somatic pathology, using a set of therapeutic measures made possible eliminating the PG clinical manifestations completely though development of the preventive measures and determination of the prognosis of the disease are difficult clinical tasks for pediatric practitioners nowadays.

The effectiveness of treatment depending on an adherence to dispensary observation and antiretroviral therapy in patients with HIV infection

Aim. Determination of the causes of deaths and analysis of the survival of people living with HIV, depending on an adherence to dispensary observation and treatment. Materials and methods. The analysis of socio-demographic characteristics and clinical and laboratory data of 284 adult HIV patients observed in 1999–2011 at the Lomonosov Interdistrict Hospital named after I. N. Yudchenko was carried out. Patients who followed the prescribed monitoring regimen (at least 2 times a doctor’s visit during the year) were considered committed to dispensary supervision. Patients who observed the regularity and continuity of monitoring and receiving antiretroviral therapy (ART) were considered committed to treatment. Among the patients included in the study, 115 people were committed to treatment or follow-up and 169 patients were non-committed. Objective (biological) indicators of adherence and effectiveness of treatmentwere the number of CD4 lymphocytes and the level of HIV viral load. Based on the method of comparing survival curves, factors related to the life expectancy of HIV patients were assessed, taking into account the gender of patients, their adherence to monitoring and treatment, indicators of HIV viral load and the number of CD4 lymphocytes and the outcome of the disease from the moment of registration at the dispensary and over the next 120 months (after 3 months, 6 months, 1.5 years, 2 years, 5, 7 and 10 years). Results and discussion. Significant differences were found in the survival curves of patients who received and did not receive ART (117.9 and 91.4 months, p<0.005) and patients who were committed and non-committed to therapy (116.9 and 83.8 months, p<0.005). Regardless of adherence to outpatient follow-up and therapy, the survival time of women compared to men for the entire follow-up period was longer (105.0 and 92.4 months, respectively, p<0.005). Among those committed to treatment, 21% of patients died due to concomitant somatic pathology, 5% from injuries incompatible with life. In the group of those committedto follow–up, the causes of deaths in 12% were various somatic pathology, brain lymphoma — in 1% and injuries incompatible with life — in 3% of cases. The highest mortality rates were recorded among patients who were not exposed to ART (71%) and the routine of follow-up (52%). Almost half of these patients (49%) died from secondary HIV infections, of which 85% of cases were posthumously diagnosed with tuberculosis, mainly the pulmonary form of the disease. The second most common cause of death was violent death, including drug poisoning. Conclusion. Regular dispensary observation, timely initiation of ART and adherence to therapy make it possible to control the disease, prevent the development of opportunistic pathology, and improve the quality and life expectancy of patients with HIV infection. Despite the increased availability of ART and strategies for active involvement and retention of patients in dispensary care, issues of patient adherence to therapy remain key in the management of HIV patients.

Оценка эффективности и переносимости карипразина у пациентов с параноидной шизофренией

Despite the emergence of a large number of new antipsychotics in recent decades, the therapy of schizophrenia, especially its paranoid form, remains a difficult and urgent task for practicing psychiatrists. This is primarily due to the complexity and often polymorphism of the clinical picture of the disease, the predominance in the structure of one or several characteristic symptom complexes – hallucinatory-paranoid, affective-delusional, senesto-hypochondriacal. The onset of paranoid schizophrenia at a young age makes it difficult to select a drug for therapy, which, along with a pronounced antipsychotic effect, a positive effect on both productive and negative symptoms, should have good tolerability in general and a favorable neuroendocrine profile, which will minimize the risk of the patient refusing therapy and maintain his social and labor functioning. As well as the therapy of elderly patients and patients with comorbid neurological, cardiovascular, and endocrine diseases, it also requires careful selection of the drug, taking into account its possible adverse effects and effects on the course of concomitant diseases. We present a number of clinical observations that demonstrate the effectiveness of the third–generation antipsychotic cariprazine – as a powerful antipsychotic drug with a favorable safety profile, providing high adherence to therapy and successfully used both in young patients with a complex clinical picture of paranoid schizophrenia, including those resistant to psychopharmacotherapy, and in patients with poor tolerability of drugs of various groups and the presence of concomitant somatic pathology.

Evaluation of the effectiveness of comprehensive treatment of combined pulpalperiodontal lesions in patients with concomitant somatic pathology

Aim: The study aimed to improve the treatment outcomes of combined pulpal-periodontal lesions in patients with various multisystem disorders.Material and Methods: The study included 150 patients with associated lesions of the intracanal-periradicular complex and various multisystem disorders. The age of the patients ranged from 20 to over 50 years. The patients were grouped based on the method used for endo-periapical therapeutic and preventive intervention. The first (main) group of somatic patients (n=50) received Hyaludent №4 and a calcium hydroxide preparation for prolonged endo-periapical effect over a month, coupled with macrophage reprogramming procedures using autoplasm.Results and Discussion: In the somatic patients of the main group, by the end of the year from the start of the endoperiapical treatment and after 24 months, the visual-instrumental examination indicator of the intracanal and periradicular status was zero. In the first control group of patients, the total indicator of the visual-instrumental examination of the endo-periapical state after the first month was 17.1% less than that of the second group, and after 6 months, it was 10.2% less. In the second control group of patients, the minimum value of the visual-instrumental examination of the intracanal-periradicular status was noted one year from the beginning of the pulpal-periodontal treatment.Conclusion: The maximum effectiveness of endo-periapical treatment was achieved in the main group of patients with intrasystem pathology, where the efficacy of endo-periapical treatment was nearly 90.0%.

Method and organization for expert evaluating of rehabilitation services for lower limb prosthetics: problems and solutions

Relevance. Prosthetics of the lower limb after amputation restores the patient's ability to move and self-care. Preparation and prosthetics in the early stages after amputation, in the absence of contraindications, improves the physical, psycho-emotional state of patients, reduces the risk of complications due to forced exercise and exacerbation of concomitant somatic pathology, as well as increases exercise tolerance, restores mobility, functioning after amputation.The aim of the work is to improve the quality of life of patients with mobility disabilities.Materials and methods. The information base of the study was the normative legal acts of the Russian Federation, standards, clinical recommendations defining the existing system of providing rehabilitation services for prosthetics of the lower limb.Conclusion. Unsatisfactory prosthetics of the limb after amputation negatively affects the quality of life of the patient. For this reason, the assessment of the rehabilitation service of prosthetics of the lower limb, including using the tools of the International Classification of Functioning, Disability and Health, is both relevant and necessary.

Роль предоперационной подготовки к кохлеарной имплантации у пациентов с тяжелой сопутствующей патологией

The own experience of managing patients with severe hearing loss and severe somatic concomitant pathology at all stages of cochlear implantation (CI) under local anesthesia is presented. Patients and methods. On the basis of the Center for Otorhinolaryngology, CI was performed under local anesthesia in 25 patients with sensorineural hearing loss grade IV or deafness with concomitant somatic pathology, 25 patients consisted of 17 men (68%) and 8 women (32%). The average age was 53.2±2.6 years. CI was performed under local anesthesia with 2% lidocaine solution using 1 mg adrenaline for 20 mL 2% lidocaine. The operation was performed using the classical method under the control of an OMPI Sensera S8 Karl Zeiss operating microscope. Results. Before the operation, all patients in the conversation were familiarized with each stage of the operation and with visual tables for contact between the doctor and the patient during the operation to monitor their subjective feelings. During the operation, anesthesia was well tolerated, and there were few complications. None of the patients showed feelings of anxiety, worry, or fear during the operation. After surgery, patients were questioned to identify early postoperative symptoms. Pain in the wound area of mild and moderate severity, mainly on the 1st day after the operation, was experienced by all patients; systemic dizziness, 7 patients (28%), hematoma around the implant was noted in 2 patients (8%). These symptoms were relieved by standard therapy by the 3rd day after surgery. Deterioration of the general condition associated with concomitant pathology was not observed in any of the patients. Conclusion. Compliance with the patient management algorithm at all stages of CI under local anesthesia with high-quality psychological preparation ensures good tolerability of the operation, psychological comfort of the patient during the operation, and a small number of complications, both during and after the operation.

Генетические предикторы выживаемости и развития MACE в остром периоде инфекции, вызванной SARS-COV-2, у пациентов высокого кардиоваскулярного риска

Introduction. Despite the fact that the SARS-CoV-2 virus is highly contagious, the clinical manifestations of the disease caused by it can have significant differences: from a low-symptom course to extremely severe forms with the development of a fatal outcome. It is obvious that the observed polymorphism of the development of infection caused by SARS-CoV-2 is due, among other things, to genetic factors. These include single-nucleotide polymorphisms of genes involved in the stages of the pathogenesis of infection: from the penetration of the virus into target cells, the expression of its RNA to the response of the host organism. The study of genetic predictors that cause changes in susceptibility to the SARS-CoV-2 virus and differences in the severity of infection will help to better understand the pathogenesis of this disease and give an idea of promising areas of therapy and prevention. Aim. To study the relationship of genetic biomarkers with the severity of infection caused by SARS-CoV-2, cardiovascular complications and the risk of death in the early period of the disease. Design. A single-center retrospective study. Materials and methods. The study included 164 patients (90 men, 74 women) with infection caused by SARS-CoV-2. All patients were classified as high and very high cardiovascular risk. Concomitant somatic pathology: arterial hypertension in 164 (100%), coronary heart disease in 80 (48.9%), alimentary obesity in 100 (61%), prediabetes in 52 (31.74%), chronic kidney disease in 34 (20.7%) patients. At the first stage of the study, the relationship of genetic biomarkers with the severity of the disease was evaluated, at the second — with cardiovascular complications, and at the third — with the onset of death. Results. In the group of patients with severe disease, variant DD of ACE Alu I/D gene polymorphism, rs4646994 (p = 0.004), variant GG of IL-10 polymorphism 1082 G/A, rs1800896 (p = 0.043), allele *11 HLA-DRB1 (p = 0.015) were significantly more common. The genetic predictors of the development of cardiovascular complications were the genotype DD of the ACE gene (rs4646994) (p = 0.038), the allele *3 HLA-DRB1 (p = 0.041), the allele *13 HLA-DRB1 (p = 0.047) was less common. When searching for a correlation between the selected genetic biomarkers and mortality, only a negative contribution of the ACE Alu I/D polymorphism variant DD, rs4646994 (p = 0.015) was revealed. The survival analysis showed that in the DD variant of the ACE Alu polymorphism I/D, rs4646994, the median survival rate is lower than in the II variant (13 (9–15) days and 21 (12–n/o) days, respectively (p = 0.03)), and lower than in the ID (31 variant (14–n/ o) day (p < 0.0001)). The survival rate of patients with the heterozygous variant of the polymorphism MTRR –66 A/G, rs1801394 was 11.5 (9–16) days, with variant AA — 7 (3–n/o), and with variant GG — 6 (4–14), p = 0.013. With the *16 HLA DRB1 allele, survival was only 5.5 (2–n/o) days versus 22 (17–n/o) days in patients without it, p = 0.04. Conclusion. Predictors of an increased risk of severe infection caused by SARS-CoV-2 include the DD variant of the ACE Alu I/D gene polymorphism, rs4646994, the GG variant of the IL-10 1082 G/A gene polymorphism, rs1800896 and the *11 HLA-DRB1 allele. The negative effect of the DD variant of the polymorphism of the ACE Alu I/D gene, rs4646994, the *3 HLA-DRB1 allele and the protective effect of the *13 HLA-DRB1 allele have been proven in relation to the overall risk of major cardiovascular complications. The carriage of the *16 HLA-DRB1 allele and the DD variant of the ACE Alu I/D gene polymorphism, rs4646994, correlate with an increased risk of early hospital mortality in patients. At the same time, the heterozygous variant of the MTRR –66 A/G polymorphism, rs1801394, is a protective biomarker and is associated with better survival. Key words: COVID-19, SARS-CoV-2 virus, mortality, cardiovascular complications, cardiovascular risk, genetic biomarkers

Современный взгляд на проблему генитального пролапса через призму факторов риска.

Introduction. Pelvic organ prolapse (POP) is one of the varieties of pelvic floor hernias and has a significant impact on the quality of life of a modern woman. The prevalence of POP is quite high, and the peak values of its occurrence reach 5% in women aged 60 to 69 years. The current trend in the world towards an increase in the occurrence of POP is associated with an increase in the life expectancy of women, the participation of women in the production process, the presence of concomitant somatic pathology, the identification of risk factors in the detection of a small degree of prolapse allows identifying risk groups for rapid progression of POP and timely implementation of therapeutic measures. Aim. To identify new modern risk factors for POP. Materials and methods. The study is a cohort retrospective non-randomized. The main group consisted of 110 patients with grade II-IV POP according to the POP-Q classification. The control group consisted of 34 women without established gynecological diseases. Results. Women with PОР were significantly more likely to live in rural areas, had a higher average body weight than patients without gynecological pathology, they were in postmenopause for a longer time. Patients with POP were significantly more often observed for diseases of the chronic tonsillitis, the cardiovascular system, as well as for varicose veins of the lower extremities. The patients of the main group had more abdominal operations in the anamnesis and higher parity than in the control group. Conclusion. The risk factors for POP were the duration of postmenopause, high parity (natural childbirth) and overweight. The risk factors for PОР are diseases of the cardiovascular system, varicose veins of the lower extremities, chronic tonsillitis and surgical interventions on the abdominal organs.

Gottron’s Carcinoid Papillomatosis: Case Report

Introduction. Gottron’s papillomatosis is a rare benign type of dermatosis with pseudoepitheliomatous hyperplasia of the epidermis, first described as an independent disease by the German dermatologist H.A. Gottron. Invasive epidermal growth and hyperkeratosis reveal no signs of malignancy. Chronic venous insufficiency and lymphedema can be associated with various secondary skin lesions: the formation of ulcers, hyperkeratosis and skin papillomatosis, as well as infectious complications. Skin papillomatosis may be a manifestation of paraneoplastic syndrome, which requires a careful differential diagnosis. Timely treatment of complications in a patient with concomitant somatic pathology performed by a multidisciplinary team of specialists is necessary to improve the prognosis. Considering the relative rarity of Gottron’s papillomatosis and the lack of awareness among practicing physicians regarding the differential diagnosis of this disease, we present this clinical analysis.Description of a clinical case. Patient L., 42 years old (body mass index — 76.5 kg/m2) with chronic lymphovenous insufficiency, lymphedema, erysipelas of the right lower limb associated with unspecified skin papillomatosis, was urgently hospitalized in a health care institution “City Clinical Hospital No. 3” of Grodno (Republic of Belarus), consulted by a multidisciplinary team of clinicians including a therapist, a cardiologist, a dermatologist, an endocrinologist, an infectious disease specialist, and a surgeon. Taking into account the clinical status of the patient and the retrospective analysis of archival records of previous examinations performed on the patient in the health care institution “Grodno University Clinic”, the type of dermatosis was determined as Gottron’s papillomatosis of both lower extremities. In terms of the clinical diagnosis of the patient, complex therapy was initiated in a hospital setting, which was then continued at the outpatient stage.Conclusion. Adequate long-term treatment of morbid obesity and chronic lymphovenous insufficiency is necessary to prevent serious complications. According to the academic literature, timely diagnosis of such a rare dermatosis as Gottron’s papillomatosis, as well as the prescription of adequate therapy determine the possibility of regression in the early stages of the disease.

Diagnosis of posterior laryngeal cleft in a newborn with multiple congenital malformations

The article describes a rare congenital malformation – laryngeal cleft in a newborn. Clinical manifestations are characterised by diverse non-specific symptoms in the form of dysphagia, cough, aspiration, and stridor. The severity of the condition is determined by the depth and degree of the defect and concomitant somatic and neurological pathology of the child. The article presents a clinical case of a Type 3 laryngeal cleft in a newborn with multiple congenital malformations and presents a diagnostic search for a cleft. At the age of 7 months, endoscopic suturing of the defect was performed, which allowed restoring enteral nutrition and normalizing the nutritional status of the child.

Minimally-invasive and non-invasive methods of thermal destruction in the treatment of patients with aggressive fibromatosis

The purpose of the study was to characterize various methods of local physical destruction used in the treatment of patients with aggressive fibromatosis and demonstrate international experience of their use.Material and Methods. literature search was conducted in the electronic databases Rsci (Russian science citation index) and NcBi (National centre for Biotechnology information) in the interval time between 2002 and 2022. The review was devoted to the thermal ablation modalities (radiofrequency, microwave ablation, cryodestruction, high-intensity focused ultrasound ablations) used in therapy of patients with desmoid fibromas of various locations, as well as their safety and efficacy.Results. The review presents the current data on safety and efficacy of minimally-invasive and non-invasive methods of hypo- and hyperthermic local destruction in patients with aggressive fibromatosis, gives the characteristics of exposure and biological effects when performing radiofrequency and microwave ablation, cryodestruction, high-intensity focused ultrasound therapy, describes the main limitations of the methods, indications and contraindications for their application, as well as the methods of prevention of the development of desmoid fibromas.Conclusion. The described methods of local destruction are used in clinical practice mainly for palliative and symptomatic purposes, in case of persistent tumor growth or recurrence, ineffectiveness of other treatment options or contraindications to them due to concomitant somatic pathology or functional status of the patient. Inclusion of these methods in the treatment plan of patients with aggressive fibromatosis can contribute to the reduction of pain syndrome, improvement of functional status of patients as well as long survival with no evidence of tumor progression.

Perforative duodenal ulcer in a patient in the acute period of ischemic stroke. Case report

Perforated duodenal ulcer is a common pathology with fairly high postoperative mortality, especially in late diagnosis. In some cases, timely diagnosis of a perforative ulcer may be difficult and the results of the survey may be contradictory. The classical triad of clinical signs of perforative ulcers is not always observed in patients, sometimes the clinical picture is so unclear that the final diagnosis can only be made intraoperative. The article presents an analysis of the clinical case of difficult diagnosis and treatment of perforative duodenal ulcer in a patient in an acute period of ischemic stroke. In addition, the patient had severe concomitant somatic pathology with a high risk of systemic thromboembolism and at the same time a high risk of bleeding.

Medical and social factors of delinquency in children with pervasive neurodevelopmental disorders

Recently, a number of delinquencies with children and adolescents increases. Currently, numerous sociopsychological factors of deviant behavior have been identified. At the same time, modern research of delinquency is also focused on the study of medical prerequisites for the deviant behavior development, such as the presence of mental diseases that cause low intelligence, a tendency to auto-aggression and extra-aggression, emotional insensitivity and asociality. Until now, medical aspects of delinquency have been mainly focused on psychosocial factors and psychiatric nosologies. However, such an important factor as the general somatic health of the child is often not taken into account. Despite the high frequency of somatic morbidity in children with autism spectrum disorders (such as: gastrointestinal functional disorders, allergic diseases, metabolic disorders), the role of psychosomatic factors and comorbid conditions and their association with delinquency is still undetermined. The aim is to determine the structure of delinquency and the importance of psychosomatic factors in the formation of externalizing disorders in children and adolescents with neurodevelopmental disorders, which was conducted with the participation of 32 children aged 2 to 11 (7.3±0.5) years. It was established that changes in the cog­nitive (56.2±7.0%) and emotional (62.5±8.6%) spheres prevail in the structure of psycho-behavioral disorders of children with neurodevelopmental disorders. A significant role in the formation of externalizing disorders is played by concomitant somatic pathology, which is characterized by a tendency to process chronification, disturbs the quality of life, and negatively affects emotional and volitional indicators. An integrated assessment of social, psychological, pedagogical and medical factors of delinquency is the key to effective correction and prevention of behavior disorders in children.

The prevalence of anxiety syndrome in people with chronic non-communicable diseases in real clinical practice

Objective: to study of the features of the spread of anxiety syndrome in patients with chronic non-communicable diseases (CNCD) in outpatient practice. Materials and methods: the study included persons of both sexes over 18 years of age who visited outpatient facilities in a large industrial center of Eastern Siberia in the summer of 2022. Diagnosis of chronic NCDs was established according to modern clinical guidelines. The examined were divided into two groups. The first group included persons without NCDs, the second group included patients with concomitant NCDs. The psycho-emotional state was assessed using the Spielberger-Khanin test with separate determination of the levels of personal and situational anxiety. Statistical data analysis was carried out using the Statistica 12.0 software package (StatSoft Inc., USA). Results: the level of situational anxiety in patients with chronic NCDs was statistically significantly higher compared to individuals without concomitant somatic pathology. In patients with chronic NCD, compared with individuals without them, a significant increase in the median scores for the level of low and moderately expressed personal anxiety and for the level of moderate and high situational anxiety was revealed. In the group of patients with CND, a high level of personal and situational anxiety was significantly more often observed in comparison with persons without CND. Conclusion: the prevalence of anxiety syndrome, especially situational anxiety in patients with chronic NCD in the outpatient network is quite high and reaches 93%, which requires a solution to the issue of practical psychiatric care for these patients.

On the use of narrow-band optical radiation with an average wavelength of 470 nm in comprehensive therapy of Covid-19 in a hospital setting

The purpose of the study is to substantiate the use of narrow-band optical radiation with an average wavelength of 470 nm (blue light) as a part of the comprehensive therapy of COVID-19. Materials and methods. 29 patients with COVID-19 were examined. All the patients were randomly divided into 2 clinically comparable groups: the main group (16 patients), in parallel with the drug therapy, received 10 sessions of narrow-band optical radiation with an average wavelength of 470 nm using the laser-LED therapeutic system «Spectrum-LC»; the control group (13 patients) received drug therapy in accordance with the scheme of the interim guidelines for the prevention, diagnosis, and treatment of the novel coronavirus infection COVID-19. The unified examination algorithm included the analysis of medical histories, anamnesis of the disease, concomitant somatic pathology, and allergic reactions. The following laboratory methods were used: complete blood count, biochemical blood test, coagulogram parameters (fibrinogen, D-dimer, Quick prothrombin time, activated partial thromboplastin time), polymerase chain reaction; the instrumental examination methods were as follows: pulse oximetry, electrocardiography, and multispiral computed tomography of the chest. After the comprehensive therapy with the blue light, the following results were noted: a significant decrease in the severity of the pathological process based on the results of computed tomography of the lungs — a decrease in the volume of lung tissue damage by 9 %, relief of intoxication, neurotic, and astheno-depressive syndromes on the 10th day of inpatient treatment, stabilization of the general condition on the 8th-10th day of inpatient therapy, reduction of hospitalization time to 13–14 days, positive changes of laboratory parameters: a significant decrease in the neutrophil parameter by 26.35 %, in the CRP parameter by 89.24 mg/l, in the fibrinogen parameter by 2.75 g/l, and in AST parameter by 61.27 units/l.

Intraoperative neurophysiological monitoring in surgery of lumbar spinal stenosis

Background. Lumbar spinal stenosis is a pathological constriction of the central spinal canal, lateral pocket or intervertebral foramen. The complication rate of lumbar spinal stenosis surgery ranges from 10 to 24 %. In order to reduce the number of intraoperative and early postoperative complications accompanied by the development of neurological deficit, various techniques of intraoperative neurophysiological monitoring are used.Aim. Study of informativity of the use of intraoperative neurophysiological monitoring during surgical treatment of degenerative lumbar spinal stenosis based on the experience of the neurosurgical department of the Republican Clinical Hospital (Yoshkar‑Ola, Mari El Republic).Materials and methods. Thus, 69 decompressive‑stabilizing surgical interventions for degenerative lumbar spinal stenosis at the L3–L5 level, performed with intraoperative neurophysiological monitoring (free‑run electromyography, transcranial motor evoked potentials, somatosensory evoked potentials, triggered electromyography were included in the retrospective study).Results. During intraoperative neurophysiological monitoring transcranial motor evoked potentials from the legs was registered in all cases. Normal somatosensory evoked potentials were recorded in most cases, in 12 cases (17.4 %) baseline somatosensory evoked potentials were not registered due to preoperative neurological deficits and the presence of concomitant somatic pathology. 308 inserted pedicular screws were examined using the triggered electromyography. Muscle responses were registered in 31 (45 %) operations, 45 (14 %) screws. True negatives were registered with 29 (64.4 %), true positives were registered with 12 (26.7 %), and false positives were registered with 4 (8.9 %) screws. In the postoperative period no increase in motor and sensory neurological deficits was observed in all patients; no neurological signs of screw malpositioning were revealed.Conclusion. The use of multimodal intraoperative neurophysiological monitoring during surgical treatment of lumbar spinal stenosis reduces the risk of postoperative neurological complications.

<i>Stenotrophomonas maltophilia</i> Infection in Trauma and Orthopedic Patients: Clinical Experience and Review

Background. Stenotrophomonas maltophilia (S. maltophilia) is a gram-negative non-fermenting bacillus and is a rare pathogen of orthopedic infection. Due to the relatively low virulence of S. maltophilia, many clinicians are still faced with the question of whether this bacterial species is simply a colonizing agent or the true cause of infection.
 Aim of the study to raise the awareness of practitioners about S. maltophilia as a rare pathogen of orthopedic infection.
 Methods. A retrospective analysis was performed concerning the frequency of S. maltophilia isolation from patients treated at the Vreden Center for periprosthetic infection and/or osteomyelitis from January 1, 2009 to October 31, 2022. The literature search by keywords was carried out in the PubMed/MEDLINE, Scopus, eLIBRARY, and Cyberleninka databases. The search retrieved 587 articles published in Russian or English over the period from 2012 to November 2022.
 Results. During the study period, 9 cases of orthopedic monoinfection with S. maltophilia were identified in 9 patients aged 36 to 83 years. At the time of admission, no leukocytosis was detected in patients, and only 2 of 9 patients had elevated C-reactive protein level. S. maltophilia is naturally resistant to many broad-spectrum antibiotics. Co-trimoxazole is considered the drug of choice for the treatment of S. maltophilia infection. The limited choice of drugs for targeted therapy, the presence of multiple determinants of antibiotic resistance, the existence of microbial associations and patient risks including implantation, chronic nature of infection, elderly age, as well as the presence of significant concomitant somatic pathology can lead to the ineffectiveness of the ongoing treatment of infections caused by S. maltophilia. Our experience shows that in the case of sensitivity of S. maltophilia strain to co-trimoxazole it is possible to prescribe this drug for a long course as monotherapy, provided that the radical surgical treatment of the focus is performed.