Federal Clinical Recommendations Research Articles

Microbiological studies of juniper extract to determine sensitivity to strains of microorganisms

Juniper is a widely used resource in the food, cosmetic, and medical industries. However, its application in veterinary medicine represents a less researched area. Literature studies confirm the presence of terpenoid compounds, tannins, ketones, sugars, organic acids, and flavonoids in juniper. Determination of the chemical composition of juniper essential oil revealed the prevalence of terpenes such as α-pinene, β-pinene, ocimene, and α-limonene, with variations depending on the species and habitat of the plant. Analysis of the literature data highlights the significant importance of α-pinene, serving as the primary and most studied terpene in juniper essential oil with notable diuretic properties. Furthermore, juniper essential oil possesses antibacterial, antifungal, anti-inflammatory, and deodorizing properties. The aim of the study was to reassess the antimicrobial and antifungal properties of the extract obtained from common juniper fruits through extraction. The research used extracts of essential oils obtained from common juniper fruits and tested them for antibiotic activity against microorganisms of various taxonomic groups. The experiment was conducted in accordance with sanitary and epidemiological requirements and federal clinical recommendations. The research methodology included serial dilutions, preparation of microbial suspensions, inoculation of nutrient media, incubation, and result assessment.

Sacroiliac joint syndrome is the cause of musculoskeletal back pain

The article considers a clinical case of treatment of one of the variants of nonspecific back pain – sacroiliac joint syndrome. In this case, we tried to demonstrate the importance of timely and accurate determination of the cause of dorsalgia using currently available tools: medical scales, X-ray and MRI examination, diagnostic drug blockade of the pain zone. A scrupulous analysis of complaints, anamnesis and clinical manifestations of the patient, a differential diagnosis with a number of diseases with a similar clinical picture, as well as the choice of treatment tactics based on federal clinical recommendations for the treatment of patients with nonspecific back pain made it possible to quickly determine the diagnosis and cope with the pain syndrome. Therapy with the inclusion of medications, physiotherapy, manual therapy, post-isometric relaxation, physical therapy, posture correction allowed the patient to stop the pain syndrome and return to an active lifestyle. Dexketoprofen (Dexalgin®) was prescribed to relieve the pain syndrome. Optimization of the method of administration of the drug is a step-by-step scheme for prescribing dexketoprofen: parenteral administration of 2 injections (50 mg) intramuscularly daily for 2 days, then transfer to oral Dexalgin intake – 25 mg 2 times a day for 3 days under the guise of proton pump inhibitors – Esomeprazole 40 mg 1 time a day, the use of a patch with a local anesthetic, vitamins of group B – 12 days, therapeutic and diagnostic drug blockades – contributed to a significant reduction in the intensity of the pain syndrome and allowed to prevent its transformation into a chronic process. As a result of the use of complex, pathogenetically based therapy, a rapid positive therapeutic effect was achieved.

Федеральные клинические рекомендации по диагностике и лечению саркоидоза: комментарии и акценты

Федеральные клинические рекомендации по диагностике и лечению саркоидоза: комментарии и акценты

Сlinical and economic evaluation of various etiotropic chemotherapy regimens in patients with respiratory tuberculosis with multidrug and extensively drug resistance

Objective: analysis of clinical and economic efficiency of various etiotropic chemotherapy regimes in patients with respiratory tuberculosis with multidrug- and extensively drug-resistant (MDR and XDR) pathogen using the pharmacoeconomic modeling method (Markov model).Material and methods. A single-centre, observational, retrospective, cohort study was performed, which included patients who received treatment in clinics and affiliated organizations of the main Moscow tuberculosis institution during 2014–2019 regarding respiratory tuberculosis with the MDR/XDR pathogen. The data of 1387 patients were analysed, of which 1093 patients received “optimized basic regimen” (OBR) in accordance with the Federal Clinical Recommendations of 2015, 294 patients received etiotropic therapy in accordance with the recommendations of the World Health Organization of 2018–2019. To evaluate economic efficiency, the pharmacoeconomic costeffectiveness analysis and pharmacoeconomic modeling were used. When assessing the economic costs of treatment, the direct costs (medical and non-medical) were taken into account.Results. The study results showed that 68.4% of patients in the group with bedaquiline-containing chemotherapy regimens reached the outcome of “treatment successfully completed” (patient was cured or transfered into the III group of dispensary follow-up) compared to 51.8% in the OBR group. The use of “new” etiotropic therapy regimens is most economically justified in patients with ХDR-tuberculosis with repeated treatment courses: incremental cost-effectiveness ratios (ICER) were 24,530.20 and 21,526.50 rubles per 1 patient. Markov model was developed, transitions from one state to another were evaluated according to the results of clinical observations during the first 2 years of research.Conclusion. The use of the dynamic model of the patient state made it possible to refine the estimates of the effectiveness of the compared etiotropic chemotherapy regimens for tuberculosis with MDR/XDR pathogen. Based on the results of modeling the dynamics of patients in the interval of 2 to 10 years of treatment, the use of “new” regimens provides a significant increase in the proportion of treatment success (by 16.1–29.8% in different groups of patients and at different times), a decrease in mortality (by 6.1–11.0%), and in the proportion of those who interrupted treatment (by 8.0–21.8%) in comparison with OBR.

Analysis of the impact of uterine fibroids of different locations and sizes on the perfusion and metabolic characteristics of the endometrium

BACKGROUND:Uterine fibroids are the most common benign tumor of the female reproductive system. A number of factors affect endometrial receptivity in patients with uterine fibroids such as transcription factorsHOXA10andHOXA11, cytokines (growth factors and inflammatory markers), etc. The negative effect of myomatous nodes, which deform the uterine cavity, on endometrial receptivity has been well studied and is beyond doubt, while the influence of intramural and intramural-subserosal fibroids on the endometrium is debatable. An important point is to define clear criteria that justify myomectomy in patients without clinical symptoms of the disease who are planning pregnancy, in particular, with the help of assisted reproductive technology. This article presents the results of studies on the impact of uterine fibroids of different locations on the endometrium. The data were obtained from foreign literature sources and such electronic databases as PubMed, CyberLeninka, and Google Scholar in the period from 2000 to 2022. This survey also reflects the main aspects of federal clinical recommendations and demonstrates the results of our own research.
 AIM:The aim of this study was to determine the effect of intramural and intramural-submucosal myomatous nodes nodes on the perfusion and metabolic characteristics of the endometrium.
 MATERIALS AND METHODS:We conducted a comprehensive examination of 20 patients of reproductive age with uterine fibroids who underwent surgical treatment in Gynecological Department One with Operating Unit of the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott (Saint Petersburg, Russia) and the Gynecological Department of N.A. Semashko City Hospital No. 38 (Saint Petersburg, Russia). Two groups were formed: group I consisted of 10 patients with multiple uterine fibroids (FIGO types 2 and 3); group II included 10 patients with intramural and intramural-subserosal myomatous nodes (FIGO types 4 to 6). Studies of endometrial perfusion and metabolism were carried out using a fiber optic system that implements fluorescence spectroscopy and laser Doppler flowmetry, including the LAKK-M diagnostic complex (Lazma Ltd., Russia) and a laparoscopic fiber optic probe, followed by registration of optical signals.
 RESULTS:In the group of patients with uterine fibroids that deform the uterine cavity, we revealed a statistically significant decrease in the microcirculation index in endometrial tissues and an increase in fluorescence signals at a wavelength of 365 nm. This may indicate hypoxic phenomena in endometrial tissues of patients with FIGO types 2 and 3 fibroids. These findings are some of the significant pathogenetic causes of implantation disorders and abnormalities in the physiological course of pregnancy in patients of this study group.
 CONCLUSIONS:The data obtainedsubstantiate the need to continue research in this direction in order to develop perfusion-metabolic criteria that allow for optimizing the choice of treatment strategies in patients with uterine fibroids.

Modern approaches to classification of adenomyosis

This article presents a modern review of the main classifications of adenomyosis based on the clinical course, the prevalence of the pathological process, the results of ultrasound and magnetic resonance imaging, and histological verification. The analysis is based on domestic and foreign literature, federal clinical recommendations, and results of our own research. Despite the large number of different classifications of the disease, there are still shortcomings noted in this review. Based on the available rubricators, we emphasized the need to create a classification of adenomyosis with an assessment of the clinical picture, genetic and molecular profiles, the results of non-invasive assessment methods, and a correlation with the histological conclusion. A unified classification would solve many problems in scientific and practical activities for accurate and early diagnosis of adenomyosis, identification of risk groups for patients with an aggressive course of the pathological process, selection of reasonable recommendations, and timely appointment of pathogenetic therapy.

Development of knowledge base structure for gout diagnosis

Gout belongs to the group of microcrystalline arthritides and is a systemic tophus manifested by inflammation of various tissues caused by deposition of monosodium urate crystals. Verification of gout diagnosis in Russia takes on average four to eight years from the beginning of the disease. This period is sufficient for the development of various complications (for example, gouty nephropathy) and disability of patient, and, therefore, it is necessary to revise the existing strategy for the diagnosis of this disease. One of the options for improving the provision of medical care can be attributed to the creation of a clinical decision support system (CDSS), which is based on the knowledge of experts, formalized as a knowledge base (KB).Aim. To develop a KB structure for CDSS for gout diagnosis.Material and Methods. Clinical information for gout diagnosis, presented as a nomenclature of medical concepts and logical schemes, which were collected on the basis of federal clinical recommendations, various literature sources and expert knowledge were used as materials. The ontological method was used as a method of knowledge structuring. Combined semantic network and frames were used as the methods of representation.Results. While developing KB structure, a combination of two methods of knowledge representation including semantic network and frames was used. An ontological approach was used in terms of knowledge structuring. The structure was built on the clinical knowledge collected in cooperation with experts in gout diagnosis. Compared with similar developments of diagnosing diseases based on knowledge engineering methods, the main feature of developed KB structure was the use of a separate type “Syndrome” concept as an aggregator accepted in medicine, significantly reducing the volume of KB for diseases.Conclusion. The KB structure was developed comprising the use of seven types of concepts and 11 types of relationships. The structure involved the use of ontological approach and combination of two models of knowledge representation, namely: a semantic network and a frame model.

Risk factors of healthcare-associated infections in recipients of bone marrow transplant

Bone marrow recipients are the most immunocompromizied patients who are susceptible to multiple infections. It is especially true for long-term episodes of drug-associated granulocytopenia. Our research goal was to identify risk factors of healthcare-associated infections (HAIs) in patients after bone marrow transplantation (BMT). Risk factors of developing HAIs were identified by accomplishing an analytical epidemiological “case – control” study with 973 patients participating in it. They all underwent BMT in the Hematology, Chemotherapy and Bone Marrow Transplantation Department of the Pirogov National Medical and Surgical Center on a period from 2015 to 2018. The following diseases were diagnosed in them: lymphoma (n = 158), multiple myeloma (n = 96), and multiple sclerosis (n = 719). HAIs cases were selected based on the standard (epidemiological) case definition in accordance with the Federal Clinical Recommendations on Epidemiological Surveillance over HAIs approved by the National Association of Experts responsible for Control over Healthcare-Associated Infections. Retrospective analysis established 75 HAIs cases or 7.7 % of the total number of the analyzed patients after BMT. Catheter-related bloodstream infections took the leading place among all the HAIs accounting for 52.0 ± 2.4 %. They were followed by bloodstream infections, 28.0 ± 3.1 %; lower respiratory tracts infections, 17.0 ± 3.2 %; and post-injection complications, 3.0 ± 0.6 %. Oncological diseases were established to cause HAIs in bone marrow recipients more frequently (ОR = 5.603; 95 % CI = 3.422÷9.174) than multiple sclerosis (ОR = 0.178; 95 % CI = 0.109÷0.292). This indicates that an underlying disease has its influence on a risk of infectious complications. We established a direct correlation between HAIs frequency and contamination with opportunistic microorganisms detected in objects in the hospital environment (r = 0.79, p = 0.01). This calls for implementing up-to-date disinfection provided for such objects.

Факторы риска развития инфекций, связанных с оказанием медицинской помощи, у реципиентов костного мозга

Bone marrow recipients are the most immunocompromizied patients who are susceptible to multiple infections. It is especially true for long-term episodes of drug-associated granulocytopenia. Our research goal was to identify risk factors of healthcare-associated infections (HAIs) in patients after bone marrow transplantation (BMT). Risk factors of developing HAIs were identified by accomplishing an analytical epidemiological “case – control” study with 973 patients participating in it. They all underwent BMT in the Hematology, Chemotherapy and Bone Marrow Transplantation Department of the Pirogov National Medical and Surgical Center on a period from 2015 to 2018. The following diseases were diagnosed in them: lymphoma (n = 158), multiple myeloma (n = 96), and multiple sclerosis (n = 719). HAIs cases were selected based on the standard (epidemiological) case definition in accordance with the Federal Clinical Recommendations on Epidemiological Surveillance over HAIs approved by the National Association of Experts responsible for Control over Healthcare-Associated Infections. Retrospective analysis established 75 HAIs cases or 7.7 % of the total number of the analyzed patients after BMT. Catheter-related bloodstream infections took the leading place among all the HAIs accounting for 52.0 ± 2.4 %. They were followed by bloodstream infections, 28.0 ± 3.1 %; lower respiratory tracts infections, 17.0 ± 3.2 %; and post-injection complications, 3.0 ± 0.6 %. Oncological diseases were established to cause HAIs in bone marrow recipients more frequently (ОR = 5.603; 95 % CI = 3.422÷9.174) than multiple sclerosis (ОR = 0.178; 95 % CI = 0.109÷0.292). This indicates that an underlying disease has its influence on a risk of infectious complications. We established a direct correlation between HAIs frequency and contamination with opportunistic microorganisms detected in objects in the hospital environment (r = 0.79, p = 0.01). This calls for implementing up-to-date disinfection provided for such objects.

СОВРЕМЕННЫЕ МЕЖДУНАРОДНЫЕ И РОССИЙСКИЕ РЕКОМЕНДАЦИИ ПО МОНИТОРИРОВАНИЮ И ЛЕЧЕНИЮ БРОНХИАЛЬНОЙ АСТМЫ У ДЕТЕЙ

Modern international and Russian recommendations for monitoring and treatment of bronchial asthma (BA) in children make it possible to form a unified position and achieve significant success in diagnostics and treatment of BA, reduce the mortality and disability of patients. The current revision of the National Program incorporates up-to-date changes and additions in accordance with the latest data accumulated by domestic and foreign researchers: GINA 2020-2021, Federal Clinical Recommendations for BA (2019), clinical recommendations of the European Respiratory Society as well as foreign best practices for treatment of BA in children. The systematic work of experts and the continuous update of the National Program have ensured its wide implementation and significant progress in the diagnostics and treatment of BA coupled with decrease in mortality and disability of patients.

Natural therapeutic factors in medical rehabilitation of patients with post-COVID syndrome

To develop a new medical technology for the 3rd outpatient stage of medical rehabilitation of the patients with post-COVID syndrome using natural therapeutic factors of Nalchik resort. There has been carried out a controlled study in compliance with the principles of randomization to develop an outpatient medical rehabilitation program including 168 patients with post-COVID syndrome. All the patients were divided into four groups: the control group (n=40) was prescribed pharmacotherapy and physical therapy in the hall in accordance with federal clinical recommendations; comparison group 1 (n=43) had drinking mineral water in addition; comparison group 2 (n=43) received physical therapy on the route of Nalchik resort terrainkur in addition to the treatment in comparison group 1; the main group (n=42) included a group psychotherapy on the Terrainkur route in addition to the treatment in comparison group 2. The results of the comparative analysis showed the feasibility of the developed outpatient medical rehabilitation program for the patients suffering from post-COVID syndrome: the overall effectiveness of rehabilitation measures increased compared to other follow-up groups by 10-15% due to the improvement of external breathing function (p<0.05), cognitive status (p<0.01), increased exercise tolerance (p<0.01), physical recovery (p<0.01) and mental health (p<0.01). The summation and integration of sanogenetic effects of physical factors, psychocorrective techniques, and pharmacotherapy provide a significant improvement in the physical and mental status of the patients with post-COVID syndrome.

Therapeutic physical factors in restorative treatment of patients with nonalcoholic steatohepatitis combined with biliary sludge

Purpose of the study. To study the effectiveness of restorative treatment of patients with nonalcoholic steatohepatitis in combination with biliary sludge at the inpatient stage when low-mineralized mineral water and preformed peloid therapy are included in the basic scheme. Material and methods. A total of 119 patients with nonalcoholic steatohepatitis in combination with biliary sludge were observed and distributed into 3 randomized groups: in the main group, 39 patients received basic drug therapy in accordance with the Federal Clinical Recommendations, «Sernovodskaya» mineral water for ingestion and in the form of gallbladder cleanse, and preformed application peloid therapy; in the comparison group, 40people received only pharmacotherapy and balneotherapy, in the control group — pharmacotherapy. The control of the effectiveness of the treatment was carried out according to the dynamics of clinical, biochemical and functional studies. Results. The inclusion of medium-mineralized mineral water «Sernovodskaya» in the form of drinking treatment and cleanse and preformed peloid therapy in the complex of therapeutic measures for patients provides a significant decrease in the intensity of clinical manifestations by 54.4% versus 40% with the use of pharmaco- and balneotherapy and 28,8% — with only drug therapy; cytolysis and cholestasis syndromes — by 46,2; 39,8 and 28.9%, respectively. Restoration of the contractile function of the gallbladder is observed in 78,8% of cases versus 65.6% when using only pharmacotherapy. The duration of hospitalization in the main group was reduced by 3 days, and in the comparison group — by 1,5 days, compared with the indicators in the control group. Conclusion. The developed new medical technology for the treatment of patients with nonalcoholic steatohepatitis in combination with biliary sludge with the combined use of mineral waters and preformed peloid preparations against the background of basic pharmacotherapy at the inpatient stage provides a significant increase in the efficiency of therapeutic measures.

Potential protective effect of zoledronic acid when switching from long-term therapy of osteoporosis with denosumab

In accordance with the data of the Federal Clinical Recommendations for the Diagnosis, Treatment and Prevention of Osteoporosis, with the latter, antiresorptive drugs (denosumab, bisphosphonates) are used, which mainly suppress bone resorption, and anabolic compounds (teriparatide), which enhance bone formation. The vector of their pharmacological effect helps to prevent BMD loss and significantly reduces the risk of low-energy vertebral fractures and fractures of other localizations. The experience of clinical trials makes it possible to successfully carry out antiresorptive therapy with some drugs (denosumab) for up to 10 years, demonstrating good adherence and tolerance. Bisphosphonates remain in the bone matrix for a long time and are characterized by a period of a certain aftereffect. Denosumab and teriparatide show their effect only during the period of direct use. According to some data, when denosumab therapy is canceled in a situation where the targeted goal is achieved, the incidence of vertebral fractures increases, especially in patients with a history of low-traumatic fractures. The article will present the main provisions of the European Calcified Tissues Society, the European Medical Agency, the Russian Association for Osteoporosis regarding the timing of treatment and an analysis of clinical situations requiring the appointment of alternative antiresorptive therapy. According to the resolution of the Council of Experts of the Russian Association on Osteoporosis, bisphosphonates are recommended for all patients to prevent an increased risk of vertebral fractures 6 months after patients had their last subcutaneous injection of denosumab. Oral bisphosphonates should be taken immediately, and zoledronic acid injection should be delayed for another 65 days following a missed denosumab injection.

Draft of the federal clinical recommendations for diagnosisi and treatment of amiodarone-induced thyroid dysfunction

Amiodarone is an antiarrhythmic drug that is commonly used for treatment of various supraventricular and ventricular arrhythmias. Amiodarone and its main active metabolite desethylamiodarone have a direct dose-dependent cytotoxic effect on thyroid follicular cells. Consequently, some patients receiving amiodarone may develop thyroid dysfunction: amiodarone-induced hypothyroidism (AIH) or amiodarone-induced thyrotoxicosis (AIT). The diagnosis, classification, and treatment of amiodarone-induced thyroid dysfunction remain to be a challenge to all clinicians deal with this problem. This draft of clinical recommendations was developed by a group of specialists experienced in the diagnosis and treatment of amiodarone-induced thyroid dysfunction. AIH does not require amiodarone withdrawal. Thyroxine treatment is recommended for all patients with manifest AIH, subclinical forms of AIH do not always need its prescription. There are two main types of amiodarone-induced thyrotoxicosis: AIT type 1 (is a hyperthyroidism that develops due to excessive iodine intake in autonomous thyroid nodules or latent Graves ‘ disease) and AIT type 2 (develops due to destructive thyroiditis because of the cytotoxic effect of amiodarone). In addition, there is a mixed form, which has features of both types of AIT. Autonomous AIT 1 is characterized by the presence of one or more «hot» nodules in the thyroid. Elevated TSH receptor antibodies or typical clinical manifestations confirm the diagnosis of diffuse toxic goiter and, consequently, AIT1. Colour-flow Doppler sonography (CFDS) is proposed as the basic method of differential diagnosis of AIT 1 and AIT 2. CFDS «pattern 0», usually indicates AIT 2, the presence of «patterns I-III» mostly typical for AIT 1. The thyreostatics are recommended for AIT 1, oral glucocorticoids for AIT 2 and their combination for a mixed AIT. Emergency thyroidectomy should be applied to patients with deteriorating cardiovascular pathology and ineffective drug therapy. In the absence of clinical suspicion on thyroid dysfunction, thyroid hormones assessment should be done 3 months after the start of amiodarone treatment, thereafter every 6 months.

Наш опыт хирургического лечения врожденной катаракты

Aim. To present our experience and evaluate the results of surgical treatment of congenital cataracts. Methods. A clinical analysis of the results of congenital cataract aspiration in 16 children (22 eyes) aged 2 months to 5 years is performed. Bilateral cataract was determined in 6 children, unilateral – in 10. Preoperative examination of children aged 3–5 years was carried out in a standard way. Children younger than 3 years of age at the initial appointment underwent non-contact examination methods, the remaining studies were performed under general anesthesia in the operating room immediately before surgery. Congenital cataract phacoaspiration was performed under general anesthesia using the Stellaris microsurgical system (Bausch and Lomb, USA) through a 1.2-mm paracentesis in the lens irrigation-aspiration regime. Hydrophobic IOL models were implanted. The posterior lens capsule was preserved in all cases. Mandatory was the appointment of cycloplegics in drops in the early postoperative period. Results. An increase in visual acuity (from 0.03 to 0.7) occurred in all cases. However, presence of obscuration amblyopia of varying degrees required regular courses of pleoptic treatment. Conclusions. The effectiveness of congenital cataracts phacoaspiration is ensured by the fulfillment of federal clinical recommendations, however, sutureless surgery allows achieving high functional results in the treatment of this pathology. Key words: congenital cataract; phacoaspiration; intraocular lens.

Measles in children. Weren’t you waiting? What should a pediatrician know

From a long time ago to the present day, measles remains one of the leading health problems in the world. The main reason for this is high mortality from measles – 1/500. Despite the availability of an effective and safe vaccine, which was discovered in 1963, there are still epidemic outbreaks of measles. According to WHO, there were 413,308 confirmed cases in 187 countries and 764 deaths during 2019. Most measles deaths are due to complications associated with the disease.Complications are most common in children under five or in adults over 30 years of age. The most serious complications include blindness, encephalitis leading to cerebral edema, severe diarrhoea and associated dehydration, purulent otitis and severe lower respiratory tract infections such as pneumonia. In a study from 2019, Michael J. Mina and colleagues showed that after measles in the group of unprivileged people, 11 to 73% of previous immune memory is “erased”. Currently, there is no specific etiotropic therapy for measles. One of the pathogenetic links in therapy is the use of interferon replacement therapy. According to the Federal Clinical Recommendations and WHO recommendations, the use of recombinant interferon α-2B and vitamin A is recommended. The effectiveness of interferonotherapy for measles was first shown in 1992 by the Leopardi R team. This study showed that the secretion of measles virus in human peripheral blood mononuclear cells was gradually reduced by increasing the concentrations and blocked at the concentration of interferon α-2B in 1000 units/ml. Moreover, at the XXIV World Congress of Neuroscientists (WCN) it was noted that the safest and most effective method of treatment of subacute sclerosing panencephalitis, one of the severe complications of measles, is recombinant human α-2B interferon.

Myocarditis in Children: Clinical Overview, Diagnosis and Treatment

The lecture presents modern views on the problem of myocarditis in pediatrics. Current ideas about the definition, prevalence, etiology and pathogenesis of inflammatory myocardial lesions in children are presented. Features of clinical manifestations of the disease in patients of different age groups, difficulties of diagnosis and treatment of myocarditis and its complications are disclosed in accordance with federal clinical recommendations. Special attention is paid to diagnostic approaches adjusted with the European society of cardiologists, including first and second level techniques, determination of indications for their implementation and diagnostic capabilities, as well as differential diagnosis of myocarditis with other cardiological diseases. Issues of heart failure treatment in myocarditis and indications for heart transplantation for patients under 18 years of age were also discussed. The lecture has illustrated clinical examples that clearly demonstrate the diversity of the clinical picture and the ambiguity of myocarditis prognosis in children and teenagers.

Laser technologies in the management of patients with complicated forms of sexually transmitted infections

Aim. To study and assess the clinical effectiveness of medical laser technologies in the complex treatment of complicated forms of sexually transmitted infections (STIs).&#x0D; Methods. Modern technologies of molecular biological laboratory diagnostics in real time with Real-time amplifier CFX96 Bio-Rad Laboratorias (USA), were used for etiological diagnostics of pathogens. Determination of infectious and inflammatory lesions of tissues of the genital system was carried out using ultrasound on ALOKA CCL-680 device (Japan) using cavity sensors with an operating frequency of 5 MHz. Drug therapy was carried out in accordance with the Federal clinical recommendations of the Russian society of dermatovenerologists and cosmetologists Dermatovenerology (Moscow, 2015). To assess the effectiveness of laser technologies in complex treatment, patients with complicated forms of STIs were randomly divided into 2 groups: the control group (32 patients), where only traditional therapy was used, and the main group (108 patients), in which, in addition to traditional therapy, treatment was supplemented with laser therapy.&#x0D; Results. The effectiveness of antibiotic therapy in the main group was 14.0%, and treatment using laser technology was 33.1% higher than the effectiveness of treatment in the control group. This shows the effectiveness of laser technologies in the treatment of infectious and inflammatory structural changes in the tissues of the organs of the reproductive system.&#x0D; Conclusion. The use of medical laser technologies in the treatment of complicated forms of STIs with a change in exposure parameters depending on the revealed inflammatory-structural changes in the tissues of the affected organs showed high efficiency (79.6%); this technology can be recommended for use in practical health care for the treatment of complicated forms of STIs.

ИНТЕГРАЛЬНАЯ ОЦЕНКА СТЕПЕНИ ТЯЖЕСТИ ТИРЕОТОКСИКОЗА

Introduction. Estimate thyrotoxicosis severity considering proposed integral index based on a medical history, the main clinical, laboratory and instrumental methods of research Purpose. A study of 37 patients with toxic goiter using the proposed thyrotoxicosis severity integrated estimation was conducted. 23 (62.1%) were diagnosed with diffuse toxic goiter (DTZ), and 14 (37.8%) had multinodular toxic goiter (MTZ). There were 31 women (83.7%) and 6 men (16.2%). Results. Using our integrated thyrotoxicosis severity estimation 11 people (29.7%) were diagnosed with mild thyrotoxicosis, 25 people (67.5%) - moderate severity, 1 man (2.7%) - severe thyrotoxicosis. Compared with the classification specified in the Federal Clinical Recommendations (2014), 1.6 times more cases of mild thyrotoxicosis and 6 times less cases of severe thyrotoxicosis were detected. Conclusion. The proposed thyrotoxicosis severity integral estimation index is simple and affordable for clinical practice usage, it allows to more accurately estimate patient’s condition severity, suggests a personalized approach not only to thyrotoxicosis severity estimation, but also to determine further treatment tactics.

ОБОСНОВАНИЕ УСТАНОВЛЕНИЯ ПЕРВИЧНОГО И КЛИНИЧЕСКОГО ДИАГНОЗА В ГРУППЕ ЗАБОЛЕВАНИЙ – ОСТРОЕ ОТРАВЛЕНИЕ ПСИХОТРОПНЫМ СРЕДСТВОМ

The study, based on clinical observations of a group of specialists (toxicologists, anesthesiologists, resuscitators), reflects the course of clinical symptoms that occur in acute poisoning with new psychotropic drugs (alpha-pyrrolidinopentiophenone). The article provides a rationale for establishing primary and clinical diagnoses that reflect the quality of medical care in patients in this nosological group of diseases, evaluated on the basis of Federal clinical recommendations and orders of the Ministry of health of the Russian Federation.