General Somatic Status Research Articles

Markers of oncological prognosis in the surgical treatment of oral squamous cell carcinoma

The progression of head and neck squamous cell cancer (HNSCC) may be influenced by the characteristics of the local and systemic immune response, including the peculiarities of systemic inflammatory response during surgical interventions. The dependence of the prognosis of cancer patients on the preoperative general somatic status and postoperative complications is demonstrated precisely through the prism of a systemic inflammation development promoting the progression of oncological process. It is necessary to study the interaction of a typical inflammatory reaction and the features of reparative processes to understand the correct treatment strategy for patients with oral cancer in the conditions of the existing oncological process. It was found that chronization of inflammation is associated with m2-macrophage polarization which contributes to the tumor progression. And systemic inflammation indices correlate with treatment results. It is also necessary to identify prognostic factors of postoperative complications that affect the chronization of inflammation. They may include the general somatic and nutritional status of patients, concomitant diseases and indices of systemic inflammation. It is obvious that improving the results of surgical treatment of patients with oral cancer can be influenced by various ways of managing the inflammatory response, including the peculiarities of performing the reconstructive interventions and improving the preoperative general somatic and nutritional status.

Low level of the dental health as an indicator of malignant of the oral mucosa

Introduction. The manifestation of oncological alertness during dispensary observation by a dentist is very important. The most accessible options for preventing malignancy of the oral mucosa are sanitation, regular professional oral hygiene, as well as educational work among doctors and the population. However, despite the visual accessibility of tissues and organs of the oral cavity, there is an annual increase in malignant neoplasms in this area. In this case, most patients are diagnosed with a tumor process of the last stage. malignant neoplasms of the head and neck organs require special attention due to high risk of disability even at an early stage. Aim. To evaluate a correlation between malignancy of the oral mucosa and the burdened dental status of patients. Materials and methods. A controlled study was conducted which included 142 patients with cancer of the oral mucosa without sequential or parallel inclusion of patients in groups. Dental status was assessed at help-seeking stage or during clinical examination, as planned, by evaluation of main dental indices. The morphological diagnosis was established using histological verification. Results. The majority of patients with oral tumors had hard dental plaque (81.7 % of cases). The condition of the soft tissues, in addition to presence of the mucous membrane lesion, was characterized by bleeding (69 % of cases). moderate periodontal pathology was detected (19 % of cases). patients with the cavity tumors had an acute traumatic edge of hard tissues (70 % of cases), extensive caries (26 % of cases) and the presence of removable dentures (82 % of cases). Conclusion. The values of parameters evaluated in patients in the study with squamous cell carcinoma of the oral mucosa show its relation to aggravation of general somatic status. All patients in the study required dental treatment and training in oral hygiene care.

The role of a complete clinical examination for the safety of wearing contact lenses for myopia control (literature review)

Introduction. In the light of E.S. Avetisov’s hereditary-physiological theory of the pathogenesis of myopia and works devoted to the infl uence of peripheral myopic and hyperopic defocus on refraction, it makes sense to consider myopia as a multifactorial disease, so patients with myopia should receive comprehensive monitoring and treatment from related specialists. However, in practice, the general somatic status of patients and the presence of concomitant diseases in them are often not studied. Purpose: to analyze literature data on the impact of patients’ comorbidities on their wearing of contact lenses, to assess potential risk factors in such patients, and to draw the attention of an ophthalmologist to the importance of a complete clinical examination. Materials and methods. An analysis was made of publications on such resources as Pubmed, eLibrary, Medline over the past 30 years. 43 literature sources were analyzed, of which 37 were published no later than 10 years. Results. The authors of these publications describe how taking drugs from the group of retinoids, the presence of allergic conjunctivitis, thyroid diseases, rheumatoid arthritis, diabetes mellitus, and the characteristics of the patient’s psycho-emotional state can infl uence the incidence of complications when using contact lenses. Conclusions. Taking into account numerous studies on the relationship between the progression of myopia and general somatic diseases, as well as the features of contact correction in childhood with comorbidities, we can say that a complete clinical examination of each patient is of high importance.

УЧЕТ ИНДЕКСА КОМОРБИДНОСТИ ПРИ ПРОВЕДЕНИИ ПРОТИВООПУХОЛЕВОЙ ЛЕКАРСТВЕННОЙ ТЕРАПИИ У ПАЦИЕНТОВ ПОЖИЛОГО И СТАРЧЕСКОГО ВОЗРАСТА С КОЛОРЕКТАЛЬНЫМ РАКОМ (ОБЗОР ЛИТЕРАТУРЫ)

The problem of treating elderly patients is one of the most pressing in modern clinical medicine. Colorectal cancer is one of the main causes of mortality from malignant neoplasms in Russia and other developed countries. At the same time, the incidence of tumors of the colon and rectum steadily increases with age. Before starting treatment for elderly patients, it is necessary to carefully weigh the potential risks and the possibility of achieving positive results of antitumor therapy. Objective: To summarize the literature on the use of a comprehensive geriatric assessment, including the Cancer and Aging Research Group (CARG) toxicity assessment, to predict the risk of adverse events during anticancer drug treatment in elderly patients diagnosed with colorectal cancer. Materials and methods: The search for scientific sources was carried out in PubMed / Medline / UpToDate using the following keywords: “malignant tumors”, “metastatic colorectal cancer”, “senile age”, “antitumor drug therapy”. The time horizon covered 2016–2023. Using a time filter, the most relevant and innovative research papers on the issues of chemotherapy treatment of elderly and senile patients were selected. Results: Most current evidence demonstrates the importance of performing a comprehensive geriatric assessment (CGA), Cancer and Aging Research Group (CARG) toxicity assessment in elderly and geriatric patients. Information obtained from geriatric assessment should be used to predict and manage treatment toxicity. And also for assessing and predicting overall survival. Activities based on CGA can reduce the toxicity of chemotherapy, improve the quality of life of patients, and increase compliance with medical recommendations. Undoubtedly, a comprehensive geriatric assessment (CGA) can help achieve the necessary balance between the potential effectiveness and adverse events of chemotherapy. The choice of treatment tactics for an elderly and senile cancer patient should be based on the patient’s functional status (PS), general somatic status according to the ECOG scale, and the risk of toxicity according to the CARG scale. In the presence of colorectal cancer, patients with good functional status who need antitumor systemic effects can be prescribed polychemotherapy with FOLFOX, XELOX, FOLFIRI doublets with the addition of targeted drugs: bevacizumab or cetuximab (depending on the results of gene profiling of the tumor). Patients who are not candidates for polychemotherapy in standard doses, who have a general somatic status on the ECOG scale of 1-2 and an average risk of developing toxicity of grade 3 on the CARG scale, can undergo PCT with FOLFOX, XELOX, FOLFIRI doublets with a reduction in the starting dose by 20%, or monochemotherapy with antimetabolites: capecitabine, 5-fluorouracil; topoisomerase I inhibitor irinotecan. Patients with poor functional status, general somatic status on the ECOG scale 3-4, and a high risk of developing toxicity on the CARG scale are not candidates for systemic combination chemotherapy. Particular attention should be paid to maintenance therapy in this subgroup of patients. However, if the decrease in PS level is directly related to malignancy and PS ≥2, the possibility of monochemotherapy by infusion of a combination of 5-fluorouracil and leucovorin FU/LV can be evaluated.

ВЫБОР МАТЕРИАЛА ПРИ ОКАЗАНИИ ОРТОПЕДИЧЕСКОЙ ПОМОЩИ ПАЦИЕНТАМ С ЧАСТИЧНЫМ И ПОЛНЫМ ОТСУТСТВИЕМ ЗУБОВ (обзор литературы)

Orthopedic treatment is extremely difficult for diseases of the oral mucosa, such as chronic recurrent aphthous stomatitis, leukoplakia, lichen planus, etc. Domestic scientists have long recognized the need for a differentiated approach to the selection of material for the manufacture of dentures, taking into account the individual characteristics of the patient’s dental and general somatic status, and microflora of the oral cavity. The choice of material is carried out taking into account not only its physicochemical characteristics, but also the biological effect on the oral mucosa. Purpose of the work: to identify new scientific data by analyzing systematic reviews that reveal the etiological aspects and pathogenesis of lichen planus of the oral mucosa. A review of domestic and foreign scientific literature over the past 10 years was conducted, which analyzed dissertations and articles published only in peer-reviewed scientific journals. Acrylic resins remain the most common structural material in partial and complete removable prosthetics. But such negative properties of acrylic orthopedic structures, such as residual monomer and microporosity, often lead to an increase in the number of allergic reactions in patients, the occurrence of microcracks in the prosthesis and other negative consequences. An alternative to removable dentures made of acrylic plastics are fairly widely used orthopedic structures made of thermoplastic materials, which in their chemical structure do not have the main negative properties inherent in acrylic plastics, and in terms of strength indicators are several times higher than acrylic ones. Depending on the specific clinical situation, the type of base material from thermoplastic masses for prosthetics for patients is selected. The chemical composition and choice of such materials is quite large. The issues of studying the mechanisms of tissue stress, the reactions of elimination of polymers during prolonged stay in the oral cavity, and the development of criteria for the biocompatibility of thermoplastic materials remain relevant today.

Effectiveness of Drug Therapy in Abortion on Medical Indications in Hospital Conditions

BACKGROUND: The model in the Specialized Hospital of Obstetrics and Gynecology in Varna is becoming more and more widespread. The medical abortion, as a means of choice for behavior in abortion on medical indications, in hospital conditions, after the opinion of the commission to a hospital institution with a profile of specialty gynecology, and in case of abortion on request in hospital or pre-hospital medical activity. In Europe, this model has been in place for 30 years, and clinical experience shows that complications and mortality are many times lower than with surgery. MATERIALS AND METHODS: Conducted own survey for the period January 2021-July 2023 of 37 patients who went through a pregnancy termination committee on medical grounds. RESULTS AND DISCUSSION: About 89.2% of cases have a positive opinion of the commission in the hospital structure. Patients with higher education had better outpatient follow-up (χ2 = 12,662, p = 0.002). The greatest effectiveness is the three-fold administration of a drug regimen between 6 and 12 h (χ2 = 74,000, p = 0.000) and the gestation period of 12–20 g.w. (χ2 = 38.858, p = 0.025), and single drug administration during pregnancy (8–13 g.w.) (χ2 = 30.537, p = 0.006) and effect up to the 6th h (χ2 = 8.133, p = 0.004). CONCLUSION: The choice of a method of medical behavior is the result of a complex approach with regard to a number of factors related to pregnancy, general somatic status, and carried out diagnostic activities. An applied therapeutic approach reduces hospital costs, and the patient has a quick recovery period. Early and timely diagnosis and outpatient follow-up of patients in pre-hospital care are important informative values.

ANALYSIS OF INTERCONNECTION PROBLEMS DATA INDICATORS OF THE PATIENT'S QUALITY OF LIFE WITH MANUFACTURING PRINCIPLES OF REMOVABLE DENTURES

Assessing the quality of patient's life can become a crucial criterion when evaluating the effectiveness of disease treatment, as well as when comparing the efficiency of various programs: conservative and surgical treatment, various types of drug therapy, rehabilitation regimens, etc. In recent years, increasing attention has been paid to health, particularly dental, associated with the study of the life quality indicators.
 The purpose of our study was to analyze the relationship between patient's quality of life indicators and the organization of the patient's dental rehabilitation with removable denture structures and the treatment of partial and complete adentia.
 The study included 56 patients who sought dental care for partial or complete adentia. One of the conditions for forming the selective statistical population was its homogeneity in terms of age and gender composition, as well as general somatic status. When analyzing the data on the life quality of patients with partial and complete adentia, we used the SF-36 questionnaire (The Short Form-36) as a basis, comparing the data both before and after prosthetic treatment to evaluate its effectiveness. Moreover, we took into account both objective and subjective factors that could affect the life quality of patients during prosthetic treatment.
 The results of quality of life indicators in patients with partial adentia (PA-1 group) and complete adentia (CA-2 group) considering gender and age before and after treatment with partial removable and complete removable dentures, were determined applying the SF-36 questionnaire in compared groups.
 Thus, analyzing the overall picture, it is possible to note a statistically significant (Р<0.05) decrease in quality of life indicators on all scales in patients with complete adentia (CA) compared to the group of patients with partial adentia (PA).
 The evaluation of quality of life indicators has an extremely important clinical and prognostic value when making diagnosis, selecting prosthetic treatment method, and evaluating the long-term prosthetic outcomes.
 These data should be taken into account in the practical activities of prosthetic dentists, to prevent common conflicts arising due to the inconsistency of patients' expectations with the predicted results of treatment and the results of rehabilitation measures.

Assessment of employability in patients with breast cancer with a completely unfavorable clinical-labor prognosis

Objective. To develop objective criteria applicable in the practice of medical and social expertise when assessing the employability of patients suffering from breast cancer with absolutely life-threatening clinical and labor prognosis.Materials and methods. In order to realize our aims we conducted a retrospective study of 37 female patients of employable age with malignant neoplasms of the breast, who at examination (primary or repeated) in medical and rehabilitation expert commissions (MREC) were assigned the first disability group due to absolutely unfavorable clinical and labor prognosis in respect of life in the nearest future. Inclusion criteria were morphologically confirmed breast cancer, absolutely unfavorable clinical and clinical and labor prognosis. Exclusion criteria were synchronous and metachronous cancer, presence of significant concomitant pathology.Results. The results of the study showed that it is reasonable to use quantitative values of the Karnovsky index and ECOG scale as the simplest and the most universal criteria for evaluation of the general somatic status of a patient when examining patients with breast cancer with absolutely unfavorable prognosis at MREC. During the study, the quantitative values of the given indicators correlating with the degree of severity of disability to labor activity are determined: at the values of the Karnovsky index 60 points and more, the ECOG status 2-3, a reliable correlation (τ = 0,51, p < 0,001) with severely limited ability to work (АС 4) is revealed. As a result of the study, it was demonstrated that disabled individuals of the first group can be recognized as able-bodied with limitations only with higher values of these scales, taking into account harmful and dangerous production factors, as well as class of working conditions.Conclusion. We found that when assessing the degree of severity of limitations to the ability to work in the disabled people of the first group with absolutely unfavorable clinical and labor prognosis, it is reasonable to be guided by the generally accepted scales of assessment of the general condition of a cancer patient (Karnovsky index, ECOG scale), taking into account the existing harmful and/or dangerous production factors, as well as the working conditions class.

Anti-angiogenic therapy in the treatment of diabetic macular edema in various variants of the vitreoretinal interface

BACKGROUND: Anti-angiogenic therapy for diabetic macular edema (DME), recognized as the gold standard, is not always effective. When compensating for the general somatic status, it is necessary to search for local causes of DME resistance to anti-angiogenic therapy.
 AIM: To study the effectiveness and features of anti-angiogenic therapy for DME in normal and pathological vitreoretinal interface (VRI).
 MATERIALS AND METHODS: Patients who received anti-angiogenic therapy for 12 months, in addition to the standard examination, underwent optical coherence tomography with an assessment of morphometric parameters and VRI.
 RESULTS: In addition to the groups of normal and pathological VRI, a group of transformation from pathological to normal VRI was identified. Visual acuity increases with normal VRI, decreases with pathological. OCT scores decrease in both groups. In the transformation group, an increase in vision and a decrease in OCT parameters were observed only after VRI transformation.
 CONCLUSION: The pathologic condition of the VRI reduces effectiveness of anti-angiogenic therapy for DME, except for 10% of cases in which VRI is transformed into normal within 5-6 months from the start of treatment. These data should be taken into account when choosing a treatment strategy for DME.

Среднесрочные результаты лечения тяжелой деформации переднего отдела стопы у пациентов пожилого возраста

Severe complex deformities of the forefoot in elderly patients with no rheumatoid arthritis result in the pronounced decrease in quality of life, chronic pain, reduced mobility, failure to get shoes for everyday use, exacerbation of the concomitant somatic diseases. The use of conventional joint preservation techniques in such patients often leads to the deformity relapse, persistent pain, and the need for revision surgery that is often impossible due to worsening of the patients' general somatic status and local functional status. The study was aimed to improve surgical outcomes in elderly patients with no rheumatoid arthritis who had severe forefoot deformities. The prospective cohort study that involved allocation to the retrospective group for comparison of surgical outcomes in 65 patients was carried out in 2016–2019. The results obtained before and after surgery were assessed using the FFI, AOFAS Hallux, and AOFAS Lesser Toes scores. The Maryland scores were used to assess the outcomes during the postoperative period. The study revealed significant differences in treatment outcomes based on the AOFAS Hallux (p = 0.0001), AOFAS Lesser Toes (p = 0.0001), FFI (p = 0.0001), and Maryland (p = 0.0001) scores. In view of the elderly patients' specific nature, the radical surgical techniques that do not ensure joint preservation may be considered as effective and predictable methods of correction aimed at reducing the rate of revision surgeries. These techniques represent a one-step method to improve the quality of life of elderly patients.

Current Problems of the Diagnostics and Treatment of Sepsis and Burn Injuries: The Modified Pathogenetic Concept

Background: The deep understanding of pathogenesis is a key moment in the formation of the modern strategy of modern medicine. We conducted the thorough analysis of the microscopic processes occurring in the bodies of patients with purulent-septic complications. The modified pathogenetic concept of the diagnostic and treatment model of diseases with septic complications is presented. The obtained information about the mechanisms of origin and development of these diseases is fundamentally important for finding the modern effective methods of treating patients. The aim of the research is to modify treatment tactics for patients with sepsis and burn injuries based on the modified pathogenetic concept using modern diagnostics, i.e. the method of fluorescence spectroscopy (MFS) and biomarkers. Materials and Methods: The proposed modified pathogenetic concept of the diagnostic and treatment model of diseases with purulent-septic complications along with standard methods was used successfully for effective treatment of 15 patients with sepsis and 25 with burn injuries. Results: 3 main scenarios of behaviour of spectral-fluorescence characteristics of patients with sepsis are illustrated. Spectral-fluorescence markers of sepsis were studied, which are informative 24 to 48 hours before the appearance of obvious clinical and laboratory signs of significant changes in the general somatic status of patients. Conclusions: The proposed diagnostic and therapeutic approach is new and fundamentally important for diagnostics and monitoring of the process of treatment of patients with purulent-septic diseases and burn injuries. An in-depth understanding of the dynamics of septic complications and the corresponding changes of the main markers of these diseases during treatment is especially relevant. The use of infusion therapy with solutions of donor albumin as an effective pathogenetic treatment is scientifically justified.

DENTAL STATUS OF BRONZE AGE POPULATION FROM THE AREA OF MODERN POLTAVA REGION (ACCORDING TO THE ANTHROPOLOGICAL MATERIALS)

In modern medical science, and in particular in dentistry, regarding pathology, the following question is actual invariably: Have there always been manifestations of diseases as we see them today? At the same time, research on dental diseases in ancient people remains also a reliable source of knowledge about the causes of oral cavity pathology in the modern population.
 Therefore, it is important to study deviations from the norms of development and peculiarities of skeleton of populations in various periods.
 The purpose of the study. To investigate the condition of hard oral tissues in the Bronze Age population from the area of modern Poltava region by skeletal remains.
 Object and methods of research. For the analysis the bone remains of 47 representatives (4 children's, 20 women's and 23 men's skeletons) of population of the Bronze Age (middle of the 3rd millennium – the 2nd millennium BC), from the area of modern Poltava region (main group), from the mound located in the vicinity of the village Hittsi of the Lubenskyi district, discovered by the archeological expedition in 2021 were selected.
 Anthropological series of individuals living in the Bronze Age on the territory of modern Poltava region described earlier were taken as a control group for comparison.
 The materials were discovered during the archaeological excavations carried out in 1998-2012, where a total of 102 skeletons were examined (30 children's skeletons, women's skeletons among examined are 20, and male ones are 52.)
 The study of the material was carried out by the method of skeletal tissue analysis of ancient people, developed by the authors of this publication on the basis of the Laboratory of Medical and Historical Anthropology of the Municipal Establishment "Center of Protection and Research of Archaeological Monuments" of Poltava Regional Council and the Children's Department of Therapeutic Dentistry with prevention of dental diseases of Poltava State Medical University. The method provides maximum preservation of bone and teeth tissues.
 Research results. Differences in the dental status of the main group correspond to the results of the paleopathological analysis of the collective anthropological series of the Bronze Age control group from the area of Poltava region (where there were found 4 tooth cavities per 102 persons and in another 22 persons dental mineralized deposits were observed) which reflect a specific consequence of the negative impact of social factors and environment in places of residence. However, the difference was determined in the form of coverage of the chewing organs with teeth mineralized deposits. Discrepancy in the number of encounters of mineralized deposits in the teeth of the studied groups is probably explained by the difference in food consumption and possible differences in types of lifestyles, the possible tendency of the male population to long transitions.
 Conclusion. The general somatic status of the control group of the studied people corresponds to the state of health of the Bronze Age population of the main group from the area of Poltava.
 So, another 47 people of the Bronze Age showed the same dynamics of the development of dental pathology with previously studied skeletons of representatives of this time from the area of the modern Poltava region.

Epidemiology and results of the first line therapy for HIV-related Hodgkin lymphoma

Introduction. The risk of developing Hodgkin lymphoma (HL) with HIV infection is higher than in the general population, and the course of the disease itself is more aggressive. Currently, there is no unified approach to the treatment of HIV-related HL, and data on its epidemiology in the Russian Federation are limited.The objective was to study epidemiological characteristics, the used therapeutic tactics and the results of treatment for HIV-related HL.Methods and materials. The multicenter retrospective study included 46 patients with HIV- related HL treated in 9 centers of the Russian Federation. Descriptive statistics methods were used, the analysis of overall survival (OS) and progression-free survival (PFS) was performed using the Kaplan–Meier method.Results. HIV-related HL is more often represented by an advanced stage, B-symptoms, and extranodal lesions. The ABVD regimen was used as the first-line therapy in 60 % for HIV-related HL. The overall response to therapy was 81.6 %, and the 2-year OS and PFS were 85 % and 49 %, respectively. Factors that worsened OS were CD4+˂266 cells/mcL and general somatic status ECOG≥2.

P1077: HODGKIN LYMPHOMA IN PATIENTS WITH HIV: NATIONAL RETROSPECTIVE MULTICENTER STUDY

Background: Patients with HIV infection have a significantly higher risk of developing cancer than the general population. In the era of antiretroviral therapy (ART) the cancer risk and mortality have been decreased, however, the risk of developing Hodgkin lymphoma (HL) increased. The ART allows treating HIV-infected patients with lymphomas with protocols for patients in the general population. Withal the data on the results of the treatment HL in patients with HIV controversy. Aims: To study epidemiology and evaluate the results of the treatment of HL in patients with HIV in national multicenter study. Methods: The study included 45 patients with HL in patients with HIV who received treatment in 9 Russian centers from 2007 to 2021. The median follow-up was 9 months (1-129). Patients and treatment characteristics were analyzed. Overall survival (OS) and progression-free survival (PFS) were calculated within two years from the diagnosis using the Kaplan-Meier method. Results: The median age was 39 years (25-66), men - 25 (55.6%), women - 20 (44.4%). Histological variants of HL in most cases were represented by nodular sclerosis (56%) and mixed-cell variant (41%). The advanced stage of the disease (3-4 Ann Arbor) was observed in 72.7% of patients, B-symptoms at the onset of the disease - 68.2%. The majority of patients (97.7%) received ART at the diagnosis of HL. The median number of CD4+ cells/µl at the onset of HL was 352.8 (50-692) cells/μl. General somatic status at the start of chemotherapy ECOG 0-1 - 34 (82.9%), ECOG≥2 - 7 (17.1%). As the first line of therapy, patients with localized stages of HL received ABVD (75%) and BEACOPP (25%), with advanced stages - ABVD (61.3%) and BEACOPP (38.7%). The median courses of first-line therapy were 4 (1-10). Radiation therapy in first-line therapy was performed in 4 patients (8.9%). The structure of response to first-line therapy were complete response - 51.4%, partial response - 25.7%, disease stabilization - 2.9%, disease progression - 20%. Fourteen and 8 patients received second and third-line therapy, respectively. Autologous hematopoietic stem cell transplantation was performed in 6 patients - the only 42.8% of patients with relapsed / refractory HL. OS in the study group was 81%, PFS - 38% (median PFS - 23 months). The level of CD4+ cells at the onset of HL less than 250/µl was associated with a statistically significant worsening of OS during 1 year (50% vs 100%, p=0.014). Factors such as gender, age, stage of the disease, ECOG status, the presence of B-symptoms at the onset of the disease, and the treatment regimen did not statistically significantly affect the two years OS and PFS from the diagnosis of HL in patients with HIV. Summary/Conclusion: The national multicenter study allowed characterization of HL in patients with HIV and evaluation of the efficacy of first-line therapy, which was found to be lower than in the general population. The level of CD4+ cells was the only factor that affect 2-year OS. The obtained data can form the basis for further prospective studies aimed at improving the results of HL treatment in HIV-infected patients.

ASPECTS OF RADIOTHERAPY OF BREAST CANCER METASTASES TO THE BRAIN: A LITERATURE REVIEW

Relevance: Breast cancer is one of the most common diseases among women in developed countries worldwide. Breast cancer ranks
 first in incidence and third in mortality among malignant neoplasms in women. Despite many advances in breast cancer treatment, the
 prognosis for patients with metastatic breast cancer remains poor. The life expectancy of these patients is usually about one year. The
 accuracy of diagnosis and determining the number and sizes of oligometastases by contrasted brain MRI or PET-CT with methionine
 is vital for effective cancer treatment. The emergence of treatment techniques, such as stereotactic radiosurgery (SRS) and stereotactic
 radiotherapy (SRSR), significantly improved the disease prognosis. The use of high-tech radiation therapy in patients with oligometastases from breast carcinoma improves local control of intracranial lesions, prevents death, maintains the quality of life, and improves
 overall survival.
 The study aimed to analyze the results of key prospective studies on aspects of radiation therapy for breast cancer metastases to
 the brain.
 Methods: This review included key randomized trials on using radiation therapy for breast cancer metastases in the brain. The search
 was conducted in the PubMed database for 2005-2020 by the keywords “radiation therapy,” “breast cancer,” and “brain metastases.”
 Results: Reduced treatment time due to stereotactic radiosurgery and radiotherapy allows for maintaining productive life without expressed neurological symptoms. SRS is efficient in patients with up to five oligometastases in breast cancer. More metastases require total
 brain exposure, which is a poor prognostic factor. In prospective studies, SRS in breast cancer with brain metastases is recommended to
 improve the quality of life.
 Conclusion: The treatment of breast cancer with brain metastases requires a multidisciplinary approach based on the prevalence of
 the process, previous therapy, general somatic status, comorbidities, and available therapy options. Systemic therapy for breast cancer
 patients with brain metastases follows several schemes that demonstrate their therapeutic effectiveness.

ASPECTS OF RADIOTHERAPY OF BREAST CANCER METASTASES TO THE BRAIN:
 A LITERATURE REVIEW

Relevance: Breast cancer (BC) is one of the most common diseases among women in developed countries worldwide. BC ranks first in incidence and third in mortality among malignant neoplasms in women. Despite many advances in the treatment of BC, the prognosis for patients with
 metastatic BC remains poor. The life expectancy of these patients is usually about one year. The accuracy of diagnosis and determining the number
 and sizes of oligometastases by contrasted brain MRI or PET-CT with methionine is vital for effective cancer treatment. The emergence of treatment
 techniques, such as stereotactic radiosurgery (SRS) and stereotactic radiotherapy (SRSR), significantly improved the disease prognosis. The use of
 high-tech radiation therapy in patients with oligometastases from breast carcinoma improves local control of intracranial lesions, prevents death,
 maintains the quality of life, and improves overall survival.
 The study aimed to analyze the results of key prospective studies on aspects of radiation therapy for BC metastases to the brain.
 Methods: This review included key randomized trials on the use of radiation therapy for BC metastases in the brain. The search was conducted
 in the PubMed database for 2005-2020 by the keywords “radiation therapy,” “breast cancer,” and “brain metastases.”
 Results: Reduced treatment time due to stereotactic radiosurgery and radiotherapy allows for maintaining productive life without expressed
 neurological symptoms. SRS is efficient in patients with up to five oligometastases in BC. More metastases require total brain exposure, which is a
 poor prognostic factor. In prospective studies, SRS in BC with brain metastases is recommended to improve the quality of life.
 Conclusion: The treatment of BC with brain metastases requires a multidisciplinary approach based on the prevalence of the process, previous
 therapy, general somatic status, comorbidities, and available therapy options. Systemic therapy for BC patients with brain metastases follows
 several schemes that demonstrate their therapeutic effectiveness.

ВЛИЯНИЕ ГИПОФУНКЦИИ ЩИТОВИДНОЙ ЖЕЛЕЗЫ НА ПРОГНОЗ СТОМАТОЛОГИЧЕСКОГО ОРТОПЕДИЧЕСКОГО ЛЕЧЕНИЯ

Background. The problem of preventing complications of complex dental treatment is one of the main problems in modern dentistry, the solution of which is impossible without a systematic approach, including, among other things, the relationship of these complications with the general somatic status of a particular patient. The aim of the study. Identification of the features and terms of use of dentures in patients with reduced thyroid function. Methodology. The data of 304 patients who applied to a dental clinic for re-prosthetics of the dentition were studied. The distribution of patients into groups was carried out in accordance with the type of denture and the presence or absence of thyroid diseases established by the endocrinologist, leading to hypothyroidism. Standard clinical (survey, examination, etc.) and paraclinical (radiological, functional) methods of examination were used for such diagnoses. Edema of the oral mucosa was determined by palpation, and their frequency and severity were recorded. Results. Statistically significant differences in the reasons for replacement of dentures between patients of different groups were revealed. The difference in the terms of use of dentures in patients of different groups was determined. Clinical differences in the state of the tissues of the prosthetic bed and the supporting teeth of the bridge prostheses in patients, depending on the presence of hypofunction of the thyroid gland, were revealed. Conclusions. The presence of hypothyroidism in the anamnesis of patients worsens the long-term prognosis of dental orthopedic treatment. The dispensary observation of patients with hypothyroidism should differ from the observation of healthy individuals, in the direction of reducing the inter-examination intervals in order to identify early complications of dental treatment.

АССОЦИАТИВНЫЕ ПАРАЛЛЕЛИ ВЗАИМОСВЯЗИ И ВЗАИМООБУСЛОВЛЕННОСТИ КЛИНИЧЕСКИХ ОСОБЕННОСТЕЙ СТОМАТОЛОГИЧЕСКОЙ ПАТОЛОГИИ С СЕРДЕЧНО-СОСУДИСТЫМИ ЗАБОЛЕВАНИЯМИ

Subject. Diseases of the cardiovascular system are characterised by oral cavity manifestations which possible has inverse relationships. Prevalence and features of hard oral tissues, mucosa of the oral cavity and periodontium in cardiovascular patients is investigated. Aim — to form a list of main trends and scientific practical prospects related to cardiovascular diseases and dental pathology. Methods. In order to perform analysis of the studied topic, a review of 30 periodicals dated 2007-2019 was performed. Results. The analysis of Russian and foreign scientific literature resulted in formulation of three main groups of dental diseases with peculiarities in manifestations if IHD and HD: 1. Diseases of hard oral tissues; 2. Diseases of the mucous coat of the oral cavity; 3. Periodontium tissue diseases. Examination of oral cavity hygienic condition in CVD patients showed worse values in comparison with the control group. A major emphasis is placed on the role of C-reactive protein and the role of systemic inflammation in dental and cardiovascular pathology. Also, there is data regarding treatment of periodontium tissues and its influence on the cardiovascular system. Inverse interaction was noted: intake of medicines against the main pathology exerted influence on the oral cavity condition. Conclusion. The performed review of Russian and foreign literature makes it possible to conclude that the data presented is insufficient to draw any firm conclusion. Of principal interest are periodontium tissue diseases and their correlation with general somatic pathology, indicative of which is a significant number of practical researches devoted to this issue. However, the data analysed are of controversial character and do not make it possible to form a single trajectory for management of such patients and assessment of not only dental but also general somatic status of the patient.

Course Of Post-Infarction Depression Taking Into Account The Time Of Its Once

A study of 341 patients with an established diagnosis of acute myocardial infarction was carried out. The patients are divided into 2 groups. The first, main, included 233 patients with acute myocardial infarction, who subsequently developed depressive disorders, confirmed clinically and using diagnostic scales; the second group consisted of 108 patients who also had acute myocardial infarction, but did not subsequently suffer from symptoms of depression. Clinical and dynamic observation of patients in the postinfarction period was carried out with control of the condition in a month, three months, six months, 12 months after myocardial infarction. Clinical observation was used to detect the presence of symptoms of depression. Among patients with MI with DS in the first days after MI, more than half (51.1%) reported a permanent decrease in mood more often than other symptoms, i.e. these patients showed an affective component of depression, while the ideator component of depression, which manifested itself in thinking retardation to one degree or another, was in 27.5% of patients, motor retardation (motor component) was detected in 21.5% of those observed. In patients with almost the same frequency, the anxious and melancholic type of affect was noted (47.0% and 41.2%, respectively), the dysphoric type of affect was found in 11.8% of cases, which is 4 times less than anxious and 3.5 times less than the melancholic type. In cases of prolonged depression, the severity of affective disorders more often directly correlated with the severity of the physical condition. If not so long-term depressive episodes were largely due to "their own vision of the disease", the severity of their symptoms depended on the conversation with the doctor and the information received from him, the degree of awareness of his diagnosis, possible complications, and not very much depended on the general somatic status itself. then the course of prolonged depression in patients worsened with the aggravation of the cardiological and general somatic condition of patients. Psychosomatic parallelism in the majority of protracted depressions was manifested by the generalization of asthenic symptom complexes (increased general weakness, intolerance to exertion, lethargy, adynamia, severe daytime sleepiness in combination with early insomnia) with deterioration of the somatic state. At the same time, it was noted that with prolonged depression, there were always more or less pronounced cognitive disorders (reduced memory for past events, limited ability to comprehend what was happening around, remember new information, impaired concentration). Postinfarction depressive episodes lasting up to six months can be attributed to nosogenies; depressive episodes of postinfarction genesis with a protracted course, probably with a high degree of confidence can be attributed to somatogenias.

Possibilities of palliative chemotherapy in patients with locally advanced and metastatic pancreatic cancer

Currently, pancreatic cancer remains one of the most unfavorable tumor pathologies, characterized by pronounced difficulties in diagnostics and treatment, a significant impact on the ability to work and quality of life of patients, and low indicators of patient life expectancy. Features of the development of malignant neoplasms of this localization contribute to limiting the possibility of performing radical surgery, and therefore a special role in the treatment of patients with pancreatic cancer is assigned to chemotherapy. Specific systemic drug therapy for this pathology is the most important and, in the majority of cases, mandatory element of treatment. It can be carried out in a neoadjuvant, adjuvant and independent mode, include mono- or multi- component schemes, and be combined with other types of systemic or local antitumor effects. The choice of chemotherapy regimen depends primarily on the General somatic status of the patient and is determined by the potential toxicity of a particular combination of cytostatics. This review of the literature demonstrates the effectiveness of various chemotherapy regimens in patients with stage III–IV pancreatic cancer in the first and second lines, describes the frequency of adverse reactions to treatment and their nature, and mentions ways to reduce the toxicity of multicomponent drug therapy regimens. This review is based on the analysis of scientific sources of the Internet resource "National Center for Biotechnological Information".