Nosological Unit Research Articles

Clinical picture, modern diagnostics and tactics of treatment of spinal cord tumors (literature review)

Tumors of the spinal cord include several nosological units and are classified depending on their location and histological type. The article presents the general characteristics, classification, and epidemiology of spinal cord tumors. The paper presents the clinical manifestations of intradural extramedullary tumors of the spinal cord. The main methods of diagnosing extramedullary tumors of the spinal cord are highlighted. Furthermore, the paper details the modern aspects of the surgical treatment of spinal cord tumors. Particular emphasis is placed on the complications of surgical interventions. The radicality of neurosurgical treatment of spinal cord tumors depends not only on the location and size of the tumor, but also on its histological structure, which determines the outcome of the disease.

ПРОГНОСТИЧЕСКАЯ ЗНАЧИМОСТЬ КЛИНИКО-ЛАБОРАТОРНЫХ МАРКЕРОВ ПОРАЖЕНИЯ НЕРВНОЙ СИСТЕМЫ, АССОЦИИРОВАННЫХ С БЕРЕМЕННОСТЬЮ

Abstract. Objective: To study, to systematize and to evaluate the prognostic significance of clinical and laboratory markers of nervous system damage associated with pregnancy with and without arterial hypertension (AH) in order to determine the main risk factors for the development of stroke. Materials and methods. Assessment of autonomic dysfunction, neuro-ophthalmological examination, additional research methods: laboratory and instrumental methods, including the study of gene polymorphism, CT, MRI Results. Based on the results of constructing a set of logistic regression models that generalize their results of a high probability detection algorithm, it is shown that in order to identify the final group of high risk of developing ischemic stroke in pregnant women, it is necessary to exclude patients without autonomic dysfunction before pregnancy, and also take into account the risks if they are detected in at least two stages. Factors such as the presence of cephalgic syndrome, autonomic dysfunction before pregnancy, contraception, concomitant pathology of more than 3 nosological units, hypoplasia of cerebral vessels, retinal angiopathy according to neuro-ophthalmological examination, elevated levels of fibrinogen and high activity of von Willebrand factor are common risk factors for the development of cerebrovascular accident ischemic type, regardless of the presence or absence of arterial hypertension.

Schizoaffective disorder: the past and the future of hybrid construction

The article argues for the discrepancy between the artificial construction of «schizoaffective disorder» (SAD) and the principles of nosological diagnostics. The term of «acute schizoaffective psychoses», was introduced by Y. Kazanin in 1933, is still remain a controversial nosological unit. This diagnosis often made at the cut of a psychotic episode on a «dichotomous scale» by «weighing» schizophrenic and affective symptoms. In the history of the creation of the concept of SAD, there is a tendency towards reductionism and the search for universal manifestations. Each individual clinical case must be considered holistically. It is unacceptable to extract the individual signs (which does not fit syndromal structures) from general picture of the disease. However, this requirement is in contradiction with the current trends towards simplification, discreteness and loss of clinical thinking in currents classifications of diseases. The inadequacy of the available diagnostic approaches and criteria for distinguishing between SAD, bipolar disorder and schizophrenia leads to the fact that the patient’s diagnosis is based on the subjective preferences of a clinician, and during patient’s life can many times be changed. The results of the the phenotype and genotype of the corresponding disorders searching partially shed light on the features of the diagnosis; but at the same time, some researchers are artificially combine the discrete properties and coming to incorrect conclusions; often such an identity simply does not make sense. The authors join opinion of experts who suggesting the existence of a «third psychosis» or even several discrete forms of diseases, which, along with unrecognized attacks of bipolar psychosis and schizophrenia are still mistakenly dissolved in the dichotomous / dimensional hybrid SAD. Diagnostics, taking into account the follow-up, regularities of the course, pathophysiological changes and psychopathological structure, has not only clinical value, but is also responsible for the selection of effective treatment, correct preventive measures, affects the social status and, ultimately, the quality of life of the patient.

Evolution of the Affective Catatonia Concept in XIX–XXI Centuries

Background: the connection of catatonic disorders with affective pathology is noted in publications related to the prenosological stage of research in psychiatry. Numerous publications of the last and the current centuries are devoted to clinical studies of the relationship between affective and catatonic symptoms. At the present stage of scientic development, catatonia is considered as a transnological formation, manifesting in the framework of various nosological units, including affective diseases. Aim: analysis of the affective catatonia construct’s development in the period of the XIX–XXI centuries and development of affective-catatonic states, forming in the clinical space of schizophrenia and schizophrenic spectrum disorder, conceptual model. Conclusion: affective-catatonic disorders represent a continuum of psychopathologically differentiated phase-owing state. At one of the continuum pole there are catatonic disorders manifesting in the structure of affective pathology, which is realized at the level of recurrent depressions; at the other pole — affective-catatonic states of more severe psychopathological register, acting in the clinical space of bipolar affective disorder and schizoaffective psychoses. The role of movement disorders in affective-catatonic attacks and phases, as well as the modus of interaction of catatonic disorders with affective ones, also varies widely. In some cases, motor symptoms replace the affective symptoms, on the basis of which they were formed, and completely determine the clinical picture of the state; in others — they only modify the manifestations of affective disorders without altering their syndromic structure.

Forensic veterinary diagnosis of dog’s fatal poisoning with anticoagulant rodenticide – bromadiolone

One of the objects of the forensic veterinary examination is the animal’s corpses, the death of which occurred suddenly, or from violent actions, including cruel treatment. A variation of the manifestation of cruelty to animals is their deliberate poisoning. Among the wide variety of toxic substances, pesticides, including rodenticides, occupy a significant place. The aim of the study was to develop an algorithm for forensic veterinary diagnostics and evaluation of dog corpses in case of their sudden death from poisoning with anticoagulant rodenticide – bromadiolone. The objects of the study were the seven dog’s corpses, on which a forensic veterinary examination was carried out for the period from 2010 to 2021 with a clinical diagnosis of acute poisoning with lethal fleeting consequences from poisoning with anticoagulant rodenticide – bromadiolone, established during life. The article shows that the general algorithm for the forensic veterinary examination of the corpse of an animal whose death occurred from poisoning includes the following steps: establishing a list of objects provided for research and information about their condition, conditions for conducting forensic veterinary research, applied methods of studies, their registration numbers (if any); study of the case and the animal’s death anamnesis circumstances; study of veterinary documents and individual case materials related to the examination or provided to the expert additionally at his request; forensic veterinary examination of an animal corpse; study of registration data; external examination of the corpse of an animal; internal examination of an animal corpse; additional studies of the corpse: chemical-toxicological, histological (cytological), microbiological, etc.; forensic veterinary diagnosis; synthesizing research; formulation of conclusions (results); formulation an expert opinion. The forensic veterinary diagnosis, established on the basis of the results of a forensic veterinary examination of the corpses of the dogs under examination, is formulated according to the established rubric structure: the main nosologicalunit and its fatal complication(internal bleeding – hematoperitoneum, hemothorax, bilateral pulmonary edema); accompanying nosological units (acute hemorrhagic gastroenterocolitis, acute hemorrhagic endocarditis, general anemia, congestive venous hyperemia of the kidneys, liver and spleen); background nosological units (undifferentiated hepatopathy and nephropathy, chronic pancreatitis, polyarthritis). The positions of the formulated forensic veterinary diagnosis indicate that they are generally characteristic of acute poisoning. The cytogram data analyzed in the article coincide with the data obtained during the forensic veterinary autopsy of animal corpses, indicating that the poison, from which the death of the dogs under examination occurred, belongs to the group of hemolytic toxins. A chemical-toxicological investigation of the contents of the stomach of the corpses of the dogs under expert identified the poisonous substance of the second generation of rodenticides – bromadiolone at a concentration of 10 mg/kg. A complex of investigations has proved that there is a direct necessary causal relationship between the dog’s death and the nature of the poisoning. Key words: forensic veterinary examination, animals, intoxication, poisonous substances, autopsy, chemical and toxicological research, algorithm.

TAVI in bicuspid aortic valve

Transcatheter aortic valve implantation (TAVI) is an established choice for the treatment of severe aortic stenosis (AS) in patients who are deemed inoperable or at high surgical risk. There are limited data for the safety and effi cacy of the method in patients with bicuspid aortic valve (BAV), the most common congenital valve defect. Patients with BAV were excluded from randomized clinical trials (RCTs), comparing TAVI to surgery due to the heterogeneous anatomy of this nosological unit and concerns about unsatisfactory procedural and clinical outcomes after TAVI. With the improvement of the design of the new generations devices, with the growing technical experience of the teams and the progress in the imaging techniques, better results and fewer complications are observed, which could be a prerequisite for expanding the indications for TAVI in patients with BAV. This review presents TAVI treatment options for patients with BAV, the results of available registers in terms of safety and effi cacy of the procedure, and future perspectives.

Morphological features of the intestinal mucosa in ulcerative colitis in various forms of the disease

Background. Chronic inflammatory bowel disease (CIBD) is one of the most complex nosological groups in gastroenterology, due to the constant increase in their prevalence, shifting the onset to an earlier age, increasing the frequency of severe complicated forms. The most common representative of CIBD is nonspecific ulcerative colitis (UC). At the heart of UC is a diffuse ulcerative-inflammatory lesion of the colon. The leading role in the diagnosis of UC belongs to the comparison of the results of endoscopic and morphological methods of research. The morphological method of colonobiopsy examination in UC is the gold standard of diagnosis and makes it possible to determine the signs of disease activity even in endoscopic remission. In contrast to descriptive histology, pathological anatomy, quantitative morphology complements and clarifies the data of studies conducted by conventional morphological methods from the standpoint of generalized approaches. The purpose of quantitative morphology is the maximum objectification of the study of qualitative and quantitative manifestations of pathological processes, nosological units, their pathogenesis, morphogenesis, as well as the exclusion of measurement errors and, as far as possible, the subjectivity of the researcher. The purpose of the study: to conduct a comparative histological examination of biopsies of the mucous membrane of the colon in patients with UC of different severity of the disease. Materials and methods. Histological examination of intestinal biopsy specimens was performed in 55 patients with ulcerative colitis. Patients were divided according to the severity of the disease. Group I (n=11)— mild form, group II (n=39)— moderate form and group III (n=5)— patients with severe UC. Results. In 63.6% with a mild severity of UC edema was not observed, the condition of the epithelium was unchanged, the architecture is not disturbed. Crypt abscesses were detected in 54.6% of cases, atrophic changes— in 90.9%. Inflammatory infiltrate consisted mainly of neutrophils ((176.0±8.22) per 1 mm2 stroma) and mononuclear cells ((232.4±22.83) per 1 mm2 stroma), which indicates the activation of regenerative functions of the mucous membrane. From morphometric measurements the highest indicator was the height of the crypt epithelium (38.3±1.49) μm. With an moderate degree of UC in 33.3% of cases there was a violation of the integrity of the epithelium, atrophic changes were diagnosed in 23.1% of cases, violations of crypt architecture— in 17.9%, the presence of crypt abscesses— 48.8%, edema— 64.1%. Morphometric measurement of intestinal mucosal biopsies with moderate severity of UC showed the highest crypt depth (452.6±8.12) μm, crypt epithelial height (42.3±0.33) μm and the number of goblet cells (26.6±1.43). The height of the crypt epithelium was positively correlated with the number of goblet cells (r=0.30; p <0.05). Erosions, general epithelial disorders, crypt abscesses, and atrophic changes were observed in the majority of patients with severe UC in 40%. In severe UC, the smallest crypt depth (426.1±22.37) μm, crypt epithelial height (36.0±2.57)μm, the number of goblet cells (10.5±1.04) and the largest epithelial thickness were observed (51.5±2.81) μm. Conclusions. The presence of crypt abscesses was mainly observed in the group of mild and moderate forms of the disease. Mucosal edema was more common in the group with moderate severity disease. Increased numbers of eosinophils and neutrophils were observed in the group with severety disease.

Regulation of a delicate problem in patients with rectal diseases

This paper highlights the problem of chronic constipation, their epidemiology, etiology, clinical features in some concomitant diseases, diagnostics and approaches to therapy with a focus on sodium picosulfate preparations. Based on several scientific papers, an analysis of a group of sodium picosulfate preparations was performed, indications, dosage, efficacy and possible side effects were considered. The paper also provides a clinical example of managing a patient with chronic constipation. Who received therapy with sodium picosulfate. Constipation is a violation of the act of defecation less than 3 times a week or more than three days. At the same time, it is possible to say about chronic constipation if such symptoms persist for 6 months. To date, the discussion about constipation as a nosological unit continues. The study of the epidemiology of constipation in various scientific sources indicates the wide spread of this disease. The diagnosis of “Constipation” is based on the Rome Criteria IV adopted in 2016. By origin, constipation can be primary and secondary, and among the factors provoking them are not only gastroenterological diseases, but diseases of other organ systems, as well as environmental factors and the intake of certain groups of medicines. Therapy of chronic constipation is carried out both medicamentally and non-medicamentally (surgical methods today have no proven effectiveness). The analysis of sodium picosulfate preparations proved their effectiveness and safety, which was also noted in our clinical case.

Functional gastrointestinal diseases: mechanisms of development and principles of multitarget therapy

Currently, functional dyspepsia (FD) and irritable bowel syndrome (IBS) are among the most common nosological units in the structure of functional gastrointestinal diseases in adults. An important problem of treatment of these diseases at the current stage of medicine is low efficiency of monotarget drugs, which is determined by multicomponent pathogenesis. Indeed, the currently available methods of drug treatment of FD and IBS have suboptimal efficacy, as illustrated by recent meta-analyses demonstrating high rates of NNT (the average number of patients who need to be treated to achieve a certain favorable outcome). In addition, the frequent “overlap” of these diseases forces clinicians to prescribe several drugs with different pharmacological actions to the patient, which inevitably leads to a decrease in compliance. The optimal strategy for managing patients with FD and IBS is the tactics of multitarget drugs that act on several links in the pathogenesis of these pathologies and have a significant evidence base in the effectiveness and safety of use. STW 5 (Iberogast®), included in the clinical guidelines of the Russian Gastroenterological Association on the diagnosis and treatment of patients with FD, published in 2017, has the above-mentioned characteristics, as well as the clinical guidelines of the Russian Gastroenterological Association in collaboration with the Russian Association of Coloproctologists on the diagnosis and treatment of IBS, published in 2021. The clinical effectiveness of Iberogast in the treatment of FD and IBS has been demonstrated in a number of randomized trials, the results of which showed high efficacy of the drug and its good tolerability.

Diagnostic and treatment of fibrinothorax

The OBJECTIVE was to promote the official introduction into clinical practice of the term «fibrinothorax» as a separate nosological unit and a special form of exudative pleurisy. This term reflects the essence and timing of the pathological process in the pleural cavity and defines a specific set of necessary therapeutic and diagnostic measures.METHODS AND MATHERIALS. 67 patients with fibrinothorax of different volumes were examined and treated. Two methods of pleural cavity sanitation were used: operative (thoracoscopic) and «closed» with the use of proteolytic enzymes.RESULTS. Among 67 patients, the leading cause of fibrinothorax was nonspecific (para- and metapneumonic) pleurisy – 48 (72 %) patients. In 7 (10 %) cases, fibrinothorax was established, which complicated the course of pleurisy of tuberculous etiology. In 6 (9 %) cases, pleural effusion was a transudate, in which, against the background of repeated punctures and long periods of fluid accumulation in the pleural cavity, partial delineations in the form of fibrinothorax formed. Carcinomatous pleurisy was diagnosed in 6 (9 %) patients of the study group. Pleural cavity sanitation through the use of proteolytic enzymes was performed in 49 (73 %) of 67 patients. Thoracoscopic sanitation with biopsy for fibrinothorax was performed in 18 (27 %) patients. This material formed the basis of the concept of diagnosis of fibrinothorax and optimization of treatment.CONCLUSION. The introduction of the term «fibrinothorax» into clinical practice, reflecting the essence of this pathological condition, contributes to the formation of a treatment and diagnostic algorithm aimed at the sanitation of the pleural cavity in optimal ways.

The study of the impact of the developed metallurgical industry on the population health in the industrial centre

Introduction. The metallurgical enterprises of the city of Lipetsk are city-forming and provide the main anthropotechnogenic burden on the health of the population. The priority of preserving the health of the population determines the importance of studying the determinants of the environment on the health of the population and creates conditions for the organization of scientific research, which are aimed at developing scientifically based recommendations to reduce this process. The purpose of the study is to identify the features of the formation of the prevalence of non-communicable diseases in an industrial centre with a developed metallurgical industry. Material and methods. We used the data of the regional information fund concerning the state of the human environment and public health, the materials of the consolidated volume of maximum permissible emissions (MAE) of the city of Lipetsk, and statistical data. The comparative non-carcinogenic hazard indices and the assessment of mass non-communicable morbidity thresholds were calculated. Results. The analysis showed that as a result of the implementation of environmental measures at the city’s enterprises, there was a significant decrease in the level of atmospheric pollution. Positive changes in the habitat state are confirmed by the incidence rate for individual nosological units. A conjugated analysis of the indices of comparative non-carcinogenic hazard and morbidity made it possible to establish a threshold for mass non-infectious morbidity by nosology for the adult population and children. Discussion. The incidence rate has also dropped significantly. The improved quality of atmospheric air has erased the apparent dependence of the level and structure of morbidity from the impact of metallurgical production alone. Conclusion. Despite the decrease in emissions from stationary sources due to technological re-equipment, the implementation of environmental measures, and the incidence of many nosologies, many problems remain unsolved.

NOSOLOGICAL PROFILE OF PARASITIC INFECTION PATHOLOGY OF DOMESTIC CARNIVORES IN ALEKSEYEVKA TOWN, BELGOROD REGION

Determination of a nosological profile of parasitic infection pathology of domestic carnivores plays one of the key roles in developing an effective, comprehensive and scientifically-based system for rehabilitation and prevention of, first of all, invasive animal diseases that are dangerous to humans. The work was carried out on retrospective and operational analysis of statistical data from veterinary reports of the Veterinary Laboratory in Alekseyevka, the Belgorod Region. Based on the data obtained, we prepared a nosological profile of the parasitic infection pathology of domestic carnivores which is characteristic for this territory. The nosological profile includes 9 nosological units, namely, 8 helminth species and one protozoan species from the coccidia group. The following species have been registered in dogs: Toxocara canis, Trichocephalus vulpis, Dipylidium caninum, Dirofilaria repens and Dirofilaria immitis. In quantitative terms, geohelminthiasis prevails. The prevalence of infection in dogs reaches 50% with toxocariasis, more than 30% with trichocephaliasis, 10% with dipylidiasis and 17% with dirofilariasis. The following species have been registered in cats: Toxocara mystax, Trichocephalus vulpis and Opisthorchis felines. The prevalence of infection in cats with helminthiasis is lower than in dogs and is 30% with toxocariasis, 9.5% with opisthorchiasis, and 13% with dipylidiasis. From the group of protozoan diseases, one nosological unit, Toxoplasma gondii, was recorded in cats, and the prevalence of infection reaches 43%.

TRANSCULTURAL ADAPTATION AND VALIDATION OF THE UKRAINIAN VERSION OF THE SPECIALIZED PHLEBOLOGICAL QUESTIONNAIRE FOR QUALITY OF LIFE ASSESSMENT

Today, quality of life assessment is an informative, reliable and economical method of studying health, both at the individual and group levels, and is an important integral indicator of the severity and dynamics of the pathological process in different nosologies. The most convenient way to measure the quality of life is to use questionnaires, which are divided into general, used for all diseases, and specialized, used for a particular nosological unit. Proper construction of quality of life questionnaires is extremely important for obtaining objective information, and in the case of using foreign language versions, it is necessary not only to make a correct translation, but also to follow the procedure of transcultural adaptation and validation. A number of general quality of life questionnaires (SF-36, Euro-Quality of Life 5D-5L) have Ukrainian versions and have been adapted and validated in accordance with international requirements. As for specialized phlebological questionnaires for quality of life assessment, after analyzing the available information resources, we did not find any description of the process of transcultural adaptation and validation of questionnaires for patients with varicose veins of the lower extremities in Ukrainian language, which became the basis of our work, during which, in accordance with the recommendations of the WHO and the Professional Society for Health Economics and Outcomes Research, the process of transcultural adaptation of the specialized phlebological questionnaire for quality of life assessment, Aberdeen Varicose Vein Questionnaire, was conducted. The validity of the adapted Ukrainian version of the questionnaire was determined using various methods: by analyzing the internal stability (Cronbach's coefficient), which according to the study is 0.76, which is comparable to the original version of the questionnaire and shows the internal consistency of the questionnaire. The next tool used to determine the validity of questionnaire questions is the "test-retest" method: conducting two tests with an interval of 14 days. According to the results of this method, a strong direct relationship with the overall Spearman coefficient = 0.965 (p <0.01) prevailed, which indicates a reliable repeatability of the test. The result of the Lawshe validation assessment aimed at the involvement of specialized experts and confirmed the importance of all 13 questions of the questionnaire for assessing the quality of life in patients with varicose veins of the lower extremities. Based on the study, the following conclusions were made: the Ukrainian language version of the AVVQ phlebological questionnaire, performed in accordance with international standards of language and cultural adaptation is an effective tool for assessing quality of life in patients with varicose veins of the lower extremities. The total quality of life assessment significantly complements the characteristics of the pathological process in patients with varicose veins of the lower extremities, its dynamics under the influence of various treatment measures, provides valuable information about the patient's response to the disease and treatment. The Ukrainian-language version of AVVQ can be used as a guide to record changes in the quality of life of people with varicose veins of the lower extremities and used in the future as an independent, no less important indicator than the usual clinical and sonographic criteria.

Профилактика новой коронавирусной инфекции (COVID-19) в специализированном стационаре психиатрического профиля

At the end of 2019, an outbreak of a new coronavirus infection occurred in the People’s Republic of China (PRC), with its epicenter in the city of Wuhan (Hubei Province). The World Health Organization (WHO) has defined the official name of the infection caused by the novel coronavirus as Coronavirus disease 2019 («COVID-19») [4]. The International Committee on the Taxonomy of Viruses assigned the official name of the causative agent of infection – SARS-CoV-2 [3]. In accordance with the sanitary legislation of the Russian Federation, the virus is assigned to pathogenicity group II [5]. COVID-19 occurs in two main forms that are subject to registration as independent nosological units: clinically pronounced – (U07.1) and carriage of the causative agent of coronavirus infection – (Z22.8) [4]. All forms of manifestations of coronavirus infection are dangerous, but the asymptomatic form poses the greatest epidemiological danger, due to the difficulty of detection and, as a result, the untimely implementation of anti-epidemic measures [2]. The role of COVID-19 as a healthcare-associated infection has been established [3]. Sysin E.I. and co-authors established the maximum values of the foci index (IO) for nosocomial spread of COVID-19 in psychiatric hospitals [9]. The inclusion of COVID-19 in the «List of diseases that pose a danger to others» [7] determines the epidemic significance of the disease. Keywords: new coronavirus infection, anti-epidemic regime, psychiatric hospital, quality of anti-epidemic regime.

Reclassification of Glioblastoma Multiforme According to the 2021 World Health Organization Classification of Central Nervous System Tumors: A Single Institution Report and Practical Significance.

IntroductionThe 2021 World Health Organization (WHO) classification of tumors of the central nervous system (CNS) has introduced significant changes to tumor taxonomy. One of the most significant changes in the isolation of isocitrate dehydrogenase (IDH) mutant forms of glioblastoma multiforme (GBM) into separate entities, as well as no longer allowing for entries to be classified as not otherwise specified (NOS). As a result, this entity now includes only the most aggressive adult-type tumors. As such, established prognostic factors no longer apply, as they now form the criteria of different disease entries or have been established based on a mixed cohort. Herein, we aimed to reclassify glioblastoma cases diagnosed per the 2016 WHO tumors of the CNS classification into the 2021 WHO tumors of the CNS classification and establish a patient survival pattern based on age, gender, tumor location, and size as well as tumor O‐6‐methylguanine‐DNA methyltransferase (MGMT) mutation.Materials and methodsA retrospective, non-clinical approach was utilized. Biopsy specimens of adults diagnosed with GBM, WHO grade 4, NOS in the period February 2018-February 2021 were reevaluated. The data regarding the patient's gender and age were withdrawn from the medical documentation. Immunohistochemistry was performed with mouse monoclonal anti-IDH R132H and rabbit polyclonal anti-MGMT. Radiology data on tumor location and size were pulled from the radiology repository. Data were statistically analyzed for significance, using Kaplan-Meier survival analysis, with a 95% confidence interval and p<0.05 defined as significant.ResultsA total of 58 cases fit the set criteria, with eight of them (13.7%) harboring an IDH R132H mutation and were hence reclassified as diffuse astrocytoma IDH-mutant, WHO CNS grade 4. The cases that retained their GBM classification included n=28 males and n=22 females, a male to female ratio of 1.27:1, and a mean age of 65.3 years (range 43-86 years). The MGMT mutational status revealed a total of n=17 positive cases (35%), while the remaining cases were negative. No hemispheric predilection could be established. Lobar predilection was as follows: temporal (37.78%), parietal (28.89%), frontal (24.44%), and occipital (8.89%).The mean tumor size measured on neuroradiology across the cohort was 50.51 mm (range 20-76 mm). The median survival across cases was 255.96 days (8.41 months), with a range of 18-1150 days (0.59-37.78 months). No statistical correlation could be established between patient survival and gender, hemispheric location, lobar location, and tumor size. A significant difference in survival was established only when comparing the 41-50 age groups to the 71-80 and 81-90 age groups and MGMT positive versus negative tumors (p=0.0001).ConclusionFrom a practical standpoint, the changes implemented in the new classification of CNS tumors define GBM as the most aggressive adult type of tumor. Based on their significantly more favorable prognosis, the reclassification of IDH mutant forms of astrocytomas has had little epidemiological impact on this relatively common malignancy but has significantly underlined the dismal prognosis. The changes have also led to MGMT promoter methylation status being the only significant prognostic factor for patient survival in clinical use, based on its prediction for response to temozolomide therapy in this nosological unit clinically presenting when it has already reached immense size.

Neuro-oncology, 2021. Brief analysis of the new World Health Organization classification of tumors of the central nervous system

The author’s translation of the new World Health Organization classification (2021) of tumors of the central nervous system is presented. Its fundamental differences from the previous edi100 tion are considered with a list of the main new nosological units. It is important to note that central nervous system tumors were divided into “adult-type diffuse gliomas” and “paediatric-type diffuse gliomas” (low-grade and high-grade). A new section has appeared — “gliomas, glioneuronal tumors, and neuronal tumors”. This rubric includes “ependymal tumors” and “glioneuronal and neuronal tumors”. In the fifth-edition Central Nervous System Tumours volume of the Classification, the sections have disappeared: “other astrocytic tumors” and “other gliomas”. Many nosologies from these sections, according to growth patterns, have formed a new rubric — “сircumscribed astrocytic gliomas. The approach to the classification of ependymomas has been fundamentally changed. Now it is based on anatomical localization and its corresponding genetic aberration. Attention is paid to the growing role of molecular diagnostics, which is fundamental in terms of nosology, and to the difficulties associated with the transition to the new version of classification. Information about the degree of malignancy of the most common neoplasms of this localization is given.

ПРИМЕНЕНИЕ БИОТЕХНОЛОГИЧЕСКИХ ЛЕКАРСТВЕННЫХ СРЕДСТВ В ПЕДИАТРИЧЕСКОЙ ПРАКТИКЕ РЕСПУБЛИКИ БЕЛАРУСЬ

The article deals with the use of biotechnological drugs (BTLG) in the treatment of children of the Republic of Belarus, mainly suffering from rheumatoid arthritis. This group of drugs is a new, very promising and insufficiently studied group in the world pediatric practice. The work assessed the effectiveness of the use of BTLG, taking into account the indications in pediatric practice. The results of studying the structure of patients receiving BTLG depending on the nosological unit of the disease, age, sex, place of residence of patients are presented; analyzes the effectiveness of de-escalation of therapy, switching to another drug, “escape” of the effect when using BTLG. The authors substantiate the need for a further differentiated approach to the use of the BTLG group in the treatment of severe forms of rheumatoid arthritis in children, the need to take into account the effects of the therapy.

Нейрокогнитивные модели вербальных галлюцинаций при шизофрении: обзор

Recent studies at the interface between psychiatry and neuroscience demonstrate a trend towards the investigation of single significant clinical characteristics of mental disorders in contrast to the analysis of a mental disorder as a homogeneous nosological unit. Thus, a large body of studies is focused on auditory verbal hallucinations (AVH) in schizophrenia, which are one of the core positive symptoms of the disorder and an important diagnostic criterion. Nevertheless, the neuropsychological and neurophysiological mechanisms of AVH in patients with schizophrenia remain debatable. In this paper, we will review the main neurocognitive models of AVH in schizophrenia, including models of intrusive cognitions and poor inhibitory control, a model of attentional shift to inner auditory stimuli and an inability to reallocate its resources, a model of expectation maximization, a model of working memory deficit, a model of poor source-monitoring, models of AVH within cultural-historical approach, and a model of impaired verbal self-monitoring in inner speech. The results of several neuroimaging and neurophysiological studies relevant to the models are also highlighted. We conclude that schizophrenia patients with AVH demonstrate deficits in executive functions and language, or rather a poor cross-functional interaction between them.

Psychophysiological Training of Physical Culture Teachers and Coaches to Preserve the Mental Health of Teenagers

The article reveals the main dimensions of the psychophysiological training of future physical education teachers and coaches in general secondary education institutions, sports clubs and children’s and youth sports schools to understand and take into account in the pedagogical work the peculiarities of adolescence, to create conditions for the formation of physical culture of children and adolescents with various acquired dysfunctions in wartime conditions. It is noted that the psychophysiological preparation of future physical education teachers and trainers determines the motives, content and direction of children’s motor activity, which is characterized by distinct tendencies towards individualization according to indicators of psychophysiological development and nosological units of chronic diseases. Attention is drawn to the general trend caused by the Russian Federation’s war against Ukraine, aimed at the destruction of the Ukrainian people and, first of all, its younger generations, which is the increase in the disability of children of all age groups. Related to this is the emergence of a general societal need for the training of future physical education teachers and coaches in general secondary education institutions, sports clubs and children’s and youth sports schools, capable of creating conditions for the formation of physical culture of children and adolescents who have lost limbs, have been traumatized, which led to persistent impairments of intelligence, locomotor apparatus, vision, hearing, speech or a combination of various dysfunctions acquired in wartime conditions.

Spontaneous spinal epidural haematoma: management and main risk factors in era of anticoagulant / antiplatelet treatment.

Spontaneous spinal epidural haematomas (SSEH) are rare nosological units wherein acute collections of blood develop in the spinal canal. SSEH are usually manifested by sudden severe back pain accompanied by the development of neurological symptoms. In this study, we retrospectively describe management and the main risk factors of SSEH in a series of 14 cases. Between 2010 and 2019, we examined 14 patients (age range 17-89 years, 10 women) diagnosed with SSEH. Eight cases were patients using anticoagulant therapies (six warfarin, one dabigatran, one apixaban) and two others were using ASA of 100 mg/day. The exact localisation and extent of changes was determined from acute magnetic resonance imaging. Three people using warfarin had INR values higher than 3.0 at the time of their diagnosis. Ten patients (71%) were taking oral anticoagulants or antiplatelet agents. In seven patients, SSEH were localised in the lower cervical/thoracic spine. Ten patients (71%) had arterial hypertension. Six patients underwent acute surgery due to rapidly developing spinal cord compression. Eight patients (57%) with slight or mild neurological symptoms were successfully managed without surgery. SSEH should be suspected in any patient receiving anticoagulant/antiplatelet agents who complains of sudden, severe back pain accompanied by neurological symptoms. SSEH is mostly localised in the lower cervical/thoracic spine. Arterial hypertension appears to be a risk factor of SSEH. Early decompression is an important therapeutic approach; in cases with minor neurological deficits, conservative treatment may be chosen.