Presence Of Concomitant Diseases Research Articles

CLINICAL AND ANAMNESTIC CHARACTERISTICS OF REPRODUCTIVE WOMEN WITH RECURRENT FORMS OF VULVOVAGINAL CANDIDIASIS

Vulvovaginal candidiasis remains an actual problem of lot of women of reproductive age. Despite significant advances in medical science, the percentage of recurrent forms of candidiasis continues to grow.
 The purpose of the study is to summarize the set of data on the clinical and anamnestic characteristics of women who contract recurrent forms of vulvovaginal candidiasis.
 Study materials and methods. Retrospective analysis of outpatient cards of reproductive women with characteristic complaints of vulvovaginal candidiasis and laboratory confirmation of the disease. Anamnestic data on carry of somatic and gynecological pathology, as well as the presence of concomitant diseases at the present time, were taken into account.
 Study results and their discussion. Anamnestic data showed the largest share of women with сoncomitant metabolic syndrome, diseases of the gastrointestinal tract, in particular, noninfective enteritis and colitis. Protective mechanisms counteracting the manifestation of opportunistic pathogens may be deficient in metabolic disorders, in particular, metabolic syndrome and the presence of bowel diseases. Endocrine pathology and diseases of the urinary system were the next most frequently detected. Analysis of generative function and gynecological pathology indicates a hormonal imbalance in the reproductive system and the presence of conditionally pathogenic factors of the inflammatory process.
 Conclusions. Somatic pathology has, albeit indirectly, an undeniably significant impact on the risk of recurrence of vulvovaginal candidiasis. A detailed analysis of the clinical and anamnestic data of women with recurrent vulvovaginal candidiasis will allow to optimize the not only treatment regimen, but also prevention of the disease.

Оn the issue of diagnosis of Norwegian scabies on the example of a clinical case

Norwegian scabies is a rare form of a fairly common contagious skin disease. It is characterized by difficulties in diagnosis due to the absence of a typical clinical picture and characteristic complaints of the patient. Also, the diagnosis of Norwegian scabies is often complicated by the presence of concomitant diseases, such as ichthyosis and mental retardation. As a result of impaired cognitive functions in patients, it is quite problematic to collect complaints and anamnesis. An incorrect diagnosis leads to the appointment of ineffective therapy and, as a result, to further progression of the disease, accompanied by the addition of secondary infection and deterioration of the general condition of the patients body.
 Training of doctors of various specialties (dermatovenerologists, therapists and general practitioners) in the skills of differential diagnosis of Norwegian scabies is relevant due to the increase in cases of this disease in various groups of people, mainly related to boarding houses and long-stay hospitals.
 In this article, the authors provide an overview of the etiology, pathogenesis, and clinical manifestations of a rare form of scabies ― Norwegian scabies, and highlight the difficulties of differential diagnosis of this dermatosis. A clinical case of Norwegian scabies in a 52-year-old woman suffering from ichthyosis and mental retardation on the background of Down syndrome is described.

АНАЛИЗ ПЕРВИЧНЫХ ОБРАЩЕНИЙ ЗА СТОМАТОЛОГИЧЕСКОЙ ПОМОЩЬЮ ПАЦИЕНТОВ, ПЕРЕНЕСШИХ НОВУЮ КОРОНАВИРУСНУЮ ИНФЕКЦИЮ COVID-19

Subject. The imposed restrictions on doctor visits caused by the pandemic Covid-19 and the severe course of the new coronavirus infection have changed the structure of dental care encounters.
 Objective of the study is to conduct a structural and quantitative analysis of dental care encounters of patients with the previous new coronavirus infection Covid-19.
 Methodology. A clinical and statistical patient chart was developed for this study. The initial encounters were analyzed in the period from March 2020 to December 2021. We have studied the frequency and structure of dental disease causes in patients who had recovered from the new coronavirus infection Covid-19 depending on the peaks of the Covid-19 incidence. In addition, the age and sex structure, the presence of concomitant diseases, and indicators of the oral cavity state were studied in the main group of patients: the decay-missing-filled index, mouth hygiene index, lesions of the oral mucosa, and regional lymph nodes reaction. The obtained data were processed with the statistical program Statistica 6.0, and differences in subgroups were analyzed according to the Student's t-test: the critical significance level was taken at p ≤ 0.05 when testing statistical hypotheses.
 Results. This study showed the dependence of the causes, frequency, and structure on pandemic periods. The predominance of the reasons for encounters changed in different periods of the pandemic. Besides, the age structure of patients changed in some periods of the pandemic. At the same time, no dependence of medical encounters on gender composition and comorbidities was observed. 
 Conclusion. This study showed a high level of spread of the carious process. The level of the hygiene index was initially satisfactory, but also moved towards unsatisfactory. Enlargement of lymph nodes and the spread of lesions of the oral mucosa tended to increase during 2020–2021.

Histological features of scar tissue formation in different methods of postoperative wound closure

Scar tissue formation is a natural reaction to a violation of the integrity of body tissues, including after any surgical procedure. The main role in wound reparative histogenesis occurs due to the growth of connective tissue, the cells of which begin to healing processes belongs to the connective tissue. A big role in wound healing processes belongs to the connective tissue, which cells have an extremely high reactivity, grow, from both edges of the wound, towards each other and fasten the edges of the wound with their fibers, which in turn become stronger (they are sclerosed) and form a dense scar. Factors such as heredity, the state of the immune system, the patient's age, the presence of concomitant diseases, and many others have a great influence on the healing of the postoperative wound and the formation of scar tissue. Also, intraoperative methods of influence on wound healing such as a method of wound closure, drainage, hemostasis, debridement, influence on wound infection, etc., are undoubtedly very important. An experimental study was conducted to study and compare the histological changes of scar tissue in some options for closing the postoperative wound at the early postoperative stage. 60 animals were operated on, that were divided into 5 groups: one control and 4 experimental. They compared the methods of closing surgical wounds using the methods of suturing the wound with knotted sutures, intradermal suture, gluing the edges of the wound and using the method of electrowelding of tissues. The results of the histological examination showed equal effectiveness of the compared methods of closing the postoperative wound, with a tendency for faster development of the connective tissue of the dermis in the group in which electric welding was used. Keywords: skin, scars, postoperative stage, morphological and morphometric methods, regeneration.

Results of kidney transplantation from suboptimal donors to recipients of the older age group

Introduction. Among the growing number of patients with chronic renal failure who need dialysis therapy or kidney transplantation, a significant proportion are people over 60 years old, making from 30 to 45% of all patients who need dialysis, according to various sources. The elderly age of the recipient contributes to the risk of developing graft dysfunction due to the presence of concomitant diseases that worsen the immediate and long-term results of transplantation. And the probability of receiving a kidney graft in elderly patients is significantly lower than in young recipients. One of the ways to solve this problem is to use kidneys from suboptimal donors.Material and methods. The analysis of clinical examinations, laboratory and instrumental test results obtained in 124 patients who underwent cadaveric kidney allotransplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine, including that from suboptimal donors, was carried out. Of these, 69 (55.6%) recipients aged 60 years and older were included in the main group (group 1), and 55 recipients younger than 60 years (44.4%) in the comparison group (group 2).Results. Kidney transplantation to elderly patients (aged 60 years and older), including from a suboptimal donor, provides a sufficiently high efficiency with a 1-year recipient survival rate of 98.6% and a functioning graft for 1 year in 75.4% of cases, which does not differ from the survival rate of younger recipients (98.2%), but is inferior by the case rate of keeping the graft functioning (91.9%). Meanwhile, the parameters characterizing the functional state of the transplanted organs that maintained their function for 1 year did not differ statistically significantly between elderly and younger recipients.Conclusions. The results of the study showed that kidney transplantation from suboptimal donors to patients of the older age group provides acceptable results with low mortality of recipients and a 1-year functioning of the graft in 75% of cases. This makes it possible to increase the availability of kidney transplantation for patients of the older age group and achieve better survival results, provided adequate selection of recipients and an objective assessment of the quality of transplanted organs.

Analysis of the Epidemiological Situation on the Pneumonia with Signs of Coronavirus Infection among the Population of the Republic of Kazakhstan

New coronavirus infection caused by SARS-CoV-2 (COVID-19), as well as pneumonia with signs of coronavirus infection, continues to spread around the world, but the epidemiological situation is not the same in different countries.
 The aim of the study: to analyze the epidemiological situation of coronavirus infection and pneumonia with signs of coronavirus infection in the Republic of Kazakhstan.
 Material and methods of the research: retrospective epidemiological analysis of the incidence of coronavirus infection and pneumonia with signs of coronavirus infection in the republic according to official statistical reporting, as well as a statistical analysis of discharge records of patients diagnosed with coronavirus infection (no virus identified) in a small town of Karaganda region was carried out.
 Results: An increase in cases, sick persons, recovered persons and lethal cases in population with positive PCR for COVID-19, as well as pneumonia with signs of coronavirus infection in the Republic of Kazakhstan was registered for the period from 08/01/2020 to 12/31/2021. The number of cases of coronavirus increased in 10.93 time, those who recovered – in 15.78 times, deaths – in 16.4 time, respectively. The increase in the number of cases of pneumonia with signs of coronavirus infection also increased in 16.24 time, the number of those who recovered at the beginning of the observation was not established, by the end the number of recovered was 76,989 people, the number of deaths increased in 173.83 time.
 Conclusion: An analysis of the discharge records of patients with pneumonia with signs of coronavirus infection revealed that 54.2% of the patients were females and 45.8% were males. The disease was registered in 21.8% of patients older than 60 years in the presence of concomitant diseases. Concomitant diseases were represented in 42% by arterial hypertension, in 26% by ischemic heart disease, in 14% by pyelonephritis. The same percentage of cases (12%) were chronic obstructive pulmonary disease and iron deficiency anemia, 11%

Epidemiological surveillance of surgical site infections in large joint replacement

Joint replacement is a reliable and effective surgery that allows profound pain relief and restores joint function in patients. Despite the progress made and the experience gained in joint replacement, surgical site infection is one of the leading postoperative complications. It can proceed as a periprosthetic joint infection, osteomyelitis, sepsis and lead to disabled or dead outcomes. Systematization of risk factors for infectious complications plays an important role as an element of epidemiological surveillance system optimization. Age, the presence of concomitant diseases (for example, diabetes mellitus, cancer, arthritis and systemic collagenosis), carriage of antimicrobial-resistant microorganisms, infectious and inflammation both outside and in the area of surgery, and external factors (surgery duration, correct antibiotic prophylaxis and surgeon's experience) are the most significant risk factors for periprosthetic joint infection. In world practice, the National Nosocomial Infections Surveillance System surgical site infection risk index is used. This criterion does not consider all potential risk factors. It is important to analyze and rank the identified risk factors according to the impact on the development of infectious complications in organizing an epidemiological surveillance system process in a medical organization. Risk factors analysis will identify the most significant modifiable factors for the development, implementation and execution of organizational, preventive measures and epidemic control. The creation and implementation of a standardized preoperative protocol based on a risk factors assessment will allow predicting the surgery outcome and arguing the strategy and tactic of preventive measures.

Role and place of radiotherapy in neoadjuvant treatment of pancreatic cancer

Background. Myocardial revascularization is a life-saving technology, which contributes to increase in lifespan, reduction in myocardial infarction recurrences and repeated surgeries along with improved life quality of the patients with coronary artery disease (CAD). Estimation of the risks, severity of coronary bed lesion, presence of concomitant diseases, and area of hibernating myocardium, as well as patient’s agreement are the basis of treatment method selection. Positive structural and functional changes in myocardium (increase in area of viable myocardium), restoration or improvement of systolic function of left ventricle (increase in ejection fraction and decrease in end-diastolic volume), reduction of angina symptoms are the expected results from the surgical treatment.
 Purpose – to determine the influence of risk factors for coronary artery disease on the outcome of surgical treatment by the method of aorto-coronary artery bypass grafting with the help of diagnostic evaluation of myocardial scintigraphy parameters.
 Materials and methods. For the implementation of the clinical objectives, 62 patients with coronary artery disease were examined. The average age of the patients was 59.6 ± 8.2 years. Myocardial scintigraphy was performed in the SPECT mode with ECG synchronization (Gated SPECT). 99mTc-MIBI with an activity of 555-740 MBq was used. Myocardial scintigraphy was conducted over time of treatment (before and after coronary artery bypass grafting) according to One Day Rest protocol.
 Results. The influence of risk factors was assessed using dynamic and static integral indices. The dynamic integral index didn’t reveal statistically significant risk factors: smoking (p = 0.54), left ventricular contractility impairment (p = 0.43), history of myocardial infarction (p = 0.4), stage of heart failure (p = 0.53), and functional class of angina (p = 0.08). The static integral index didn’t reveal statistically significant influence as well: smoking (p = 0.13), left ventricular contractility impairment (p = 0.58), history of myocardial infarction (p = 0.1), stage of heart failure (p = 0.11), and functional class of angina (p = 0.6).
 Conclusions. The studied risk factors for coronary artery disease, namely: history of myocardial infarction, left ventricular contractility impairment, stage of heart failure, functional class of angina, and smoking in the study group of patients had no registered influence on the revascularization effect by coronary artery bypass grafting method (integrated static and dynamic indices p > 0.05).

Influence of clinical presentation, site, and extent of venous thrombosis on decision about duration of anticoagulation: Data from the international, prospective, observational WHITE study

BackgroundLow attention has generally been dedicated to the influence of clinical presentation, extent of venous thrombosis and presence of residual vein obstruction (RVO) on the decision about the duration of secondary prophylaxis after a first venous thromboembolism (VTE). AimThis study aimed at investigating the role of the mentioned VTE characteristics on the therapeutic decision using the information collected in the international, prospective, observational WHITE study. Results1240 patients were recruited by 79 clinical centers in 7 countries (China, Czechia, Poland, Portugal, Russia, Slovakia, and Tunisia). 35 patients had as index event a pulmonary embolism (PE) without a deep vein thrombosis (DVT), and all continued anticoagulation. We focused on the 1205 subjects with DVT. The treatment decision differed among countries; altogether, more than 85% of patients with proximal (with or without distal) DVT continued a prophylactic treatment with anticoagulants, or antithrombotics; 34% of patients with isolated distal DVT stopped treatment, and more than 85% of patients with a PE associated to a DVT continued treatment. At multivariable analysis, the presence of proximal DVT, signs of post-thrombotic syndrome (PTS), residual vein obstruction (RVO), maintenance <180 days and concomitant diseases was associated with increased probability to continue secondary prophylaxis. ConclusionThe presentation as proximal DVT (with or without PE) or isolated PE influenced the treating physicians' decision in favor of extension of secondary prophylaxis, together with the presence of concomitant diseases and local conditions which may increase the risk of post-thrombotic syndrome.

The Effect of Nosocomial Infection on the Severity and Outcome of the Disease in Patients with Severe and Extremely Severe COVID-19

The mechanisms of development of nosocomial infectious complications in COVID-19 and the contribution of bacterial and mycotic superinfection to the formation of extremely high mortality among patients with severe and extremely severe course of this disease have not yet been fully revealed. The objective: to study epidemiology, risk factors for the development of nosocomial superinfection, and its effect on the severity and outcome of the disease in patients with COVID-19.Subjects and Methods. 383 cases of severe and extremely severe COVID-19 were retrospectively analyzed. Demographic data, the presence of concomitant diseases, community-acquired co-infection at the time of hospitalization, data on the methods used to treat new coronavirus infection, severity of the course of the disease, developed infectious complications and their etiology, and the disease outcome were studied. Risk factors for the development of secondary infectious complications and the contribution of nosocomial superinfection to the severity of COVID-19 and the disease outcome were evaluated.Results. Risk factors for the development of secondary infectious complications include age over 65 years (OR 1.04; 95% CI 1.03–1.06; p &lt; 0.0001), concomitant cardiovascular pathology (OR 3.82; 95% CI 2.02‒7.19; p &lt; 0.0001), chronic kidney disease, including requiring renal replacement therapy (OR 2.01; 95% CI 1.33–3.02; p = 0.0007), and glucocorticoid therapy (OR 1.62; 95% CI 1.02–2.69; p = 0.04). The development of nosocomial infectious complications in patients with COVID-19 is associated with a more severe course of the disease and unfavorable prognosis (OR 13.44; 95% CI 8.23‒21.92; p &lt; 0.0001).Conclusion. Identification of risk factors for the development of secondary infectious complications in COVID-19 allows developing differentiated approaches to the pathogenetic treatment of patients with severe COVID-19, increasing alertness in terms of the development of nosocomial infections, ensuring their timely diagnosis and treatment.

Clinical analysis of dogs with parvovirus

This study aimed to classify the clinical profile of dogs affected by parvovirus at the Veterinary University Hospital of a higher education institution in Rio Grande do Sul. The clinical histories of the animals seen at the hospital from January 2017 to July 2019 were reviewed, using the patients’ medical records. During this period, 176 animals were suspected to have parvovirus. The prevalence of disease was 44.3% (78/176). Positive patients were classified according to breed, gender, age, and vaccination status, then separated according to the bodily systems involved: digestive, neuromuscular, multisystemic, hematopoietic, respiratory, lymphatic, ophthalmic, urinary and cutaneous; clinical signs and the presence of concomitant diseases. Parvovirus occurs more often in males up to one year old and without predisposition for particular breeds. The researchers observed that most dogs had no previous vaccination history. This study highlights the infection patterns of this viral diseases, which mainly affects young unvaccinated animals, reinforcing the notion that preventive measures are essential for the control of the disease and the protection of the health of canine populations.

Relationship of coronary heart disease and comorbide dental background

Cardiovascular disease has serious economic and social consequences that affect people, health systems and societies around the world. Ischemic heart disease is one of the main global causes of death of the population, and its growth is predicted in the coming years. This fact continues to be of serious concern to health, social and economic services. Cardiovascular disease remains the most common cause of death, and age-standardized rates are higher for men than for women. Cardiovascular comorbidity increases significantly with age.The combination of ischemic heart disease and comorbid pathology is noted in cancer incidence, bronchial asthma, non-alcoholic fatty liver disease, type 2 diabetes mellitus, chronic obstructive pulmonary disease, periodontal disease, etc. It is necessary to analyze the existing disease with past diseases, risk factors and predictors available in the patient. The presence of concomitant diseases quite often requires additional diagnostic methods and changes in the tactics of treating coronary heart disease due to the fact that some of them are a contraindication to the use of certain groups of drugs. Periodontal disease includes a wide range of inflammatory conditions that affect the supporting structures of the teeth, which can lead to tooth loss and contribute to systemic inflammation. Periodontal disease is associated with several systemic diseases, one of which is coronary artery disease. It is imperative that clinicians understand the link between periodontal disease and cardiovascular disease. Comprehensive treatment of periodontitis and restoration of a healthy periodontium can help reduce overall inflammation in the body and reduce the risks of coronary heart disease.

Role of Genetic and Environmental Factors in Determining the Response to Metformin

Metformin is one of the most commonly prescribed drugs for the treatment and prevention of type 2 diabetes mellitus (T2DM). Numerous evidence accumulates indicating that both genetic and environmental factors underlie adverse side effects of metformin, as well as individual differences in patient response to treatment The present review summarizes information on genetic factors and environmental modifiers determining patients’ individual response to metformin treatment. The data on the role of polymorphism of the most significant genes and protein products encoded by them both in the development of adverse effects and in determining the therapeutic response are summarized, and the place of metformin in the realization of the phenotypic effects of these genes is discussed.Endogenous conditions and exogenous effects modifying the response to metformin are considered. Among them are factors that affect the functional state of the genome (the level of methylation of genes, one way or another associated with the response to metformin, etc.), reflecting the biological characteristics of the organism (gender, age), health level (the presence of concomitant diseases, the supply of biometals and vitamins), taking other medications, etc. Thus, there is a wide range of factors modifying the response to metformin, which, unlike genetic characteristics, are largely controllable. At the same time, both genetic and environmental factors may differ in significance in different ethno-territorial groups of the population. This information should be taken into account when developing a personalized approach to prescribing metformin for the treatment of type 2 diabetes, as well as when recommending its use for the treatment of other diseases.

Случаи кетоацидоза на фоне приема сахароснижающих препаратов из группы ингибиторов натрий-глюкозного котранспортера у пациентов с сахарным диабетом

The diabetic ketoacidosis (DKA) is the most frequent urgent condition in patients with diabetes mellitus which requires hospitalization and results to mortality. The most common causes of DKA are the presence of concomitant diseases in diabetic patients, as well as the violation of the insulin therapy regimen. With the appearance of hypoglycemic drugs from the group of sodium-glucose co-transporter inhibitors (iSGLT2), isolated cases of DKA associated with their intake began to be recorded. This article describes 4 cases of ketoacidosis in patients with type 2 diabetes mellitus and type 1 diabetes mellitus taking dapagliflozin which is a hypoglycemic drug from the group of inhibitors of the sodium-glucose co-transporter.

Primary Analysis of the Risk Factors for Severity and Mortality in COVID-19 Patients in Uzbekistan

A retrospective analysis of 561 patients with confirmed COVID-19 was performed to determine the risk factors for severity and mortality which could predict the disease outcome in early stages. Patients were divided into 4 groups in accordance with disease severity: mild, moderate, severe and critical. And initial clinical and laboratory parameters of patients at admission were studied. The age of severe and deceased patients was significantly higher than patients with mild and moderate course (р=0.003). Patiens with severe disease and fatal outcome had higher incidence of concomitant diseases compared to patients with mild and moderate course (p=0.01). The time passed from onset of first symptoms and hospital admission was shorter in patients with mild and moderate disease than patients with severe and critical disease (р=0.0001). The leukocytosis, significant lymphopenia (р=0.0001), high D-dimer and ferritin levels were associated with severe disease. Male gender, old age, presence of concomitant diseases should be considered as risk factors for severe course and death at COVID-19.

Delayed cutaneous manifestations in patients with COVID -19 caused by SARS -COV-2. Clinical observations in the Russian Far East

Chung M. K., Zidar D. A., Bristow M. R., et al. (2021) warn that a historic pandemic due to the coronavirus disease, COVID-19, could have negative potential consequences for the cardiovascular system for millions of survivors worldwide [1]. At the present stage, mechanisms of the long-term consequences of COVID-19 disease caused by SARS-COV-2 are not studied well; any assumptions regarding to the consequences of SARS-Cov-2 are hypothetical. Therefore, long-term effects require indepth research in the dynamics of recovery process after severe infections and rehabilitation of survivors. This will facilitate and increase the effectiveness of the treatment protocol for this disease and its complications [2]. The duration of the incubation period of the disease, the presence of sometimes not expressed or absent symptoms makes identification of the disease caused by SARS-CoV-2, COVID-19 infection, in some cases, too complicated [3]. The duration of the rehabilitation time, the complexity of pathogenetically based treatment do not yet have comprehensive information, therefore, it is difficult to resolve the issue of the timing of vaccination of patients who have recovered from COVID-19 infection. All the data obtained for each case of the disease, depending on age, the presence of concomitant diseases and individual terms of health recovery with the characteristics of complications in the late periods after recovery, has high relevance and great importance [4]. According to Wu Y., Guo C., Tang L., (2020), the excretions of recovered patients remains dangerous for others around 5 weeks after clinical recovery [5]. At the moment, there is practically no exact information about the duration and intensity of immunity in an infection caused by SARS-CoV-2 [6]. To develop protocols of COVID-19 treatment, principles and paradigms for the development of alternative effective vaccines for the prevention COVID-19 affects the health of consumers of the vaccine, which requires long-term monitoring in the post-recovery

РАДЖАСТАН ШТАТЫНДАГЫ (ИНДИЯ) ЭКИ ШААРДАГЫ КОРОНАВИРУСТУК ИНФЕКЦИЯНЫН АГЫМЫНЫН САЛЫШТЫРМА МҮНӨЗДӨМӨСҮ

Today, the covid 19 pandemic continues around the world. India, with 12.2 million cases, has the third largest number of detected cases of coronavirus infection after the United States and Brazil. The situation with coronavirus infection in India, as well as around the world, remains tense and urgent, due to the rapid spread, with a large number of cases and deaths. This article presents a comparative clinical characteristics of coronavirus infection in two cities of India in the state of Rajasthan (Kota and Jaipur), with the study of the epidemiological history, age, and gender of the patients. Special attention is paid to the peculiarities of the course of infection in children and elderly patients, the presence of concomitant diseases and the development of severe complications.

Lifestyle factors and medical activity of patients with COVID-19 treated on an outpatient basis using telemedicine technologies

The study of lifestyle factors (LS) and MA was conducted by an anonymous survey of 7,743 patients with COVID-19. The patients' health was assessed based on the study of the course of the underlying disease and the presence of concomitant diseases, which were detected in 24.3% of COVID-19 patients according to the data of copying information from medical records. It was revealed that the prevalence of tobacco smoking was 33.25 cases per 100 respondents, 45.4% of respondents were overweight, 75.6% of patients had a low level of physical activity, 68.2% and 53.8% of patients had low medical literacy and MA, respectively. It is established that the greatest impact on the health status of the patients interviewed was provided by the bio-social activity (Smoking) (h = 0.702; m = 0.0063; p = 0.0022), physical activity (h = 0.624; m = 0.0026; p < 0.001, health behavior (h = 0.527; m = 0.0030; p < 0.001) and health literacy (h = 0.532; m = 0.0028; p < 0.001). The studied risk factors affecting the health status of COVID-19 patients, most of which are manageable, should be taken into account when forming therapeutic and preventive measures.

Possibilities of application a fixed combination of alogliptin and pioglitazone for type 2 diabetes mellitus treatment

Hyperglycemia in T2DM is based on three main mechanisms: insulin resistance, progressive β-cell dysfunction, and excess glucose production by the liver.The onset of T2DM is usually preceded by a long period of insulin resistance. Prescribing sugar drugs that affect different links of pathogenesis, reducing a steady decrease in glycemia. To date, in clinical practice, various combinations of hypoglycemic drugs are used, the choice of which is determined by the characteristics of the course of diabetes in the patient, the presence of concomitant diseases and complications of diabetes, as well as the dominant clinical problem. This resolution provides an expert council opinion on the feasibility of using a combination of alogliptin and pioglitazone in patients with type 2 diabetes.

Temporary urethral stent with perineal fixation for posterior urethral stenosis (preliminary results)

Introduction. Urethroplasty is the “gold standard” treatment of urethral stenosis. However, often in connection with old and senile age, as well as due to the presence of concomitant diseases, it is not possible to carry out urethroplasty due to its certain invasiveness. In such cases, one of the methods of treatment is the installation of a urethral stent. But this method has not found practical application due to the frequent migration of stent and the high frequency of its incrustation. The approach developed by us avoids stent migration.Purpose of the study. To evaluate the immediate results of the placement of a urethral stent with fixation through the perineum.Materials and methods. A total of 18 patients with urethral stenosis aged 68 to 84 years have been operated on since February 2019. Ten patients had stenosis of the urethrocystoneoanastomosis after radical prostatectomy, 6 patients had iatrogenic stenosis of the prostatic urethra, 1 patient had post-radiation stenosis of the bulbo-membranous urethra. All patients in the preoperative and postoperative periods underwent: IPSS-QoL questioning, uroflowmetry, bladder ultrasound with residual urine volume evaluation, urethroscopy, ascending and micturition urethrocystography. The first stage was an internal optical urethrotomy according to the standard technique. Then, a urethral stent was installed in the area of dissected stenosis. The second stage was an incision in the perineum, the urethra was isolated, and under optical control, through the perineum, the stent was fixed to the urethra with non-absorbable suture material. The stent was removed endoscopically after 6 months.Results. The median surgery duration averaged 45 minutes. Patients were discharged 2 to 3 days after surgery. The maximum observation period was 20 months. During the observation period, not a single case of stent migration was recorded. All patients showed a persistent increase in Qmax and no residual urine. Six patients had a stress component of urinary incontinence, 4 patients had total urinary incontinence. According to control urethrocystoscopy 6 months after stent removal, clinically insignificant urethral stenosis was noted in all patients. In all cases, moderate signs of stent encrustation were identified. Dysuric phenomena disturbed 5 patients, who were stopped by rectal suppositories with NSAIDs, as well as taking herbal uroseptics. The data from the IPPS-QoL questionnaires confirm the positive effect of the treatment.Conclusions. Temporary placement of a urethral stent for urethral stenosis is an effective minimally invasive treatment. The technique of fixation through the perineum allows preventing migration in all cases. This approach to treatment significantly improves the quality of life of patients who were contraindicated for urethroplasty for one reason or another. However, the technique requires longer observation and analysis.