Somatic Pathology Research Articles

COVID-19-associated schizophrenia-like psychosis during the COVID-19 pandemic

IntroductionThe viral theory of the development of psychoses was formulated in the 19th century, but the role of viral agents in the pathogenesis of psychoses remains a matter of debate. In the context of the 2020 pandemic, the results of several papers on the characteristics of psychotic disorders in COVID-19 have been published. Coronaviruses are neuroinvasive, capable of affecting mental and body functions.ObjectivesThe aim of the study was to identify patients with acute psychosis without a history of mental disorders in order to test the hypothesis about the possibility of manifestation of schizophreniform psychosis due to a viral attack.MethodsWithin a year and a half, 50 patients with mental disorders associated with COVID-19 were identified. The reason for hospitalization in a psychiatric hospital is the development of acute schizophreniform psychosis against the background of a new coronavirus infection. The diagnosis was verified according to traditional clinical criteria and modern psychometric tools. Inclusion criteria: no previous visits to a psychiatrist; verified acute polymorphic psychotic disorder and coronavirus infection COVID-19 (ICD-10); manifestation of psychosis against the background of infection with COVID-19; age 18-60 years; consent to participate in the study. Exclusion criteria: signs of organic brain damage; indications of substance abuse; delirium of any etiology; somatic pathology in the stage of decompensation.Results27 women (54%) and 23 men (46%), aged 20 to 57 years (average age 34.5±7.6), of which 18 people (36%) worked, 2 (4%) studied , 29 (58%) people are unemployed. 27 people (54%) are single, 16 (32%) are married, 7 (14%) are divorced; 18 people (36%) were raising children, which indirectly indicated a relatively favorable premorbid functioning. At the time of the examination, the condition was determined by polymorphic psychotic symptoms with a predominance of dissociative-delusional, paraphrenic and oneiric phenomena with plots containing plots of infection and the spread of coronavirus. At the same time, the sum of PANSS is from 53 to 130 (85) points, including PANSS P - from 15 to 37 (27), PANSS N - from 7 to 44 (18), PANSS G - from 23 to 57 (39.9 ); P1 - 5.7; P3 - 5.1. When comparing the obtained data with the world experience, we found some differences. Delusional symptoms were diagnosed twice as rarely, cases with tactile hallucinations were not detected, but catatonic symptoms were observed twice as often, and manic arousal was twice as rare. In general, the studied data are comparable with the results published in the world practice.ConclusionsThe unique experience of the coronavirus pandemic will allow us to assess the influence of environmental factors, namely the role of infections, in the manifestation or predisposition to schizophrenia spectrum disorders. It is planned to evaluate the dynamics of the course of the disorder after the relief of the acute period.Disclosure of InterestNone Declared

Suicidal crisis in the adolescent: About 3 clinical cases

IntroductionSuicide is the third most common cause of death among adolescents. It is linked to several mental pathologies. Early detection and effective and rapid management are essential elements to improve the mental health of the adolescent and prevent suicidal behaviour.ObjectivesOur objective is :-To discuss through these medical observations the risk factors and pathologies at high risk of suicide,-To detail the urgent course of action to be taken in the event of suicide attempts and-To underline the importance of early management to prevent suicide in adolescentsMethodsWe report hereafter the clinical cases of 3 adolescents followed in child psychiatry for the management of a suicidal crisis.Results1st clinical case :This is a 13 year old girl, brought back by the staff of the Lalla Meryem child protection centre, where she has been living since her separation from her family following abuse by her mother. She reports a reliving of scenes where her mother burned her private parts. She reports disturbed sleep with night terrors and nightmares. In addition, the centre’s staff reported irritability, crying spells and verbalized suicidal threats.2nd clinical case:This is a 15 year old girl referred by the paediatric service for management of a suicide attempt by ingestion of rat poison. She stopped her schooling 2 years ago to take care of her mother who had cervical cancer and died 6 months ago. Since then, she has experienced sadness of mood, low self-esteem with ideas of devaluation. During the first psychiatric interview, she did not criticize her suicidal act and said that she wanted to kill herself, which she considered the only solution to her suffering.3rd clinical case:This is a 12-year-old adolescent, followed in child psychiatry for conduct disorder with problematic use of tobacco, cannabis and benzodiazepines. He had stopped going to school since the third grade.He consulted for a suicide attempt by ingesting 30 antihypertensive tablets. After somatic care, he was referred to us from the medical emergency department for psychiatric care.ConclusionsSuicide among adolescents is on the increase in Morocco. It is necessary to take into account the risk of suicide in the face of any mental or somatic pathology. A rapid and urgent course of action is necessary to avoid recurrence.Disclosure of InterestNone Declared

Psychiatric manifestations of corticosteroid therapy

IntroductionChildren and adolescents treated with corticosteroids (CS) may experience psychiatric side effects, including psychotic symptoms. These can occur at any time during treatment, including withdrawal. There is evidence in the adult literature that higher doses of CS increase this risk. However, the dose-response relationship is not clearly identifiable. This is probably a reflection of the complexity of the effects of CS on the central nervous system and the body.Objectivesthe objective of this study is to discuss the psychiatric manifestations secondary to corticosteroid therapyMethodsThis is a descriptive study of 10 children with a history of somatic pathologies for which they were placed on oral, nasal, or intravenous corticosteroid therapy and who during the course of this corticosteroid therapy presented with various psychiatric manifestations.ResultsThe majority of the children studied were male, i.e., 7 boys to 3 girls, six children either 60%, were on nasal corticosteroids; 20% on intravenous corticosteroids, ., 20% orally.The psychiatric manifestations noted were represented by : depressive disorder in 8 childrens Anxiety in 7 childrens a psychotic disorder in one child ADHD in 3 childrens.ConclusionsA causal role of corticosteroid therapy in the development of mental disorders in children and adolescents has been widely discussed but the results are controversial with respect to the route of administration, the relationship with the dose and the chronology of the development of mental disorders.Disclosure of InterestNone Declared

Obsessive-compulsive disorder comorbid with rheumatoid arthritis: case report and review of literature

IntroductionObsessive-compulsive disorders are complex pathologies causing a major psychosocial handicap. However, their association with a disabling somatic pathology such as rheumatoid arthritis makes management more difficult.ObjectivesTo investigate through a case analysis and a review of literature the association between obsessive-compulsive disorder (OCD) and rheumatological disorders.MethodsWe reported a case of a woman with a long history of obsessive compulsive disorder who presented rheumatoid arthritis and we conducted a review of literature through search on Pub-Med/MEDLINE following the terms “obsessive-compulsive disorder”, “rheumatoid arthritis”, “association”, “inflammation”.ResultsCase presentation: A 62-years old woman who had been followed at the psychiatric consultation for 20 years for OCD. She had been stabilised on clomipramin at a dose of 100 mg per day until 2012 and since then she had been lost to follow-up with the notion of poor compliance with the treatment. She re-consulted in August 2022 for worsening psychiatric symptoms such as phobic obsessions with delusional beliefs, verification compulsions, sleep disorders and multiple somatic complaints including diffuse arthralgia and chronic arthritis evolving for 6 months.The patient was put on risperidone 2mg with anxiolytic without improvement. She was referred to the rheumatology consultation where the diagnosis of very active rheumatoid arthritis was retained, hence she was put on 20mg of prednisolone per day with methotrexate.The evolution was marked by the accentuation of obsessions and compulsions with the appearance of depressive elements, hence the introduction of fluoxetine 40 mg per day, the increase in the dose of risperidone to 4 mg with the anxiolytic with an improvement on the somatic and psychiatric symptoms.ConclusionsLiterature had shown that patients with this OCD usually suffer from inflammatory or rheumatological comorbidities. This association could complicate the management of these patients.Disclosure of InterestNone Declared

Obstetrical and perinatal consequences of birth in women depending on the term of gestation

The objecticve: to analyze peculiarities of pregnancy course, childbirth and the condition of newborns in women, depending on the gestation period on the basis of clinical and statistical analysis.Materials and methods. An analysis of pregnancy course, childbirth and perinatal outcomes has been carried out in 137 pregnant women. Patients were divided into 2 groups depending on the gestational age: 41 patients (I group) delivered in 37–40 weeks of gestation and 96 patients (II group) – in 41-42 weeks of pregnancy. Functional assessment of the fetal condition was performed using a cardiotocographic examination with cardiomonitors «Oxford Team 8000» and Hewlett Packard according to the generally accepted method, ultrasound examination – by ultrasound machine «Biomedica Au-530» with a linear sensor of 3.5 MHz frequency. Variational and statistical processing of the results has been carried out using licensed standard packages of multivariate statistical analysis application programs «STATISTICA 13».Results. An evaluation of anamnestic data allowed to establish that the majority of patients in the II group (53.13 %) had extragenital pathology that was in 2 times more than in the I group (24.39 %). The frequency of chronic salpingo-oophoritis was also significantly higher in the II group compared to the I one (12.50 % and 2.44 %, respectively), and such pathology as uterine leiomyoma (7.29 %) and cervical dysplasia (4.17 %) were diagnosed only among the women in the II group.A higher rate of pregnancy loss, anemia during pregnancy and disorders of uteroplacental bloodflow in patients in the II group was determined. The frequency of obstetric complications in the II group was in 4 times higher compared to the I group. This had a direct impact on the increase in the rate of cesarean section and vacuum extraction of fetus. Thus, fetal distress during childbirth was diagnosed in 13.54 % of women in the II group and in 7.32 % in the I group, and the weakness of labor activity (8,3 %) and clinically contracted pelvis (5.21 %) were determined only in the II group. Trauma of the birth canal was found in 37.5 % of women in the II group, which was almost 4 times higher than in the group I (9.76 %). The frequency of postpartum bleeding was also higher in the group II (15.6 %) and exceeded the indicator in the I group (4.88 %) in 3 times.The signs of prolonged pregnancy were found in 7.32 % newborns in the I group and 13.54 % – in the II group. It should be noted that the clinical features of early adaptation, which are characterized by a low Apgar score at birth, as well as higher morbidity, including high frequency of damage to the nervous system were determined in the newborns in the II group.Conclusions. Results of the study indicate the importance of constitutional and age characteristics, as well as concomitant somatic pathology and genital inflammatory diseases in women with a delivery date of 41–42 weeks of pregnancy, which can increase the probability of postterm pregnancy in these women. According to the results of the comparative analysis in the research groups, depending on the date of delivery, the predominance of obstetric and perinatal complications was established in women who delivered at 41–42 weeks of pregnancy compared to women who had labor at 37–40 weeks. A high rate of obstetric complications (anomalies of uterine activity in labor, fetal distress, clinically contracted pelvis) had a direct impact on the increase in a percentage of operative delivery (vacuum extraction of a fetus and caesarean sections). Babies born at 41–42 weeks had clinical features of early adaptation, characterized by a low Apgar score, higher morbidity and frequent damage of the nervous system compared to newborns with gestation period of 37–40 weeks.

Оцінка стану тканин пародонта у хворих із соматичною патологією

The purpose of the study was to investigate the influence of concomitant somatic pathology on periodontal tissues. Materials and methods. 104 patients, aged 28–46 years, with diseases of periodontal tissues, who had somatic pathology, were involved in the study. The examined persons were divided into groups: 35 persons (group 1) with pathology of the hepatobiliary system, 37 persons (group 2) with pathology of the gastrointestinal tract, and 32 persons (group 3) with pathology of the cardiovascular system. The comparison group included 30 people with periodontal tissue diseases without somatic pathology. To determine the depth and prevalence of the inflammatory process of the gums the Svrakov’s number indicator was used. Oral hygiene was assessed according to the Silness-Loe and Stallard indices. The papillary-marginal-alveolar index (C. Parma, 1960) was determined to assess the severity of gum inflammation. Bleeding gums were assessed by the gum's papilla bleeding index according to Muhllemann. Statistical processing of the research results was carried out with a computer program for variational and statistical analysis of medical and biological research data “GraphPad Prism 5”. Results and discussion. Patients with diseases of periodontal tissues against the background of somatic pathology had the highest percentage of chronic generalized periodontitis of the II degree, in contrast patients of the comparison group had the highest percentage of chronic generalized periodontitis of the initial – I degree. Svrakov's number in patients with periodontal disease against the background of somatic pathology significantly (р ˂0.05) exceeded the indicators of patients of the comparison group. At the same time, there is no significant difference between the results of groups 1, 2 and 3. The highest values of the indexes of Silness-Loe and Stallard were recorded in patients with the cardiovascular system pathology, which significantly (p<0.05) exceeded the data in the comparison group, but did not significantly differ from the results of patients with pathology of hepatobiliary system and gastrointestinal tract. The papillary-marginal-alveolar index data were the highest in patients with hepatobiliary system pathology (64.25 ± 8.19%), which significantly (p<0.05) exceeded the results of the comparison group and in individuals of groups 2 and 3. The highest indicator of the bleeding index is 1.98 ± 0.22 points in patients of the 1st group, which significantly exceeds the indicators in the group of people without somatic pathology and in the group of patients with pathology of gastrointestinal tract and cardiovascular system. Conclusion. The conducted studies show that the presence of somatic pathology contributes to the development of periodontal tissue diseases, and certainly aggravates their course, which is proven by the results of the index assessment

Evaluation of Oral Hygiene and Periodontal Indices of 6–14-Year-Old Children with Insulin-Dependent Diabetes Mellitus

The purpose of the study was to evaluate oral hygiene and periodontal indices in children with type 1 diabetes mellitus. Materials and methods. 258 children aged 6-14 years were examined, including 129 children with type 1 diabetes mellitus and 129 children without concomitant somatic diseases. All patients were divided into four subgroups according to the presence of gingivitis. We determined the oral hygiene index-simplified (according to Green, Vermillion, 1964), the papillary-marginal-alveolar index in Parma modification (1960), the gingival index according to Loe, Sillness (1967). The t-test for paired samples was used to compare values. The difference was considered statistically significant at p<0.05. Results and discussion. The worst level of oral hygiene was in group of children with type 1 diabetes mellitus and chronic catarrhal gingivitis because gum bleeding and pain in gums in these children did not allow them to make full efforts and carry out oral hygiene well. Our research showed a statistically significant difference between the patients with type 1 diabetes mellitus and control group in accordance with periodontal indices. Children with diabetes mellitus had the highest values of periodontal indices. The inflammatory processes in the tissues of periodontium in patients with type 1 diabetes mellitus are expanded, so it is very important to recognize them and diagnose them as early as possible. Periodontal indices in patients of the youngest age subgroup, namely, both the group of patients with diabetes mellitus and the group of children without somatic pathologies were the lowest. The totality of data on periodontal indices in children with chronic catarrhal gingivitis and type 1 diabetes mellitus indicated an average degree of severity of gingivitis, namely, the papillary-marginal-alveolar index was 42.77 ± 1.31%, the gingival index was 1.81 ± 0.05 points. Protective mechanisms in young patients with type 1 diabetes mellitus are changed. Children with this endocrine illness suffer from swelling of the gums and have extreme gum bleeding along with the development of the main endocrinological disease compared to healthy patients of the same age. According to the results we obtained, we believe that screenings of the oral cavity and preventive programs should emphasize the importance of early diagnosis of gingivitis and periodontitis even during the milk and mixed bite period, particularly in children with type 1 diabetes mellitus. Conclusion. Children with type 1 diabetes mellitus had a worse state of oral hygiene than healthy children. Children with diabetes mellitus had gum bleeding both during the period of temporary bite, and during the period of mixed bite

Антропометричні особливості обличчя у дітей з уродженими дефектами коміркового відростка верхньої щелепи до хірургічного втручання

The purpose of the study was to investigate the anthropometric parameters of the nasolabial complex in patients with different sizes of the congenital defect of the alveolar process before surgical intervention. Materials and methods. To achieve the goal, a clinical assessment of the nasolabial complex was carried out in 54 children with clefts of upper lip and palate (aged 10 to 19 years). The next indicators were included: the length of the nasal wing, the width of the bottom in the nostril, the vertical displacement of the nasal wing and their ratios. The children were divided into three subgroups, depending on the size of the bone defect, which involved the planning of a different type of surgical intervention: 1 (n=13) – recovery of the defect without osteoplasty, 2 (n=11) – osteoplasty using the mandibular symphysis tissue, 3 (n=30) – osteoplasty using an autograft from tibia. Results and discussion. Clefts of upper lip and palate are accompanied by numerous anatomical and functional disorders in the maxillofacial system. Reconstruction of the maxilla alveolar processes on the cleft side is a necessary stage of the complex rehabilitation of the patient. The degree of severity of functional disorders in cases of clefts of upper lip and palate depends on many factors and conditions – the form and size of the cleft, the patient's age, concomitant local and general somatic pathology, as well as the success of the performed complex treatment. Fixation of the patient's rehabilitation process by photography and analysis of clinical photos are important components of evaluation of treatment results. The volume of the congenital (residual) defect of the alveolar process on maxilla directly affects the level of facial asymmetry which is reflected in changes in the ratios on the affected and healthy side – the length of the nasal wing, the width of the nostril, the angles of the base of the nasal wing. Such anthropometric data may be crucial points in the selection of surgical intervention methods and the use of different autologous transplants. The obtained results are consistent with similar studies by Ajami S., 2020, which established pronounced differences in the structure of the nasolabial complex even under the conditions of full and timely rehabilitation of children with congenital cleft of the upper lip and palate, compared to the ethnic anthropometric norm of healthy patients. And the sooner the integrity of the upper lip is restored, the better the symmetry of the nasolabial complex is achieved. Alveolar process plasty significantly equalizes the symmetry of the nose and upper lip in patients with congenital cleft of the upper lip and palate, which was shown by three-dimensional anthropometric studies in a number of clinics around the world. Conclusion. Anthropometry (photogrammometry) of the nasolabial complex on the face is an additional method in diagnostic that is necessary to make the correct clinical decisions during the planning of reconstructive interventions on the maxilla in case of clefts of lip and palate

Beneficial effects of statins on adropin level in patients with arterial hypertension

Introduction. Adropin is a new secretory hormone that takes part in the regulation of energy homeostasis. Hormone is known to have positive effects on endothelial cell proliferation and prevention of atherosclerosis, and low adropin level may be a risk factor and potential predictor of atherosclerosis. Arterial hypertension (AH), which remains one of the most common somatic pathologies among middle-aged and older people, plays an important role in predicting cardiovascular morbidity and mortality. A number of medications that are used as antihypertensive therapy contribute to an increase in the content of adropin. At the same time there are not enough studies on the effect of statins on the content of adropin.
 Aim of the study.To investigate the effects of statins on adropin level in patients with AH.
 Material and methods. 70 patients with hypertension aged 62,1 ± 9,9 years were examined. They were divided into 2 groups: 1 group – patients with AH, overweight and obesity who did not take statins (n=40); group 2 – persons with AH, overweight and obesity who took statins (n=30). All individuals underwent determination of basic indicators of biochemical blood analysis, lipid profile (total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), triglycerides (TG), atherogenicity ratio). The level of adropin was determined by enzyme immunoassay (Finetest Elisa Kit) in blood serum.
 Results. Systolic blood pressure (BP) was significantly higher in group 1 individuals (p<0.05), while diastolic BP remained unchanged (p>0.05). Among patients who took statins, a significantly lower level of TC, LDL, atherogenicity ratio (p<0.01), HDL (p<0.05) was found, while the level of TG remained unchanged.
 Taking statins and achieving the target level of LDL improves the prognosis of patients with cardiovascular pathology, as evidenced by a significant increase in the content of adropin in blood serum in patients of the 2nd group. In women who took statins, a direct correlation was found between the level of adropin and HDL (r=0.609; p<0.05).
 Conclusions. Taking statins is associated with significantly higher levels of adropin in patients with AH compared to individuals who did not take these drugs. A direct correlation was noted between the level of adropin and HDL in women who took statins. Statins effectively reduce atherogenic fractions of cholesterol and help to increase the concentration of adropin in blood serum.

НЕОБХОДИМОСТЬ СОЗДАНИЯ ИНДИВИДУАЛЬНОГО ПРОГНОСТИЧЕСКОГО КРИТЕРИЯ ОЦЕНКИ СОСТОЯНИЯ ЗДОРОВЬЯ БЕРЕМЕННОЙ

Due to the clear depopulation trends in the country, the problem of protecting the health of mother and child, preserving the reproductive potential has become extremely acute. The current situation causes reasonable concern of the state and the medical community for the quality of health of future generations. The increase in extragenital and gynecological morbidity, the negative nuances of the reproductive behavior of adolescent girls and women creates a real threat to the successful implementation of their reproductive function and replenishment of the country's demographic reserve in the near future.The real improvement in statistics was due to the rationalization of the prevention of full-term pregnancy. The purpose of the study: to improve the outcomes of gestation for the mother and fetus based on the creation of an individual prognostic criterion for assessing the state of health. Results and discussion. In order to determine the effectiveness of the proposed set of measures to reduce the risk of adverse pregnancy outcomes, a prospective study was conducted in the "organizational modeling" group in 174 pregnant women. In order to determine the predictors of gestational complications in the process of a comprehensive examination of patients during pregnancy registration, it was found that the predictive factors for the development of pregnancy complications that subsequently affect the realization of reproductive potential are: menstrual dysfunction, somatic and gynecological pathology, previously transferred infectious diseases, as well as neuro-metabolic-endocrine diseases. The main methodological principle of the stage-by-stage monitoring of pregnancy management is the inseparable unity of the implementation of all points, control of the full scope of a single strategy and evaluation of the result obtained. The specified components of the methodology are mandatory. Conclusions: the informational significance of evaluative and prognostic predictors (calculation of pregnancy health indices by trimesters) determines the possibility of stratifying tactics by perinatal risk groups: exclusion of obstetric aggression at a low degree (index I), therapeutic and preventive measures at an average (index II, III) and high degree of risk (index IV, V).

History of the study of the neural crest (review)

The neural crest has long attracted the attention of evolutionary biologists and, more recently, clinical specialists, as research in recent decades has significantly expanded the boundaries of knowledge about the involvement of neural crest and neural crest cells in the development of human pathology. The neural crest and neural crest cells are a unique evolutionarily based embryonic structure. Its discovery completely changed the view of the process of embryogenesis. Knowledge of neural crest development sheds light on many of the most «established» questions of developmental biology and evolution. Our article will reflect on the historical stages of the discovery and study of the neural crest and the impact of this discovery on entrenched ideas about germ layer specificity and the theory of germ layers – the reasoning of the neural crest as the fourth germ layer. The aim of this review is to describe the history of the discovery and study of neural crest and neural crest cells based on an analysis of the literature. In writing this article, an analysis of the scientific literature was conducted using the search terms «neural crest», «neural crest cells», «neural crest cell morphology», «germinal layers» and «embryonic development» in the computer databases PubMed, Scopus, Web of Science, and eLibrary. The depth of the analytical search corresponds to the period of the discovery of the neural crest and the first mention of the neural crest as an embryonic morphological structure in the scientific literature. The information presented confirms the high interest of research scientists and clinical specialists in the study of neural crest and neural crest cells. The involvement of neural crest cells in the formation of somatic and musculoskeletal pathologies has received particular attention in recent decades. The literature sources are represented by 169 full-text manuscripts and monographs mainly in English. Conclusions. Neural crest and neural crest cells are unique evolutionary structures. Regularities of formation, reasons which condition migration, differentiation, interaction of neural crest cells with other structures during embryogenesis as well as their potential, which is realized in postnatal period, continue to be the subject of research up to now.

ПЕРСПЕКТИВЫ ПРИМЕНЕНИЯ ЭНДООССАЛЬНОГО ЦЕЛЬНОКЕРАМИЧЕСКОГО ВИНТОВОГО ОДНОЭТАПНОГО ИММЕДИАТ-ИМПЛАНТАТА В ОРТОПЕДИЧЕСКОЙ РЕАБИЛИТАЦИИ ПАЦИЕНТОВ С АДЕНТИЕЙ

The subject of the study is the prospects for the introduction of an endosseous all-ceramic screw one-stage immediate implant in the clinical practice of orthopedic rehabilitation.
 The objectives analysis of the prospects for the use of the developed dental implant (endossal all-ceramic screw single-stage implant) in dental practice during orthopedic rehabilitation of patients with adentia.
 Methodology. The study was performed on the basis of an analysis of orthopedic rehabilitation means and their effectiveness in patients of dental clinics in the cities of Kemerovo for 2018–2022.
 Results.The results of rehabilitation of patients with adentia using dental implants based on zirconium dioxide (both imported and patented bio-implants) and implants based on titanium alloys are presented.
 The new endosseous all-ceramic screw one-stage implant developed by the author of the study (RF Patent for Invention No. 2651052; Eurasian Patent No. 035482) is distinguished by its design (rough active two-component thread passing into a polished neck by switching the platform and then into a suprastructure with the possibility of its individualization in the cavity mouth) and the method of treating the surface of the exclusively threaded part of the implant with calcium hydroxyapatite.
 The possibility of using the developed implant will satisfy the needs of patients for a minimally invasive implantation procedure, ensuring its economic efficiency in relation to an analogue imported ceramic implant. In addition, due to the specialized surface treatment, the developed implant does not require the use of bone substitutes, and the presence of a biocoating allows expanding its use in groups of patients with somatic pathologies.
 Conclusions. The performed study allows us to recommend the use of the developed bio-implant in clinical dentistry in order to study the possibilities of its use in the near and long term.

Interventional pathway in the management of refractory post cholecystectomy pain (PCP) syndrome: a 6-year prospective audit in 60 patients.

Post cholecystectomy pain syndrome can affect over a third of patients undergoing laparoscopic cholecystectomy. Acute exacerbations can result in recurrent emergency admission with excessive healthcare utilization. Standard surgical management appears to focus on visceral aetiology. Abdominal myofascial pain syndrome is a poorly recognised somatic pathology that can cause refractory pain in this cohort. It develops as a result of trigger points in the abdominal musculature. The report describes the pathophysiology and a novel interventional pathway in the management of post cholecystectomy pain secondary to abdominal myofascial pain syndrome. The prospective longitudinal audit was performed at a tertiary pain medicine clinic in a university teaching hospital. Over a six-year period, adult patients with refractory abdominal pain following laparoscopic cholecystectomy wereincluded in a structured interventional management pathway. The pathway included two interventions. Intervention I was a combination of abdominal plane blocks and epigastric port site trigger injection with steroids. Patients who failed to report durable relief (>50% pain relief at 12weeks) were offered pulsed radiofrequency treatment to the abdominal planes (Intervention II). Outcomes included patient satisfaction, change in opioid consumption and impact on emergency visits. Sixty patients who failed to respond to standard management were offered the pathway. Four patients refused due to needle phobia. Fifty-six patients received Intervention I. Failure rate was 14% (8/56). Forty-eight patients (48/56, 86%) reported significant benefit at 12weeks while 38 patients reported durable relief at 24weeks (38/56, 68%). Nine patients received Intervention II and all (100%) reported durable relief. Emergency admissions and opioid consumption were reduced. Abdominal myofascial pain syndrome is a poorly recognised cause of post cholecystectomy pain. The novel interventional management pathway could be an effective solution in patients who fail to benefit from standard management.

Risk factors for development of the post-COVID syndrome

Aim:to study risk factors of development of the post-COVID syndrome (PCS).Material and methods.210 patients with a history of new coronavirus infection (COVID-19) (47 men, 163 women aged 18–85 years) were examined by doctors of various specialties. Patients were divided into several groups depending on the presence of PCS, as well as the severity of the disease.Results.The risk factors of the PCS development are moderate and severe course of the pathological process in acute period of COVID-19 disease (p< 0.001). In women, PCS is seen more often than in men (30 / 135vs. 17 / 28,p< 0 / 001), other risk factors are age over 50 years (p< 0.05), polymorbidity (p< 0.01), treatment with glucocorticoids in acute disease period (76 / 165vs. 4 / 45,p< 0.001). In cases of mild COVID-19 course, neither age nor polymorbidity increased the risk of PCS development (p> 0.05), however a dysfunction of cellular immunity was significant, specifically the proliferative activity of lymphocytes in response to mitogen: 50.6 ± 10.4 %vs. 54.0 ± 5.1 %,p< 0.05). In cases of severe COVID-19 course, the gender differences and dysfunction of the cellular immune system are not the determinants for the PCS development (p> 0.05), however the age (56.7 ± 13.1 yearsvs. 42.1 ± 15.4 years,p< 0.01) its linkage to somatic pathology (a cardiovascular disease) besides glucocorticoids threatment (64 / 89vs. 3 / 9,p< 0.05) are important risk factors for PCS.Conclusions.The main risk factor for PCS development is the moderate and severe course of the pathological process in the acute period of COVID-19 infection, female gender, age over 50 years, polymorbidity, treatment with glucocorticoids in the disease acute period. In case of mild COVID-19 course, neither age nor the polymorbidity increased the risk of PCS development, but the dysfunction of cellular immunity is significant. In case of severe COVID-19, the gender differences and dysfunction of the cellular immune system are not the determinants for the PCS development, however age, concomitant somatic pathology (a cardiovascular disease) and glucocorticoids treatment in acute period are important risk factors for the PCS development. The titer of protective IgG class antibodies to SARS-CoV-2 is not linked to risk of the PCS development.

The role of magnetic resonance imaging (IMR) in the diagnosis of tumor and somatic pathologies. Introduction.

Magnetic resonance imaging (MRI) is a non-invasive investigation, which allows the anatomical investigation, but also the physiological processes of the human body, for the diagnosis of tumors, somatic diseases, etc. MRI can be diversified into neuroimaging, cardiovascular, musculoskeletal, functional, angiography, and other special-izations and techniques.The purpose of the work. Analysis of the possibilities and effectiveness of the application of MRI in the diagnosis of tumors and somatic pathologies in one year of activity (2021-2022) at an Ingenia Ambition-1.5T installation and the annual functional possibilities. Materials and methods. MRI investigations were performed at the Ingenia Ambition-1.5T Philips Magnetic Resonance Facility on 8,789 patients aged between 1 month and 84 years, with tumors and somatic diseases, applying the techniques and protocols corresponding to the investigative level. The protocols were applied in different planes (axial, coronary, sagittal, oblique), and techniques such as T2w, T1w, PD, FLAIR, SWI, DWI, DWI_ZOOM, DTY, DWI_BS, STIR, SPIR, T1_mDICSON, T2_mDIXON, 3D-DIR, T1w+Cdyn, T2*perfusion, ASL perfusion, 3D pCASL perfusion, Spectro, BTFE, dual FFT, MRSP, mDIXON_quantification.

Clinical and Morphological Evaluation of Erosive and Ulcerative Gastric Lesions in Patients with Rheumatoid Arthritis.

One of the most important problems associated with the treatment of Rheumatoid Arthritis (RA) is erosive-ulcerative lesions (EUL) of the gastroduodenal zone, which is associated with the use of non-steroidal anti-inflammatory drugs (NSAIDs). Our research aims to study the clinical and histo-morphological criteria for forming the EUL of the gastroduodenal zone in patients with RA. Patients were divided into 3 groups, depending on the presence of an EUL, according to Fibrogastroduodenoscopy (FGDS) data with a negative test for H. pylori. Group 1 included RA patients without EUL (n = 18), group 2 RA patients with erosive lesions of the gastroduodenal zone (n = 57), and group 3 consisted of RA patients with ulcerative lesions (n = 17). As a norm, we used data from a survey of 18 healthy donors corresponding to RA patient's age and sex distribution, where no somatic pathology was revealed. GSRS questionnaire was used for assessment of subjective symptoms. For histomorphological studies, biopsy specimens were taken during FGDS using an Olympus Evis Exera II digital video endoscope. Patients of RA with EUL in the gastro-duodenal zone were significantly different from the group of healthy donors and patients of group 1 by the severity of 5 symptoms related to the upper gastrointestinal tract according to the GSRS questionnaire, including abdominal pain, heartburn, belching acid, a feeling of sucking and burning in epigastria, nausea and vomiting. In general, there were no clinically significant differences between the frequency of occurrence and the severity of symptoms on the GSRS scale between group 2 and group 3, except for complaints of heartburn. So, RA patients of group 3 had a higher rate of heartburn feeling of 3.0 (2.0-3.0) points than patients of group 2 with 2.0 (1.0-2.0) points. The development of a EUL of the gastroduodenal zone in patients with RA is associated with low activity of inflammation in all studied slides, regardless of structurally destructive changes in the stomach and duodenum and compensatory hyperplastic reactions in the superficial layer of mucosa membrane, which can be determined by minimal subjective sensations or even complete absence of clinical manifestations with the formation of "silent ulcers", complicated by bleeding and perforation.

ИСПОЛЬЗОВАНИЕ ОПРОСНИКОВ ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКИ ДЕПРЕССИВНЫХ СОСТОЯНИЙ, ОПРЕДЕЛЕНИЯ СТРЕССОУСТОЙЧИВОСТИ И СОЦИАЛЬНОЙ АДАПТАЦИИ В СОСТАВЕ КОМПЛЕКСНОГО ПОДХОДА К ЛЕЧЕНИЮ И РЕАБИЛИТАЦИИ СОТРУДНИКОВ ОРГАНОВ ВНУТРЕННИХ ДЕЛ, ПЕРЕНЕСШИХ НОВУЮ КОРОНАВИРУСНУЮ ИНФЕКЦИЮ COVID-19

Introduction. Psychoemotional disorders arising against the background of general somatic diseases, and often being their root cause, undoubtedly affect not only the prognosis and dynamics of somatic pathology, but also the quality of life of the individual as a whole. Aim. The aim of the work was to assess the extent of stress load, identify premorbid deviations of the psycho-emotional state, as well as the presence of signs of borderline mental disorders in order to use the results in the planning and implementation of psychocorrective (psychotherapeutic) interventions. Material and methods. A study of the psycho-emotional state of 98 employees of internal affairs bodies who were admitted for treatment to the therapeutic department of the hospital of Federal Medical Unit of the Ministry of Internal Affairs of Russia in the Amur region was carried out. 46 of those examined tested positive for COVID-19. Results and discussion. A comparative analysis of the frequency of occurrence of deviations in the psycho-emotional state in patients who underwent COVID-19 and patients who did not have a new coronavirus infection did not reveal statistically significant differences. Conclusion. It was concluded that the approach of continuous psychological testing of patients entering hospitalization helps to quickly identify a contingent with signs of comorbid pathology (simultaneous coexistence of somatic diseases and psycho-emotional disorders), which in turn makes it possible to plan and implement psycho- correctional measures in a timely manner.

Soluble endoglin as a perspective marker of endothelial dysfunction in patients with primary hyperparathyroidism: a pilot study

BACKGROUND: Primary hyperparathyroidism (PHPT), one of the most common endocrine pathologies, is associated with a higher incidence of cardiovascular diseases, in particular, those caused by endothelial dysfunction. Evaluation of endothelial dysfunction in patients with PHPT will predict the development of cardiovascular pathology and determine the optimal tactics for PHPT management.AIM: To evaluate the concentration of soluble endoglin and photoplethysmographic parameters as potential markers of endothelial dysfunction in patients with PHPT.MATERIALS AND METHODS: A single-center interventional single-stage study was carried out. 2 groups were formed. The first group included 50 patients with verified PHPT who did not have cardiovascular or other concomitant somatic pathologies in anamnesis. The comparison group included 21 healthy volunteers comparable in sex and age. All participants underwent a biochemical blood test (total calcium, ionized, albumin, lipidogram, urea, uricacid, glucose, creatinine, alkaline phosphatase), parathyroid hormone, 25 (OH) D and endoglin concentrations were evaluated. In addition, echocardiography, ultrasound of the brachiocephalic arteries and arteries of the lower extremities, as well as photoplethysmography were performed.RESULTS: The groups differed in mineral parameters associated with PHPT; no differences were found in parameters of lipid, uric acid and carbohydrate metabolism. Serum levels of endoglin were lower in PHPT patients (p=0.002). We found a negative correlation between the concentration of albumin-corrected calcium and PTH with endoglin (r1=-0.370, p1=0.003 and r2=-0.475, p2<0.001, respectively) and a positive correlation between the concentration of endoglin and phosphorus (r=0.363, p=0.003). These associations s were accompanied by changes in photoplethysmographic parameters that indicate an increase in the vascular wall stiffness.CONCLUSION: The serum level of soluble endoglin is lower in patients with PHPT than in healthy volunteers, negatively correlates with calcium and PTH concentrations and positively with serum phosphorus concentrations. Further studies will make it possible to establish the pathogenetic mechanism of the identified relationships and evaluate the role of endoglin as a potential predictor of cardiovascular pathology in PHPT population.

Определение цитокинов в сыворотке крови и во влаге передней камеры у пациентов с глаукомой и катарактой на фоне псевдоэксфолиативного синдрома

Purpose. To investigate changes in proinflammatory cytokines Interleukin (IL 1β) and Tumor necrosis factor (TNF-α) before surgery in anterior chamber moisture and in blood serum in cataract and in its combination with glaucoma due to pseudoexfoliative syndrome (PES). Material and methods. The results of the examination included 61 patients aged 56 to 86 years (average age 72.2 years) who were hospitalized for cataract surgery. Among them, 12 (19.7 %) people had primary open-angle pseudoexfoliative glaucoma with normalized intraocular pressure (IOP). A group of 34 patients were diagnosed with PES, but without the presence of glaucoma. The control group consisted of 15 patients with cataracts of comparable age without signs of PES. The analysis of the results took into account the data of ophthalmological examination, immunological studies, namely measurements of the concentration of IL-1ß and TNFa in blood serum and in the moisture of the anterior chamber, as well as somatic status. Results. PES, in general (i.e. in the study of 46 patients), occurred in 23.9 % of cases, stage II — in 43.5 % and stage III — in 32.6%. With a combination of cataracts and glaucoma (in the advanced stage), PES stage I was diagnosed more often — in 33.3 %.Inflammatory postoperative complications were diagnosed only in stages II or III of PES, and more often with a combination of glaucoma and cataract (in 33.3 % of cases) than with isolated surgical treatment of cataract (11.8 %). There was a statistically significant (p < 0.05) increase in the indicators of proinflammatory cytokines IL- 1ß and TNF-α in blood serum and especially in the moisture of the anterior chamber in patients with PES in comparison with the age control group. Various concomitant somatic pathologies in patients with PES, especially in the presence of glaucoma, occurred more often (93.5 %) than in patients without pseudoexfoliation (73.3 %). Conclusion. Significantly increased, in comparison with the control rate, concentrations of proinflammatory cytokines IL-1β and TNFa in blood serum and moisture of the anterior chamber of the eyes with unoperated cataract, and especially when combined with glaucoma due to PES, correlated with the degree of its development and the risk of postoperative, including inflammatory, complications. Taking into account more frequent presence of somatic pathology in patients with PES, it is necessary to have more frequent dynamic follow-up after surgery of patients with PES for the purpose of early diagnosis and timely treatment of potential complications. Keywords: cataract, glaucoma, surgical treatment, pseudoexfoliative syndrome, proinflammatory cytokines Interleukin (IL-1β) and Tumor necrosis factor (TNF-α), postoperative, inflammatory complications

Cytokine profile of gingival crevicular fluid in children with impaired immunological surveillance system

Aim. To study the cytokine profile of the gingival crevicular fluid (GCF) in children with a juvenile rheumatoid arthritis (JRA).Materials and methods. We examined 20 children with JRA and 10 patients without somatic pathology aged 6 to 16 years old. The condition of periodontal tissues was assessed by periodontal indices – gingival index GI (Loe, Silness, 1963) and gingival bleeding index GBI. Biomaterial sampling from the gingival sulcus was carried out using special endodontic absorbent paper points. Enzyme immunoassay for IL-18, IL-10, IL-1ß, IL-1RA, MCP-1, VEGFs in the GCF was performed using the test kits of Vector-Best LLC (Novosibirsk, Russia).Results. Mean GI index in the JRA group was 0.31 ± 0.10 and in the control group – 0.20 ± 0.05 (p < 0.05), mean GBI index – 19.90 ± 3.14 and 10.80 ± 2.60 respectively (p < 0.05), which was accompanied by a more pronounced degree of inflammation of periodontal tissues. The GCF concentration of IL-18 in the JRA group was 6.70 (4.97–7.92) pg/ml, in the control group – 11.25 (8.70–13.10) pg/ml (p < 0.05), while the concentration of IL-1ß was 15.30 (13.79–17.18) pg/ml in the JRA group and 5.36 (5.32–5.54) pg/ml in the control group.The IL-10 concentration in the JRA group was 3.60 (2.89–4.45) pg/ml, which was comparable to the values of the control group. The concentration of IL-1RA was lower in the JRA group than in the control group: 3638.5 (2397.5–4133.5) pg/ml and 4951.0 (4303.0–5455.0) pg/ml respectively. The total GCF chemokine concentration for MCP-1 was determined at the level of 15.65 (14.15–17.39) pg/ml and 15.50 (12.80–21.20) pg/ml for the main and control groups and for VEGF – 49.60 (41.95–54.50) pg/ml in the JRA group and 12.00 (11.00–13.00) pg/ml in control group.Conclusion. In children with juvenile rheumatoid arthritis, an imbalance of pro- and anti-inflammatory cytokines in GCF plays a role in the development of gingivitis: an increased of IL-1ß concentration – a triggering factor of pro-inflammatory chains, a decreased concentration of IL-1RA – an anti-inflammatory cytokine, an increased concentration of VEGF – a marker of hypoxia.