Somatic Pathology Research Articles

Periodontal pathology in patients with cirrhosis of the liver

The frequency and clinical course of chronic generalized periodontitis against the background of liver cirrhosis of various etiologies were studied. 70 patients with chronic generalized periodontitis of varying degrees in combination with liver cirrhosis were examined (23 patients (32.9%) had liver cirrhosis class A, 25 (35.7%) — class B, 22 (31.4%) — class C. Comparison group — 17 patients with periodontitis without somatic pathology. Control group — 20 practically healthy volunteers. A signifi cantly reduced level of oral hygiene was revealed in patients with liver cirrhosis of classes B and C. Periodontal pathogenic microorganisms were signifi cantly more common in the contents of periodontal pockets with cirrhosis. With an increase in the class of CP, the frequency of bacterial expansion increased. The severity of periodontal damage in patients with liver cirrhosis is associated with a loss of bone mineral density by the type of osteopenia (47.2%) or osteoporosis (31.4%), increasing according to the class of liver cirrhosis and the severity of periodontal disease The degree of resorption of the alveolar process is associated with a systemic decrease in bone mineral density. The eff ects of generalized osteopenic syndrome and resorption of the alveolar processes are characteristic of patients with alcoholic liver damage and liver cirrhosis with cholestasis syndrome.

Clinical case of visual axis opacification after primary posterior capsulorhexis

The formation of posterior continuous capsulorhexis during cataract removal has traditionally been used to prevent visual axis opacification. According to the current literature, closure of the posterior capsulorhexis opening in our patient's case should not have developed in a period of 1year, but it did in only one of the two eyes, despite the presence of equal conditions the same surgeon, the same IOL (sharp-edged hydrophilic acrylic with hydrophobic coating), no concomitant eye diseases and somatic pathology. We conducted a literature search to find the cause of the unilateral development of this complication, as well as the optimal treatment method. The difference between two surgeries was in the diameter of the anterior and posterior capsulorhexis on the right eye they were 0.51.0mm larger than on the left eye, and the left eye has developed opacity, which required surgery. An effective and safe way of treating this problem is the capsulotomy using a 25gauge-vitreotome. The clinical case shows the need for further research on this topic, as formation of posterior continuous capsulorhexis has a risk of intra- and postoperative complications, and more data should be considered to ensure that there is no such recurrence of opacity.

ФАКТОРЫ РИСКА РАЗВИТИЯ ПАРОДОНТИТА У ПАЦИЕНТОВ В ПОСТКОВИДНЫЙ ПЕРИОД

Abstract. Introduction. According to independent epidemiological research of World Health Organization (WHO) intact periodontitis occurs only among 2-10% of the population, while inflammatory periodontal diseases are detected in 90- 95% of cases. The awareness of risk factors and their impact on periodontal diseases in somatic pathology allows not only to reduce the aggressiveness of disease development with the help of preventive measures, but also to predict possibilities of the main disease development. Aim. To identify the nature of periodontal microvasculature disorders among patients during post-covid period. Material and methods. We performed laboratory hematological examination, arterial blood oxygen level estimation, Doppler microcirculation study of periodontal tissues in patients diagnosed with B 34.2 «Coronavirus infection unspecified» COVID-19 of medium severity in hospital and in outpatient clinic after recovery. We conducted a questionnaire survey of patients «Subjective characteristic of the general state at the time of the disease outbreak», «Subjective characteristic of the state of the oral cavity in the aftercare period». Results and discussion. The Covid infection is associated with changes in the blood coagulation in conditions of persistent hypoxia, which is confirmed by all the stated methods of research. Complaints of varying degrees of severity about poor general well-being and changes in the oral cavity were noted in 100% of cases. No clinical manifestations of inflammation of periodontal tissues causing concern were found in patients in the post-occlusive period during the initial examination, but Doppler examination showed significant microcirculatory disorders. Conclusion. Laser Doppler flowmetry as an additional method of investigation reveals persistent microcirculatory disorders of periodontal tissues on the basis of extensive vascular endothelial damage in patients post COVID-19 which are not clinically manifested at this stage.

STATE OF ORAL HYGIENE, RATE OF SALIVATION AND VISCOSITY OF ORAL LIQUID IN 3-6 YEARS OLD AGED CHILDREN, TAKING INTO ACCOUNT THE DEGREE OF CARIES ACTIVITY

Oral fluid performs a number of important functions: mineralizing, protective, cleansing, creating an optimal environment for the functioning of the hard tissues of the teeth. Research results show that the condition of the oral cavity, its biophysical and biochemical indicators provide information on the general resistance of the body. The possibility of complicating both dental diseases and somatic pathology at the expense of each other has been proven, that is, there is a mutual aggravation. The indicators were studied taking into account the age of the children and the degree of caries activity in them. 335 children aged 3-6 years were examined. Oral hygiene index according to Fedorov-Volodkina was determined in each age period and taking into account the degree of caries activity. Thus, children without caries and children with a compensated degree of caries activity in all age groups had a satisfactory state of oral hygiene. A comparison of 3-year-old children, but of different groups by the degree of caries activity, did not reveal a probable difference in the state of hygiene. And in 4, 5, and 6-year-olds with subcompensated and decompensated levels of caries activity, a probable difference in the state of oral hygiene was revealed. We observe a significant increase in the hygiene index in the entire group of children aged 3-6 years, respectively, with an increase in the Decay Extracted Filling index (р < 0,01; р < 0,001). The rate of salivation in the examined children of all groups corresponded to the norm or was at the level of slight hyposalivation. During the examination, a significant decrease in the numerical values of the salivary rate was found in children with subcompensated and decompensated caries activity compared to healthy children and with compensated caries activity. Studying the viscosity index of oral fluid, a probable increase in the index was established in children with subcompensated and decompensated levels of caries activity compared to healthy children in each age group. In children with a decompensated degree of caries activity, the highest index of oral fluid viscosity was found in each age group.
 The results of the examination showed a significant deterioration of oral hygiene in children with various degrees of caries activity compared to children without caries. The rate of saliva secretion is also likely to decrease, and the viscosity of the oral fluid increases as the caries situation in the oral cavity worsens in all age groups. Considering the multifactorial etiology of caries, it is necessary to continue the study of the relationship between the occurrence of caries in children, taking into account the influence of oral fluid and morphological features of the occlusal surface on the state of resistance of the hard tissues of the teeth.

Патогенетические аспекты катарактогенеза с позиции коморбидной патологии

Relevance. Research by ophthalmologists, biologists, biochemists, biophysicists, physiologists have shown the significance of xeno- and endobiotic effects on the induction of cataracts and other degenerative diseases of the structures and membranes of the eye. Objective research goal was an evaluation of comorbid background in people of different ages with a diagnosis of senile cataract. Material and methods an analysis of the case histories of 173 patients of an independent sample with a diagnosis of "senile cataract" admitted for planned inpatient surgical treatment was carried out. The evaluation was carried out by decades of human life: younger than 40 years old, 41–50 years old, 51–60 years old, 61–70 years old, 71–80 years old and over 80 years old. The Charlson method was used to calculate the comorbidity index. Results patients who had senile cataract and concomitant somatic diseases, the most frequent- diseases of the cardiovascular system – 129 (74.6 %); violation of carbohydrate metabolism – 35 (20.2 %); diseases of the central nervous system – 33 (19.1 %); musculoskeletal system – 30 (17.3 %); diseases of the respiratory system – 19 (11.0 %). Conclusions. 1. A human's age of 51–60 years should be considered critical for the occurrence of senile cataract. 2. In the decade of life 51–60 years, there is an increase in persons with senile cataract by 3.3 and the frequency of concomitant somatic pathology (according to the index of comorbidity) by 2.25. Keywords: senile cataract, age, somatic diseases, index of comorbidity

Периоперационный инфаркт миокарда при хирургическом лечении повреждения позвоночника

INTRODUCTION: In the literature, there are reported cases of myocardial infarction in young patients after strenuous physical activity, as well as without any evident connection with physical load. The most common causes of the acute coronary syndrome in young individuals are anomalies in the development of coronary arteries. The article is devoted to the description of a clinical case of acute myocardial infarction in the anterior septal region of the left ventricle in the perioperative period after surgery of spinal injury in a patient without severe somatic pathology. During the surgery, unstable hemodynamics was noted with the development of arterial hypotension, which required infusion of norepinephrine. On the basis of clinical, laboratory and instrumental examinations, in the postoperative period the diagnosis: “Q-positive myocardial infarction of the anterior septum” was made. Coronary angiography visualized the presence of an intramural passage in the middle segment of the anterior descending artery with up to 30% stenosis in systole. The resulting arterial hypotension at the operational stage, with the myocardial bridge in the anterior descending artery, was the cause of circulatory disorders in the anterior septal region with the development of myocardial infarction and a decrease in the pumping function of the heart with subsequent hemodynamic disorders. CONCLUSION: Myocardial muscle bridges are a common anomaly of coronary arteries, which is usually asymptomatic. Clinical manifestations, if present, are blurred and atypical. In certain conditions, the given anomaly may be the cause of development of the acute coronary syndrome, in young individuals as well, which shows reasonability of monitoring of ECG and of markers of myocardial infarction in the postoperative period.

INDEX ASSESSMENT OF PERIODONTAL TISSUES IN PATIENTS WITH GOUT

Periodontal disease is a global public health concern. The presence of accompanying somatic pathology, in particular, rheumatologic, is a significant factor that underlies the course and prognosis of periodontal diseases. Gout is a chronic, progressive disease associated with a purine metabolism disorder that is characterized by an increase in the level of uric acid in the blood, hyperuricemia, and deposits of the sodium salt of uric acid in the tissues of the musculoskeletal system and internal organs
 with the further development of acute arthritis and the formation of gouty nodules (tophus). Though gout is considered as well studied diseases, but, nevertheless, its aetiology and pathogenesis are not completely clear. Recent studies have reported a rapid increase in prevalence of gout, especially in young people, early complications, involvement of the cardiovascular system and kidneys in the pathological process. Moreover, patients with gout demonstrate the growth of dental pathology, in particular, periodontal disease. Despite the difference in the causative factors, the commonality of inflammation in the tissues of the periodontium and joints, kidneys, and endothelium in gout is quite natural, since sodium monourate crystals induce a response of a non-specific link of innate immunity, similar to a microbial process. There are a few studies investigating the condition of periodontal tissues in patients with gout. The aim of this work is to perform the index assessment of periodontal tissues in patients with gout. The participants were divided into 2 groups: the main one included 131 patients with gout and periodontal diseases; and the group of comparison was composed of 54 people with periodontal disease without rheumatologic pathology. The age of the participants ranged from 30 to 59 years. In patients with gout, the values ​​of periodontal indices were significantly higher in all age categories, compared to the individuals without rheumatologic pathology. The average value of the PI index in patients with gout corresponded to a severe degree of periodontitis, and was 2.5 times higher than in people without comorbid pathology, who had moderate periodontitis. Over the age of 40, the patients of the main group developed severe periodontitis. The reference value of the PMA index in both examined groups corresponded to the average degree of gingivitis; however, in the patients with gout, this indicator was 1.5 times higher than in the comparison group. Thus, the pathogenetic mechanisms formed in gout, the main of which is hyperuricemia, are determinants of the development and severity of destructive-inflammatory lesions of the periodontium.

HOMOCYSTEINE LEVELS IN WOMEN WITH SYMPTOMATIC UTERINE FIBROIDS

Uterine fibroids are considered one of the most common benign tumors of the reproductive system. This disease ranks second (20–50 %) among the causes of hospitalization in gynecological hospitals.
 The aim of the study is to evaluate the effect of homocysteine levels on the state of uterine fibroids.
 Materials and Methods. The study involved 112 women: 60 with uterine fibroids and 52 without uterine fibroids. General clinical, biochemical, ultrasound, and statistical research methods were used. Mathematical data processing was carried out according to Lang T. and Altman D. (2014). Quantitative data analysis on the normality of distribution was carried out using the Shapiro-Wilk test.
 Results. The normal homocysteine (Hc) level was found in 80.7 (5.5) % of patients without uterine fibroids, which is statistically more significant than in the group of women with uterine myoma (38.3 (6.3) %, p<0.001). HC level was at the upper normal level in 33.3 (6.1) % of women in the main group and 15.3 (5.0) % of women in the comparison group. An excess of normal values was found in 25.0 (5.6) % of women in the main group and only in one in the comparison group (p<0.001). Due to additional therapy of uterine fibroids, the state of myomatous nodes stabilized in 61.6 (6.3) % of patients. There was no progression of uterine fibroids during a year. Before complex therapy, surgical indications were in 25.0 (5.6) % of patients with uterine fibroids. After a year of complex therapy, surgical indications remained only in 6.6 (3.3) % of women with uterine fibroids, which is statistically less significant than before the prescribed treatment (p=0.005).
 Conclusion. In women with uterine fibroids, there are multiple genital and somatic pathologies that contribute to the increase of Hc level and the development of uterine fibroids.
 The use of folic acid and B-group vitamins in addition to the clinical protocol for the treatment of uterine fibroids made it possible to stabilize the myomatous nodes and reduce surgical treatment by 4 times.

Risk factors for suicidal behavior: A Romanian mixed methods study.

This study had two purposes: to explore the main socio-demographic and medical characteristics of the psychiatric patients with a history of suicidal behavior, and to identify the main risk factors underlying the suicidal ideation and acts among psychiatric patients, in the light of two recent theories of suicidal behavior. The study is based on a mixed methodological design. During 2019 to 2021, 65 hospitalized psychiatric patients, who committed at least one non-lethal suicide attempt, were investigated using a questionnaire a scales for data collection. Medical records were used to gather data about certain socio-demographic characteristics and the health status of the respondents. Patients also participated in a narrative interview aimed at disclosing their subjective experiences about their past suicidal behavior. The typical psychiatric patient with a history of suicidal behavior, as highlighted by the quantitative analysis, portraits a young old male from an urban environment, childless, educated, having experienced employment problems, being involved in religious activities. The clinical picture of the patient with suicidal antecedents included a moderate or severe level of depression, the presence of socio-emotional loneliness, the manifestation of frequent and long episodes of suicidal ideation, and the intention of committing suicide in order to stop the pain, whose acts resulted in minor injuries. Findings from the qualitative data revealed four major risk factors for the non-lethal suicidal attempts: family disruptions and social problems; economic burdens; a mixture of psychiatric pathologies; and, to a lesser extent, somatic pathologies. This study is the first to explore the triggers of suicide acts conducted in a clinical environment in the Balkan region. Implications of the pandemic are also discussed. The findings are useful for designing prevention strategies based on individual psychotherapy and therapeutic or support groups, addressing the main risk factors behind the suicidal ideation and gestures.

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.

Regard des patients psychiatriques sur leur prise en charge somatique en psychiatrie : enquête et propositions

Literature's data report the existence of numerous somatic comorbidities in patients with mental diseases. In order to improve practices, HAS-labeled recommendations were written in 2015. These recommendations advocate the improvement of current practices, by integrating into the accreditation procedures of institutions the somatic management of patients including a complete somatic examination of any hospitalized patient. Outpatient follow-up is also mentioned, especially when the patient does not have a general practitioner: “the psychiatrist will naturally be in charge of managing the patient's somatic problems”. This text reminds us that psychiatry belongs to the medical world and that it is necessary to improve patient care. Nevertheless, these recommendations may come up against the usual practice of psychiatrists who do not generally carry out a somatic clinical examination. Indeed, the particularity of the French psychiatric practice is that it is rooted in the field of human sciences where subjectivity plays a major role. However, the somatic examination is in essence objectifying, leading to an ethical conflict for the psychiatrist between an adapted somatic management and an optimal psychiatric management. In order to help us in our reflection, we decided to question the patients, by focusing our work on their social representations concerning the psychiatrist and his function. The objective of our work will thus be to discuss the dilemmas resulting from these recommendations in the light of other ethical principles and to propose practical reflections on their implementation with an ethical concern by placing the patient at the center of the care system. In France or internationally, no study on the social representations that patients have of their somatic care has yet been conducted. MethodWe conducted a prospective study in the form of semi-structured interviews with a sample of 21 patients treated in a general psychiatric ward. The interview guide included four themes: definition of the doctor and the psychiatrist, the course of care in psychiatry, the relationship between patients and therapists in psychiatry, and the role of the psychiatrist in somatic care in psychiatry. The results show the ambivalence of patients who wish to receive comprehensive care without expecting psychiatrists to invest in their somatic evaluation. These representations are linked to the heritage of French psychiatry, but also to the subjective link between the patient and his psychiatrist in the psychotherapeutic framework and finally, to the position of specialist assigned to the psychiatrist treating a specific medical field. ConclusionIt is therefore the psychiatrist's ethical responsibility to question the practical implementation of his medical skills (in particular in the field of somatic comorbidities) and his psychotherapeutic skills by adapting them in a singular way to each patient according to his pathology, his degree of autonomy and his social representations in order not to be harmful on the psychic level while wanting to be beneficial on the somatic level. The psychiatrist must inform the patient of his or her competencies and limitations in terms of somatic care and of the specific somatic aspects of the patient's pathology. Finally, patients followed in psychiatry often have a lack of access to care as well as an unfavourable socio-economic level. In this context, they may have difficulty accessing the various medical specialists. Most inpatients benefit from appropriate somatic care thanks to the development of somatic care units in the institutions. Thus, we see that the will to improve the situation in the hospital has led to socio-economically favourable solutions and to the training of competent general practitioners in this field. It is necessary to continue efforts in this direction, but also in general medicine. Even if psychiatrists are aware of patients’ somatic pathologies, take them into account, and occasionally perform a somatic examination, they cannot replace a trained and competent general practitioner.

Intérêt de l’évaluation somatique systématique chez les patients adultes à présentation psychiatrique en structure des urgences

IntroductionDuring a consultation with a psychiatric presentation in emergency departments (EDs), a somatic examination is often performed. However, the value of systematic somatic assessment remains debated. Materials and methodsMulticenter study in three EDs, retrospective, over two months, including all major patients consulting in an ED for psychiatric reason, without associated intoxication. The primary objective was to evaluate the rate of consultations in which a somatic etiology was found on admission and at D7. The secondary objective was to look for initial clinical features predicting the risk of an underlying somatic problem in ED. ResultsIn all, 638 consultations were included. Main reasons were anxiety (35.7%) and depression (35.7%). Psychiatric history was found in 60.7% of cases. No abnormalities in the vitals parameters were found in 412 cases (64.6%) during the nurse screening. A somatic etiology related to the reason for consultation was found in ED on day 0 for 38 (6.0%) consultations. The hospitalization rate was 47.3%, mainly in psychiatry (87.4%). Analysis of the files revealed 63 (10.9%) somatic adverse events at D7, which may have created or increased psychiatric symptoms. The somatic cause found (55.6% of new pathologies) was neurological in 34.9% of cases, metabolic in 30.1%, and infectious in 12.6%. Factors correlated with a somatic etiology at admission were (P<0.001 for all): older age: 64.5 [46.5–83.8] vs. 37 [25–54] years; the presence of behavioral disorders: 68.4% vs. 29.3% or delusions: 36.8% vs. 9.8%; the existence of a history of cardiological, neurological, renal or metabolic disorders; the presence of at least one abnormal parameter at the time of the nurse triage: 63.2% vs. 33.7%. In young patients (≤45 years), with no history other than psychiatric, no delusions or behavioral problems, and no abnormalities on the nurse triage, we found a significant somatic etiology in 1% of cases on admission and 3.2% of cases at D7. ConclusionThe prevalence of somatic problems in patients with a psychiatric presentation is low in our study but somatic examination remains desirable for certain categories of patients where the incidence of somatic pathology is higher.

Bacterial Flora in Dental Cavities after Traditional and Alternative Methods for Cavity Preparation

The aim of the study was to establish the qualitative and quantitative composition of microbial flora of dental cavities (DCs) after traditional and alternative preparation, including different methods of isolating the working field. Material and Methods: Our study included 60 patients (mean age of 25.0±3.1 years) with DC Class 1 (Black's classification) without concomitant somatic pathology. To accomplish the study’s aim, 60 teeth were prepared. The main group (MG) consisted of 45 teeth prepared under absolute isolation with a rubber dam (RD). In the MG, 15 teeth were treated traditionally with a diamond bur with red and yellow markings (MG-1), 15 teeth were treated by ultrasound with a diamond tip (MG-2), and 15 teeth underwent hydrokinetic preparation (MG-3) with the Aquacut device (Velopex). In the comparison group (CG), which included 15 teeth, DCs were treated traditionally with a dental bur without the RD. The MG and CG were comparable in terms of the initial state of dental and microbiological status. The study of the qualitative and quantitative composition of the DC microflora showed that all DCs contained pathogenic β-hemolytic streptococcus in the CG. At the same time, the maximum number of cases (80%) was moderately contaminated.. MG-1 and MG-2, as in the CG, were characterized by the predominance of β-hemolytic streptococcus at the bottom of the treated cavity. At the same time, the incidence of moderate contamination decreased by 4 times and single contamination increased in the cultures to 80%, compared to the CG (P=0.001). In MG-3, β-hemolytic streptococcus also dominated in the bottom of DCs after RD setting. The number of colonies was single (66.7% of cases) and moderate (33.3% of cases), indicating a significant increase in single and a decrease in moderate infestation, compared to the CG (P&lt;0.01). Analysis of the quantitative characteristics of the microbial composition of the cavity floor after preparation of fissure caries showed the highest bacterial contamination in CG: β-hemolytic streptococcus predominated, averaging 251.20±2.5CFU/tampon. Lactobacillus and Neisseria spp. were detected much less frequently (3.16±1.6 and 1.99±1.3 CFU/tampon, respectively). There was a 10-fold decrease in the number of β-hemolytic hemolytic streptococcus cultures in MG-1 (25.12±2.0 CFU/tampon), MG-2 (25.12±2.0 CFU/tampon) and MG-3 (19.95±2.0 CFU/tampon), compared to the CG (P=0.000). The opportunistic microorganisms in the treatment of hard tissues by different methods (burr, ultrasound, hydrokinetic) under absolute isolation conditions were identified in almost equal numbers, with the Lactobacillus contamination being significantly lower in MG-1, MG-2, and MG-3 than in the CG (P&lt;0.01). Conclusion: After the preparation of DCs, a single presence of opportunistic microorganisms, moderate or single contamination with pathogenic bacteria, and absence of anaerobic bacteria were noted. Absolute isolation with RD provides a reduction of microbial infection regardless of the preparation method, and the maximum positive effect is DC preparation with dental burr and ultrasound.

The Prognostic Value of the Geriatric Index of Comorbidity for Predicting an Outcome in Patients Over 60 Years of Age With Polytrauma. Retrospective Cohort Study

Background Nowadays, since the older people are keeping and increasing their professional and social activity, the risk of injury in these patients is escalating. However, the results of polytrauma treatment among patients over 60 years old are worse than in the group of younger patients. This may be associated with the presence of concomitant somatic pathology, which worsens the prognosis of for survival among elderly and senile patients. In the modern literature, there is no description of effective tools for assessing the comorbid status in elderly and senile patients with polytrauma. Nevertheless, there are scales and indices of comorbidity developed for non-surgical patients. To increase the effectiveness of treatment of patients over 60 years of age with polytrauma and a several concomitant diseases, it is necessary to develop new or adapt one of the already created tools for assessing comorbid status.Purpose of the study To assess the dependence of the mortality rate in a group of patients with polytrauma over 60 years of age on the presence of concomitant somatic pathology and its severity, calculated by the geriatric index of comorbidity.Materia l and methods During the period from 2005 to 2020, 116 patients with polytrauma and chronic somatic pathology were treated at the Sklifosovsky Institute. The inclusion criteria for the study were the following: patients aged over 60 years old; или patients’ age over 60 years old; the Injury Severity Score over 17, the presence of concomitant somatic pathology in patients. The exclusion criteria were the lack of complete necessary information in the medical history, patients’ age being less than 60 years old. The Geriatric Index of Comorbidity was calculated for each patient. A retrospective analysis was conducted.Results A Geriatric Index of Comorbidity of 3 or more in the elderly patients with polytrauma was found prognostically unfavorable for survival (p=0.005). When implementing the Geriatric Index of Comorbidity rating system, the presence of concomitant somatic pathology was found to have the greatest impact on elderly and senile patients with polytrauma and Injury Severity Score 18–24 (p=0.001).Conclusion The system of calculating the Geriatric Index of Comorbidity is advisable to use for assessing the risk of mortality from concomitant somatic pathology and its severity in patients with polytrauma over 60 years of age.

Diseases of pulp-periodontal complex associated with different directions between systems disorders

BACKGROUND: Caries complications (pulpitis and periodontitis) alongside caries remained the most widespread pathology on dentistry dispensary acceptance. This is a study of the disease structure of the pulp and periodontal for dentistry patients with intersystem disorders.&#x0D; AIM: To improve the treatment methods of pulp-periodontal defeats for patients with between system disorders&#x0D; MATERIAL AND METHODS: This retrospective study included 568 dispensaries of the cards using the casual sample dentistry patient with different directions between system disorders (main group), and 570 dispensaries of the cards patient without somatic pathology (group of the comparison) primarily addressing employees of therapeutic dentistry department. Patients with between systems disorders were chosen following the World Health Organization recommendation, defining the given group as a contingent on the high risk for dentistry level health estimation of somatic patients.&#x0D; RESULTS: Among examined contingent, the prevalence of pulp inflammation was determined in 209 (36.8%) events of 568 addresses. Prevalence of chronic periodontitis was determined in 183 (32.2%) events of 586 addresses.&#x0D; CONCLUSIONS: The interconnection pulp-periodontal disease complex analysis discovered the reliable correlation between pulpitis and periodontitis between the compared groups.

Nialamide in the treatment of depressive states

Depression is a mental disorder manifested by depressed mood, cognitive and motor retardation, and suicidal ideas. In the modern world, the number of cases of a combination of mental and somatic pathologies is increasing in medical practice. Therefore, the issue of studying and correctly prescribing antidepressants is crucial. It is necessary that the drug should not only treat the mental illness of the patient, but also should not harm his/her physical health. Nialamide belongs to antidepressants, the mechanism of which is non-selective and irreversible inhibition of MAO-A and MAO-B.

Options to optimize the orthopedic treatment protocol to prevent inflammatory complications at the immediate prosthetic stage in patients after multiple teeth extraction

BACKGROUND: Simultaneous multiple loss of teeth significantly increases the need for immediate orthopedic treatment in dental patients, often with the use of removable immediate dentures due to general somatic pathologies and local Dental Prostheses System features.&#x0D; AIM: The study aimed to optimize the orthopedic treatment protocol for patients after multiple teeth extractions.&#x0D; MATERIAL AND METHODS: As part of the study, the orthopedic preparation of 18 patients was conducted for further permanent prosthetics. Patients underwent tooth extraction in the upper or lower jaw amounting to the formation of included, combined, or terminal dentition defects. The following were used for patient treatment: a standard protocol for immediate prosthetics, a modified protocol, including an improved method of vital mucous membrane staining of the prosthetic bed in the surgical intervention area using standard and immediate original design prostheses. The treatment option effectiveness was evaluated based on the results of diagnostic monitoring of wound healing zones in the prosthetic bed area of immediate prostheses, including visual-palpation assessment, vital oral mucosa staining with an iodine-containing diagnostic solution to control inflammation, and a modified Doppler observation method.&#x0D; RESULTS: Study results revealed that all patients, who used standard immediate prostheses without considering the diagnostic control of inflammation areas, had objective signs of inflammation up to the 20th day of treatment with low microcirculation dynamics in the wound healing area. In 4 out of 6 patients using standard immediate prostheses, considering inflammation control, the vital staining indicators by day 20 indicated a possible trend toward chronic inflammation development in the prosthetic bed area, which was confirmed by an unstable microcirculation picture. The severity of inflammatory changes was insignificant in patients who received the original design of the immediate prosthesis, starting from the 7th day of observation and minimal by the 20th day. At this time the hemodynamics are physiologically normal.&#x0D; CONCLUSIONS: Based on the study results, the orthopedic rehabilitation protocols effectiveness, with the use of a modified design based on the immediate prosthesis and permanent diagnostic, mucous membrane staining of the prosthetic bed was established to detect inflammatory complications in the wound healing areas.

Optimization of nutrition and the role of dietary supplements for food in the correction of the diet of a modern person

The task of a healthy diet is to support the body’s resistance to adverse environmental factors and infectious agents, to provide the possibility of restoring health in case of somatic pathology and injuries. Given the growing number of people over working age in the Russian Federation, much attention should be paid to the nutrition of older people in order to maintain active longevity, physical and mental activity. Of great importance is the nutrition of a pregnant woman, since it affects not only the condition of the mother and fetus, but also programs the activity of metabolic processes in a child in adulthood. To individualize and optimize the nutrition of an individual, biologically active food supplements can be used, taking into account gender, age, level of physical activity and the physiological state of a person. Appointment and issuance of prescription forms for dietary supplements for food should not be carried out, because Dietary supplements are not medicines. However, dietary supplements should be recommended by doctors to healthy and sick people to optimize, correct and enrich the diet for the purpose of diet therapy and dietary prevention.

A case of bronchial asthma in a patient with long-term cough

BACKGROUND: The regulatory documents determining the phthisiatric care for population do not provide diagnostics and treatment of comorbid somatic pathology with tuberculosis in tuberculosis dispansery. If patients with diagnosed tuberculosis or suspected tuberculosis need therapeutic specialists consultation, they have to be referred to the district polyclinic working in the medical insurance system. So, timeliness of diagnostics and chronic diseases management decreases. The course of tuberculosis becomes more complicated and lengthened. At the same time tuberculosis specificities are not taken in to account complicating comorbid pathology. For effective diagnostics and treatment tuberculosis and comorbid pathology the special algorithms of patient management were develop in Tuberculosis Dispensary No. 5.&#x0D; AIM: To describe the clinical case of bronchial asthma in a 35 year old female patient as an example of effective interdisciplinary communication between general practitioner, phthisiatrician and specialists of therapeutic profile.&#x0D; MATERIALS AND METHODS: Patients with suspected tuberculosis are comprehensively examined by the phthisiatrician and therapeutic profile specialists according to special developed algorithms of diagnostic search at Tuberculosis Dispensary No. 5.&#x0D; RESULTS: The patient with long-term cough was comprehensively examined. Within a short time tuberculosis was excluded, bronchial asthma was diagnosed. The effective treatment of asthma and a plan of further patient flow-up in the district polyclinic was recommended.&#x0D; CONCLUSIONS: An experience of the interdisciplinary communication phthisiatricians and specialists of therapeutic profile who have entered the department of medical-social care and rehabilitation demonstrated the relevance and appropriateness in diagnostics of tuberculosis and concomitant chronic uninfection diseases, that let minimize risks of cross adverse effects and choose the optimal tactics of patient management.

New approaches of rehabilitation organization improving in orthopedic dental care for the elderly people

Scientific research on the development of issues of optimization of gerontological care is traditionally conducted in the field of somatic pathology and, to a lesser extent, in the field of dental care. Purpose of the study is to determine the socio-hygienic dental status, the need for the elderly population in the "Center for the provision of special and social services", the Great Patriotic War polyclinic and in the dental clinic of JSC NMU im. Asfendiyarov, Almaty, Kazakhstan. Research objectives: 1. To analyze the influence of the state of dental health on the quality of life of elderly and senile people. 2. To assess some of the physicochemical properties of the oral fluid (salivation rate, viscosity and acid-base state) in the examined group of persons. 3. To study the features of some biochemical parameters of the oral fluid in elderly and senile people (calcium, magnesium, phosphorus, protein, TBA-active products). 4. To evaluate the effectiveness in the complex treatment and prevention of dental diseases in elderly and senile patients for: the clinical course of the disease, some physicochemical and biochemical parameters of the oral fluid, the state of the dental health of these persons and the level of their quality of life.