Somatic Pathology Research Articles

Adverse cardiological and neurological reactions associated with air traffic and the possibility of their pharmacological correction

Air transport may provoke or aggravate a medical event in a passenger with concomitant medical problems. We searched the PubMed and Scopus databases for the period up to 08/29/2024 for sources that examined the impact of air travel on human health. There are 2 main categories of stressors associated with air travel and affecting the body, generally divided into:(1) psychological and physical stressors and (2) physiological Possible changes in health associated with air travel can be divided into functional, mostly reversible, and organic: (1) exacerbation/decompensation of existing somatic pathology;(2) development of pathological conditions de novo, for which possible stressors can serve as a trigger, directly or sequentially as a result of the previous development and progression of functional disorders. The literature focuses on safety issues during air travel for patients with existing cardiovascular pathology. Adverse functional cardiological and neurological reactions and their pharmacological correction have been less studied. Fear of flying and phobia of flying are very common among the general population and can lead to significant stress. For situational correction of reactions to everyday stressful events, it is possible to use drugs with anxiolytic action of a non-benzodiazepine This group includes the drug Valocordin®, the action of which is aimed at various manifestations of stress, anxiety states, autonomic dysfunction, increased excitability and irritability, mild sleep disorders. In case of pre-flight anxiety and fear, taking Valocordin® (depending on the situation or in a short course) can be the drug of choice for both the air traveler and his relatives seeing him off/meeting him.

The condition of the oral mucosa in somatic pathology

Lesions of the oral mucosa (SOPR) are often the primary pronounced clinical symptom of somatic diseases. It is possible to find out which pathogenetic mechanisms and links of somatic pathology create conditions for the implementation of risk factors, the implementation and development of structural and functional disorders in the oral mucosa, with the aim of targeted therapeutic effects on changes in the SOPR and the general condition of the body as a whole. The purpose of the study was to establish the structure of diseases of the oral mucosa depending on gender and age in patients with various somatic pathology. Materials and methods: A survey was conducted of 164 patients who sought advice from the Dental Hospital of Khabarovsk. Between the ages of 18 and 89. The average age of patients was (55.7 ± 1.38) years. All the subjects were divided into 4 groups depending on their age and the presence of diseases of internal organs. The comparison group included 30 somatically preserved patients of similar age and gender, by random sampling. Results: It was found that with pathology of the oral mucosa, women out of the total number of cases were 2.5 times more than men. The greatest number of patients’ complaints about the diseases of COPD was in the age group of 60-74 years, unlike other age groups: 18-44 years by 1.8 times; 45–59 years by 1.2 times; 75–89 years by 2.7 times, respectively. Most diseases of the oral mucosa are manifested in the presence of systemic pathology. Somatic diseases were detected in 62.2 % of patients with COPD. Pathology of internal organs and systems affects 70.42 % of patients with lichen planus, 50 % of patients with leukoplakia, 80 % of patients with candidiasis, 26.32 % of patients with chronic aphthous stomatitis and 79.17 % of patients with glossitis. Diseases of the gastrointestinal tract are 1.2 and 2.8 times more dominant in the structure of the lesions of the SOPR compared to the pathology of the cardiovascular and endocrine system. Findings: The revealed pattern of manifestations of pathological changes in the oral mucosa against the background of somatic pathology is of great diagnostic importance not only for dentists of various profiles, but also for clinicians of specialized departments, since ultimately all this affects the timeliness and quality of medical and diagnostic care for this category of patients.

Clinical and immunological characteristics of COVID-19 in patients with disease dynamics

The aim is to study the clinical and immunological indicators of COVID-19 in the dynamics of the disease with the determination of predictors of the development of changes in the lungs. Materials and methods. The object of the study was 35 patients aged 22 to 75 years in the acute period and dynamics of COVID-19 disease, divided into two groups according to the identified clinical and immunological disorders. Markers of cellular (CD-3, CD-4, CD-8, CD-19) and humoral immunity, cytokines (IL-6,8, TGF-β, TNF-α), CEC were determined in all examined patients. Statistical processing of the obtained results was carried out using the computer program Statistica 10.0. Results. It was found that all the subjects retained clinical and immunological changes during the entire follow-up period, which indicates an ongoing disease. At the same time, significant differences in the severity of changes in individuals were revealed, taking into account age and the presence of chronic somatic pathology, expressed primarily in violation of the parameters of the T-system of immunity. In patients with the development of postcovoid changes in the lungs, characteristic immunological features were revealed, taking into account age. Conclusions. A violation of the detected indicators of the immune system may indicate the persistence of the virus, which means a prolongation of a specific inflammatory response with the risk of extensive tissue damage. Within three months after recovery, the tendency towards the formation of humoral immunity persists in both groups, which occurs by the end of 1 month after the disease in both groups and continues throughout the entire follow-up period. In the risk group for the development of pneumofibrosis in the outcome of a new coronavirus infection, the combination of IL-8 and TGF-β is the most optimal, despite their significant decrease in dynamics compared with the acute period.

The role of immuno-mediated dysregulation in the progression of allergic pathology in military personnel under occupational stress

In order to identify clinical and immunological predictors of the progression of allergopathology in military personnel participating in special operations under conditions of professional stress, 43 military personnel participating in special operations divided into two groups were examined. Group 1 consisted of officers with allergopathology or who first debuted symptoms of allergic diseases during or within 6 months after participating in special operations (n = 13, average age 36.4±4.5 years). Group 2 included officers participating in special operations who did not have symptoms of allergic diseases (n = 13, average age 36.4±4.5 years). The analysis of complaints and medical documentation were carried out. Clinical and laboratory examination was performed without exacerbation of somatic pathology. The immune status was assessed by the expression of CD3+, CD4+, CD8+, CD16+, CD19+, HLA-DR+, intracellular FoxP3 content in CD4+CD25+T cells, granzyme B in CD3-CD16+ and CD3+CD8+ lymphocytes using appropriate monoclonal antibodies (Beckman Coulter) and taking into account the results on the cytofluorometer “FC 500”. Immunological monitoring was performed before participation in hostilities and 6 months after return. A comparative assessment of the cellular and humoral state of military personnel of both comparison groups before leaving for an area with an unfavorable operational situation revealed the following differences. In the group of military personnel with allergic manifestations, significantly fewer CD4+ lymphocytes were noted, as well as significantly fewer CD3+CD4+CD25+FoxP3 regulatory lymphocytes and an increase in the number of circulating B lymphocytes were recorded. When dynamically monitoring the parameters of the cellular and humoral immune response in military personnel participating in hostilities, 6 months after returning from a business trip to areas with an unfavorable operational situation, unidirectional changes in the immune status were recorded in the form of a violation of the differentiation processes of the T cell link of the immune system. In the group of servicemen suffering from allergic diseases, the revealed changes were accompanied by a weakening of the processes of physiological immunosuppression in the form of a persistent decrease in the content of regulatory T lymphocytes in the dynamics of observation for 6 months.

Роль и место медицинской информационной системы при оказании дерматологической помощи в частной медицинской организации

Dermatological diseases retain statistically significant positions in the structure of modern somatic pathology and are often characterized by severe medical and social consequences. The latter include an unreasonably high number of unsatisfactory treatment results, high level of expenses for diagnostics and treatment, low level of patient satisfaction. Taken together, this allows us to consider the comprehensive quality of dermatological care as a whole insufficient. Medical organizations in the private healthcare segment are no exception in this regard. One of the modern effective directions in improving the quality of a wide variety of types of medical care for the population is the widespread use of the so-called medical information systems (MIS). However, at the level of dermatological organizations in the private healthcare segment, this direction has not been practically worked out to date. Purpose of the study: improving the quality of dermatological care for the population in a private medical organization based on the development and implementation of a medical information system. Materials. The study included 2000 dermatological patients of a private medical organization. The control group (1000 people) consisted of patients in the period before the implementation, the main group (1000 people) – patients in the period after the implementation of the developed system. The duration of the compared periods was 2,5 years. Мethods. To obtain the results, the methods of objective examination, specialized patient questionnaires, simple and extended dermatoscopy, content analysis of medical documentation and databases of the medical organization, pharmacoeconomic analysis were used. The system of integrated assessment of the quality of medical care was applied. The methods of variation statistics were used to analyze the results. The exact level of statistical significance of differences in the results before and after the implementation of the developed MIS was calculated.. Subject. The study is at the intersection of two subject areas: «Organization of dermatological care for the population» and «Medical information systems». Results. As part of this study, a MIS was developed aimed at improving the organization of dermatological care for the population. The system was implemented in a medical organization in the private healthcare segment. The main results of such implementation were: an increase in the number of successful treatment results, the level of patient satisfaction with the quality of dermatological care, the level of its standardization, a decrease in direct economic costs for diagnostics and treatment. The integrated and comprehensive indicators of the quality of dermatological care have been increased.. Conclusion. Improving the quality of dermatological care for the population in a medical organization of the private healthcare segment based on the development and implementation of a medical information system has been achieved. The results obtained have a high level of statistical and medical-social significance.

Characteristics of the fetus in pregnant women with thyroid diseases

BACKGROUND: Thyroid dysfunction can cause adverse effects on metabolic changes in the body and disturbances during the gestational period and intrauterine development of the fetus. In developing prevention methods, it is crucial to objectively substantiate and re-confirm theoretical assumptions. AIM: To assess the functional state of the fetus in pregnant women with certain thyroid diseases. MATERIAL AND METHODS: The results of instrumental studies in 118 pregnant women, who were divided into three clinical groups, were analyzed. Group 1 (44 people) consisted of patients with autoimmune thyroiditis (AIT). Group 2 (52 people) included patients with diffuse toxic goiter. Group 3 (control group) consisted of 22 pregnant women who had no somatic pathology and gestational complications. Thyroid diseases were diagnosed by an endocrinologist during a consultation in the third trimester of pregnancy based on laboratory and instrumental data. The functional state of the fetus was assessed using the total result of cardiotocographic and ultrasound studies, for which Partecust (Siemens, Germany) and Aloka-1700 (Hitachi, Japan) were used. Statistical processing of clinical material was performed using StatSoft software (Russia). RESULTS: A comprehensive assessment of the adaptive capabilities of the fetus showed changes in its functional state in pregnant women with thyroid pathology. Prognostically, the most crucial characteristic in pregnant women with autoimmune thyroiditis and diffuse toxic goiter is a decrease to 0–1 point in indicators that determine motor activity and tone, respiratory movements, and reaction to a non-stress test. Among patients with autoimmune thyroiditis and diffuse toxic goiter, a high assessment of the biophysical profile of the fetus occurred 4 and 3.4 times, respectively, less often than among women with a normal pregnancy (among pregnant women without somatic pathology and gestational complications). CONCLUSION: Disturbances in thyroid gland function during the gestational period can have an adverse effect on the development of the fetus, which is a theoretical basis for the development of treatment and preventive methods aimed at improving perinatal outcomes in this group of patients.

Role of oxidative stress in the occurrence of periodontitis in the background of metabolically associated diseases

Oxidative stress is an important component of slow pathological inflammation in metabolic diseases and chronic periodontitis. Periodontal diseases are interrelated with somatic pathology. This results in both local and systemic inflammatory reactions, which increases the risk of the onset and progression of somatic diseases. Psychological stress associated with oxidative stress with increased production of oxidants and oxidative damage is an important factor in the etiology of both periodontitis and metabolic disorders. Objective — to analyze the possible bond between chronic periodontitis, 8‑hydroxydeoxyguanosine (8‑OHdG), as a biomarker of oxidative stress, and cortisol in persons with metabolic‑associated diseases. Materials and methods. 68 people were surveyed, of which 47 had metabolically ‑associated diseases that were diagnosed according to domestic and international criteria. The control group consisted of systematically healthy people, representative by age and article that did not receive dental therapeutic and preventive measures for the last 6 months. The diagnosis of «chronic periodontitis» was carried out in accordance with existing recommendations provided at World Workshop on the Classification of Periodontal and Peri­Implant Diseases and Conditions (2017). The concentration of 8‑OHdG in plasma and the level of saliva cortisol were measured by the immunoenzyme method according to the manufacturer’s instructions. The arithmetic mean, standard error, and Student’s t‑test were calculated to compare the characteristics. Pearson’s correlation test was used to identify the relationship between the indicators. Results. Each of the groups had patients who had a healthy periodontium and those who had chronic periodontitis. The 8‑OHdG level in the main group was much higher (p<0.001) than in the control group, and the difference in the concentration of 8‑OHdG was also observed between those patients who had periodontal disease and those who had a healthy periodontium. The level of salivary cortisol in patients with chronic periodontitis was much higher compared to patients with clinically healthy periodontium (p=0.00). A correlation was found between cortisol levels and the presence of periodontal disease (r=0.619; p=0.00), between plasma 8OHdG levels and the epithelial attachment loss index (r=0.537; p=0.00), the hygiene index (r=0.599; p=0.00), and between 8OHdG levels and salivary cortisol concentrations (r=0.292; p=0.036). Conclusions. Oxidative stress plays an important role in delayed pathological inflammation in both metabolic diseases and chronic periodontitis. 8‑OHdG is a key and universal biomarker for the evaluation of DNA oxidative damage. There is a positive relationship between the oxidative marker, periodontitis and cortisol.

Clinical and laboratory peculiarities in postmenopausal patients with benign ovarian tumors

Objective. To assess clinical and laboratory peculiarities of postmenopausal patients with benign ovarian tumors. Materials and methods. The data of a prospective study of concomitant somatic and gynecological pathology in postmenopausal patients with benign ovarian tumors (basic group, n = 40) and patients without pathologies (comparison group, n = 15) are presented. Clinical and laboratory data were evaluated in both groups as well. Results. Postmenopausal patients with benign ovarian tumors were frequently exposed to myomas, chronic salpingitis and chronic cervicitis, when women with no ovarian neoplasms did not have these pathologies. Patients of the main group had higher levels of FSG, leptin, GBP and lower levels of vitamin D, than patients of the comparison group. Conclusions. Postmenopausal patients with benign ovarian tumors frequently have concomitant gynecological pathology, pronounced vitamin D insufficiency and high levels of FSG, leptin and GBP in serum samples.

Characteristics of risk factors and molecular genetic parameters in children with chronic kidney disease

Introduction. Information about the health status of children with nephrological pathology includes many manifestations of functional system disorders. However, early diagnosis of chronic kidney disease (CKD) is rarely carried out due to the lack of reliable predictors of this process.The aim: To analyze the association of anamnestic signs, laboratory and genetic research results with chronic kidney disease in children to identify potential predictors of the disease.Material and Methods. The data were obtained from a single-center retrospective catamnestic cohort study (2011–2022). The main group included 128 children with chronic kidney disease aged 1 to 17 years. The comparison group consisted of 30 children without diagnosed kidney pathology aged from 1 to 17 years. There were no statistically significant differences in sex and age between the two groups. The informative value of more than 150 features, including anamnestic ones, the state of the mother’s health during pregnancy, antenatal and perinatal factors, features of the child’s development and manifestation of the disease, the results of clinical, laboratory, and genetic research methods were evaluated. An integrated approach to the study included methods for hypotheses testing on statistical significance of indicators differences, regression analysis, and ROC analysis.Results. Hereditary burden of nephrological pathology in the family, unfavorable course of pregnancy (anemia, toxicosis of the first half), obstetric and somatic pathology in the mother, the serial number of childbirth are associated with the subsequent development of CKD. Erythrocytes in the urine and daily protein loss were detected only in the group of children with CKD. In this group, a decrease in the number of red blood cells, increased erythrocyte sedimentation rate (ESR), allergies at an early age, otitis media, persistent viral and bacterial infections, and a number of signs of connective tissue dysplasia were more common. The main group statistically significantly differed from the comparison group by a number of polymorphic genetic markers. It can be assumed that the polymorphisms AGT1 Thr174Thr, AGT2 Thr235Thr, NO3 C786T are associated with a predisposition to CKD, and the products of polymorphisms AGT1 Thr174Met, AGT2 Met235Met, R1 AGT2 C1166C, NO3 T786T may have a protective effect according to development of CKD.Conclusion. The risk factors for CKD identified in this study can be used to develop software to support medical decision making for early detection of children at high risk of disease progression.

Quality of life assessment with SIBDQ in children with upper gastrointestinal pathology

Functional and organic diseases of the digestive system today occupy one of the leading places in the structure of somatic pathology of childhood and adolescence and negatively impact young patients’ quality of life. Among the gastrointestinal tract diseases, the first place is occupied by the pathology of the gastroduodenal zone in children. Gastrointestinal diseases rarely occur in isolation in the form of damage to only the upper or lower parts of the digestive system, especially in childhood. Therefore, in the presence of dysfunction symptoms and pathological changes in the upper gastrointestinal tract, it is advisable to use non‑invasive means to diagnose pathological changes in the lower gastrointestinal tract. Objective — to analyze the quality of life using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) in children and adolescents with upper gastrointestinal tract pathologies. Materials and methods. The study involved 174 children who visited the Kharkiv city children’s clinical hospital No 19 with complaints about upper gastrointestinal disorders (7—18 years old). Patients were interviewed using the self‑reported inflammatory bowel disease quality of life questionnaire SIBDQ, which assesses physical, social and emotional well‑being (the result is determined from 10 to 70 points, where 10 is the worst condition). Results. The median SIBDQ score for the entire sample was 51 points [Q1; Q3: 45; 58], with 47.1±3.7% of respondents having up to 50 points. In girls, the median was significantly lower than in boys — 49 [40; 55] versus 55 [49.0; 65.5] (pU=0.05). According to the nature of the endoscopic picture, 55% of children with gastroesophageal and duodenogastric reflux, 38.6% of children with erythematous duodenopathy, 45.9% of children with erosive and ulcerative changes and 61.5% of patients with esophagitis had a low SIBDQ score. Boys with low SIBDQ scores were more prone to gastroesophageal and duodenogastric reflux. All other endoscopic changes were significantly more common (p <0.05) in girls with less than 50 points according to the survey results. Conclusions. In 47% of children with complaints of upper gastrointestinal dysfunction, the quality of life score was low by the SIBDQ (< 50). The median SIBDQ score in girls was significantly lower than in boys: 49 [40; 55] versus 55 [49.0; 65.5] points (pU=0.05), respectively. Girls with instrumentally confirmed esophagitis had significantly lower SIBDQ scores compared to boys with esophagitis and girls with other gastrointestinal disorders — 41.5 [37; 46] (p <0.05). The use of the SIBDQ questionnaires in school‑age children and adolescents is advisable not only for lower gastrointestinal tract diseases but also for gastroduodenal zone diseases.

Significance of correcting magnesium deficiency in different groups of women in surgical menopause

Background. In the 21st century, there is a clear trend towards an increase in the proportion of women with climacteric syndrome (CS) and surgical menopause. Medical care for such patients usually includes menopausal hormone therapy (MHT), which often causes changes in magnesium and pyridoxine metabolism and their deficiency, leading to the development of adverse reactions. Therefore, it is necessary to improve rehabilitation programs designed to increаse the quality of life (QoL) for this category of gynecological patients.Objective: to assess the profile of women with CS and surgical menopause receiving and not receiving MHT and to identify the significance of magnesium deficiency (MD) effect on the recovery process.Material and methods. The observational non-interventional study included a total of 9168 women, of which 1528 patiеnts with CS and surgical menopause were taking MHT (Group 1), and 1528 patients with CS and surgical menopause were not taking MHT (Group 2). The Magnesium Deficiency Questionnaire (MDQ) was used to determine the number of participants with MD. A biochemical blood test was also performed, including determination of plasma magnesium concentration. The patients’ profile was analyzed for general somatic pathologies, obstetric and gynecological history, complaints, and MD symptoms using visual analogue scale. To assess QoL before the start of 4-week MD replenishing course and at the end of therapy, the World Health Organization Quality of Life Questionnaire (WHOQL-26) was applied.Results. The MDQ data showed that the prevalence of DM in Group 1 was higher compared to Group 2. In both groups, women with hypomagnesemia had a higher incidence of viral infections, vegetative-vascular dystonia, osteochondrosis and arterial hypertension, more pronounced sleep disorders, irritability, back pain, rapid fatigue, and higher MDQ scores. After completion of the course of therapy with magnesium citrate and pyridoxine combination, the MDQ scores in patients with DM decreased along with an increase in plasma magnesium concentration. Besides, women's satisfaction with their physical, psychological, social wellbeing and microsocial support increased, and self-perception improved. A decrease in the severity of DM and a significant improvement in QoL according to WHOQOL-26 were demonstrated in patients with CS and surgical menopause after therapy.Conclusion. The profile of patients with CS and surgical menopause, regardless of MHT, is often characterized by DM and decreased QoL. It seems reasonable to include blood magnesium level monitoring and DM correction in the comprehensive rehabilitation program for such patients.

Chronic pelvic pain syndrome in women of reproductive age: An observational cohort clinical ultrasound study

Background. The annual number of new cases of chronic pelvic pain syndrome in women of reproductive age is increasing worldwide. The high prevalence of this condition among the able-bodied female population leads to higher state expenditures on the treatment of this category of patients. New methods of diagnosis and early prophylaxis contribute to reducing economic burden associated with chronic pelvic pain syndrome in women and improving health of the female population as a fundamental demographic factor.Objectives. To determine somatic, obstetric-gynecological, anatomical, and psycho-emotional predictors of chronic pelvic pain syndrome.Methods. An observational cohort clinical and ultrasound study involved 60 patients of reproductive age. The study was conducted on the basis of the clinic for women, Voronezh City Outpatient Clinic No. 1 — clinical base of the Department of Obstetrics and Gynecology No. 2, Voronezh State Medical University named after N. N. Burdenko, Russia. According to clinical and laboratory data, the participants were divided into 2 groups. Group 1 (n = 30) included women of reproductive age without clinical manifestations of chronic pelvic pain syndrome; Group 2 (n = 30) enrolled women of reproductive age clinically diagnosed with chronic pelvic pain.Results. The mean age of the study participants in the main group comprised 27.4 ± 6.30 and 26.3 ± 7.25 years in the control group, p > 0.05. Diseases of gastrointestinal tract, endocrine, cardiovascular, musculoskeletal and urinary systems, as well as neurocirculatory and vegetative disorders prevailed in the structure of somatic pathology in the main group, p < 0.001. Analysis of obstetric and gynecologic anamnesis revealed no statistically significant differences in the incidence of gynecologic pathology in the study groups. However, according to the detailed analysis of the delivery history of the participants, 23 patients of the main group (76 %) and 3 patients (6.6 %) of the control group underwent episiotomy during labor, p < 0.001. The evaluation of the comparison groups in terms of pain component in myofascial syndrome involved the pain rating index, number of selected descriptors, sensory index of the selected descriptors, emotional index of the selected descriptors, and pain intensity. Statistically significant differences were revealed for all of the above indicators, thereby confirming a reliable picture of pathopsychological changes in the compared groups of women. The analysis of the ultrasound parameters of topographic and anatomical relationships demonstrated the relevant change in the following parameters: urethral length, diameter of the external urethral sphincter, angle between the external urethra and the body of the bladder, direct and transverse dimensions of the levator hiatus in the studied groups under the muscle tension.Conclusion. An issue of early diagnosis and prophylaxis of chronic pelvic pain syndrome in women of reproductive age remains urgent and requires interdisciplinary participation of medical specialists. The development of new approaches to ultrasound evaluation of pelvic floor will increase the effectiveness of therapeutic and prophylactic measures and reduce the economic burden of this nosology in the morbidity structure of the able-bodied female population.

Pregnancy and psychoemotional state of women after in vitro fertilization

Aim. To study the psycho-emotional state of pregnant women after IVF and to identify the factors influencing it.Materials and methods. A total of 104 pregnant women were included in a comparative study. They were divided into two groups: one group consisted of women whose pregnancy occurred after IVF (main group), and the other group consisted of women whose pregnancy occurred naturally (comparison group). Psychodiagnostic questionnaires were used to assess the psycho-emotional state of the pregnant women. Statistical processing was performed using the STATISTICA 10.0 program, and differences were considered significant at a significance level of p=0.05.Results and discussion. The results of the analysis showed that the mean age of pregnant women after IVF was 30.8±1.3 years, which was significantly higher than that of women with natural pregnancy (mean age 22.38±4.6 years). In the group of women who became pregnant after IVF, there were more women with a complicated obstetric and gynaecological history and with extragenital pathology. The results of psychodiagnostic studies showed that women in the IVF group had a high level of anxiety. Factors such as the age of the pregnant woman, history of infertility, longterm and unsuccessful infertility treatment, and the presence of somatic pathology negatively affect the mental health of pregnant women.Conclusion. Thus, a high level of anxiety, fear about the course of the pregnancy and the health of the unborn child is characteristic of women whose pregnancy occurred after IVF. Psycho-emotional reactions are associated with the nature of the pathology of the pregnancy, the duration of infertility treatment and a burdened obstetric and gynaecological history. It is important to create special consultation rooms for psychological support. The help of a perinatal psychologist is necessary. Collaboration between the psychologist and the attending physician can achieve the best results.

Characteristics of the hemostatic system “P-selectin — von Willebrand factor — metalloprotease ADAMTS13” during childbirth

Introduction. The physiological task of the blood coagulation system during childbirth is to prevent excessive blood loss.Aim: to evaluate the quantitative and qualitative characteristics in the system P-selectin-von Willebrand factor (vWF)-metallo-protease ADAMTS13 during natural and uncomplicated childbirth in women with a physiological pregnancy.Materials and methods. The study included 40 pregnant women without somatic pathology, with a physiologically progressing pregnancy that ended with physiological birth (general group). Of these, 16 women had their first birth (group 1), 18 had their second birth (group 2) and 6 had their third birth (group 3). Venous blood sampling was performed at three points throughout the study: 1st point — the onset of labor, 2nd point — 2 hours after childbirth and 3rd point — 24 hours after child -birth. The control group consisted of 25 healthy non-pregnant women. The blood samples were examined for: vWF antigen (vWF:Ag), binding ability of vWF to platelet receptor GPIb (vWF:GPIb), binding ability of vWF to collagen type I (vWF:CBAI) and type III (vWF:CBAIII), antigen and activity ADAMTS13 (ADAMTS13:Ag and ADAMTS13:AC), antibodies to ADAMTS13 (ADAMTS13:AB) and P-selectin.Results. The medians of the studied vWF characteristics in the genera l group were statistically significantly higher compared to the control group at all study points, with the exception of the medians of the vWF:GPIb/vWF:Ag ratio, which in the general group were statistically significantly lower at all study points when compared with the control group. The median values of vWF:GPIb and vWF:Ag in women in the second group were statistically significantly higher at all points of the study, compared with similar indicators in both the first and third groups. The median values of ADAMTS13:AC and ADAMTS13:AB in the overall group were statistically significantly higher when compared with the control group at all study points. Median ADAMTS13:Ag and ADAMTS13:AC/ADAMTS13:Ag ratios were statistically significantly lower at all study points. Individual P-selectin values varied widely from 212.1 to 1398 ng/ml, but the medians of this indicator were statistically significantly higher in all study groups and at all study points compared to the control group.Conclusion. The increase in platelet-binding and collagen-binding abilities of vWF suggests that these adhesive properties of the hemostatic protein play an important role in preventing excessive bleeding during labor. Taking into account the decrease in the vWF:GPIb/vWF:Ag ratio compared to the control group, the adhesion of vWF to collagen is more important under these conditions. Despite the fact that ADAMTS13 concentration does not decrease, an actual twofold increase in its activity provides a sufficient antithrombotic effect. The interaction between vWF and ADAMTS13 under conditions of physiological labor does not lead to excessive formation and accumulation of high-affinity antibodies to ADAMTS13.

Fisher – Evans syndrome: rare cause of cytopenias in children

Interested in the problem of cytopenic conditions in children is associated with a various causes of them. The spectrum of differential diagnostic search is very wide: hemoblastoses, myelodysplastic and paraneoplastic syndromes, aplastic anemia. It is necessary for assessment of the main cause of cytopenia to pay attention on the patient’ common status (his complaints, anamnestic data — features of the start of the disease, previous diseases, concomitant somatic pathology, constant medication). Also on the complex and features of the clinical manifestations, the functional state of organs and systems, and in particular the liver, hematological changes in peripheral blood and bone the brain. The combination of immune thrombocytopenic purpura with autoimmune hemolytic anemia are named Fisher — Evans syndrome (FES). The article presents a clinical case of the combination Fisher — Evans syndrome and preceding B-lymphoma in a preschool child, and also reflects the main etiopathogenetic mechanisms of development this pathology. Fisher — Evans syndrome (SFE) is a rare autoimmune disease characterized by the immune thrombocytopenia (ITP) and Coombs–positive autoimmune hemolytic anemia (AIGA), which can develop simultaneously or sequentially, and in some cases are combined with immune neutropenia. The primary and secondary variants of Fisher — Evans syndrome are described. The secondary is the background of the following pathology: Epstein — Barr viral, cytomegalovirus, immunodeficiency virus, hepatitis C, parvovirus, varicella zoster virus, mycoplasma infection, tuberculosis), immunodeficiency and lymphoproliferative conditions, rheumatoid, autoimmune and malignant diseases such as systemic lupus erythematosus (SLE), antiphospholipid syndrome (AFLS), Sjogren’s syndrome, immunoglobulin A deficiency (IgA), autoimmune lymphoproliferative syndrome (ALPS), general variable immune deficiency (OVIN), lymphogranulomatosis (LGM), chronic lymphoblastic leukemia (CLL), autoimmune thyroiditis, autoimmune hepatitis, Takayasu arteritis, systemic sclerosis. The difficulties of searching causes are and indicated this diagnosis of exclusion. The question remains: is B-lymphoma the cause or accomplice of SFE in a child?

Влияние различных факторов риска на формирование вторичных органических психических расстройств у лиц пожилого возраста с алкогольной зависимостью, сформированной в среднем и пожилом возрасте

Background. Alcohol slows down the work of the brain and central nervous system, leads to deterioration of memory and concentration, cognitive disorders, and the formation of organic mental disorders. Due to the retirement of elderly people, some of them resort to taking alcohol as an adaptogen to alleviate various social, mental and psychological disorders, which can lead to the emergence of new or exacerbation of existing somatic disorders, the formation of alcoholism, as well as organic mental disorders. Aim. To investigate the risk factors (RF) for the formation of secondary organic mental disorders (SOMD) in elderly people with alcohol dependence (AD), formed in middle and old age. Patients and methods. The study included only male patients for the purity of the study aged 60 to 74 years (average age 67.5±7.2), who were divided into 2 groups depending on the age of occurrence of AD: group 1 – 21 people (36.2%), AD occurred at the age of 51.6±1.2 years, and the symptoms of SOMD at 61.8±2.1 years; group 2 – 37 people (63.8%), AD occurred at the age of 64.5±2.5 years, and SOMD at 71.3±2.8 years. The following methods were used: questionnaire – using the developed "Anamnestic chart", clinical (anamnesis collection), statistical (parametric and nonparametric). Results. The main factors of the formation of SOMD in people with formed AD in middle and old age are combinations of various RF, as well as a monofactor in the form of chronic alcohol abuse, the proportion of which varies depending on the age of AD formation. Conclusion. When AD is formed in old age, combinations of RF have a greater influence on the development of SOMD. And in the formation of AD in middle age, both alcohol, as an exogenous mono-damaging factor, and a combination of RF contribute to the formation of SOMD. Hereditary burden of alcoholism affects the progrediency of alcoholism, but does not play a role in the rate of formation of SOMD. The formation of alcoholism in middle age is combined with a relatively slow rate of formation of SOMD and a smaller number of associated somatic pathology, and when formed in old age – with a relatively fast rate of development of SOMD and a large number of associated somatic pathology.

Homocysteine as a biomarker of physical activity and exercise tolerance in adolescent children

Purpose: To determine the homocysteine content in children and adolescents with different levels of physical activity, to establish the relationship between homocysteine content, indicators of physical development, level of physical activity and tolerance to physical activity in adolescence. Material and Methods. We examined 83 children aged 11 to 17 years, who were examined by a pediatrician, an endocrinologist, and the girls by a pediatric gynecologist. The study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Committee on Bioethics and Deontology. Height, body weight and body mass index were assessed; physical activity tolerance by the Ruffier test; physical activity was assessed using a questionnaire; serum homocysteine was determined by enzyme-linked immunosorbent assay. Results. 81% of adolescents with high physical activity had regular sports training at least three times a week. In the group with low physical fitness, only 25.6 % attended sports sections, and 44.2 % of adolescents were completely physically inactive. The level of homocysteine in the blood did not depend on the sex of adolescents and physical development. Moderate hyperhomocysteinemia was detected in 41 adolescents, 68.3 % of whom had poor and low exercise tolerance and/or low physical activity. Statistically significantly higher homocysteine levels were observed in children with low physical activity (p<0.05), those who did not have sports training (p=0.027) or had reduced adaptation to physical activity (p<0.01). Conclusions. The level of homocysteine in the blood serum of adolescents did not depend on gender, physical development and the presence of somatic pathology. Low physical activity of adolescents is accompanied by increased levels of homocysteine in the blood. On the contrary, adolescents with high physical activity have lower levels. The lowest levels of homocysteine are observed in adolescents with good to excellent exercise tolerance. Unsatisfactory and weak Ruffier test results are associated with elevated homocysteine levels in adolescents

Neurofunctional and microstructural features of the brain in patients with nutritional obesity according to special magnetic resonance imaging techniques (literature review)

Background. Obesity is a chronic disease characterized by excessive accumulation of adipose tissue in the body, manifested by an increase in body weight by 20 percent or more of the average values. Obesity is becoming an increasingly significant public health problem. Assessment of the functional pathology of the brain provides more information about the pathogenetic changes leading to metabolic disorders. Modern methods of neuroimaging make it possible to obtain information about the initial functional changes in the brain according to the data of intracerebral connectivity - functional connectivity between its individual structures.Objective. The study of modern literature data on functional disorders of brain connectivity in patients with obesity, including those with eating disorders.Materials and methods. A systematic review of studies published in foreign and domestic literature has been carried out. Articles were searched using the PubMed database and Elibrary.Results. The problem of functional and microstructural studies of the brain in obesity is covered in sufficient detail in Western English-language literature. Nevertheless, it must be stated that at the moment there are practically no articles on the subject under study in domestic scientific publications. However, it should be noted that in the foreign literature there are rare data on neuroimaging of the brain in the aspect of neural network connectivity, studies in obesity with concomitant somatic pathology, for example, in type II diabetes, and other disorders of the endocrine system. There are relatively few data where correlations would be made with the age and gender of patients, concomitant mental disorders, which emphasizes the relevance of the issue.At the subsequent stages of the joint development of endocrinology, psychiatry and radiation diagnostics, the use of modern MRI techniques will help with the choice of target structures for stereotaxic correction of the described pathology. The clinical application of functional MRI will help to reveal the pathogenesis of various types of obesity at the neurofunctional levels with further prediction and analysis of the development of the disease, while the inconsistency and inconsistency of the currently obtained results of studies of the pathogenesis of alimentary obesity in terms of the pathology of functional connectivity based on fMRI, the absence clinical application of special MRI techniques substantiate the need to continue scientific research in this direction

ВЛИЯНИЕ ОБЩЕСОМАТИЧЕСКИХ ФАКТОРОВ В РАЗВИТИИ ОСЛОЖНЕНННОЙ КАТАРАКТЫ И ГЛАУКОМЫ НА ФОНЕ ПСЕВДОЭКСФОЛИАТИВНОГО СИНДРОМА (ОБЗОР ЛИТЕРАТУРЫ).

The variety of surgical methods, modified approaches, and modern advances make it possible to predict the outcome of the intraoperative course in cataract and glaucoma surgery with minimal risk of complications. Interest in pseudoexfoliation syndrome will not subside and research and observations will be carried out at a broad clinical level, as the trend towards increasing life expectancy in the middle and older population continues. Pseudoexfoliation syndrome is a complex multifactorial process that is associated with cataracts and glaucoma. The etiology of PES remains unclear, despite the modern approach, the centuries-long development of clinical ophthalmology, non-nophysiology, and molecular biology. However, later, scientists, having discovered deposited abnormal material in internal organs and tissues, came to the conclusion that this syndrome is a systemic disorder of connective tissue metabolism. According to some authors, factors contributing to the development of this syndrome may be bad habits (smoking for many years), chronic somatic pathologies, mainly cardiovascular diseases, endocrinological pathologies, hypertension, atherosclerotic deposits, vascular aneurysms. Other authors have studied the risk of developing glaucoma with comorbid pathologies, noting the high incidence of cardiac and cerebrovascular pathologies. Comorbid pathologies can often increase intraocular fluid, which in turn can provoke the development of transient hypertension. The authors, comparing pseudoexfoliation syndrome with primary open-angle glaucoma, noted the influence of somatic conditions on orbital blood flow, which can also disrupt the hydrodynamics of the eye in the long term. In glaucoma and cataract surgery, there are various surgical, drug and non-drug approaches to improve the condition of the visual organ. This review describes the developments of various technologies, modified approaches, and the development of surgical instruments to solve complex problems for the surgeon.

Diagnostic value of the gingival cytogram in school-age children suffering from chronic gastritis and duodenitis

In recent years, there has been an increase in the incidence of morbidity associated with digestive organ pathology in the pediatric population. The oral cavity is the digestive tract opening, sharing a common ectodermal origin with it. The changes in the cytogram of the oral mucous membranes can signal about exacerbation of pathological processes in the gastrointestinal tract. The aim of this work: to identify the features of gingival cellular composition in school-age patients with chronic gastritis and duodenitis in order to improve diagnostic methods at the disease stages. Examinations of the gingival cytogram in children aged 12-17 years with chronic gastritis and duodenitis (27 individuals with the disease in acute stage, 30 – in remission) were carried out. The control group included 28 children who did not have any somatic pathology by the results of the examination. For cytological examination, imprint smears from the gingival vestibular surface of the upper and lower jaws were made. The smears were fixed and stained by the May-Grunwald Pappenheim method, and then examined using a microscope with an im­mersion system. The percentage of epithelial cells and connective tissue cells was calculated per 100 cells. The number of pathologically altered epithelial cells was determined: with vacuolated cytoplasm, with nucleus deformation. In children with chronic gastritis and duodenitis disorders in the gingival cellular composition with a predominance of dystrophic components were found, that was manifested by a decrease in the proportion of epithelial cells at terminal stages of differentiation, an increase in the proportion of cells with cytopathological phenomena, polymorphonuclear leukocytes and lymphocytes. Changes in the cytogram were especially expressed in the phase of disease exacerbation. Knowing the phases of the wound process, based on the timing and sequence of the cellular ensembles seen in the cytogram, it is possible to control the disease periods, and timely apply measures to prevent exacerbations. This diag­nostic method is especially indicated for children who have relative and absolute contraindications for fibroesogastroduodenoscopy.