Vol 8, No 4 (2023)

Aim – to determine the indicators of anxiety and depression in pregnant women who are going to have an operative delivery and, depending on this, to provide the optimal type of anesthesia and psychological support during the operation.

Material and methods. We examined 215 pregnant women aged 18 to 45 years (M=29,8±4,79) who were to undergo operative delivery. We also tested 188 women from the KG with the physiological course of pregnancy, with the same age and gestation period, whose delivery was carried out through the natural birth canal.

Results. In MG patients, the optimal type of PCGD was significantly lower than in CG patients (p<0.05). Euphoric, hypogestognosic and anxious types of PCGD in pregnant CG were also significantly higher than in MG patients (p<0.05). When analyzing the data on personal and situational anxiety, it was found that a high degree of severity according to the Spielberg-Khanin scale was observed in patients with anxious and depressive types of PCGD Endogenous depression in pregnant women of the main and control groups is absent when using the questionnaire for the presence and severity of depressive states I.G. Bespalko.

Conclusion. In pregnant women who were to have an operative delivery, the optimal type of PCGD was significantly lower than in women who were to have a natural birth. Anxious and depressive type of PCGD in patients with planned operative delivery was significantly higher than in patients with planned natural childbirth. Psychocorrective work and additional psychological support by an anesthesiologist-resuscitator during a caesarean section reduced the severity of anxiety and depressive disorders.

Aim – to study the relationship between thyroid function parameters (free T3 (FT3), free T4 (FT4), FT3/FT4 ratio), thyroid-stimulating hormone (TSH) and parameters characterizing sarcopenia (muscle mass and strength, physical performance) in patients with type 2 diabetes mellitus (T2DM) and euthyroidism.

Material and methods. The study included 312 elderly patients with T2DM in a state of euthyroidism (mean age 65.39 ± 2.28 years). In all participants the following parameters were measured: anthropometric parameters, thyroid hormones (FT3, FT4), TSH, fasting blood glucose, glycated hemoglobin (HbA1c), fasting C-peptide and insulin, lipid profile, body composition, handgrip strength, walking speed.

Results. Sarcopenia was prevalent in 26.9% of T2DM patients with euthyroidism. A binary logistic regression analysis adjusted for age, gender, smoking and alcohol consumption, T2DM duration, hypertension, HbA1c level, eGFR, TG, HDL and fat mass fraction showed that the high-normal FT3 level (OR = 0.522, 95% CI: 0.304–0.895, p = 0.018), a low-normal FT4 level (OR = 1.126, 95% CI: 1.009–1.258, p = 0.034) and an increased FT3/FT4 ratio (OR = 0.923, 95% CI: 0.879–0.969, p = 0.001) were associated with a low prevalence of sarcopenia. FT3 concentration was positively associated with muscle strength (OR = 0.525, 95% CI: 0.305–0.902, p = 0.020) and walking speed (OR = 0.443, 95% CI: 0.259–0.758, p = 0.003), while FT4 concentration was negatively associated with muscle mass (OR = 1.114, 95% CI: 1.009–1.232, p = 0.036). The FT3/FT4 ratio was positively associated with muscle mass (OR = 0.943, 95% CI: 0.905–0.981, p = 0.006), muscle strength (OR = 0.945, 95% CI: 0.901–0.992, p = 0.021), and walking speed (OR = 0.934, 95% CI: 0.894–0.975, p = 0.002). TSH levels were not associated with sarcopenia.

Conclusion. The high FT3/FT4 ratio is significantly associated with a low risk of sarcopenia in T2DM patients with euthyroidism.

The review article summarizes recent literature data on immunopathogenetic features that influence the nature of the development and course of viral infections.

According to the impact on a cell, cytopathic and non-cytopathic viruses are isolated. The course of viral infections is accompanied by cell death, immunopathology, immunosuppression, oncogenesis, and in later stages – molecular mimicry and immune amnesia. The acute course of infections is controlled mainly by the mechanisms of innate immunity. The severity of the course of such infections is associated with the genetic variability of viruses and resistance to the antibodies' neutralizing effects. Viruses that are non-cytopathic in their natural mouse hosts can cause acute and chronic infections in humans. The activity of viral reproduction, the persistent infection may be associated with the peculiarities of the expression of gene profiles of the infected cell. The synthesis of endogenous interferons can also affect the nature of the infection development. Disturbances in signaling through Toll-like receptors may contribute to the persistence of infection. Some of the viral proteins block the presentation by the molecules of the main histocompatibility complex of I, II class of viral antigens, interfering with various stages of the presentation. This process is facilitated by a decrease in the transcription of genes of the main histocompatibility complex, blocking the secretion of immunogenic peptides by the proteasome or interfering with the subsequent assembly and transport of the peptide complex to the cell surface. A number of viral proteins stimulate the virus reproduction and inhibit apoptosis. It is believed that the B7-2 molecule is most important for triggering the immune response. Immunodominant epitopes of viral antigens, mutants of cytotoxic lymphocytes are key factors in the immunopathogenesis of persistent, latent infections. Changes in the viral genome of even a single amino acid allow them to avoid recognizing epitopes by an activated T-lymphocyte. Another mechanism for viruses to escape the immune system control is the death of activated T-cells.

Aim of the review – to discuss the respiratory rate (RR) measurement methods that use sensors for analyzing chest wall movements. Strain and movement sensors can be successfully used in real clinical practice, since they can be easily integrated into clothes and garments (electronic textiles) for measuring the respiratory rate in both inpatients and outpatients. Meanwhile, magnetometers, gyroscopes and accelerometers must be located in specific places. One of the main limitations of strain and motion sensors is their sensitivity to patient's breathing-unrelated movements. In order to reduce this limitation, the sensors should most often be placed in the upper part of the chest and integrated into mechanical supports. In addition, it is recommended to use hybrid systems consisting of multiple different sensors. Such systems allow separate analysis of the thoracic and abdominal breathing patterns, providing for wide opportunities to use these sensors for scientific purposes. The use of special polymers and protective materials in a piezoresistive sensors design will allow to overcome their other drawback – the possible influence of environmental factors (for example, temperature or humidity).

Conclusion. All types of the sensors presented in this review showed generally good quality of respiratory curves at rest during normal breathing. However, in most cases, the bias increased in physical activity. The choice of a certain type of sensor for RR assessment should obviously be based on the specific clinical situation, monitoring duration, monitoring conditions (intensive care unit, inpatient, outpatient department), taking into consideration the advantages and disadvantages.

Aim – to evaluate the effect of local exposure to humic substances on the repair of smooth muscle tissue of the internal anal sphincter.

Material and methods. Laboratory male rats were subjects for experimental study. The tissues were studied using light-electron microscopy and immunocytochemistry.

Results. The study revealed the features of myocyte survival in the wound and near-wound zones, the connective tissue scar formation rate. The phenomenon of the transformation of contractile myocytes into contractile-secretory ones was confirmed. The experiment has registered several features of the compensatory processes occurring with the use of humic acids as a local therapeutic agent. Specifically, the presence of a more pronounced edema of the interstitium, prolongation in time, in comparison with the control, filling the interstitium with connective tissue, as a result of which the architectonics of collagen fibers was adequate to the direction of myocyte contraction and relaxation. In addition, mitotically dividing cells were found among the muscle layer of the wound zone in the experimental group.

Conclusion. The experimental data suggests that humic acids, being a natural factor, can contribute to the processes of intracellular and cellular regeneration, resulting in better restoration of the internal sphincter structure. Further development of humic substances along with the research on their action at the cellular and tissue levels should be encouraged.

Aim – to study the prevalence of paracardial fat as a risk factor for cardiovascular diseases in Moscow population using an automated analysis of the results of radiological examinations.

Material and methods. The research was designed as descriptive, retrospective epidemiological study. The results of chest computed tomography of 113,408 patients served as the study data. The data was analyzed by AI services in an automated mode for the presence of paracardial fat and calculation of its volume.

Results. The paracardial fat was detected in 66.5% of the examined persons. The proportion of men was 45.7%, women – 54.3% (p<0.001). The volume of paracardial fat fluctuated in the range from 1.0 to 1517.0 ml; the average value was 282.1 ml. The average volume of paracardial fat in men (326.0 ml) was significantly larger than in women (244.7 ml) in each age group. The clinically significant volume of paracardial fat (≥200 ml) was detected in 33,081 individuals (in 64.0% of people having this risk factor). The risk factor was clinically significant in 71.1% of men and in 57.9% of women (p<0.001).

Conclusion. The prevalence of paracardial fat in Moscow population was 5.97 per 1000 individuals. A clinically significant volume of paracardial fat was most often found in both sexes in the elderly (78.7%) and senile age groups (78.2%). Each 5 years of age increased the probability of this risk factor incidence by 1.282 times in general; and the risk of developing its clinical form – by 2.981 times in particular.

Aim – to analyze the dynamics of indicators of the Federal Project "Fighting Cardiovascular Diseases" and to suggest improving the project management methods in healthcare.

Material and methods. The data was collected from Federal statistical observation form No. 14 "Data on activity of divisions of the medical organizations providing in-hospital medical care", form No. 30 "Data on the medical organization". The target indicators were selected from the Passport of Federal Project "Fighting Cardiovascular Diseases". The data on mortality rate was collected from the Rosstat reports on the number of population and the number of deaths by different diseases.

Results. In Russia, the frequency of endovascular interventions in acute coronary syndrome is growing essentially exceeding the target values of the Federal Project. Several regions are leading in the intensity of performing these operations (taking into account the population size) leaving behind many developed countries. At the same time, the death rate from cardiovascular diseases in Russia remains one of the highest in the world. The problem of medical care quality is still acute. The in-hospital lethality rates from cerebrovascular accident and acute myocardial infarction have significantly exceeded the target values during the entire period of observation.

Conclusion. During the infectious pandemics, the actions and target indicators of federal projects in healthcare should be revised. The healthcare model focusing on disease prevention, conservative treatment and telemedicine is preferable.

Aim – to retrospectively evaluate the treatment results in children with diaphyseal forearm fractures operated on using intramedullary metal osteosynthesis with titanium elastic rods according to the Elastic Stable Intramedullary Nailing (ESIN) method.

Material and methods. The treatment results of 79 children were included in the retrospective analysis. The patients' mean age was 11.8 years (from 6 to16 years).

Results. The results of treatment were evaluated using the classification of Anderson et al. [20] in the early postoperative period, at 2, 4 and 6 months after surgery.

Conclusion. The ESIN osteosynthesis for diaphyseal fractures of the forearm bones in children allows for achieving excellent treatment results and early limb functionality in the absolute majority of cases.

Aim – to study the integral scale for assessing enteral insufficiency in patients with acute pancreatitis during the phases of enzyme toxemia and purulent-destructive complications; to develop a strategy for choosing a method for enteral insufficiency correction.

Material and methods. We have analyzed the treatment outcomes in 232 patients with acute pancreatitis admitted to the surgical department of the Samara Regional Clinical Hospital n. a. V.D. Seredavin for the period from 2013 to 2019. Two study groups were formed: retrospective and prospective. The retrospective (control) group included 175 patients whose treatment outcomes were assessed retrospectively for the parameters of the enteral insufficiency syndrome and measures were suggested for its differentiated correction. The prospective (intervention) group included 57 patients who were treated using the developed principles of enteral insufficiency correction.

Results. The occurrence of I and II degrees of enteral insufficiency differed significantly depending on the phase of acute pancreatitis. When using complex correction of enteral insufficiency according to the proposed scheme, in patients in the phase of enzyme toxemia the I degree enteral insufficiency was prevalent, the patients in the purulent-destructive phase were more likely to have II degree enteral insufficiency.

Conclusion. The timely inclusion of enteral insufficiency correction into the complex of therapeutic measures for pancreatitis may improve the treatment outcome in patients with moderate and severe phases of acute pancreatitis.