Vol 104, No 3 (2023)

Background. Determination of Rh-affiliation is mandatory for donors and recipients, surgical patients, pregnant women, etc. There are variants of the D antigen that are difficult to identify by serological methods, for example, a weak D antigen.

Aim. Determination of Rh-affiliation using genotyping in difficult cases, when the use of serological methods does not allow obtaining a reliable result.

Material and methods. We studied blood samples from donors (n=18), pregnant women (n=17) and patients with hematological diseases (n=15): 22 men and 28 women, median age 36 years (25 to 54 years). Serologically, antigen D was determined by gel technology in ID-cards and in an indirect antiglobulin test with anti-D-IgG reagent. Weak D antigen variants were diagnosed and phenotype determined using polymerase chain reaction with allele-specific primers. For significance of differences in the frequency of types of weak antigen D, a nonparametric statistical method using a two-tailed Fisher's exact test was used. Differences were considered statistically significant at p <0.05.

Results. The use of genotyping made it possible to detect the presence of a weak antigen D in 41 samples. Its specificity was represented by the following types: 1; 1.1; 2; 3. Other types of weak antigen D [4; 4.0; 4.1; 4.2 (DAR); 5; 11; 14; 15; 17] were absent. The study of the phenotype of erythrocyte antigens of the Rhesus system using genotyping revealed the predominance of the Ccee phenotype in people with a weak D antigen. Significant differences in the frequency of types of this antigen were revealed.

Conclusion. The use of molecular genetic typing made it possible to determine the types of the weak antigen D and to accurately determine the Rh-affiliation of the subjects.

Background. Individual anatomical variability in the human body shape can be characterized by its proportions, which serve as the main components of assessing the type of human constitution.

Aim. Establish individual typological features of the age-related changes in the fat component of the examined children, adolescents and youth.

Material and methods. 409 residents of the Smolensk region aged 4–20 years were examined: 212 males and 197 females. The cohort was divided according to the International Age Periodization 1965. Studies of the longitudinal-transverse type lasted for 10 years (2010–2020). The research methods included anthropometry, somatodiagnostics, determination of the biological development variant. To determine the fat component, the thickness of the skin-fat folds was measured, the calculation was made according to the formulas of Ya. Mateyko. The analyzed data had a normal distribution (Shapiro–Wilk test). The hypothesis of statistical significance of differences was tested using Student's t-test.

Results. Assessment of age-related changes in the body fat component of the subjects showed its continuous increase from 4 to 20 years. In female subjects it was higher, the significance of differences was established from the age of 12 (p ≤0.05). The fat component had a high and moderate degree of correlation with body height and weight (r=0.533–0.753 and r=0.530–0.833), skin-fat folds (r=0.501–0.941) and body circumference (r=0.503–0.790). Significant differences were established between the extreme variants of biological development (isochronic approach) (t=2.305–2.604; р ≤0.05). In the examined males, the difference was 10–12%, females — 25–30%. Somatotypological assessment (isosome approach) showed significant differences (t=3.462–6.781; p ≤0.001) in the severity of fat mass in the subjects of both sexes of macrosomal and microsomal types.

Conclusion. The conducted studies have confirmed the presence of high individualization of the fat component’s growth processes of male and female subjects of various somatic types and biological development variants.

Background. The postoperative period is often accompanied by pain and limited mobility in the ankle joint. There is a need to evaluate the effectiveness of additional rehabilitation methods in the late postoperative period.

Aim. Evaluation of the effectiveness of complex (standard + osteopathic) treatment compared with standard resto¬rative treatment in patients with distal tibia fractures in the late postoperative period.

Material and methods. In the course of a randomized study, patients in the late postoperative period (6–8 weeks after surgery; n=40) were divided into two groups: the main group (n=20) received a standard rehabilitation treatment regimen and osteopathic treatment (correction of identified somatic dysfunctions); the comparison group (n=20) — only the standard rehabilitation treatment regimen. The amplitude of motion of the affected ankle joint was assessed using a goniometer, the level of pain in the affected ankle joint was assessed using a visual analogue scale, and the level of quality of life was assessed using the SF-36 questionnaire. Data are presented as arithmetic mean and standard deviation — M (SD). When analyzing intergroup differences, the nonparametric Mann–Whitney test (U-test) was used; when analyzing intragroup differences, the nonparametric Wilcoxon test (W-test) was used. The critical level of statistical significance was taken as 5% (p=0.05).

Results. The addition of osteopathic treatment to the standard scheme led to a significant decrease in the level of pain (0.3 points in the main group, 1.5 points in the comparison group; p=0.0026), an increase in the amplitude of active movements in the ankle joint (64.7° in the main group, 51.8° in the comparison group; p=0.000217), improvement in the quality of life — physical functioning (an increase in the indicator in the main group by 39 points, in the comparison group — by 26 points), general health (an increase in the indicator in the main group by 47 points, in the comparison group — by 28 points).

Conclusion. Combined treatment (standard plus osteopathic) improves the results of restorative treatment compared with standard therapy alone in patients with fractures of the distal tibia in the late postoperative period.

According to global statistics, 25% of deaths every year are cases of sudden cardiac death. Implantation of cardioverter-defibrillators is currently used as its prevention. In the coming years, the world is projected to see an increase in the number of implantations of cardioverter-defibrillators in high-income countries, as well as an expansion of the range of medical devices offered, including subcutaneous cardioverter-defibrillators, which are currently being considered as a promising alternative. We systematized the literature data presented in various international studies evaluating the efficacy and safety of the use of subcutaneous cardioverter-defibrillators. A review of the medical literature published in the period from 2015 to 2022 was carried out using the information and analytical systems MEDLINE, Scopus, Clinicaltrials.gov, Google Scholar and Web of Science. The review was performed in accordance with the checklist of preferred reporting items for systematic reviews and meta-analyses. 398 original publications were selected, of which 50 original scientific articles on the research topic were included in the analysis. Modern international studies have demonstrated the efficacy and safety of the use of subcutaneous implantable cardioverter defibrillators. An improvement in the performance of unmotivated discharges over time was noted, which was associated with the improvement of implantable cardioverter-defibrillators. The operating time for implantation of subcutaneous cardioverter-defibrillators was significantly less compared to transvenous cardioverter-defibrillators. Subcutaneous cardioverter-defibrillators were associated with a lower incidence of perioperative complications and high efficacy of shock therapy. Subcutaneous cardioverter-defibrillators were as effective as transvenous implantable cardioverter-defibrillators and did not have the risk of complications associated with implantation of endocardial electrodes. The main limitations of the technique were the impossibility of pacing and the absence of antitachycardic stimulation.

Anemia of chronic disease occurs in patients with infectious, autoimmune, kidney diseases, neoplasia, inflammatory bowel disease, obesity, diabetes mellitus, congestive heart failure, and chronic lung disease. This variant of anemia is characterized primarily by impaired iron homeostasis, the suppressive effect of pro-inflammatory cytokines on erythropoiesis, and changes in the erythrocyte membrane that worsen their survival. Anemia of chronic disease is micro- or normocytic anemia with low levels of reticulocytes. In anemia of chronic disease, serum iron and transferrin levels are usually reduced or normal, and serum ferritin levels are within reference values or elevated. The article provides a review of studies on epidemiology, including age aspects, provides information on the etiology and prognosis in patients with anemia of chronic diseases. The issues of the history of anemia of chronic diseases and its place in the structure of all anemias are also covered. Anemia of inflammation is recognized as a widespread pathology; it occupies 40% in the structure of all anemias. It is important to note that anemia of chronic diseases, while accompanying a number of dangerous diseases, actually serves as a natural defense mechanism. This is due to the occurrence of “iron starvation” for microorganisms, since inflammatory reactions increase the synthesis of iron proteins, which quickly extract extracellular and unbound iron. This mechanism allows a person to destroy the infection in time with the help of innate immunity. The article reveals the pathogenetic aspects of anemia of inflammation development and data on the role of iron in the functioning of macro- and microorganisms. Particular attention is paid to the differential diagnosis of anemia of chronic diseases and iron deficiency anemia, key diagnostic hematological markers of anemia, iron metabolism, inflammation and erythropoiesis are given. The pros and cons of therapy options, as well as possible new pathogenetic methods for the treatment of anemia of chronic diseases, are described.

Background. For pain management during caesarean section, the correct choice of anesthesia and adequate analgesia are of great importance.

Aim. To study pain management methods for caesarean section, to develop their pharmacoepidemiological and pharmacoeconomic characteristics in a chronological aspect.

Material and methods. A retrospective pharmacoepidemiological and pharmacoeconomic analysis of 1025 birth histories of women after caesarean section with a detailed assessment of the use of local anesthetics, central deprecating agents, opioid and non-opioid analgesics in 2007–2009 (523) and 2016–2017 (502) was carried out. Frequency of use, total consumption and cost of drug therapy during and after surgery were analyzed. The significance of differences in relative indicators was assessed by Pearson (χ2).

Results. In the first time period, regional methods of anesthesia were used in 98.5% of cases: epidural anesthesia — in 428 (82%) cases, spinal anesthesia — in 87 (16.5%) cases (p=0.001). In the second period, regional methods of anesthesia were used in 97.5% of cases: epidural anesthesia — in 157 (31%) cases, spinal anesthesia — in 334 (66.5%) cases (p=0.001). Intraoperatively, in the second period, trimeperidine for spinal anesthesia, fentanyl for epidural anesthesia (p=0.001; p=0.001) were prescribed 2 times more often; intraoperative consumption of opioid analgesics was greater than in the first period. After surgery in the first period with epidural anesthesia more often than in the second, trimeperidine (45%), ropivacaine (96%); for spinal and epidural anesthesi — paracetamol, ketorolac (p=0.001), were prescribed. Spinal anesthesia in both periods was characterized by a greater consumption of adjuvants than epidural anesthesia. In the first period, 12 drugs for pain management from 5 pharmacotherapeutic groups were used, in the second — 10 drugs from 5 groups. The cost of epidural anesthesia was 4 times higher in the first period, and 7 times higher in the second.

Conclusion. Between 2007 and 2017, there was a transition from epidural to spinal anesthesia, and opioid analgesics were more often added to local anesthetics to manage pain during surgery in the second period; the cost of epidural anesthesia was high due to the price of ropivacaine.

Background. Losses in the labor and demographic potential of society concerning mortality due to cardiovascular pathology are significant, accounting for more than a third of all deaths of the population. The study of the socio-economic damage caused by the main nosological groups — coronary heart disease and cerebrovascular diseases, is an urgent task.

Aim. To determine the cost of demographic losses due to premature mortality from cerebrovascular diseases in the Irkutsk region.

Material and methods. The subject of the study was deaths from cerebrovascular diseases in the population of the Irkutsk region for the period 2015–2019. A continuous method of statistical observation was used. The assessment of the value of the person’s average life was carried out by collecting statistical information from special accounting forms. Demographic losses were determined by calculating the indicator of years of potential life lost (unlived years). Economic losses were determined by calculating the cost of years lost as a result of premature death from cerebrovascular disease.

Results. As a result of the study, it was found that the cost of one year of life for men was higher than for women. The differences were due to the high difference in the average life expectancy of the male and female population. Demographic losses due to premature mortality from cerebrovascular diseases were increasing in dynamics for the male population, while decreasing for the female population. The age range of maximum losses from mortality for the male population was in the age group of 60–64 years, for the female population — 70–74 years. The dynamics of economic losses for the region in 2015 amounted to 45.9 billion rubles, in 2019 — 48.7 billion rubles. The cost of one year of average life was significantly affected by the extremely high gap in the average life expectancy of the male and female population of the region.

Conclusion. The indicator of demographic losses in the Irkutsk region due to the unlived years of the population associated with mortality from cerebrovascular diseases was 12,026.9 person-years in 2015, and 11,129.3 person-years in 2019.

Background. Primary reconstructive operations aimed at restoring the passage of bile are rather complicated due to the cicatricial process and in 15–30% lead to a distant recurrence of the disease.

Aim. To present the results of combined X-ray surgery and endoscopic transfistula antegrade interventions in the treatment of benign bile duct strictures.

Material and methods. For the period from 2011 to 2019 31 patients with benign bile duct strictures were treated in the surgical departments of the City Clinical Hospital No. 14 in Yekaterinburg. The mean age of the patients was 60.3±12.7 years, the comorbidity index was 2.6. As follows from the presented data, in 13 patients the stricture developed in the area of biliodigestive anastomoses. Another 17 patients had stricture after surgery for cholelithiasis. In 1 case, there was a persistent narrowing of the lumen of the choledochus against the background of indurative pancreatitis. In 25 (80.6%) cases, the first step was percutaneous transhepatic cholangiostomy under ultrasound guidance. Another 6 (19.4%) patients had a T-shaped drainage of the choledochus.

Results. For the treatment of strictures of the bile ducts, 97 operations were performed: an average of 3.1 operations per 1 patient. Lithoextraction with a wire basket was performed in 17 patients with calculi. 5 patients with stones larger than 10 mm required contact lithotripsy. Stricture was confirmed in 25 patients. Balloon dilatation was performed in 21 cases. In 8 cases, dilatation was supplemented with papillosphincterotomy. In 6 patients with deformation of the anastomosis zone, framed drainage was installed for 12 months. In 3 patients, bilioduodenal stenting with a nitinol stent was performed. It was not possible to recanalize the stricture in 4 (13%) cases. Complications were registered in 1 (3.2%) patient (IIIB degree according to Clavien–Dindo).

Conclusion. Transfistula cholangioscopy is an effective endoscopic technology in the treatment of patients with benign bile duct strictures.

Background. Immediate postoperative complications in the surgical treatment of autoimmune thyroiditis range from 8.5 to 15.0% of the total number of operated patients.

Aim. Improving the results of surgical treatment of patients with autoimmune thyroiditis through the introduction of advanced surgical techniques and the use of CO2 laser in surgical interventions.

Material and methods. The immediate postoperative results of surgical treatment of patients with autoimmune thyroiditis at the clinical base of the Scientific Center for Surgery named after M.A. Topchibashev for 2015–2021 were studied. The analysis was carried out in two groups with the inclusion of data from 207 operated patients aged 27 to 73 years, mostly patients with hypertrophic form of AIT. There were 183 (88.4%) women and 24 (11.6%) men. The first group consisted of 96 (46.4%) patients who underwent an advanced surgical technique using a CO2 laser. The second group included 111 (53.6%) patients who underwent surgery using traditional methods. The immediate postoperative specific complications (paresis of the larynx and hypoparathyroidism) and the results of surgical treatment of patients in two groups were compared. To test the statistical significance of differences, nonparametric Pearson's χ2 and Student's t tests were used. Differences were considered statistically significant at p <0.050.

Results. The number of patients with complications among the patients of the first group was 3 (3.1%), among the patients of the second group — 16 (14.4%) (χ2=7.870, p=0.006). The greatest number of complications was noted in patients with large goiter and recurrence of the disease in those previously operated on for autoimmune thyroiditis. The proposed method using a CO2 laser in the surgical treatment of patients with autoimmune thyroiditis can reduce the incidence of laryngeal paresis (χ2=4.057, p=0.044), hypoparathyroidism (χ2=4.381, p=0.037) and mortality (χ2=3.840, p=0.050), reduce the duration of hospital stay by 22% — from 9.6 to 7.4 days (t=2.588, p=0.007).

Conclusion. The use of advanced surgical techniques, the performance of the operation in an adequate volume and the use of a CO2 laser made it possible to reduce the number of postoperative complications and improve the results of treatment of patients with autoimmune thyroiditis.

The article discusses the views of doctors of the 19th — early 20th centuries on the causes of leprosy, presents the main etiological theories of their consistency and relationship with the climate and the population’s life characteristics of the north-eastern Siberia. On the basis of modern research and literary sources of the 19th century, the probable ways of introducing leprosy to Eastern Siberia, on the coast of the Sea of Okhotsk and the territorial distribution of infection foci are shown. The attitude of foreigners to those infected with leprosy, based on the fear of being infected, is revealed. The purpose of the work is to study the facts indicating the prevalence of leprosy in Eastern Siberia in the 19th — early 20th centuries. As part of the study, a content analysis of the source base, indicating the incidence of leprosy in the population of the northeastern districts of Siberia, was used. The work is based on the study of primary sources on the topic for the period 1840–1929, materials from the State Archives of the Irkutsk Region, as well as literary sources of the 19th — early 20th centuries. Data showing the incidence of leprosy in the districts of the Irkutsk General Government are provided.

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Cashin AG, Wand BM, O'Connell NE, Lee H, Rizzo RRN, Bagg MK, O'Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2023. Issue 4. Art. No.: CD013815. DOI: 10.1002/14651858.CD013815.pub2.