Vol 104, No 6 (2023)

Background. The effect of pharmacotherapy used to treat patients with the new coronavirus infection COVID-19 on immune parameters after treatment has not been sufficiently studied.

Aim. To study the effectiveness of pharmacotherapy and evaluate its impact on the immune response in patients with COVID-19.

Material and methods. The subjects of the study were 98 patients with COVID-19 aged from 32 to 68 years who were treated at the Penza Regional Clinical Center for Specialized Types of Medical Care from November 2022 to March 2023. The average age of the patients was 50±18 years. Computed tomography revealed pneumonia in all patients (CT1–CT4). The outpatient observation group included patients with COVID-19 (n=32), who were characterized by a mild course of the disease, 36 patients with moderate severity of COVID-19, and 30 patients with severe and extremely severe disease. Patients with mild COVID-19 received molnupiravir as antiviral therapy, patients with moderate COVID-19 received favipiravir, and patients with severe and extremely severe COVID-19 received remdesivir. After treatment, 72 patients were examined on an outpatient basis 3–4 weeks after discharge from the hospital. In the blood of patients before and after treatment, the populations of T- and B-lymphocytes, the functional activity of T-lymphocytes, cytokine indicators — tumor necrosis factor α, interleukins-4, -10 and -18, interferon γ — in cell supernatants were studied. Statistical analysis of the groups was carried out according to Wilcoxon, differences were considered significantly significant at p <0.05.

Results. In the observation group (98 patients), in patients with mild disease (32 patients), recovery occurred in 31 (96.8%) people. With a moderate course of the disease, a favorable outcome with clinical and laboratory improvement was noted in 33 (91.7%) patients out of 36, and with a severe course of COVID-19 — in 7 (23.4%) patients out of 30, 5 (16.6%) patients died, in 18 (60.0%) people after the 10th day of therapy complications from the cardiovascular system in the form of heart attacks and strokes were noted. After treatment in patients with COVID-19, the immune system showed an increase in the relative number of lymphocytes (p=0.034171), indicators of cytotoxic CD3+CD8+ T cells (p=0.001090), spontaneous synthesis of interferon γ (p=0.003246), induced production of interleukin-18 (p=0.003278), decrease in the absolute number of leukocytes (p=0.004319) and induced synthesis of interleukin-10 (p=0.042439).

Conclusion. Regardless of the type of antiviral therapy administered, a high recovery rate was recorded in patients with mild and moderate disease compared with severe and extremely severe disease.

Background. Over the past decades, the role of the microbial factor in the development of atherosclerosis has been discussed. To date, data on the composition of the microflora of atherosclerotic plaques have been accumulated, but in these studies the blood microflora in atherosclerosis was not studied.

Aim. To determine the contamination frequency of biopsy samples of atherosclerotic plaques and peripheral blood with cultured microorganisms in patients with atherosclerosis of the brachiocephalic arteries.

Material and methods. A cross-sectional study in 35 patients with atherosclerosis of the carotid arteries; the average age of the patients was 58.2±8.3 years, was performed. Blood and atherosclerotic plaque samples from 23 men (mean age 58.6±10.3 years) and 12 women (mean age 57.3±14.3 years) were examined. Anaerobic flasks for blood cultivation were incubated at 35 °C for up to 6 months, from which they were regularly inoculated onto solid nutrient media to obtain culture growth. Cultures of tissues of atherosclerotic plaques of the carotid arteries in test tubes with thioglycollate medium were thermostated until visible growth of the culture was obtained; observation was carried out for up to 2 months. Identification of crops was carried out using commercial kits. For statistical analysis of the results obtained, the equality of the average values in two samples was checked using the Student’s statistical reliability test. Correlation analysis of the tightness of the connection was carried out using the Spearman rank correlation method.

Results. The frequency of detection of microorganisms in samples of atherosclerotic plaques was 48.6% (17/35), including Cutibacterium acnes — in 31.4% (11/35), the genus Staphylococcus — in 22.9% (8/35), associations of these microorganisms — in 5.7% (2/35) of samples. C. acnes was cultured in the blood of 11.4% (4/35) of patients. In 5.7% (2/35) of patients, cultures of C. acnes bacteria were isolated from both atherosclerotic plaque biopsies and blood. Bacterial cultures exhibited slow growth on nutrient media. Correlation analysis of the closeness of the connection according to the Chaddock scale demonstrated the presence of a high and very high closeness of connection between the amount of high-density lipoproteins and the daily growth of C. acnes in atherosclerotic plaques (p=0.812) and blood (rxy=–0.969), the content of leukocytes showed a very high closeness of connection with days of growth of C. acnes in the blood (rxy=–0.957); Student's t-test revealed a statistically significant relationship with the fact of detection of C. acnes cultures in atherosclerotic plaques (p=0.013).

Conclusion. Bacterial cultures isolated from blood samples and atherosclerotic plaques of patients with atherosclerosis had slow growth on nutrient media, and the period of their growth or the fact of detection correlated with the number of leukocytes and the level of high-density lipoproteins in the blood of patients.

Background. The study of multimorbidity is an urgent task for assessing individual clinical risks and prognosis, developing a treatment and rehabilitation plan.

Aim. To study multimorbidity in patients with chronic musculoskeletal diseases.

Material and methods. The study was conducted in 2022–2023 on the basis of the medical center for the treatment of spine and joints “DEMA” and the Peoples' Friendship University of Russia named after Patrice Lumumba. Study subjects were patients with musculoskeletal diseases (n=212) who sought medical and physical rehabilitation. Men — n=75 (average age 40.2±6.65 years, proportion of patients ≥60 years — 20%), women — n=137 (average age 47.2±6.84 years, proportion of patients ≥60 years — 18%). The subject of the study was polymorbidity in patients with musculoskeletal diseases. The following methods were used: content analysis, analytical, statistical, mathematical, comparative analysis method.

Results. Spinal diseases were detected in 79.2% of patients, and various dysfunctions of the musculoskeletal system were detected in 19.36%. 43 (20.28%) patients were diagnosed with two diseases of the musculoskeletal system. Women were more likely than men to be diagnosed with spinal osteochondrosis (p=0.015), cervicalgia (p=0.015), degenerative diseases of the hip and knee joints (p=0.022) and consequences of skeletal injuries (p=0.015). Of the concomitant diseases in all patients, eye (23.1%) and cardiovascular diseases (25.5%) were common. Women were more often diagnosed with endocrine (p=0.025), ophthalmic (p=0.001), gynecological (p=0.001) diseases, urolithiasis (p=0.025) and cholelithiasis (p=0.025); men — with consequences of injuries/surgeries (p=0.025). Polymorbidity was established in 50.33% of patients — 42 men and 72 women. Two and three concomitant chronic diseases were predominantly diagnosed in women, and six or more were diagnosed in men. All patients ≥60 years of age (25%) had three or more chronic diseases.

Conclusion. Most patients with musculoskeletal pathology suffer from several chronic diseases.

Background. In autoimmune thyroiditis, in addition to impaired immunological tolerance, a significant role is played by biochemical markers such as matrix metalloproteinases and antibodies to deoxyribonucleic acid (DNA), which can contribute to the pathogenesis of the disease.

Aim. Studying the activity of metalloproteinases-3, -7 and the level of antibodies to DNA in patients with autoimmune thyroiditis.

Material and methods. In 2019–2021 a non-randomized study in the research laboratory at the Department of Biochemistry of the Azerbaijan Medical University, during which the blood serum of 170 patients with autoimmune thyroiditis, 64 (37.6%) men, average age 39.4±11.2 years and 106 (62.4%) women, average age 37.8±9.05 years, was conducted. Inclusion criteria: men and women aged 18 years and older with a primary diagnosis of “autoimmune thyroiditis” without concomitant allergic or other autoimmune diseases and severe somatic disorders. The control group consisted of 65 people (average age 38.7±10.8 years) without any thyroid disease or autoimmune pathology. Analysis of clinical and laboratory studies with determination of the level of thyroid-stimulating hormone, free thyroxine and free triiodothyronine made it possible to divide patients into two groups: the first group — 74 patients with a subclinical form of the disease; the second group — 96 patients with a manifest form of the disease. In all patients, the activity of metalloproteinases-3 and -7 in the blood serum was determined by enzyme-linked immunosorbent assay, and the content of antibodies to native and denatured DNA was determined by enzyme-linked immunosorbent assay. Intergroup comparisons on quantitative indicators were carried out using the nonparametric Mann–Whitney rank test, taking into account the difference in the distribution of the analyzed indicators from the normal one. Qualitative characteristics were assessed as percentages.

Results. The median activity of metalloproteinases-3 and -7 in the total group of patients was 56 (51.0; 59.0) and 4.6 (4.3; 5.2) ng/ml, respectively, which was significantly higher than the control values — 23.0 (16.0; 26.0) and 3.6 (3.4; 4.1) ng/ml, respectively (p=0.0001252 and p=0.00054). There were no statistically significant differences in the level of metalloproteinase-7 in patients with subclinical and manifest thyroiditis (p=0.097), while the median activity of metalloproteinase-3 in the manifest group was 59.0 (56.0; 65.0) ng/ml and it was higher than in patients of the subclinical group by 13.2%. The content of antibodies to native DNA in patients was 4.4 (2.3; 9.9) units/ml, which was statistically significantly higher compared to the control group — 2.6 (1.5; 3.6) units/ml (p <0.001), while no significant differences were found in the levels of antibodies to denatured DNA in patients compared to control values.

Conclusion. The worsening of the autoimmune process is accompanied by an increase in the activity of metalloproteinases and antinuclear antibodies.

Background. The most important etiological factor in the development of caries is a violation of the structure and quality of nutrition, leading to an imbalance of essential nutrients.

Aim. Studying the influence of sucrose-lactose imbalance in nutrition on the biochemical parameters of saliva and the risk of developing caries in teenage girls. Materials and methods. Teenage girls (n=138, age 11–14 years) living in urban areas, health groups 1–2, without lactase deficiency and dental anomalies, were examined. In two groups differing in the level of sucrose-lactose imbalance (control group — low sucrose-lactose imbalance, n=30; experimental group — high sucrose-lactose imbalance, n=74), comparable in age (p=0.1921) and ethnic composition (p=0.3451), determined the prevalence of caries and its intensity according to the СFEt index (C — number of carious, F — filled, E — extracted teeth), as well as nutritional factors correlating with disaccharide imbalance and caries. In the subgroups formed from them, differing in the absence/presence of caries (low sucrose-lactose imbalance without caries and high sucrose-lactose imbalance with caries), the biophysical and biochemical parameters of mixed saliva were determined. The significance of differences between groups/subgroups was assessed using the nonparametric Mann–Whitney test, and in the case of normal distribution, using a two-sided Student t-test. To identify factors associated with caries, the binary logistic regression method was used; the closeness and direction of the relationship between individual parameters was assessed using the Spearman correlation coefficient and the ¬Chaddock scale.

Results. 74 girls were characterized by a “sweet” and “low-milk” type of diet with a high level of sucrose consumption and a low level of lactose consumption, leading to a high sucrose-lactose imbalance. In the group of high sucrose-lactose imbalance compared to low, the prevalence of caries and its intensity were 8.32 times (p=0.0047) and 4.53 times (p=0.0118) higher, respectively. In the subgroup of high sucrose-lactose imbalance with caries, in comparison with the subgroup of low imbalance without caries, the rate of salivation was significantly reduced by 1.86 times (p=0.0136), the surface tension of saliva was reduced by 1.25 times (p=0.0498), mineralizing potential of saliva by 1.68 times (p=0.0250), pH value by 1.13 times (p=0.0403), acid buffer capacity of saliva by 1.27 times (p=0.0192); saliva viscosity and lactate content were increased by 1.81 times (p=0.0455) and 1.79 times (p=0.0122), respectively; the optimal ratio of free and bound calcium was impaired. A pronounced cariogenic effect was identified for nutritional factors contributing to high sucrose-lactose imbalance in the diet: sucrose consumption ≥50 g/day (odds ratio 6.86), especially in terms of caloric intake ≥10% of energy value (odds ratio 8.53) , lactose intake ≤7.0 g/day (odds ratio 6.72) and milk calcium ≤150 mg/day (odds ratio 5.92).

Conclusion. A high sucrose-lactose imbalance in the diet of teenage girls leads to negative dynamics of the biochemical parameters of saliva, increases the prevalence of caries and its intensity.

Changes in connective tissue against the background of hyperglycemia in patients with type 1 diabetes mellitus is a morphological substrate for the formation of diabetic complications. The presence of undifferentiated connective tissue dysplasia in a patient with absolute insulin deficiency, the prevalence of individual external manifestations of which among young people is 85.4%, can increase the risk of developing and progressing complications of diabetes mellitus. The purpose of the review is to summarize the literature data on the impact of undifferentiated connective tissue dysplasia on the course of type 1 diabetes mellitus and its complications when they are combined in one patient. An analysis of the literature has shown that today there are single studies that have studied the specifics of the course of type 1 diabetes mellitus and its complications against the background of undifferentiated connective tissue dysplasia, with some aspects analyzed in children and adolescents, others in adults, which does not allow to draw clear conclusions. The results of these studies demonstrated earlier development and progression of such diabetic complications as nephropathy, neuropathy, post-injection lipodystrophy in patients with increased dysplastic stigma. According to some experts, patients with type 1 diabetes mellitus and concomitant undifferentiated connective tissue dysplasia should be allocated to a separate group of dispensary observation, since they may have a higher risk of developing and progressing rate of chronic complications of diabetes mellitus, which leads to a concomitant decrease in quality of life and increased risk of disability. However, to date, the question of the influence of increased dysplastic stigmatization on the course of type 1 diabetes mellitus has not been fully studied.

The present review considers current data on the structure, functions and role of interleukin-13 in the pathogenesis of vascular wall varicose transformation in terms of proteolysis and inflammatory response. It is known that interleukin-13 is able to interact with transforming growth factor-β1 in diseases associated with fibrosis. The latter activates fibroblasts and excessive formation of the extracellular matrix, thereby inducing fibrosis of the vascular wall, which is one of the links in the pathogenesis of varicose veins. Also, to date, there is evidence of the interleukin-13 participation in the induction of certain proteolytic enzymes’ synthesis, such as matrix metalloproteinases. For the latter, participation in the transformation of the venous wall has been proven to date. The remodeling of the venous wall itself can lead to an increase in the expression of proteinases, providing a proteolytic mechanism for changing the structural organization of the venous wall in varicose veins of the lower extremities. At the same time, the involvement of lysosomal cysteine proteinases remains poorly understood. The expression and production of individual cathepsins are regulated by biologically active molecules: interleukin-1, interleukin-6, tumor necrosis factor α, which are directly involved in inflammatory reactions in the wall of varicose veins. In particular, venous pathology develops in a vicious circle of inflammation with the formation of abnormal venous blood flow, chronic venous hypertension and dilation, and the recruitment of leukocytes. This leads to a further, deeper, remodeling of the walls and valves of the veins, an increase in blood pressure and the release of pro-inflammatory mediators — chemokines and cytokines. In connection with the above, in order to understand the mechanisms of proteolysis in the vascular wall in varicose veins of the lower extremities, it is important to have an idea about the possible interactions of interleukin-13 with transforming growth factor-β1, inflammatory cytokines, and cathepsins.

Background. Mortality from cerebrovascular diseases in Russia is one of the highest in the world.

Aim. To determine trends in the incidence of cerebrovascular pathology, including in connection with the pandemic of the new coronavirus infection COVID-19.

Material and methods. The structure, indicators of primary and general incidence of cerebrovascular pathology in 2010–2022 in Russia as a whole according to statistical observation form No. 12 were analyzed. Intensive, extensive, and standardized indicators were calculated and regression analysis was performed.

Results. The share of newly diagnosed cerebrovascular diseases in the structure of circulatory system diseases in Russia during the study period decreased from 21.7 to 17.4%. The overall incidence of cerebrovascular pathology ranged from 4371.1 to 4938.1, primary — from 599.8 to 791.2 per 100 thousand population. The primary incidence rate of stroke in the period from 2010 to 2019 increased from 270.1 to 296.6 per 100 thousand population, with a subsequent decrease in 2022 to 275.3 per 100 thousand population. When standardizing the primary incidence of stroke by age, no significant changes in the indicator were detected over the entire observation period. During the COVID-19 pandemic, the incidence of cerebrovascular diseases (general and primary), as well as the incidence of their individual units, decreased or deviated from the upward trend. The proportion of strokes not specified as hemorrhage or infarction decreased from 10.2 to 1.8%. During the pandemic period (2020–2022), there was an increase in the risk of developing cerebral infarction compared to intracranial and intracerebral hemorrhages (from 1.7:1 to 1.9:1; p=0.0000). The primary incidence of hemorrhagic and ischemic strokes increased from 161.3 (2010) to 238.1 (2019) per 100 thousand population; in 2022 it was 225.7 per 100 thousand population. During the study period, there was no trend towards an increase in the standardized incidence of strokes.

Conclusion. From 2010 to 2019 in Russia there was an increase in the primary incidence of cerebrovascular pathology, a decrease in overall and primary incidence in 2020–2022.

Background. Global trends in recent years are associated with an increase in the proportion of young people who are overweight and obese, that is why studying the prevalence of physical development disorders and assessing risk factors are necessary for the development of preventive measures.

Aim. Assessment of the prevalence and likelihood of developing overweight and obesity in working and studying youth depending on certain lifestyle factors.

Material and methods. An anthropometric examination was carried out on 513 young men and 1465 young women (average age 21.3±0.09 and 21.2±0.05 years, respectively) living in the Yaroslavl region. Among men and women, people of different social status were identified: working and studying young men (average age 22.9±0.12 and 20.3±0.08 years; p=0.0001) working and studying young women (average age 22.9 ±0.07 and 20.3±0.04 years; p=0.0001). The questionnaire method was used to determine the lifestyle characteristics of young people (drinking alcohol, smoking, irregular physical activity, sleep and eating disorders). Comparison of independent groups was performed using the Wald–Wolfowitz and Mann–Whitney tests, the presence of differences between proportions was performed using the χ2 criterion, and predictors were assessed using the odds ratio.

Results. Overweight was found in 23.2% of males and 11.5% of females (p=0.0001), 23.5% of working men and 23.0% of male students (p=0.897), 10.5% of working women and 12.0% female students (p=0.364). Obesity was noted in 7.8% of men and 4.0% of women (p=0.0001), 7.0% of working males and 8.3% of male students (p=0.591), 6.6% of working females and 2.7% female students (p=0.0001). Among the lifestyle factors studied, the chances of developing overweight and obesity increased only among female students due to smoking (2.26 times, p=0.002).

Conclusion. The frequency of overweight and obesity among Yaroslavl young men is 2 times higher than among young women; among young men of different social status, the distribution of youth by body mass index did not differ; among working females, obesity was more common than among students; the chances of developing overweight and obesity among female students who smoked were higher compared to female students who did not smoke.

Исследования профессора Г.Г. Насибуллина стали основным научным направлением кафедры ортопедической стоматологии Казанской государственной медицинской академии. Оно включает изучение процессов перестройки ВНЧС и зубочелюстной системы при ортопедических и ортодонтических вмешательствах.

The quality of reporting practice guidelines is often poor, and there is no widely accepted ­guidance or standards for such reporting in health care. The international RIGHT (Reporting Items for practice Guidelines in HealThcare) Working Group was established to address this gap. The group followed an existing framework for developing guidelines for health research reporting and the EQUATOR (Enhancing the ­QUAlity and Transparency Of health Research) Network approach. It developed a checklist and an explanation and elaboration statement. The RIGHT checklist includes 22 items that are considered essential for good repor­ting of practice guidelines: basic information (items 1 to 4), background (items 5 to 9), evidence (items 10 to 12), recommendations (items 13 to 15), review and quality assurance (items 16 and 17), funding and declaration and management of interests (items 18 and 19), and other information (items 20 to 22). The RIGHT checklist can assist developers in reporting guidelines, support journal editors and peer reviewers when considering guideline reports, and help health care practitioners understand and implement a guideline.