RESUMEN

PURPOSE: This study was performed to assess the prevalence of the vascularized foveal zone, including macular-foveal capillaries (MFC) and congenital retinal macrovessels (CRM), and to analyze the structural characteristics of the macular area in patients with MFC. MATERIAL AND METHODS: The first phase of the study evaluated the prevalence of MFC and CRM. Optical coherence tomography angiography (OCT-A) was performed, and OCT-A images of the foveal avascular zone were analyzed. In the second phase, two groups were formed: the MFC group (12 eyes, 9 patients, mean age 43.8±10.7 years) and the control group (18 eyes, 17 patients, mean age 43.0±11.8 years). A comparative analysis was performed assessing central retinal thickness (CRT), thickness of retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer plexiform layer (OPL), outer nuclear layer (ONL), and foveal pit depth. RESULTS: MFCs were detected in 45 eyes from a total sample of 1031 eyes of 536 patients. The presence of CRM was recorded in three eyes of three patients. RNFL thickness was significantly higher in the MFC group in the inferior parafoveal sector (26.50 [26.00; 29.50] and 24.50 [21.75; 26.50] µm; p=0.022) and in the foveal zone (15.50 [14.00; 16.00] and 12.00 [11.00; 14.00] µm; p=0.017). Additionally, patients with MFC had a higher thickness of GCL and IPL in the fovea, inferior, nasal, and temporal parafoveal sectors. The depth of the foveal pit was significantly lower in the MFC group compared to the control group (83.0 [77.4; 101.6] and 128.0 [107.5; 147.05] µm; p=0.001). CONCLUSION: The prevalence of MFC was 4.36% (calculated per number of eyes), while the prevalence of CRM - 0.29%. The macular area in patients with MFC had increased thickness of the inner retinal layers and decreased depth of the foveal pit, suggesting potential disruption in the natural process of ganglion cell migration and apoptosis during embryogenesis.

Asunto(s)

Fóvea Central , Vasos Retinianos , Tomografía de Coherencia Óptica , Humanos , Fóvea Central/irrigación sanguínea , Fóvea Central/diagnóstico por imagen , Adulto , Femenino , Masculino , Tomografía de Coherencia Óptica/métodos , Prevalencia , Persona de Mediana Edad , Vasos Retinianos/diagnóstico por imagen , Capilares/diagnóstico por imagen , Capilares/patología , Enfermedades de la Retina/epidemiología , Enfermedades de la Retina/diagnóstico , Enfermedades de la Retina/etiología , Federación de Rusia/epidemiología , Agudeza Visual , Angiografía con Fluoresceína/métodos

RESUMEN

Early detection of diabetic retinopathy (DR) is an urgent ophthalmological problem in Russia and globally. PURPOSE: This study assesses the prevalence of asymptomatic retinopathy and attempts to identify risk groups for its development in patients with type 1 and 2 diabetes mellitus (T1DM and T2DM). MATERIAL AND METHODS: The study involved clinics from 5 cities in the Russian Federation and it included 367 patients with DM, 34.88% men and 65.12% women, aged 50.88±20.55 years. 34.88% of patients suffered from T1DM, 65.12% suffered from T2DM, the average duration of the disease was 9.02±7.22 years. 58.31% of patients had a history of arterial hypertension, 13.08% had a history of smoking. The primary endpoint was the frequency of detection of diabetic changes in the eye fundus of patients with T1DM and T2DM in general; the secondary endpoint - same but separately, and for T2DM patients depending on the duration of the disease. The exploratory endpoint was the assessment of the influence of various factors on the development of DR. The patients underwent visometry (modified ETDRS table), biomicroscopy, mydriatic fundus photography according to the «2 fields¼ protocol. RESULTS: The average detection rate of DR was 12.26%, primarily observed in patients with T2DM (13.81%), women (9.26%), in both eyes (8.17%). Among patients with DR, 26 (19.55%) had glycated hemoglobin (HbA1c) level exceeding 7.5% (p=0.002), indicating a direct relationship between this indicator and the incidence of DR. Logistic regression analysis showed that the duration of diabetes of more than 10 years has a statistically significant effect on the development of DR. In the modified model for odds estimation, the likelihood of developing DR is increased by the duration of DM for more than 10 years; increased blood pressure; HbA1c level >7.5%. CONCLUSION: The obtained results, some of which will be presented in subsequent publications, highlight the effectiveness of using two-field mydriatic fundus photography as a screening for DR.

Asunto(s)

Diabetes Mellitus Tipo 2 , Retinopatía Diabética , Fondo de Ojo , Fotograbar , Humanos , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/epidemiología , Femenino , Masculino , Persona de Mediana Edad , Federación de Rusia/epidemiología , Prevalencia , Fotograbar/métodos , Adulto , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Anciano , Factores de Riesgo , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/diagnóstico , Diagnóstico Precoz

RESUMEN

OBJECTIVE: To analyze learning curves and appropriate experience on the features of mini-bypass surgery in 341 obese patients. MATERIAL AND METHODS: A total of 341 laparoscopic mini-gastric bypass surgeries performed by one surgeon were studied. The median age of patients was 40.5 [34; 48.3] years. There were 284 (83.2%) women and 57 (16.8%) men. The median BMI was 45 [40;52] kg/m2. RESULTS: The period of MGB development consisted of 138 interventions. Surgery time was 120 [100; 130] min and 90 [82.5; 100] mins after development of this technique (p=0.001). Complications occurred in 5 (1.5%) patients (1 patient with Clavien Dindo grade IIIA and 4 ones with grade IIIB). Of these, there were 3 patients with stapler suture defects. There were no complications only in the 4th quartile of surgeries. Surgical experience significantly affects postoperative outcomes. Surgery time was more influenced by surgical skill rather technique of anastomosis imposing. CONCLUSION: Polynomial regression objectively characterizes development of surgical skills lasting 138 interventions. MGB is safe for morbid obesity with a complication rate of 1.5% and no mortality.

Asunto(s)

Derivación Gástrica , Laparoscopía , Curva de Aprendizaje , Obesidad Mórbida , Tempo Operativo , Complicaciones Posoperatorias , Humanos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Derivación Gástrica/métodos , Derivación Gástrica/efectos adversos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Laparoscopía/métodos , Laparoscopía/efectos adversos , Competencia Clínica , Índice de Masa Corporal , Federación de Rusia/epidemiología , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To determine the current status and main factors influencing the level of emergency laparoscopic surgery in the Russian Federation. MATERIAL AND METHODS: A retrospective nationwide analysis included patients ≥18 years old undergoing surgery for acute cholecystitis (AC), acute appendicitis (AA), perforated ulcer (PU) and ileus. The database of the chief surgeon of the Russian Ministry of Health for 2018 - 2022 was used. To investigate possible reasons influencing the level of emergency laparoscopic surgeries, we performed online survey of medical organizations connected to the electronic reporting system. RESULTS: Over five years, the incidence of laparoscopic surgeries for AC increased from 52.6% to 70.5% (p<0.001), for AA from 25.1% to 41.0% (p<0.001), for PU from 9.4% to 13.2% (p<0.001) and for ileus from 5.9% to 8.5% (p<0.001). The percentage of emergency laparoscopic surgeries in rural hospitals (level I) was 14.8%, level II hospitals - 40.2%, level III - 67.7% (p<0.001). We obtained responses from 1.982 (84.9%) out of 2.335 hospitals included in the database. Significant differences were revealed in equipment of hospitals of different levels with laparoscopic surgical systems and proportion of surgeons proficient in laparoscopic techniques (p<0.001). The same factors influence laparoscopy in different federal districts to a greater extent than their geographic and demographic characteristics. CONCLUSION: Laparoscopic emergency procedures became more widespread, but vary widely between regions, urban and rural. Availability of laparoscopic surgery is influenced by availability of equipment and trained surgeons, geographic distance and population density, level of hospital and ability to maintain acquired skills and increase experience in appropriate surgeries.

Asunto(s)

Laparoscopía , Humanos , Federación de Rusia/epidemiología , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Masculino , Femenino , Estudios Retrospectivos , Adulto , Persona de Mediana Edad , Apendicitis/cirugía , Apendicitis/epidemiología , Colecistitis Aguda/cirugía

RESUMEN

OBJECTIVE: To analyze the complications following endoscopic hemithyroidectomy and to develop the principles of tissue dissection for safe surgical intervention. MATERIAL AND METHODS: The results of surgical treatment of 136 patients were studied. The main group consisted of 44 patients who underwent endoscopic hemithyroidectomy through a «gasless¼ axillary approach (EH group). The first control group consisted of 45 patients who underwent minimally invasive video-assisted hemithyroidectomy (MIVAH group). The second control group consisted of 47 patients who underwent open hemithyroidectomy (OH group). RESULTS. O: Verall complication rate was significantly higher in the EH group (20.5% vs. 6.4% in the OH group and 4.4% in the MIVAH group; p<0.05). In the EH group, Clavien-Dindo grade I complications occurred in 11.4% of cases. There were no similar complications in the control groups (p<0.05). Clavien-Dindo grade II complications occurred in 9.1% of patients in the EH group, 4.3% in the OH group and no similar events were identified in the MIVAH group (p>0.05). Clavien-Dindo grade III complications occurred in 1 (2.1%) case in the OH group and 2 (4.4%) cases in the MIVAH group. There were no Clavien-Dindo grade III complications in the EH group. Thus, minor complications prevailed in the EH group. Their incidence decreased along with accumulation of experience. Moreover, endoscopic procedure is safer regarding the risk of severe complications. CONCLUSION: Endoscopic hemithyroidectomy is safe, and the proposed principles of tissue dissection can further increase surgical safety.

Asunto(s)

Complicaciones Posoperatorias , Tiroidectomía , Humanos , Tiroidectomía/métodos , Tiroidectomía/efectos adversos , Femenino , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Persona de Mediana Edad , Adulto , Endoscopía/métodos , Endoscopía/efectos adversos , Cirugía Asistida por Video/métodos , Cirugía Asistida por Video/efectos adversos , Disección/métodos , Disección/efectos adversos , Evaluación de Procesos y Resultados en Atención de Salud , Neoplasias de la Tiroides/cirugía , Federación de Rusia/epidemiología , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos

RESUMEN

OBJECTIVE: To evaluate the safety and advisability of repeated liver resection (RLR) for recurrent intrahepatic cholangiocarcinoma (ICC). MATERIAL AND METHODS: The results of RLR for ICC recurrence (n=10) were retrospectively analyzed between 1999 and 2023. The control group consisted of patients undergoing primary liver resection for ICC (n=195). RESULTS: Surgery time (p=0.001) and blood loss (p=0.038) were lower in the RLR group. There were no blood transfusions (0 vs. 31.8%, p=0.034) and 90-day mortality (0 vs. 3.2%, p=1.0) in the same group. The risk of complications (30.0% vs.45.6%, p=0.517) and adverse events grade ≥ III (20.0% vs. 17.9%, p=1.0) was similar in both groups. Multifocal intrahepatic nodes were more common in the RLR group (60% vs. 37.9%, p=0.193), while there were no negative factors such as lymph nodes involvement (0 vs. 34.4%, p=0.032) and invasion of surrounding structures (0 vs. 38.5%, p=0.015). Dimensions of the largest node were smaller in repeated resection (2 vs. 8 cm, p<0.0001). Incidence of R0 resections (80.0% vs. 82.1%, p=1.0) was comparable. Long-term results were similar: five-year overall survival 17.2% and 34.7% (p=0.912), three-year disease-free survival 20.0% and 26.5% (p=0.421). CONCLUSION: Similar results of repeated and primary liver resections confirm advisability of RLR for intrahepatic recurrence of ICC.

Asunto(s)

Neoplasias de los Conductos Biliares , Colangiocarcinoma , Hepatectomía , Recurrencia Local de Neoplasia , Humanos , Colangiocarcinoma/cirugía , Masculino , Femenino , Hepatectomía/métodos , Hepatectomía/efectos adversos , Persona de Mediana Edad , Neoplasias de los Conductos Biliares/cirugía , Neoplasias de los Conductos Biliares/patología , Recurrencia Local de Neoplasia/epidemiología , Estudios Retrospectivos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Reoperación/estadística & datos numéricos , Reoperación/métodos , Anciano , Federación de Rusia/epidemiología , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Tempo Operativo , Evaluación de Procesos y Resultados en Atención de Salud

RESUMEN

Currently, severe combined abdominal trauma ranks third among all causes of mortality In Russia, second only to cardiovascular and oncologic diseases. In the period from 2019 to 2020 in our country, a slight decrease in traumatism is noted due to a decrease in the number of traffic accidents as the main cause of combined and multiple trauma. The number of abdominal injuries from the total number of injuries In Russian regions ranges from 1.5 to 36.5% and is accompanied by a high level of disability (25-80% in combined trauma and 5-8% in isolated trauma). Despite modern medical advances, lethality in combined trauma of abdominal organs varies from 10.7 to 69.7%, with closed abdominal trauma accounting for up to 6% of fatal outcomes. OBJECTIVE: Improving treatment outcomes in patients with closed abdominal trauma through comprehensive diagnosis of SCN and optimization of enteral therapy in patients with closed abdominal trauma. MATERIAL AND METHODS: The study included 40 patients (29 (72.5%) men and 11 (27.5%) women), who underwent examination and treatment at the State Budgetary Institution "Research Institute of SP. Im. N.V. Sklifosovsky Research Institute of St. Petersburg State Medical Center with the diagnosis: Closed abdominal trauma. The age of the patients varied from 25 to 81 years (Mean age was 49.6±13.1). To evaluate the effectiveness of intensive therapy, the patients were divided into 2 groups: the comparison group (n=26) included patients who were treated with complex conservative therapy. Patients of the main group (n=14) conservative therapy was supplemented with the use of ER to restore the functional activity of the intestine under the control of ultrasound and assessment of the degree of intra-abdominal hypertension, as well as with Intestamine to stimulate the intestinal trauma. RESULTS: In the course of the study it was found that, as a result of complex enteral therapy in the patients of the main group, starting from the 7th day of stay in the ORIT, positive dynamics was observed, consisting in a statistically significant decrease in the levels of lactate, ALT, AST, LDH, and CRP. By the 14th day there was also a statistically significant decrease in leukocyte and PCT levels. The lethality in the main group amounted to 7.2%, n=1. At the same time, in patients of the comparison group only by the 7th day there was a decrease in concentration of CRP (p=0.065), by the 10th day - ALT (<0.001) and by the 14th day there was a decrease in leukocytes level (p=0.038). Lethality in this group amounted to 23.1%, n=6. CONCLUSION: Timely initiation of pathogenetic enteral therapy contributes to faster normalization of clinical and laboratory parameters, protection of intestinal barrier function, prevention of complications associated with bacterial translocation and bacterial overgrowth syndrome, increase in immunoresistance of the organism.

Asunto(s)

Traumatismos Abdominales , Heridas no Penetrantes , Humanos , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/terapia , Masculino , Femenino , Persona de Mediana Edad , Heridas no Penetrantes/complicaciones , Heridas no Penetrantes/terapia , Heridas no Penetrantes/diagnóstico , Heridas no Penetrantes/fisiopatología , Federación de Rusia/epidemiología , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/diagnóstico , Traumatismo Múltiple/terapia , Traumatismo Múltiple/mortalidad , Adulto , Nutrición Enteral/métodos , Nutrición Enteral/estadística & datos numéricos , Síndrome , Enfermedades Intestinales/diagnóstico , Enfermedades Intestinales/terapia

RESUMEN

AIM: To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry. MATERIAL AND METHODS: The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis <50%, n = 165; 8.7%). RESULTS: A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group. CONCLUSION: IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the "aggressiveness" of therapy.

Asunto(s)

Angiografía Coronaria , Enfermedad de la Arteria Coronaria , Sistema de Registros , Humanos , Femenino , Masculino , Persona de Mediana Edad , Federación de Rusia/epidemiología , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/complicaciones , Angiografía Coronaria/métodos , Anciano , Factores de Riesgo

RESUMEN

The article presents results of analysis of morbidity rates in children aged 15-17 years in the Russian Federation, the Volga Federal Okrug, the Udmurt Republic, the Kirov Oblast and the Republic of Bashkortostan in 2014-2022. According to research data, in the Russian Federation there is an increase of general and primarily detected (primary) morbidity by 24.0% (from 229,468.3 to 231,505.5) and by 22.3% (from 143,109.3 to 149,143.8), respectively. In the morbidity structure, the greatest increase was noted for such diseases as obesity (24.0 and 27.8%, respectively), diabetes mellitus (30.9 and 32.8%, respectively) and diabetes mellitus type I (31.9 and 30.8%, respectively). The data of statistical reports on general and primarily detected (primary) morbidity of the Central Research Institute for Health Organization and Informatics of Minzdrav of Russia were used. The study established general and primarily detected morbidity in the Russian Federation. However, forecast for 2027, as compared with 2014, is marked by decline of total morbidity by 8.3% and primarily detected (primary) morbidity by 5.2%. Due to the unfavorable forecast for morbidity in the Russian Federation for 2027, further scientific studies are needed concerning children aged 15-17 years in order to develop preventive measures at population, group and individual levels, considering regional characteristics.

Asunto(s)

Morbilidad , Adolescente , Femenino , Humanos , Masculino , Morbilidad/tendencias , Federación de Rusia/epidemiología

RESUMEN

Clarithromycin (CLR) is currently a key antibiotic for Helicobacter pylori infection treatment, however, the data on CLR resistance patterns in Russia are missing. Here, we applied WGS-based approach to H. pylori clinical isolates from Russia to comprehensively investigate sequence variation, identify putative markers of CLR resistance and correlate them with phenotypic susceptibility testing. The phenotypic susceptibility of 44 H. pylori isolates (2014-2022) to CLR was determined by disc diffusion method: 23 isolates were CLR-resistant and 21-CLR-susceptible. All isolates were subjected to WGS and submitted to GenBank. Based on complete sequence analysis, we showed that among all sequence variants, the combination of mutations A2146G/A2147G in the 23S rRNA gene is the most reliable for prediction of phenotypic susceptibility. For the first time, the average number of mutations in 106 virulence-associated genes between resistant and susceptible groups were compared. Moreover, this study presents the first WGS insight into genetic diversity of H. pylori in Russia with a particular focus on the molecular basis of drug resistance: the novel mutations were described as potential markers for the resistance development. Of these, the most prominent was a frameshift deletion (252:CGGGT) in HP0820 coding region, which is a good candidate for further investigation.

Asunto(s)

Antibacterianos , Claritromicina , Farmacorresistencia Bacteriana , Infecciones por Helicobacter , Helicobacter pylori , Pruebas de Sensibilidad Microbiana , Secuenciación Completa del Genoma , Claritromicina/farmacología , Helicobacter pylori/genética , Helicobacter pylori/efectos de los fármacos , Federación de Rusia/epidemiología , Humanos , Farmacorresistencia Bacteriana/genética , Antibacterianos/farmacología , Secuenciación Completa del Genoma/métodos , Infecciones por Helicobacter/microbiología , Infecciones por Helicobacter/tratamiento farmacológico , Mutación , ARN Ribosómico 23S/genética , Genoma Bacteriano , Masculino , Variación Genética , Femenino , Adulto , Persona de Mediana Edad , Anciano

RESUMEN

The COVID-19 pandemic has altered respiratory infection patterns in pediatric populations. The emergence of the SARS-CoV-2 Omicron variant and relaxation of public health measures have increased the likelihood of coinfections. Previous studies show conflicting results regarding the impact of viral and bacterial coinfections with SARS-CoV-2 on severity of pediatric disease. This study investigated the prevalence and clinical impact of coinfections among children hospitalized with COVID-19 during the Omicron wave. A retrospective analysis was conducted on 574 hospitalized patients aged under 18 years in Russia, from January 2022 to March 2023. Samples from patients were tested for SARS-CoV-2 and other respiratory pathogens using qRT-PCR, bacterial culture tests and mass spectrometry, and ELISA. Approximately one-third of COVID-19 cases had coinfections, with viral and bacterial coinfections occurring at similar rates. Adenovirus and Staphylococcus aureus were the most common viral and bacterial coinfections, respectively. Viral coinfections were associated with higher fevers and increased bronchitis, while bacterial coinfections correlated with longer duration of illness and higher pneumonia rates. Non-SARS-CoV-2 respiratory viruses were linked to more severe lower respiratory tract complications than SARS-CoV-2 monoinfection. These findings suggest that during the Omicron wave, seasonal respiratory viruses may have posed a greater threat to children's health than SARS-CoV-2.

Asunto(s)

Infecciones Bacterianas , COVID-19 , Coinfección , Hospitalización , SARS-CoV-2 , Humanos , Coinfección/epidemiología , Coinfección/microbiología , Coinfección/virología , COVID-19/epidemiología , COVID-19/complicaciones , COVID-19/microbiología , Adolescente , Niño , Preescolar , Femenino , Masculino , Lactante , Federación de Rusia/epidemiología , Estudios Retrospectivos , Prevalencia , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/microbiología , Infecciones del Sistema Respiratorio/epidemiología , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/virología , Recién Nacido

RESUMEN

OBJECTIVE: To determine the structure and nature of headache in pediatric patients, as well as its relationship with chronic rhinosinusitis, to develop an effective rehabilitation course for pediatric patients with headache at the sanatorium-resort stage. MATERIAL AND METHODS: The study included 100 patients aged 8 to 17 years who received a course of sanatorium treatment. Patients were divided into groups: with primary headache and with secondary headache in chronic rhinosinusitis. RESULTS: The results of a comprehensive otorhinolaryngological and neurological study made it possible to determine the mechanism of development, structure, and nature of the predominant types of headache in children and to develop a course of rehabilitation treatment. An analysis of the effectiveness of the rehabilitation course showed that it was possible to achieve a positive result in 88% of children with primary and secondary headache. The necessity of interdisciplinary participation of otorhinolaryngologists and neurologists in the examination and treatment of patients complaining of headache at the sanatorium-resort stage is substantiated. CONCLUSION: The effectiveness of the proposed rehabilitation course of headache treatment of various origins in children has been proven, the analysis of long-term results allows us to recommend it during staged therapy.

Asunto(s)

Cefalea , Rinosinusitis , Adolescente , Niño , Femenino , Humanos , Masculino , Enfermedad Crónica , Cefalea/etiología , Cefalea/rehabilitación , Colonias de Salud , Rinosinusitis/complicaciones , Rinosinusitis/diagnóstico , Rinosinusitis/terapia , Federación de Rusia/epidemiología , Resultado del Tratamiento

RESUMEN

BACKGROUND: The positive changes in hygienic living conditions are commonly believed to explain secular changes in body height and the age of maturity. However, it is difficult to estimate the separate impacts of these factors due to the lack of social and economic data and variations in the sources of information. We hypothesized that final male body height could be associated with various socioeconomic indicators, such as the development of the medical care system, the quality of nutrition, and the level of sanitary and hygienic conditions. Moreover, we hypothesized that male body height could be associated with the level of morbidity in the region during the time of conscript childhood (from 1 to 7 years old). MATERIALS AND METHODS: We used two main sources of information in the analyses. The first is the data from the Statistical Reference Book published by the Central Statistical Committee in 1929. The second is the annual data from the Statistical Reference Book published in the Russian Empire. Since the conscripts were born between 1906 and 1909, we used datasets from 1910 to 1913. To analyze the data, we used a method of analyzing interacting variables called St. Nicolas House Analysis (SNHA). RESULTS: Our analyses revealed direct associations between the morbidity of some diseases and male body height and other anthropometric parameters. CONCLUSIONS: There are associations between conscript final body height and the morbidity of influenza, dysentery and some venereal diseases, such as chancroid and syphilis. There were no associations between conscript final body height and the level of morbidity during childhood. However, other final parameters, such as BMI, weight, and chest circumference, could be associated with the morbidity of malaria, scabies, scurvy, and scarlet fever during childhood. The prevalence of these diseases could be strongly connected with unfavorable living conditions. The results are similar for both urban and rural areas.

Asunto(s)

Estatura , Masculino , Humanos , Estatura/fisiología , Higiene , Federación de Rusia/epidemiología , Niño , Personal Militar/estadística & datos numéricos , Antropología Física , Adulto , Preescolar , Adulto Joven , Factores Socioeconómicos

RESUMEN

The anthropometric index that best predicts cardiometabolic risk remains inconclusive. This study therefore assessed the prevalence of obesity using six indices and compared their associations with obesity-related cardiometabolic disorders. We determined obesity prevalence according to body mass index, waist circumference, waist-to-hip ratio, waist-to-height ratio (WHtR), body fat percentage and fat mass index (FMI) using data from the Know Your Heart study (n = 4495, 35-69 years). The areas under the receiver operating characteristic curves (AUCs) provided predictive values of each index for detecting the presence of hypertension, hypercholesterolaemia and diabetes. Age-standardised obesity prevalence significantly varied according to anthropometric index: from 17.2% (FMI) to 75.8% (WHtR) among men and from 23.6% (FMI) to 65.0% (WHtR) among women. WHtR had the strongest association with hypertension (AUC = 0.784; p < 0.001) and with a combination of disorders (AUC = 0.779; p < 0.001) in women. In women, WHtR also had the largest AUCs for hypercholesterolaemia, in men - for hypertension, diabetes and a combination of disorders, although not all the differences from other obesity indices were significant. WHtR exhibited the closest association between hypertension and a combination of disorders in women and was non-inferior compared to other indices in men.

Asunto(s)

Diabetes Mellitus , Hipercolesterolemia , Hipertensión , Obesidad , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Femenino , Hipertensión/epidemiología , Adulto , Prevalencia , Hipercolesterolemia/epidemiología , Federación de Rusia/epidemiología , Anciano , Diabetes Mellitus/epidemiología , Índice de Masa Corporal , Antropometría , Factores de Riesgo

RESUMEN

Nonsyndromic sporadic thoracic aortic aneurysm (nssTAA) is characterized by diverse genetic variants that may vary in different populations. Our aim was to identify clinically relevant variants in genes implicated in hereditary aneurysms in Russian patients with nssTAA. Forty-one patients with nssTAA without dissection were analyzed. Using massive parallel sequencing, we searched for variants in exons of 53 known disease-causing genes. Patients were found to have no (likely) pathogenic variants in the genes of hereditary TAA. Six variants of uncertain significance (VUSs) were identified in four (9.8%) patients. Three VUSs [FBN1 c.7841C>T (p.Ala2614Val), COL3A1 c.2498A>T (p.Lys833Ile), and MYH11 c.4993C>T (p.Arg1665Cys)] are located in genes with "definitive" disease association (ClinGen). The remaining variants are in "potentially diagnostic" genes or genes with experimental evidence of disease association [NOTCH1 c.964G>A (p.Val322Met), COL4A5 c.953C>G (p.Pro318Arg), and PLOD3 c.833G>A (p.Gly278Asp)]. Russian patients with nssTAA without dissection examined in this study have ≥1 VUSs in six known genes of hereditary TAA (FBN1, COL3A1, MYH11, NOTCH1, COL4A5, or PLOD3). Experimental studies expanded genetic testing, and clinical examination of patients and first/second-degree relatives may shift VUSs to the pathogenic (benign) category or to a new class of rare "predisposing" low-penetrance variants causing the pathology if combined with other risk factors.

Asunto(s)

Aneurisma de la Aorta Torácica , Predisposición Genética a la Enfermedad , Humanos , Femenino , Masculino , Federación de Rusia/epidemiología , Aneurisma de la Aorta Torácica/genética , Persona de Mediana Edad , Adulto , Cadenas Pesadas de Miosina/genética , Fibrilina-1/genética , Colágeno Tipo III/genética , Anciano , Miosinas Cardíacas/genética , Secuenciación de Nucleótidos de Alto Rendimiento , Mutación , Variación Genética , Adipoquinas

Asunto(s)

Salud Infantil , Salud Materna , Niño , Femenino , Humanos , Embarazo , Mortalidad Materna/tendencias , Federación de Rusia/epidemiología

RESUMEN

AIM: To evaluate the prognostic value of GDF-15 in relation the development of bleeding and events in stable CAD patients, receiving combined antithrombotic therapy. MATERIALS AND METHODS: The data was obtained from the prospective registry REGATA, 343 CAD patients (249 males), median age 68 [IQR 62; 75] years) were enrolled. Patients with sinus rhythm and concomitant PAD received acetylsalicylic acid in combination with rivaroxaban 2.5 mg bid (31.8%) or clopidogrel (24.8%). Other 43.4% with concomitant atrial fibrillation (AF) received direct oral anticoagulants in combination with antiplatelet therapy after elective percutaneous coronary interventions. Median follow-up was 12 months [IQR 9.0; 18.0]. The safety end point was major and clinically relevant bleedings (type 2-5) according to the BARC classification. Plasma samples for GDF-15 identification were taken at the inclusion and analyzed using ELISA assay. RESULTS: Frequency of BARC 2-5 bleedings was 16% (BARC 2 - 46; BARC 3 - 9; BARC 4-5 - 0), median GDF-15 level was 1185.0 pg/ml [850.0; 1680.0]. In patients with AF and concomitant MFA, the level of GDF-15 was significantly higher than in the subgroups of patients with only AF or MFA (p=0.0022). According to the quintile analysis, GDF-15 values in the top three quintiles of distribution (cut-off value >943 pg/ml) were associated with higher frequency of bleeding events: 23.2% versus 5.1%; p=0.0001. The multivariable logistic regression model demonstrated that bleeding events were independently associated with GDF-15 level>943 pg/ml (OR 2.65, 95% CI 1.11-6.30; p=0.0275), AF (OR 2.61, 95% CI 1.41-4.83; p=0.0023) and chronic kidney disease (OR 1.92, 95% CI 1.03-3.60; p=0.0401). Clinical factors determining the risk of bleeding events also determined a GDF-15 elevation. CONCLUSION: Assessment of GDF-15 level may improve bleeding risk stratification in CAD patients with concomitant AF and/or PAD receiving combined antithrombotic therapy.

Asunto(s)

Factor 15 de Diferenciación de Crecimiento , Hemorragia , Sistema de Registros , Humanos , Masculino , Femenino , Anciano , Hemorragia/inducido químicamente , Hemorragia/epidemiología , Hemorragia/etiología , Persona de Mediana Edad , Factor 15 de Diferenciación de Crecimiento/sangre , Estudios Prospectivos , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/sangre , Quimioterapia Combinada , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/complicaciones , Fibrinolíticos/administración & dosificación , Fibrinolíticos/efectos adversos , Aspirina/administración & dosificación , Aspirina/efectos adversos , Clopidogrel/administración & dosificación , Clopidogrel/efectos adversos , Pronóstico , Federación de Rusia/epidemiología , Inhibidores de Agregación Plaquetaria/administración & dosificación , Inhibidores de Agregación Plaquetaria/efectos adversos , Rivaroxabán/administración & dosificación , Rivaroxabán/efectos adversos , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/efectos adversos

RESUMEN

BACKGROUND: Numerous sources reported the increased risk of cerebrovascular accidents (CVA) in individuals with multiple sclerosis (MS), without a single study thus far challenging the conclusion. Before addressing hypothesis on potential cause-effect relationships, a question whether there are indeed frequent comorbidities between MS and CVA needed to be answered. METHODS: Authors designed a study to evaluate substantial populations of four independent neurology centers with the purpose to assess the prevalence of CVA diagnosis in patients with MS, and vice versa. Data of subjects meeting enrollment criteria were entered into a single database. Authors compared obtained data with the MS and CVA prevalences in the populations of specific countries. RESULTS: Of the 1881 subjects' records, the main diagnosis was MS for 51.5% and CVA for 48.5%. The CVA prevalence as a secondary diagnosis among MS subjects was 1.47% in USA cohort and 1.65% in combined USA+ Russian Federation (RF) cohorts, which is lower than known prevalence of stroke in adult population of these regions. The prevalence of MS as a secondary diagnosis among subjects with stroke in USA cohort was 0.4% and in combined USA+RF cohorts was 0.33%, which is higher, but not statistically different from calculated MS prevalence in both USA and RF populations combined. CONCLUSION: Thus, authors found that prevalence of CVA in cohorts with MS of 2 independent centers was at least not higher, than that in general population, which differs from previously published data.

Asunto(s)

Esclerosis Múltiple , Accidente Cerebrovascular , Humanos , Esclerosis Múltiple/epidemiología , Femenino , Masculino , Prevalencia , Persona de Mediana Edad , Accidente Cerebrovascular/epidemiología , Adulto , Estados Unidos/epidemiología , Comorbilidad , Federación de Rusia/epidemiología , Anciano , Estudios de Cohortes

RESUMEN

Hemorrhagic fever with renal syndrome (HFRS) and tick-borne encephalitis (TBE) are the most common viral diseases in Russia. HFRS is caused by six different types of hantaviruses: Hantaan, Amur, Seoul, Puumala, Kurkino, and Sochi, which are transmitted to humans through small mammals of the Muridae and Cricetidae families. TBE is caused by viruses belonging to five different phylogenetic subtypes. The similarities in the ecology of HFRS and TBE pathogens is presented here. Hantavirus-infected small mammals can transmit the virus to uninfected animals, and ticks can also transmit hantavirus to other ticks and mammals. Hantavirus transmission from ticks to humans is possible only hypothetically based on indirect data. Over the past 23 years, 164,582 cases of HFRS (4.9 per 105 people) and 71,579 cases of TBE (2.5 per 105 people) were registered in Russia. The mortality rate was 0.4% (668 cases) in HFRS and 1.6% deaths (1136 cases) in TBE. There were 4030 HFRS (2.5%) and 9414 TBE (13%) cases in children under 14 years old. HFRS and TBE cases were registered in 42 out of 85 Russian regions; in 18-only HFRS, in 13-only TBE, and 12 had no reported cases. The prospects of applying a combined vaccine for HFRS and TBE prevention are shown in this paper.

Asunto(s)

Encefalitis Transmitida por Garrapatas , Fiebre Hemorrágica con Síndrome Renal , Vacunas Virales , Encefalitis Transmitida por Garrapatas/prevención & control , Encefalitis Transmitida por Garrapatas/epidemiología , Encefalitis Transmitida por Garrapatas/virología , Encefalitis Transmitida por Garrapatas/transmisión , Federación de Rusia/epidemiología , Fiebre Hemorrágica con Síndrome Renal/epidemiología , Fiebre Hemorrágica con Síndrome Renal/prevención & control , Fiebre Hemorrágica con Síndrome Renal/virología , Humanos , Animales , Vacunas Virales/inmunología , Vacunas Virales/administración & dosificación , Orthohantavirus/inmunología , Orthohantavirus/genética , Virus de la Encefalitis Transmitidos por Garrapatas/inmunología , Virus de la Encefalitis Transmitidos por Garrapatas/genética , Vacunas Combinadas/inmunología , Vacunas Combinadas/administración & dosificación , Garrapatas/virología

RESUMEN

OBJECTIVE: To study forensic characteristic of drowning mortality cases in the Russian Federation for the period from 2013 to 2022. MATERIAL AND METHODS: Dynamics and territorial specificity of drowning (in absolute values and in terms of 100 thous. population), proportion of histological examinations, cases of ethanol detection in the blood upon the occurrence of death by drowning and the proportion of children under 14 years among deceased from drowning. RESULTS AND CONCLUSION: The evidence suggests the necessity for intersectoral approaches of preventive measures creation. The results of the study could be used to establish a monitoring system as part of a national water safety strategy.

Asunto(s)

Ahogamiento , Ahogamiento/patología , Ahogamiento/diagnóstico , Humanos , Federación de Rusia/epidemiología , Niño , Adolescente , Medicina Legal/métodos