№2, 2020, volume 16

Differential diagnostics of epileptic paroxysms is often complicated and requires a multidisciplinary approach. Clinical presentation of epileptic and non-epileptic paroxysms is polymorphic and correct diagnosis requires clear understanding of semiotics and etiology of these conditions. The article presents a clinical case of a complicated course of the intermediate period of TBI with SIADH and seizures which mimic posttraumatic epileptic seizures.

Objective: To evaluate the medical effectiveness of the macular hole closure (MH) technique, which is based on the limiting of the internal limiting membrane (ILM) peeling. Material and Methods: The results of surgical treatment of 80 patients (80 eyes) diagnosed with MH were analyzed. Patients are divided into two groups: group 1-patients who had a standard peeling; group 2-patients who were operated on using the original method with partial peeling of the macular area. All patients underwent visometry, biomicroscopy, ophthalmoscopy, and OCT-examination. Results: By the 30th day after surgical treatment, a statistically significant excess of light sensitivity parameters was detected in the nasal part of the pattern used: the upper-nasal and lower-nasal quadrants, where peeling was not performed (p=0.032) and (p=0.034), respectively. In the 1st observation group, the recovery of the fixation point was observed during the early and late operating period and at 12 months was 58.3% (p=0.041). In group 2 patients, by the time of 1 month after surgery, the recovery of the fixation point occurred in 88.7%. Conclusion: When conducting the method of limited peeling, the ILM is preserved, which reduces the risk of intraoperative damage to the retina layers. A higher functional result was obtained in comparison with the group where the standard method was used.

The article presents actual ideas about the role of oxidative stress in the pathogenesis of corneal burns and methods of its correction. Corneal burns are rather common ophthalmic pathology. Corneal burns are difficult to treat, so they often lead to a decrease in visual acuity and, as a result, disability of young people. Despite the high antioxidant protection of the eye structures, under the influence of damaging environmental factors on the cornea (ultraviolet, chemicals, high temperatures, etc.), there is an increase in the concentration of free radicals with a decrease in the level of antioxidants — oxidative stress develops, aggravating damage to the cornea. Medicaments with antioxidant properties have shown their efficacy in the treatment of corneal burns.

Objective: to evaluate the reserve capacity of the heart in athletes with different levels of blood pressure in the Republic of Sakha (Yakutia). Material and Methods. 205 males of Yakut nationality aged 18 to 30 years old were examined (average age was 22.2±4.04), 147 of them were professional athletes, 58 control persons. Anthropometry was performed in all subjects, measurement of office blood pressure levels, ambulatory monitoring of blood pressure, echocardiography, bioimpedansometry, genetic research. Results. In our study, the masked hypertension was detected in 40.8% of the athletes, and more often observed in athletes with the "master of sports" qualification (x2=5.68, df=1, p=0.013)and does not depend on the orientation of the training activity (kind of sport) (x2=2.09, df=1, p=0.107). Despite the same sports experience and orientation of training activity, athletes with masked hypertension have low values of heart stroke volume (p=0.033) and, accordingly, heart stroke index (p=0.041), a high double product, and high left ventricle (LV) wall thickness, LV myocardial mass index and a decrease in the end-diastolic volume of the left ventricle compared with athletes with a normal blood pressure level. Conclusion. In athletes with masked hypertension, a decrease in the reserve capacity of the heart and a less economical mode of work at rest were noted, as evidenced by the indicators of central hemodynamics and the structural and functional parameters of the LV.

The aim of the study was to determine the features of the lower respiratory tract microbiocenosis in patients with a combination of professional chronic obstructive pulmonary disease (COPD) and diabetes mellitus type 2 (T2DM). Material and Methods: The study included 123 patients with occupational COPD, 61 of them had T2DM. General clinical examination, investigation of fasting glucose and HbA1c levels, pulmonary function testing, microbiological examination of sputum were carried out in all patients. Results: The risk of detecting microbial associations increased by 4.5 times, and the relative risk of isolation of Haemophilus spp. was 3.1 [95%CI 2.0-5.0], enterobacteria and enterococcus — 5.5 [95%CI 1.3-24.2] in patients with professional COPD and diabetes mellitus type 2. The number of microorganisms in sputum cultures correlated with the severity of bronchial obstruction and the level of glycemic control: a relationship was found between the total microbial load and the value of HbA1 с (/=0.71, p<0.001), as well as the value of FEV1 (r= -0.53, p<0.001). Conclusion: Increased proportion of gram-negative microorganisms was found in patients suffering from occupational COPD combined with T2DM. Deterioration of glycemic control leads to higher microbial colonization of the respiratory tract in COPD patients.

Purpose: to analyze the dynamics of formation and changes in the quality of life of multimorbid patients with chronic cholecystitis and gastroesophageal reflux disease (GERD). Material and Methods. 186 patients were examined: 82 patients were diagnosed with chronic cholecystitis in combination with GERD, 58 were diagnosed-only with chronic cholecystitis and 46 were diagnosed-only with GERD. The diagnosis of GERD was established according to modern criteria adopted by the International Consensus Group that studied the reflux disease and was confirmed by the results of daily esophageal pH measurements. Chronic cholecystitis was diagnosed on the basis of complaints, laboratory and clinical data and was confirmed by ultrasound analysis. The quality of life of patients was assessed using the SF-36 questionnaire. Results. In most cases gastroesophageal reflux (GERD) develops over the background of chronic cholecystitis (53.4%) while the reverse situation occurs only in 25.5% of cases. Simultaneous development of both diseases was observed only for 18.9% of patients. In most cases (45.1 %) GERD manifests itself during the 2nd to 4th year of chronic cholecystitis. The quality of life in patients with GERD has been ascertained to be lower than in those with chronic cholecystitis. The summary index of physical health in patients with chronic cholecystitis made 171.4±0.4 scores, while in the GERD group it did not exceed 146.8±0.2. Similar tendency was observed in the summary index of psychological health: in patients with GERD it was 26.3% (p<0.05) lower than in those with chronic cholecystitis. With polymorbidity developed against the background of chronic cholecystitis, the summary index of physical health reduces from 171.4±0.4 to 140.9±1.1 scores (p<0.05), while that of psychological health — from 254.8±0.6 to 144.5±0.8. In patients with GERD, chronic cholecystitis is practically non-essential for the state of physical health, while their psychological health declines substantially: from 188.5±0.6 to 144.5±0.8 scores (p<0.05). Conclusion. The risk of GERD development against the background of chronic cholecystitis is 1.9 times higher that of the reverse process. GERD usually develops over the 2nd to 4th year of chronic cholecystitis. Development of multimorbid state decreases the quality of life for patients with GERD and chronic cholecystitis with psychological health aspects being the most affected according to SF-36 questionnaire. The primary cause of the decreased quality of life for patients diagnosed with chronic cholecystitis and GERD is the almost twofold increase in the number of GERD exacerbations per year due to formation of multimorbid state.

A clinical observation of a comorbid state in a 72-year-old patient with chronic bronchopulmonary pathology is presented in the work. Gastroesophageal reflux disease and large Zenker's diverticulum have been revealed. Diseases manifested simultaneously, progressed in parallel, but were not regarded as comorbid, which did not allow optimizing their therapy and prognosis.

Amniotic fluid embolism (AFE) is one of the most severe complications of pregnancy, childbirth and early postnatal period, being associated with high risk of maternal mortality. AFE manifests as significant coagulopathy with hypocoag-ulation and activation of fibrinolytic system. In recent years, coagulopathy caused by amniotic fluid entry into maternal circulation is successfully treated with recombinant coagulation factors, including prothrombin complex concentrate, and activated blood coagulation factor Vila (Eptacog alfa activated). Authors present a case of successful sequential use of the above-mentioned blood coagulation factors for combined treatment of coagulopathic syndrome in patient with AFE, which clinically manifested during early postoperative period after delivery with caesarean section. The aim of this article is to demonstrate that above-mentioned drugs are not identical and to prove that all of them should be used only when clinical indications are present, confirmed by results of laboratory studies.