№3, 2021, volume 17

The article analyzes the causes of fetal and newborn diaphragm abnormalities in women at risk for this pathology. Congenital diaphragmatic hernia is a pathological condition that gives severe complications and a high mortality rate (more than 30%). Early pre- and postnatal diagnostics allow for effective surgical correction of this congenital malformation. The article presents two clinical cases, one without complications and other developmental abnormalities, the second-having a combination of congenital diaphragmatic hernia with a heart malformation and pulmonary complications that caused a fatal outcome in a newborn.

The purpose of the review is to determine the influence of various sports on the state of the cardiovascular system, taking into account the age characteristics of athletes participating in competitions. The original articles have been searched in the PubMed database for the period from 1999 till 2020 by keywords: "arterial hypertension among athletes", "blood pressure and hypertension in athletes", "sudden cardiac death in sport", "arterial hypertension and cardiovascular risk", "exercise and hypertension", "left ventricular hypertrophy in athletes", echocardiography in athletes. We used the eLibrary.ru database for the period from 1978 till 2020 by keywords: "arterial hypertension and sports", "sports heart", "left ventricular hypertrophy and sports", with a study of the list of literary sources and works of 1899 and 1936. For the review, works were selected that took into account the differences between sports and/or age using large contingents of the surveyed. A total of 38 sources were studied. There is currently not much data on the prevalence of cardiovascular disease among athletes. In this regard, special attention should be paid to the measurement of blood pressure before and after exercise, including in persons without arterial hypertension. The relationship of ultrasound examination of the heart and blood vessels with the risk of cardiovascular complications is currently not fully understood, and there are quite contradictory data on this issue, however, the advantages of these studies are obvious.

Objective: to assess the indicators of arterial stiffness and endothelial function in patients with arterial hypertension (AH) in different periods of ischemic stroke (IS), depending on the degree of recovery of neurological functions. Material and Methods. We examined 180 patients aged over 40 years with AH in the acute period of IS, admitted to the neurological department from September, 2015 to June, 2019. The degree of functional independence was assessed using the modified Rankin scale (mRS). The patients were divided into 2 groups: group I —with a high level of recovery, mRS<3 (n=88) and group II — with a low level of recovery, mRS>3 (n=92). The oscillometric method was used to assess the average daily indicators of vascular rigidity. The level of endothelin-1 (ET-1), endothelium-dependent vasodilation (ESVD) and occlusion index were investigated. The observation period was 2 months. Results. Group II in the acute period of IS is characterized by higher values of the rigidity of the vascular wall (SPW 13.8±1.8 m/s vs 11.6± 1.7 m/s, p<0.05), an increase in the level of ET-1 (6,5±1.8 ng/ml vs 5.6±1.8ng/ml, p<0.05), decreased EDVD (5.0±1.2% vs 5.9±1.4, p<0.05). After 2 months, there was a positive trend in the studied indicators in both groups. In group II, PWV decreased from 13.8±1.8 m/s to 11.8±1.6 m/s, p<0.05; in group I, PWV decreased from 11.6±1.7 m/s to 9.8±1.5 m/s, p<0.05. Conclusion. Patients with a low restorative potential showed a decrease in endothelial function and higher indicators of vascular rigidity.

This clinical case demonstrates that percutaneous coronary intervention indicated in the treatment of ST-segment elevation myocardial infarction. Successful percutaneous coronary intervention may result in no-reflow syndrome. Drug therapy of myocardial infarction with ST segment elevation and no-reflow syndrome is accompanied by the introduction of a large number of antithrombotic drugs. The prescription of triple antiplatelet, anticoagulant therapy significantly increases the risk of gastrointestinal bleeding, especially in patients with a history of ulcer disease. The practitioner doctor being prepared for such a complication of this therapy, take timely measures to stop it, and use proton pump inhibitors for the purpose of gastroprotection.

Objective: to analyze the electrophoretic properties of erythrocytes in patients receiving programmed hemodialysis treatment. Material and methods. The study included 100 patients with an established diagnosis of chronic kidney disease, stage 5D, receiving treatment with chronic (long-term) hemodialysis. Control group was composed of 17 healthy blood donors. Evaluated indicators of the electrophoretic activity of erythrocytes: vibration amplitude, proportion of motile cells, ellipticity and aggregation index. Results. In comparison with the control group, there were revealed significant changes in the amplitude of oscillations and the proportion of motile cells (p<0.001). No significant gender-defined differences were observed (p>0.05). Significant age differences between young adults and senior adults groups (p=0.048) were observed in the average vibration amplitude, and ellipticity between the middle-aged and senior (p=0.040), old and senior (p=0.035) adults groups. According to the duration of hemodialysis treatment, a decrease in the amplitude of fluctuations to the maximum from the minimum period was revealed: less than 1 year (p=0.029); 1 year (p=0.035), the indicators of the aggregation index have the highest values in the groups with the minimum (p=0.044) and maximum (p=0.035) periods of dialysis. Conclusion. In patients on long-term hemodialysis, the amplitude of red blood cells oscillations is significantly reduced with strong decreasing tendency associated with long duration of chronic hemodialysis treatment.

Objective: development and evaluation of the effectiveness of the tactic of actions for reverse shoulder arthroplasty in conditions of defects and bone mass deficiency of the articular surface of the scapula. Material and Methods. At the department of adult orthopedics n. a. N. N. Priorov National Research Medical Center Ministry of Health of the Russian Federation, 6 patients with glenoid bone mass deficiency underwent reverse shoulder arthroplasty, which was replaced by both marginal (4 patients) and extensive bone defects (2 patients). Results. During the follow-up period of the operated patients in the period from 6 to 24 months, good clinical, radiological and functional results were obtained. There were no intra- and postoperative complications. Conclusion. The developed method of replacement of glenoid defects in reverse arthroplasty showed high efficiency.

Aim: evaluation of antimicrobial activity of toothpastes with different component composition recommended for early-aged children. Material and methods. The study material comprised dental plaque of patients under the age of 3 years with decompensated caries. Seven toothpastes with different composition for children aged from 0 to 3 years were studied. Identification of the isolated microorganisms was carried out by mass spectrometry. Antibacterial activity was determined by diffusion into agar and serial dilutions. Results. Pastes containing xylitol, lactic enzymes and components of medicinal herbs showed the absence of a zone of inhibition of the growth of microorganisms. Fluoride pastes are active against all tested microorganisms. In this case, the inhibiting final concentration of fluorine was 0.00016-0.0025%, depending on the concentration of fluorine in the paste. Conclusion. The least antimicrobial activity had complex pastes with dairy enzymes and components of medicinal herbs, as well as samples with xylitol. Simple toothpastes with organic and inorganic fluoride compounds had the greatest bactericidal effect.

Sleep apnea in adolescence is a frequent and at the same time underestimated pathology, the consequences of which can lead to cardiovascular dysfunction, cognitive and metabolic disorders. The task of an orthodontist is to recognize and reduce the risk of developing the obstructive sleep apnea syndrome (OSAS) in a timely manner. The purpose of this study was to collect theoretical data on OSAS, its effect on the body of adolescents, methods of diagnosis and treatment, as well as to identify problems of diagnosing OSAS in early adolescence. The literature review was conducted using the PubMed search engine in the Scopus and Medline electronic databases. The literature review was conducted using the PubMed search engine in the Scopus and Medline electronic databases from 2010 to 2021, 47 literature sources were analyzed. As a result of the analysis of the literature data, it was revealed that the reduction in the size of the oral cavity, mediated by the narrowing of the dentition, negatively affects the respiratory function of the body, exacerbating the syndrome of obstructive sleep apnea. Orthodontic care is focused on the treatment of dental anomalies and pathology of the development of the facial skeleton. The expansion of the jaws, aimed at increasing the volume of the airways, is an integral part of the treatment and prevention of OSAS.

Objective: to assess the dynamics of changes in the morphofunctional parameters of the macular zone in patients with diabetic macular edema (DME) with intravitreal dexamethasone implant (IVD) in vitrectomized eyes and eyes with a native vitreous (NV). Material and methods. The study involved 60 patients (60 eyes) divided into two groups with a diagnosis of diabetic retinopathy, DME. Group 1 — patients with NV, group 2 — with vitrectomized eyes. The best corrected visual acuity (BCVA), optical coherence tomography (ОСТ), ОСТ angiography and microperimetry were evaluated before, 1, 3 and 6 months after IVD. Results. In both groups, an increase in the average BCVA after IVD up to 3 months of monitoring (p<0.01); exponential decrease in central retinal thickness from 1 to 3 months (p<0,01), and an increase by 6 months (p<0.05); an increase in total vascular density during 6 months of monitoring (p<0.05); the average photosensitivity (PS) increased in group 1 — up to 3 months, and returned to the initial parameters by 6 months (p<0.05); in group 2 — up to 6 months (p<0.05); Parameter К (the number of points with PS below 24 dB) decreased in group 1 to 3 months (p<0.05) and returned to baseline by 6 months; in group 2 — during the entire observation period (p<0.01). Conclusion. IVD in DME may significantly improve the morphofunctional parameters of the macular zone in the eyes with both NV and vitrectomized eyes. The maximum effect of the drug was observed on the 3rd month of monitoring.

Objective is to assess the effectiveness of the inclusion of rhythmic transcranial stimulation (rTMS) in the treatment of climacteric (CS) and postovarectomy syndromes (POES). Material and Methods. 95 women with POES (main group IA(n=48), comparison IB (n=47)) and 135 women with CS (main IIA(n=68), comparison IIB (n=67)) were included. All patients underwent menopausal hormone therapy (MHT), in the main groups — in combination with rTMS. Results. The average age of patients with POES is 47.9±2.2, with CS — 53.6±3.5 years (p=0.042). The duration of menopause was 2.8±0.6 years. On the scales of physical and psychological components of health in the main groups IA, IIA showed higher values after 3, 6 months of therapy compared to the same parameters in the comparison groups IB, IIB. The dynamics of the decrease in the values of psychoemotional and neurovegetative disorders of the modified menopausal index in the main groups IA, MA after 3 months was more pronounced compared to the same parameters in the comparison groups IB, IIB. The ratio of the chances of normalization of the clinical picture by 6 months for the main group lAand comparison group IB is 2.5 with 95% Cl [1.05-6.16], and for the main group IIAand comparison group IIB — 7.6 with 95% Cl [3.05-19.05]. Conclusion. The inclusion in the treatment of CS and POES along with MGT rTMS improves the quality of life, improves immediate and long-term results.