2021, volume 17

Aim is to compare the effectiveness of using different molecular genetic methods in the diagnosis of tuberculosis and the determination of drug sensitivity to rifampin (Rif). Material and Methods. A retrospective analysis of the results of a study of sputum samples obtained from 1992 patients with pulmonary tuberculosis treated in the Saratov Regional Clinical ТВ Dispensary was carried out from 2014 till 2018. The following methods were used: real-time polymerase chain reaction (PCR Real Time), biological microchips, automated Xpert® MTB/Rif technology. Statistical processing of the research results was carried out using the Bayes formula based on the tables of mutual contingency of the "four-field table" and the x2 test. When determining the significance of differences in relative values, a critical significance level of 0.05 was taken. Results. A higher diagnostic sensitivity of the Real Time PCR methods (73.9%) and biological microarrays (70.3%) was established compared to the Xpert® MTB/Rif method (34.2%) (p<0,001) in the etiological diagnosis of tuberculosis. The sensitivity of the methods depended on the massiveness of bacterial excretion and clinical form of tuberculosis. Conclusion: In accordance to lower diagnostic sensitivity of the Xpert MTB/Rif method in verifying the diagnosis of tuberculosis in determination of drug resistance to Rif using the Xpert MTB/Rif method, rather high operational characteristics were found out (sensitivity — 89.7%, specificity — 89.1 % and efficiency — 89.4%) comparable with the method of biological microarrays (93.9%, 71.8%, 82.9%) (p=0.127, p<0.001, p=0.139) respectively.

The objective of the research is to present the findings of both intravital and postmortal morphological examinations revealing some features of thanatogenesis in patients with acute injury of cervical spine affected by permanent ankylosing spondylitis.

An overview of the literature data for the last 40 years (from 1984 to 2020) is presented, dedicated to the study of possibilities of using the isokinetic dynamometry method in the diagnosis and rehabilitation of patients with motor disorders in various diseases and pathological conditions (31 sources). To search for information, the Internet resources eLibrary and PubMed and scientific literature of the library of the Stavropol State Medical University were used. The article highlights the possibilities of the isokinetic dynamometry method for an objective assessment of the functional state of skeletal muscles in health and disease. The characteristics of rehabilitation measures using isokinetic dynamometry devices in patients with pathology of the knee and hip joints are given. Information on the effectiveness, safety and application possibilities of this technique in various fields of medicine is presented. Based on the review, it was concluded that it is rational to use the isokinetic dynamometry method in the complex of diagnostic and rehabilitation treatment for patients with compression radiculopathy.

The review presents an analysis of the literature on indications and contraindications for cochlear implantation (Cl) under general anesthesia, as well as under local anesthesia; special emphasis is placed on identifying the advantages and disadvantages of conducting Cl under local anesthesia. To search for articles, we used the PubMed database, eLibrary, as well as the archives of the journals: «European Archives of Otorhinolaryngology», «Canadian Medical Association Journal», «Otology and Neurotology Journal», «Singapore Dental Journal», «Journal of Applied Gerontology», «Journal of Communication Disorders», «The Hearing Journal», «Cochlear Implants International Journal». The literature review used 43 literature sources; articles were published during the period from 1954 to 2020.

Purpose: to develop and propose an algorithm for timely and accessible clinical diagnostics and basic principles of treatment of patients with MELAS syndrome (one of the most common diseases in the group of mitochondrial diseases (MB)), based on the example of a specific clinical case. The prevalence of this pathology cannot be estimated due to the variety of clinical manifestations and, as a consequence, due to the complexity of timely diagnostics. Diagnosis of this disease, from the onset of the initial clinical manifestations to the clear establishment of the MELAS syndrome, often takes years. We present and discuss clear clinical criteria for making a diagnosis, as well as the features of neu-roimaging changes in the brain, which allows us to detect the disease at the earliest stage. A detailed clinical analysis of patient B.'s own observation, born in 1993, with MELAS syndrome is presented. This clinical case clearly demonstrates the emerging difficulties for the earliest diagnosis of this pathology in patients with MB. Despite the phenotypic heterogeneity of mitochondrial disorders, the relationship between clinical signs and additional laboratory data, genetic verification of the diagnosis can provide the clinician with sufficiently important information to unravel the genetic defect, which allows for an earlier diagnosis and prescribing timely treatment.

Objective: to assess the prevalence of cognitive and affective impairment in patients with chronic lymphoproliferative diseases. Material and Methods. 130 patients (59 women and 71 men) aged 42 to 86 years were examined, including 62 patients with chronic lymphocytic leukemia and 68 with multiple myeloma. The Montreal Cognitive Assessment Scale (MoCA) was used to assess cognitive impairment, and the Hospital Anxiety and Depression Scale (HADS) was used to assess affective impairment. Results. We diagnosed cognitive impairment (MoCA<26) in 78.5% out of 130 patients, while only 33.9% complained of memory loss. The average score on the MoCA scale was 23 [20; 25] points. The level of education and age of the patients influenced the MoCa indices. Almost one third (38 out of 126 patients) had symptoms of subclinical anxiety by HADS, 28 (22.2%) patients had clinical anxiety. Forty six (36.5%) patients had symptoms of subclinical depression by HADS, 23(18.3%) patients had clinical depression. Anxiety rates were higher in women and elderly patients. Conclusion. Most patients had cognitive decline. The development of cognitive impairment in patients is influenced by age, educational level, and affective disorders. Every second patient has manifestations of anxiety and depression of varying severity, while the level of anxiety is higher in women and elderly patients.

Patients with myasthenia gravis have an increased risk of other autoimmune diseases compared to population without myasthenia gravis. The development of two autoimmune diseases in one patient suggests common pathogenetic mechanisms. The article presents a case report of progression of antiphospholipid syndrome in a 44-year-old woman 12 years after onset of myasthenia gravis with an early onset and a high titer of antibodies to acetylcholine receptors, without a history of thymectomy This woman had a good obstetric history. She was diagnosed with antiphospholipid syndrome on the basis of clinical manifestations in form of ischemic stroke, and detection of high levels of antibodies to beta-2-glycoprotein-1 twice with an interval of 12 weeks. In the scientific literature there are limited cases of

The aim is to identify the relationship between the neuropsychological state of the patient and the recovery of his motor deficits due to acute cerebrovascular accident. Material and Methods. The study involved 103 patients with ischemic stroke in the basins of the middle and anterior cerebral arteries. We gave a clinical and neurological assessment of the patient's condition, and conducted neuropsychological testing: Beck Hopelessness Inventory (BHI), the Montreal Cognitive Assessment (MoCA), SF-36, and the Visual-Analog Scale (VAS). The examination was carried out three times: in the acute period of cerebral circulatory disorders, after 2 weeks and 24-36 months. After a long follow-up, all patients were divided into groups: with a favorable and unfavorable outcome. We analyzed which values of these scales are most typical for the selected groups. Results. The indicators of general physical health from the SF-36 (p=0.007), the results of the BHI (p=0.003 and 0.002), and of the VAS (p=0.025) collected after acute ischemic stroke were prognostically significant. For both groups, the most important indicators for the prognosis of the disease were MoCA (p=0.038), BHI (p=0.009), SF-36 (OFZ) (p=0.002), regardless of the period of stroke. Conclusion. The connection between the neuropsychological state of the patient and the restoration of his motor function after stroke was revealed. The considered questionnaires can be included in the multivariate forecast model of the prognosis of stroke as one of the criteria for the outcome of the disease.

Objective: to study the cognitive status of patients in the pre-dialysis period depending on the stage of chronic kidney disease (CKD) and the category of cardiovascular risk (CVR). Material and Methods. We examined 98 patients with CKD in the pre-dialysis period (mean age 47.1 ±11.2 years). The patients were divided into 3 groups according to the criteria of CVR stratification. Group 1 consisted of 32 patients with low and moderate CVR and CKD stage C1 or C2; group 2 included 34 patients with high CVR and CKD stage C3a or C3b; group 3 assumed 32 patients with very high CVR and CKD stage C4. The SAGE test (Self-administered Gerocognitive Examination) was used to assess cognitive functions. Results. Cognitive impairment (Cl) was detected in 57% of the patients: in the 1st group in 37.5%; in the 2nd group in 44.1 %; in 3rd group in 90.5%. Dementia was diagnosed in 19% of patients with Cl. A correlation was found between the severity of Cl, the degree of decrease in glomerular filtration rate, and the educational qualification of patients with CKD in the pre-dialysis period (p<0.001). It was found that the examined persons CKD first of all had memory, constructive-spatial and logical thinking disorders. Conclusion. Chronic kidney disease is an independent risk factor for the development of Cl. Cognitive impairment progressed as the CKD stage elevated and the patient's CVR category increased, and was detected in 37.5% of patients with low or moderate CVR, 44.1% of patients with high CVR, and 90.5% of patients with very high CVR.

Objective: to evaluate the possibility of correcting gait disorders and postural instability in patients with Parkinson's disease using virtual reality method. Material and Methods. 20 patients with Parkinson's disease underwent a 10-day course on a walking simulator with a virtual reality unit. The UPDRS scale and the Freezing of Gait Questionnaire (FoG-Q) were used to assess motor disorders. Results. Training on the simulator with the VR block led to a decrease in the severity of gait disorders by 6.0% in the off state (from 55.13 to 51.81 grades in UPDRS) and by 5.6% in the on state (from 43.69 to 41.25 grades), primarily due to the effect on freezing of gait and postural instability. In addition, there was an improvement in assessment of their own state in patients according to the FoG-Q (from 9.44 to 7.38 grades). In the control group, no statistically significant dynamics was observed. Conclusion. Techniques using virtual reality can be used as an additional method for correcting of motor disorders in patients with Parkinson's disease.