2024, volume 20

Objective: to analyze the dynamics of the activities of medical organizations repurposed to provide medical care to patients with COVID-19. Material and methods. In two repurposed multidisciplinary medical organizations in Saratov, a multi-criteria assessment (according to 31 indicators) of the dynamics of their activities was carried out (retrospectively by doctors — 26 and 22 people who participated in providing medical care to patients with COVID-19). Three stages were evaluated: 1) the beginning of admission of patients in April — May 2020; 2) December of 2020; 3) December of 2021. Results. The activities of both repurposed medical organizations throughout the study received an average integral rating of "good". At the same time, its positive statistically significant dynamics between the first and second stages (from 3.9±0.1 to 4.5±0.1 points) was revealed, accompanied by a significant increase in the number of excellent grades given by respondents and indications of a high level of gradation of informative criteria. Informative criteria have been identified, the low and medium levels of which need to be corrected. Conclusion. The expediency of repurposing multidisciplinary medical organizations to provide medical care to patients with COVID-19 has been confirmed.

Objective: to assess the availability of medical care for retinal diseases in the subjects of the Russian Federation according to the data of a survey of physicians and patients with age-related macular degeneration (AMD) and diabetic macular edema (DME). Material and methods. The medical and sociological study included 20 interviews with specialized doctors from 13 subjects of the Russian Federation and questionnaire survey of 264 patients with AMD and 260 patients with DME living in 10 regions of the country. Results. According to the data of the patient survey, AMD and DME were diagnosed during prophylactic measures in 41.3% and 50.0% of respondents (p=0.009). All prescribed intravitreal injections of angiogenesis inhibitors were given free of charge to 64.4-71.4% of respondents. The wait for hospitalization was less than one month for 40.3 and 50.9% of respondents with AMD and DME (p=0.041), respectively. Some of the interviewed patients (18.0%) interrupted the intravitreal injections of angiogenesis inhibitors course due to personal circumstances. According to the data of interviews of medical specialists, the main problems in providing care to patients with AMD and DME include territorial disparities, excessive volume and repetitiveness of preoperative examination and insufficient patient adherence to treatment. Conclusion. Medical care for retinal diseases in the studied regions is characterized in general by a high level of accessibility, which is confirmed by their predominant detection during preventive measures, timely performance of the necessary examination and treatment.

Objective: to evaluate the effects of protein-energy malnutrition (РЕМ) on the course and outcome of ischemic stroke (IS) in patients with neurogenic dysphagia (ND). Material and methods. The study was performed in 110 patients (64 men and 46 women aged 44-89 years) using the National Institutes of Health Stroke Scale, Nutrition Risk Screening (NRS) 2002, Mann Assessment of Swallowing Ability (MASA). The level of total blood protein was measured at admission and on the day 10 of IS. The weight of patients was determined at admission and on the day 10 of the disease. The results of IS were analyzed according to the Glasgow Outcome Scale (GOS) and the frequency of complications: pneumonia, pulmonary embolism, phlebothrombosis, multiple organ failure, bedsores. Results. All patients with ND and IS at admission on the NRS 2002 scale had at least 3 points, signs of mild РЕМ were observed in 5.45%. On day 10, signs of РЕМ were observed in 40.9% of patients, of which mild in 20% of patients, moderate in 13.6% of patients and severe in 7.3% of patients. Differences between the level of total protein in the blood of patients with ND in IS at admission and on the day 10 from the onset of the disease were significant in all groups according to the severity of dysphagia on the MASA (p<0,001). In patients with clinical manifestations of РЕМ, the incidence of pneumonia, multiple organ failure and bedsores was statistically significantly higher than in patients without clinical manifestations of РЕМ. As a consequence of the complications that developed, a negative outcome on the GOS (1 point — death) was more common in patients with signs of РЕМ, and a positive outcome (4 points) in patients without signs of РЕМ (p=0.049). Conclusions. ND in the acute period of IS is one of the factors of the development of РЕМ, which aggravates the severity of the condition of patients, entails a number of complications and more often leads to a fatal outcome.

Objective: can dermatoscopy serve as the "gold standard" for the diagnosis of nail plate psoriasis, eliminating the need for histopathological examination for the final diagnosis of nail psoriasis. Methodology for writing a review. A literature search was conducted using Medline, PubMed, and eLibrary databases for all years to date. Search terms included words and phrases such as "psoriasis", "nail psoriasis dermatoscopy", and "nail plate dermatoscopy". The number of sources considered is 35. A total of 16 studies from 2010 to 2022 were critically assessed. Conclusion. Nail psoriasis is characterized by many specific dermatoscopic features. In this regard, dermatoscopy, which allows diagnosing psoriatic onychodystrophies, is an effective method for studying the specific lesion of the nail plates to clarify the diagnosis of nail psoriasis.

Objective: to evaluate the frequency and identify risk factors for the development of stent restenosis in patients with acute coronary syndrome (ACS) after percutaneous transluminal coronary angioplasty Material and methods. Retrospective analysis of 665 case histories of patients with acute coronary syndrome who were hospitalized from January to November 2023 was performed at the 1st stage of the study. At the second stage we analyzed the risk factors of in-stent restenosis development based on clinical and laboratory data in the compared groups of patients: group 1 (n=62) and group 2 (n=55). Results. Stent restenosis was detected in 62 patients out of 665 (9.3%). The risk of in-stent restenosis was significantly influenced by concomitant type 2 diabetes mellitus (OR 1.6 (1.2-2.3); p=0.007), IBS duration of more than 10 months (OR 2.24 (1.7-3.0); p=0.001) and stenting with a holometallic stent (OR 1.8 (0.9-3.4); p=0.049). Conclusion. The incidence of stent restenosis after stenting for ACS is 9.3%. Concomitant diabetes mellitus and duration of the underlying disease of 10 months are risk factors for early restenosis.

Objective: to evaluate the impact of a remote dynamic monitoring system on the lipid profile after myocardial infarction in urban and rural areas of the Perm Territory. Material and methods. The study, conducted between 2020 and 2022, included 253 patients diagnosed with myocardial infarction. The study compared two groups of patients: those who refused to participate (n=105) and those who took part in the "Remote health monitoring of patients with cardiovascular disease" (RM program) (n=148). Patients were monitored at least once a month via telephone calls using an approved list of questions. Results. The group of patients participating in the RM system showed a significant improvement in lipid profile compared to the groups without RM. A comparison between urban and rural patients showed statistically significant differences in the levels of cholesterol (p=0.002 for residents of the Perm region) and low-density lipoproteins (LDL) (p=0.049 for residents of Perm; p=0.025 for residents of the Perm region), indicating potential differences in the effect of RM in different areas. Patients in the RM group from the Perm region were 15.56 times more likely to achieve target LDL levels compared to a similar group without RM. Conclusion. The RM system had a positive effect on the reduction of LDL and cholesterol in groups of residents, both in urban and rural areas.

Objective: to develop a prognostic algorithm of nocturnal hypoglycemia (NH) based on the glucose monitoring mobile application data. Material and methods. The retrospective analysis of 524 continuous glucose monitoring (CGM) profiles of patients with type 1 diabetes mellitus was performed. CGM was performed using the Medtronic iPro2 system for 6-7 days, overnight periods of CGM were analyzed to identify systematic NH. There were 239 patients included in the study, among them 65 (27.1%) were identified as having systematic NH. Models of 7-point glycemic profiles were built and their data were uploaded to the DiaLog GM mobile application to calculate standardized glucose monitoring parameters. The prognostic model of NH was developed based on the logistic regression method. Results. According to the results of regression analysis the most significant predictors of NH included in the prognostic model were: glycated hemoglobin (p=0.001), using of insulin pump therapy (p=0.001), time below target range level 1 (p<0.001), coefficient of variation for glucose (p=0.02). The area under the ROC curve for the prediction model was 0.917; the optimal cut-off point for the predicted probability of NH was 0.317, with model sensitivity of 85% and specificity of 90%. Conclusions. The developed prediction model based on data from a specialized mobile application allows to improve the existing approaches to NH risk assessment due to higher predictive ability.

Objective: to substantiate the indications for repeated courses of electrical stimulation using a temporary implanted epidural electrode in patients with traction neuropathies after hip replacement. Material and methods. A method of puncture implantation of epidural electrodes was used to conduct a course of electrical stimulation. An analysis of 162 electrode implantations was performed. The results of treatment of 73 patients with neuropathies of the sciatic (n=65) and femoral (n=8) nerves after hip replacement are presented. The follow-up period was 5.5 years. Results. There was a 2-fold increase in the number of hospitalizations for every 4.5 months of interval between endoprosthetics and the first course of electrical stimulation. Depending on the initial neurological deficit, an increase in the number of hospitalizations by an average of half is predicted to increase muscle strength by 1 point. The maximum number of hospitalizations in this category of patients is 8, the average number of hospitalizations is 3. Conclusion. Indications for repeated courses of electrical stimulation using a temporary implanted epidural electrode in patients with traction neuropathies after hip replacement are substantiated. Epidural electrical stimulation allows you to relieve pain associated with traction damage to nerve axons; repeated courses of electrical stimulation contribute to a more complete restoration of nerve function.

The article describes a case of treatment of a giant gastric polyp complicated by bleeding and chronic duodenal obstruction by a new method of endoscopic surgical hemostasis by endoscopic polypectomy using a polymer alginate hemostatic sorbent. The proposed endoscopic polypectomy method using a local hemostatic agent made it possible to prevent hemorrhagic complications, create conditions for full-fledged reparative regeneration, which made it possible to exclude recurrence of the polyp at the site of its removal in the long term.

Objective: based on the analysis of the results of surgical treatment of patients with elbow contractures caused by ossification, assess the need to improve the planning and tactics of surgical interventions. Material and methods. According to the data of the primary medical documentation and a questionnaire, a retrospective analysis of the invasiveness of surgical intervention and the results of surgical treatment was performed, 406 patients of this category in the National Medical Research Center of Traumatology and Orthopedics n. a. R. R. Vreden in 2011-2021. Results. The development of late postoperative complications was characteristic of the overwhelming (about 80%) number of patients surveyed. The dominant (54.9%) complications were post-rehabilitation long-term pain and lack of movement in the operated joint. About 35% of patients rated the functional state of the operated elbow joint as satisfactory and poor. Approximately 30% of patients rated their general condition and quality of life below the average normal values. Conclusion. The existing technique of preoperative examination, planning and performing surgery for elbow contractures caused by ossification needs to be improved, since in about a third of patients it does not allow achieving stable results and does not provide a full volume of painless movements in the elbow joint in the medium and long-term observation periods.