Science and Innovations in Medicine

Aim – to study the dynamics of brain stem volumetric parameters in women from the early adulthood period to the middle old age according to magnetic resonance imaging (MRI) data.

Material and methods. The material for the study was the MRI data of 94 female patients. The MRI was prescribed to exclude a probable pathology of the central nervous system in these patients. All the subjects gave their consent to participate in the study. The study sample included individuals without pathology of central and peripheral nervous system, with absence of alcohol or drug addiction, with skulls of average shape – mesocranes. The cranial index was calculated according to the protruding extreme points on the axial section in 3D reconstruction mode. The subjects were divided into four groups according to selected age periods. The first group consisted of 25 women of the early adulthood (21-35 years); the second group included 25 women of the middle and late adulthood (36-55 years); the third group included 23 early old age women (56-74 years); the fourth group consisted of 21 middle old age women (75-88 years).

Results. The brain stem volume in women decreased by 1.21% (t=3.84; p<0.01) during the whole period of adulthood and by 0.82% (t=2.32; p<0.01) from the late adulthood to early old age. From early old age to middle old age, there was only a tendency for volume to decrease by 0.83% (t=1.75; p>0.05). In early adulthood period women, the brain stem volume was 2.8% higher than in middle old age women (t=6.47; p<0.01).

Conclusion. The results of intravital comparative analysis of the brain stem volume in women of the adulthood period, early and middle old age contribute to the knowledge about its relation to age and sex parameters and can be used in further morphofunctional studies and in clinical practice in gerontology, neurology and rehabilitation.

Aim – theoretical analysis and systematization of the knowledge on using probiotics containing Lactobacillus acidophilus in the prevention and treatment of diseases of the gastrointestinal tract.

The bibliographic databases of the scientific libraries eLIBRARY.RU, Cochrane Library and CyberLeninka, the electronic resources of the Global Health platform, the sites of scientific publications ScienceDirect and Elsevier, MEDLINE and PubMed-NCBI were searched for the relevant information. Next, the full-text sources were analysed. We used structural-logical and analytical methods in this work.

The probiotics containing Lactobacillus acidophilus were reported to enhance eradication therapy in the presence of Helicobacter pylori infection, reduce pain and normalize bowel function in irritable bowel syndrome, normalize liver function, reduce liver enzymes, prevent the development of hepatic encephalopathy in non-alcoholic fatty liver disease, support clinical remission in ulcerative colitis. Also, they demonstrated the effectiveness for the prevention and treatment of antibiotic-associated diarrhea, including clostridial infection, and the improvement of intestinal microbiota. In many gastrointestinal diseases, the effect of probiotics had a high level of evidence. The beneficial properties of probiotics can be used in the development of functional food products for therapeutic and prophylactic purposes.

Aim – to assess the prevalence of low muscle mass and low bone density in elderly patients with type 2 diabetes (T2DM), depending on the level of glycated hemoglobin (HbA1c).

Material and methods. The study included 187 patients (mean age 65.16 ± 4.31 years), who were tested for fasting blood glucose, HbA1c, osteocalcin (OC), procollagen type 1 N-terminal propeptide (P1NP), C-terminal type I collagen telopeptides (B-CTX), 25-hydroxyvitamin D, body composition and bone mineral density.

Results. The prevalence of low muscle mass, osteopenia, and osteoporosis in elderly patients with T2DM was 35.8%, 38.5%, and 30.5%, respectively. The prevalence of low muscle mass was significantly higher in women with HbA1c >9.0% (p =0.035). Osteopenia and osteoporosis prevailed in men with HbA1c >9.0% (p=0.007 and p=0.048, respectively). The appendicular skeletal muscle index (ASMI), bone mineral content (BMC) and bone mineral density (BMD) of the lumbar spine, BMC and BMD of the thigh were significantly reduced in the osteoporosis and osteopenia groups (p<0.05); while B-CTX, P1NP were significantly increased. In men, both ASMI (p=0.007) and P1NP levels (p=0.001) were important risk factors for osteopenia/osteoporosis, and in women such risk factor was ASMI (p=0.019).

Conclusion. In T2DM patients, the high HbA1c levels were associated with higher rates of low muscle mass in women and osteoporosis in men, and ASMI was a risk factor for osteoporosis in both sexes.

Aim – to evaluate the individual characteristics of the hemostatic system and lungs CT-scan data in patients with a new coronavirus infection caused by the COVID-19, depending on the severity of the disease.

Material and methods. A comparative analysis included the results of clinical, epidemiological and laboratory examination of 209 COVID-19 patients divided in two groups: in-patients of the Samara State Medical University Clinics with moderate (n=106) and severe (n=103) course of the disease. The diagnosis was verified by enzyme immunoassay (ELISA) and polymerase chain reaction (PCR). The following indicators were analyzed: gender, age, body mass index (BMI), epidemiological history, clinical signs of the disease, severity, degree of lung damage according to the results of computed tomography (CT).

Results. There were no significant differences between the groups in terms of gender and age characteristics, as well as epidemiological data of COVID-19 patients. In 91% of patients with severe COVID-19, the clinical manifestations of hemorrhagic syndrome were recorded in the form of ecchymoses at injection sites, and in 75% - in the form of bleeding of various localization. The changes in the hemostatic system in patients with severe COVID-19 were characterized by high levels of platelets, INR, APTT, fibrinogen and a decrease in PI. In patients with severe COVID-19, a positive correlation was established between the level of fibrinogen, INR, APTT, PI and consolidation of lung tissue, as well as between the level of INR, APTT, PI and the presence of lung lesions in the form of "ground-glass" opacities on the CT images.

Aim – to determine the factors associated with the risk of developing type 2 diabetes in patients with coronary artery disease (CAD).

Material and methods. The retrospective data sample included 181 patients hospitalized in the cardiology department of the SamSMU clinics. The patients were divided into two groups: group 1 – 122 patients without type 2 diabetes (77 (63.1%) men, median age 66.0 (59.0;75.0) years) and group 2 – 59 patients with type 2 diabetes (29 (49.2%) men, median age 69.0 (63.0;73.5) years).

Results. The statistically significant difference (p<0.05) was registered in glomerular filtration rate (GFR); no significant differences were demonstrated in other clinical indicators, including age and gender. Expectedly, the patients with type 2 diabetes had higher glucose levels. The parameters of the lipid spectrum and creatinine did not differ between the groups.

Conclusion. The factors associated with the risk of developing type 2 diabetes are high glucose concentration and reduced GFR. The application of the developed discriminant analysis model will allow to determine the risk group of type 2 diabetes in patients with coronary heart disease, which will ensure a timely control of the presented indicators.

Aim – to study the expert opinion of Chief Physicians of city polyclinics on the issue of motivation to healthy lifestyle, in order to find the most effective methods for managing health risk factors.

Material and methods. Using a guide developed according to the method of M. Castillo-Montoya (2016), an anonymous semi-formalized interviews were conducted with experts – heads of medical organizations that include an adult polyclinic. The expert criterion was – 7 years and more of management experience.

Results. The main motives for lifestyle changes were the fear of disability, impotency (men), an inability to lead a normal lifestyle (71.4% of respondents). We observed the need to involve nurses and non-medical personnel in the activities on patients’ motivation for healthy lifestyle to help doctors (75% of cases). All respondents rated the low efficiency of health centers for people who have no developed diseases or relatively healthy people.

Aim – to compare the results of vacuum aspiration biopsy (VAB) and sectoral resection in the treatment of benign breast tumors.

Material and methods. During the study we compared the results of treatment in two groups of patients. The main group included 50 patients (mean age 54.83±0.934 years) who underwent VAB, the control group comprised 55 patients (mean age 55.704±1.998 years) who underwent sectoral resection. Before the surgery, a tumor biopsy was performed with the following cytological and histological examination. The diagnosis of fibroadenoma was predominant. After the operation, a histological analysis of the received preparations was done. We assessed the immediate postoperative results, such as: blood loss, operation time, intensity of pain syndrome, bed-day number, quality of life after the operation.

Results. The duration of surgery was significantly lower in patients with VAB than in patients with sectoral resection (p=0.000). The blood loss after surgery did not differ significantly (p=0.921) and did not exceed 10 ml in both groups. The groups under study were comparable according to the results of the histological examination (Student's t-test was 0.501, p=0.651). In each group, the pain syndrome was assessed in the postoperative period according to a 10-point pain scale after 3 hours, 8 hours, 24 hours, 3 days, 5 days and 10 days after surgical intervention. In the VAB group, the scores were significantly lower, p=0.000.

The average number of bed-days in patients of the control group was 10.32±2.814, in the main group – 1 day, the difference was statistically significant (p=0.000). The frequency of possible complications (hematoma, seroma, infection, deformity of the mammary gland, residual masses after removal) was significantly lower (p=0.013) in patients of the main group. When assessing the life quality of patients after surgery with the MOS SF-36 questionnaire, we found that the indicators were significantly higher in patients of the VAB group (Psychological Health Scale p=0.008, Social Functioning Scale p=0.003, Physical Condition Scale p=0.041).

The treatment of localized oncological process requires a reconstructive intervention in the vast majority of cases. Thus, the problem of reconstructive plastic material is acute. There is no standard material for reconstruction, due to the variability of defects in length, composition and localization of the tumor process. Both cover tissues and fragments of the gastrointestinal tract can be used as the autologous graft.

The presented clinical case describes the esophageal reconstruction with the radial forearm flap. The radial flap is easy to cut out, survives well, and its use excludes the presence of complications from the donor area, in comparison with the techniques of using fragments of the gastrointestinal tract.

The ability to perform simultaneous tumor removal and reconstruction allows for full restoration of vital functions – eating, breathing, speech, achievement of good aesthetic and functional results, including long-term ones, and a satisfactory quality of life.