Vol 9, No 2 (2024)

Aim – to study the dynamics of pubic symphysis parameters in men in the early adulthood, early and middle old age according to computed tomography (CT) data.

Material and methods. In the study, we used the results of a CT examination of 80 men without bone or pelvic organ pathology. All participants gave their consent to routine examination to exclude possible pathology of the pelvic bones. The CT investigation included the measurement of the height, width and thickness of the pubic symphysis in 3D reconstruction mode. The subjects were divided into three groups according to anatomical age classification. The first group included 25 early adulthood men (21 to 35 years old); the second group included 29 early old age men (56 to 74 years old); the third group included 26 middle old age men (75 to 88 years old).

Results. When comparing the parameters of height, width and thickness of the pubic symphysis, their statistically significant decrease by middle old age was revealed. Its height decreased from the early adulthood to early old age by 7.1% (t = 12.82, p < 0.01) and further remained unchanged in middle old age. The width of the pubic symphysis was decreasing by 22.7% (t = 8.3, p < 0.01) from the early adulthood to early old age and by 26.5% (t = 8.32, p < 0.01) from early to middle old age. The symphysis thickness was growing from the early adulthood to early old age by 6.4% (t = 6.10, p < 0.01) and from early to middle old age – by 1.1% (t = 1.08, p > 0.05).

Conclusion. The results obtained in this study can be helpful for doctors of such specialties as traumatology, sports medicine and rehabilitation, forensic science, forensic medicine and many others.

Aim – to develop and provide clinical substantiation of experimental mathematical models for the chronic kidney disease (CKD) progression rate in patients with type 2 diabetes mellitus (T2DM) using the glomerular filtration rate reduction index (RI_GFR) as original diagnostic parameter.

Material and methods. A cross-sectional observational study of clinical status indices was performed in a sample of patients with type 2 diabetes. The significant predictors of a high rate of CKD progression were identified by regression analysis, three variants of experimental mathematical models were developed with different combinations of arguments with an emphasis on modifiable factors.

Results. The method of one-dimensional logistic regression analysis revealed the indices of clinical status having a significant impact on the rate of CKD progression on the scale of changes in RI_GFR by 1 ml/min/1.73 m² and on the binary classification of outcomes in the groups of "slow" and "fast" decrease in kidneys filtration function with a threshold value of RI_GFR of 4.21 ml/min/1.73 m² per year. These indices were age, body mass index (BMI), glycemia and duration of diabetes at the time of visit, history of insulin therapy, acute myocardial infarction in the anamnesis, pulse on the popliteal artery, concomitant retinopathy, hypertension risk group, treatment with sulfonylureas and calcium antagonists. Using multidimensional logistic regression, three types of experimental mathematical models were developed, including various combinations of predictors that demonstrated high values of diagnostic significance.

Conclusion. The mathematical modeling of CKD progression in patients with T2DM with the RI_GFR diagnostic index allows for better understanding of the pathology's development patterns. An experimental mathematical model using modifiable drug factors that a doctor can manage during the treatment (administration of sulfonylureas and calcium channel blockers) demonstrated 55.6% sensitivity, 85.3% specificity, AUC 0.76 (0.65; 0.86), which ensured high quality prediction with an accuracy of 77.5%.

Aim – to assess the public health risk associated with the quality of drinking water and food in areas with different levels of incidence of colorectal cancer.

Material and methods. An assessment was made of the carcinogenic risk and the risk of developing general toxic effects due to the intake of xenobiotics with food and drinking water in areas that differ in the incidence of colorectal cancer. To assess the risk, we used the results of laboratory studies performed as part of the social and hygienic monitoring for the period 2014–2021.

Results. Priority pollutants that make the greatest contribution to the carcinogenic risk have been identified. The range of total carcinogenic risk, depending on arsenic compounds, varied in the Arsky district from acceptable to high (from 4.98E-05 to 2.70E-03), in Drozhzhanovsky – from acceptable to alarming (from 6.81E-05 to 2.02E- 04); in Aznakaevsky – from alarming to high (from 1.99E-04 to 2.21E-03). In the Kamsko-Ustyinsky district, the risk was assessed as alarming (from 2.15E-04 to 4.13E-04), in Yutazinsky as high (from 2.91E-03 to 1.80E-02). The total hazard index associated with the intake of nitrates with food and drinking water varied from the minimum in the Arsky district (HI=0.31) to the alarming one in the Kamsko-Ustyinsky district (HI=3.13). The risk of developing non-carcinogenic effects in the gastrointestinal tract, due to the natural characteristics of drinking water sources, was assessed as acceptable in all areas.

Conclusion. In areas with an increased incidence of colorectal cancer, there were higher levels of carcinogenic health risk due to the intake of xenobiotics with food and drinking water (from alarming to high).

Aim – to assess the effect of the order and time of HIV/HCV and HIV/HBV co-infections, as well as the antiretroviral therapy regimen on the progression of fibrotic changes in the liver.

Material and methods. The object of the retrospective-prospective clinical study was 204 HIV/HCV co-infected patients, and 30 HIV/HBV co-infected patients, divided into groups according to the type of viral pathogen that first entered the patient's body. The criterion for assessing the patients' condition was the type of the liver fibrous process (progressive, stable, regressing) according to the annual transient ultrasound elastography of the liver.

Results. It was found that the order of pathogens entry significantly affected the progression of liver fibrosis. The least favorable situation arose when the first pathogen was HIV, and the interval between the entry of viral pathogens into the patient's body was more than 5 years. The degree of the fibrotic process progression was also influenced by the combination of drugs with different action mechanisms for antiretroviral therapy.

Conclusion. The risk of progressive liver fibrosis in HIV/HCV co-infection patients was associated with a situation where the first infecting pathogen was HIV, and an interval between co-infections was more than 5 years. In this case, the most optimal antiretroviral therapy regimen was a combination of nucleoside reverse transcriptase inhibitors with integrase inhibitors.

In HIV/HBV co-infection, the risk group for progressive liver fibrosis included patients having HIV as the first pathogen and an interval between co-infections 5-10 years, as well as patients having HBV as the first pathogen with an interval between the infectious agents more than 10 years. The most optimal regimen of antiretroviral therapy was a combination of nucleoside reverse transcriptase inhibitors, which also have anti-HBV effect, with protease inhibitors.

There is a number of conflicting data regarding electrocardiographic predictors of atrial fibrillation, among which extrasystoles (ES) stand out, but there is no reliable data on which extrasystoles variants may be considered as a risk factor.

To identify the relationship between extrasystoles and atrial fibrillation, we have analyzed 3927 publications, from which we identified 46 works relevant for the topic.

The data obtained allows us to consider extrasystole as one of the main predictors of the development of atrial fibrillation. An increase in the number of supraventricular and ventricular ES in the anamnesis of patients with atrial fibrillation indicates their relationship.

Aim – to analyze the effect of carotid stenosis of varying severity in combination with other factors on the risks of primary and recurrent ischemic stroke, using methods of mathematical regression analysis.

Material and methods. The study included 606 patients, examined by a neurologist, contrast-enhanced CT scan of the brain, ultrasound of the vessels of the head and neck, other tests and instrumental studies. The degree of carotid stenosis was assessed using the NASCET method (stenosis 0-49%, 50-69%, 70% or more). For the purpose of mathematical analysis, patients were divided into 3 comparison groups: those without a history of stroke, patients with a single stroke, and a group of patients with two or more ischemic strokes. In patients with a history of stroke, the size of the ischemic lesion was assessed according to CT data, the severity of neurological deficit according to the NIHSS scale and the recovery degree, and the functional outcome of ischemic stroke (Rankin scale, Rivermead index). The study used logistic regression analysis to assess the relationship between the dependent variable (presence of primary or recurrent stroke) and a set of predictors, which were a number of clinical and instrumental indicators.

Results. The presence of carotid stenosis of 50-69%, when combined with pathology of the cardiovascular system, acts as a factor that significantly increases the risk of developing primary ischemic stroke. Stenosis exceeding 70% has a high level of significance in the risk of recurrent ischemic stroke, this fact should be taken into account for secondary prevention of stroke.

Conclusion. A preliminary assessment and analysis of carotid stenosis degree and other comorbid factors co-influencing the risks of primary and recurrent ischemic stroke has an undoubted potential. This approach can reduce the risk of recurrent vascular accidents and help organizing a personalized approach to surgical treatment of patients.

Aim – to evaluate the effectiveness of an algorithm of the medical staff actions during the secondary prevention of kidney and urinary tract diseases in an outpatient polyclinic.

Material and methods. To assess the effectiveness of the proposed algorithm, we conducted a survey among outpatient clinic doctors with job-experience longer than 10 years using a specially developed questionnaire (score from 1 to 10). To assess the consistency of doctors' opinions, the Kendall's Concordance Coefficient (W) was calculated. W > 0.7 was considered as a high degree of agreement between doctors' opinions. To assess the significance of the obtained concordance coefficient, the ÷² criterion was calculated at a significance level of α ≤0.05.

Results. Our analysis of the doctors' answers revealed that the proposed algorithm can be used as an alternative to sanatorium treatment for the prevention of exacerbations of urinary system diseases.

Conclusion. The medical and organizational measures for the secondary prevention of exacerbations of urinary system diseases, embodied in the algorithm, allow for improving general well-being in patients under dispensary observation. The algorithm was positively assessed by doctors of outpatient clinics.

With each passing day, medicine strives to become more personalized, centered directly on the patient. A significant aspect of this dynamic involves the consideration of patients' gender, which influences their physiology, the pathogenesis of developing diseases, and their response to treatment.

Historically, most research has been conducted on male cells, male mice, and men, with women of childbearing age often excluded from studies for their safety. It was assumed that female cells were identical to male cells, leading medical research to be predominantly focused on male physiology. However, this approach was fundamentally flawed, as individuals of different sexes differ in terms of epidemiology, pathogenesis, clinical manifestations, disease progression, and responses to treatment. Knowledge of these gender-specific characteristics can aid clinicians in their patient management.

This literature review aims to examine the peculiarities of cancer progression in men and women, specifically in the cases of stomach and colorectal cancer.

Aim – to investigate the associations of rs3134069, rs4355801 and rs3102735 polymorphisms in the TNFRSF11B gene with knee osteoarthritis in postmenopausal women.

Material and methods. 483 postmenopausal women were examined, including 157 patients with knee osteoarthritis. The remaining 326 women had no signs of joint disease and formed the control group. All examined women were tested using real-time polymerase chain reaction for single nucleotide polymorphisms rs3134069, rs4355801 and rs3102735 in the TNFRSF11B gene.

Results. It was found that genotypes distribution of polymorphisms rs3134069, rs4355801 and rs3102735 in the TNFRSF11B gene in the total group of examined women (n = 483) corresponded to the Hardy – Weinberg law (p > 0.05). The analysis of the polymorphic variants’ frequency in the TNFRSF11B gene revealed an increased frequency of AC or CC genotypes of rs3134069 polymorphism in patients with knee osteoarthritis (OR = 1.91; 95% CI: 1.10–3.32; p = 0.030). Also, the allele C frequency of the above-mentioned polymorphism was increased among patients with osteoarthritis (OR = 1.78; 95% CI: 1.06–2.99; p = 0.040). No association with knee osteoarthritis was found for two other studied polymorphisms in the TNFRSF11B gene – rs4355801 and rs3102735 (p > 0.05).

Conclusion. The increased frequency of genotypes AC or CC registration, as well as allele C of rs3134069 polymorphism in the TNFRSF11B gene in postmenopausal women with knee osteoarthritis indicates the important role of TNFRSF11B gene mutations in the osteoarthritis development and progression. Further research in this area is of great interest both for a deeper understanding of the disease pathogenesis and for the development of personalized approach in the prevention and treatment of knee osteoarthritis in postmenopausal women.

Aim – to study the dynamics of respiratory function indicators in patients with bilateral widespread destructive tuberculosis during staged surgeryt using extrapleural pneumolysis with silicone plombage on the side of the smallest lesion.

Material and methods. The main study group consisted of 14 patients with widespread bilateral destructive tuberculosis who underwent extrapleural pneumolysis with silicone plombage (EPSP) in combination with lung resection on the opposite side. The control group included 29 patients who underwent lung resections on both sides. All patients underwent spirometry before and 3–5 weeks after each stage of surgery: FVC (forced vital capacity of the lungs) and FEV1 (forced expiratory volume in 1 second) were registered.

Results. The dynamics of the spirometric study values after staged surgery in the EPSP group was a decrease in FVC by 1.05±0.47, FEV1 by 0.95±0.6 l, and in the control group – by 1.74±0.76 l and 1.33±0.5 l, respectively (p < 0.05).

Conclusion. The staged surgery with the use of EPSP was accompanied by a significantly smaller decrease in functional parameters and can be used in patients with widespread bilateral destructive tuberculosis with low respiratory function.