Regularities of the Natural Evolution of the Proliferative Process in Diabetic Retinopathy. The Concept of Remission of Proliferative Diabetic Retinopathy

The data analyzed in this review indicate that an important feature of the natural evolution of diabetic retinopathy (DR) is the possibility of reverse development of its main signs, including newly formed vessels. The term “spontaneous remission”, proposed by M.D. Davis, may be correct for stating this condition. Spontaneous remission can be persistent and its frequency can significantly exceed the generally accepted 10 %. Signs of remission of proliferative diabetic retinopathy (PDR), regardless of the cause of occurrence (spontaneous or resulting from treatment) are: absence of ophthalmoscopically detectable neovessels; increased/appearance of the fibrous component of proliferation, which is accompanied by traction deformation of the retina. Therefore, the scale reflecting the stages of evolution of newly formed vessels and the scale of severity reflecting the degree of threat to visual functions in PDR cannot be identical. Since the development and regression of neovessels is a reflection of multidirectional processes, the identification of the phase of PDR evolution is fundamental in the formation of research design. Due to the possibility of using artificial intelligence for the analysis of “big data”, the effectiveness of the approach to the study of DR will largely be determined by the adequacy of the grouping of the source data. In this regard, the analysis of previous experience is relevant, which allows us to improve some principles of systematization of results. Conclusion: The statement of the phase of evolution of neovessels in PDR is fundamental in epidemiological and scientific studies. The identification of signs indicating the likelihood of spontaneous remission of DR/PDR will allow us to provide a differentiated approach to treatment, as well as to study the association with the dynamics of the patient’s somatic status.

Infusion-transfusion therapy in the treatment of acute massive surgical blood loss in cancer surgery

Введение. Расширенные комбинированные вмешательства являются основным методом лечения пациентов с местнораспространенными солидными злокачественными опухолями. Основным следствием масштабной онкохирургии является риск развития острой массивной кровопотери (ОМОК). Цель исследования: оценка переносимости ОМОК у онкологических больных. Материалы и методы. В одноцентровое ретроспективное исследование с января 1999 г. по декабрь 2018 г. были включены 4236 больных, оперированных в радикальном объёме по поводу злокачественных опухолей различных локализаций, течение операции у которых осложнилось ОМОК. Критерием ОМОК являлась потеря ≥ 50% от расчётного объёма циркулирующей крови (ОЦКр) в течение 3 ч операции. Пациенты, вошедшие в исследование, были разделены на 4 группы в зависимости от объёма кровопотери: от 51 до 100%, от 101 до 200%, от 201 до 300% и свыше 300% ОЦКр. Результаты. Пациенты исследованных групп не различались ни по общим показателям, ни по исходному соматическому статусу. Про анализированы качественный и количественный состав инфузионно-трансфузионной терапии (ИТТ), показатели баланса жидкости интраоперационно, продолжительность пребывания пациентов в отделении реанимации и интенсивной терапии, летальность. Заключение. Соблюдение определенного протокола ИТТ при онкологических операциях, осложнённых ОМОК, является залогом успешного лечения и позволяет снизить интраоперационную летальность до 0,8% и госпитальную летальность до 6,45%. Метод аппаратной реинфузии аутоэритроцитов продемонстрировал высокую эффективность. Background. Cancer surgery remains the backbone of treatment approaches in patients with locally advanced solid malignancies. Risk of acute massive blood loss (AMBL) remains the main complication of such large-scale cancer surgery. Objectives: assessment of AMBL tolerance in cancer patients. Patients/Methods. A single- center retrospective study from January 1999 to December 2018 included 4,236 patients who underwent radical surgery for malignant tumors of various localizations, whose course of surgery was complicated with AMBL. The AMBL criterion was the loss of ≥ 50% of the calculated circulating blood volume (СBVс) within 3 hours of the operation. The patients included in the study were divided into 4 groups depending on the volume of blood loss: from 51 to 100%, from 101 to 200%, from 201 to 300% and over 300% of СBVс. Results. Patients of the studied groups did not differ either in general parameters or in baseline somatic status. The qualitative and quantitative composition of infusion-transfusion therapy (ITT), intraoperative fluid balance, patients stay in the intensive care unit, and mortality were analyzed. Conclusions. Compliance with a specific ITT protocol during cancer surgery complicated by AMBL is the key to successful treatment and allows to reduce intraoperative mortality to 0.8% and hospital mortality to 6.45%. The method of intraoperative red cell salvage and autologus transfusion has demonstrated high efficiency.

EFFICIENCY OF PREVENTION OF DISEASES OF THE ORAL CAVITY IN CHILDREN. THE IMPORTANCE OF THE ISSUE FOR VISUALLY IMPAIRED CHILDREN

Subject. Dentine pathology is widely prevalent among children in many countries around the globe, which determines the relevance of consideration, organisation and performance of different forms of health education activities for this part of the population. Programmes for dental disease prevention are represented by different methods and means, the purpose of which is creation of correct skills and abilities aimed at preservation and maintenance of oral cavity health. For blind and hyposeeing children, there is absence of special technology for teaching dental culture and rational hygiene of the oral cavity. Aim – studying and analysis and literature related to forms and methods of health education activities for children with consideration for their somatic status. Methods.The study was carried out based on the search for and analysis of original articles devoted to issues of dental disease prevention among children and adolescents in the following databases: ELIBRARY, PubMed, Medline, Cyberleninka. A total of 45 sources have been analysed (25 by Russian and 20 foreign authors). Conclusions. Preventive dental care programmes for conventionally healthy children at the modern stage of development are sufficiently effective, diverse in their contents, point at the necessity of further introduction of individual preventive care activities. Few organisational forms of health education activities have been developed for children with health limitations. There is no special method for organisation of health education activities for blind and hyposeeing children. These circumstances point at the necessity of development and introduction of correction methods for primary prevention of oral cavity diseases for this category of subjects.

Germline Testing Data Validate Inferences of Mutational Status for Variants Detected From Tumor-Only Sequencing

PURPOSE Pathogenic germline variants (PGVs) in cancer susceptibility genes are usually identified through germline testing of DNA from blood or saliva: their detection can affect treatment options and potential risk-reduction strategies for patient relatives. PGV can also be identified in tumor sequencing assays, which, when performed without patient-matched normal specimens, render determination of variants' germline or somatic origin critical. METHODS Tumor-only sequencing data from 1,608 patients were retrospectively analyzed to infer germline versus somatic status of variants using an information-theoretic, gene-independent approach. Loss of heterozygosity was also determined. Predicted mutational models were compared with clinical germline testing results. Statistical measures were computed to evaluate performance. RESULTS Tumor-only sequencing detected 3,988 variants across 70 cancer susceptibility genes for which germline testing data were available. We imputed germline versus somatic status for > 75% of all detected variants, with a sensitivity of 65%, specificity of 88%, and overall accuracy of 86% for pathogenic variants. False omission rate was 3%, signifying minimal error in misclassifying true PGV. A higher portion of PGV in known hereditary tumor suppressors were found to be retained with loss of heterozygosity in the tumor specimens (72%) compared with variants of uncertain significance (58%). CONCLUSION Analyzing tumor-only data in the context of specimens' tumor cell content allows precise, systematic exclusion of somatic variants and suggests a balance between type 1 and 2 errors for identification of patients with candidate PGV for standard germline testing. Although technical or systematic errors in measuring variant allele frequency could result in incorrect inference, misestimation of specimen purity could result in inferring somatic variants as germline in somatically mutated tumor suppressor genes. A user-friendly bioinformatics application facilitates objective analysis of tumor-only data in clinical settings.

Geriatric portrait of patient with falls

Aim. To assess the geriatric and somatic status of older patients with falls.Materials and methods. The study included 655 patients (81% of them women) with the age of 75.1±8.2 years hospitalized in geriatric departments. Depending on whether they experienced falls, the patients were divided into two groups: group 1 (332 people, 50.7%) consisting of patients who experienced at least one fall in the current year and group 2 (323 people, 49.3%) consisting of patients who did not experience any falls. The patients underwent general clinical tests and comprehensive geriatric assessment.Results. Half of the hospitalized patients over the age of 60 experienced falls, and among patients without a fall experience 50.8% had a high risk of falls. As a result of falls 246 (74.1%) patients suffered from bruises and abrasions of soft tissues, 36 (10.8%) patients had fractures of various localizations, 6 (1.8%) patients had traumatic brain injury (TBI). Patients of both groups were diagnosed with an average of 5 diseases while there were no differences in the nosological structure among patients of both groups. As a result of the performed comprehensive geriatric assessment patients with falls were significantly more often diagnosed with frailty, dementia, depression, visual impairment, gait and balance disorders as well as orthostatic reactions.

Symptomatic Metabolic Treatment of Ophthalmopathies in Patients with COVID-19-Associated Pneumonia

Background. The causative agent of the coronavirus infection – SARS-CoV-2 – remains active and causes new cases despite the measures taken around the world. In order to timely detect ophthalmopathies in patients with dyslipidemia who have gone through COVID-19-associated pneumonia, prospective observation during the period of convalescence is advisable, justified and relevant. The assessment of the microcirculation of the bulbar conjunctiva is simple, non-invasive, safe, and allows assessing changes in the entire microcirculatory system of the body. Purpose. To study the features of the somatic status, hemodynamics of the bulbar conjunctiva in patients with dyslipidemia who have gone through COVID[1]19-associated pneumonia, depending on gender, homocysteine and cystatin C indicators during symptomatic therapy. Methods. 55 patients (110 eyes) with a documented diagnosis of COVID-19-associated pneumonia with an increased level of homocysteine and cystatin C were prospectively examined 3 months after discharge from the hospital. After consulting with therapist, cardiologist and functional diagnostics doctor, patients were divided into two groups according to gender. Results. In both groups, the dependence of the severity of lung damage on age was noted: Spearman’s correlation coefficient (r) amounted to r = 0.4; p = 0.017 and r = 0.5; p = 0.045, respectively. A direct correlation on the stage of AH was noted in patients of Group 1 (r = 0.4; p = 0.016), however, in patients of Group 2, this dependence was not found to be significant (r = 0.2; p = 0.367). There were no statistically significant changes in lipid profile in patients of both groups. The severity of endotheliosis during the period of convalescence in the study groups was confirmed by the average values of homocysteine and cystatin C compared to the reference values (1.4/1.6 and 1.62/1.67 times higher, respectively). A month of symptomatic metabolic treatment (Rosuvastatin, 1 mg of folic acid three times a day, 1 pill of Combilipen once a day, 1 drop of Chiloparin[1]Komod solution in both eyes 3 times a day) has shown its effectiveness in the course of changes in bulbar conjunctival microcirculation and disturbed total tear secretion in patients of both groups. Conclusion. In patients who went through COVID-19-associated pneumonia, markers of endotheliosis (homocysteine and cystatin C) remain during the period of convalescence, which indicates the severity of endotheliosis and the need for symptomatic metabolic treatment.

Features of the ophthalmological status and risk factors in patients with retinopathy of prematurity

Aim. To identify risk factors for the development of retinopathy of prematurity and features of the ophthalmological status in dynamics, after two years. Materials and methods. The analysis of outpatient records of 638 premature babies for three years was carried out, of which 309 girls (48.44%) and 329 boys (51.56%) were observed in the consulting and diagnostic office for the identification and monitoring of children with retinopathy of prematurity in Tyumen. Results. The study showed that boys developed more severe stages of PH. The analysis of gestation periods in the groups revealed its significant effect on the development of PH (p < 0.05). Patients with a gestation period from 24 weeks to 27.5 weeks are 1.7 times more common in patients of groups 2 and 3 compared to group 1. There was a significant (p ≤ 0.03) increase in the proportion of patients with extremely low body weight (from 500 to 1000 grams) in groups 2 and 3 compared to group 1. In all groups, the majority of patients have anemia, a syndrome of respiratory disorders. Bronchopulmonary dysplasia and intra-ventricular hemorrhages of 3-4 degrees are more common in patients in groups 2 and 3 with a significance level of p = 0.003 and p = 0.001, respectively. The analysis of the clinical course of PH showed the dependence of spontaneous regression of the disease on the stage: it occurred only in patients of groups 1 and 2. Laser retinal coagulation was required in 82.6% of cases in patients of group 3, after which induced self-regression occurred. The inability to perform laser retinal coagulation was noted in 4.3% of cases due to the severity of the somatic status. Dynamic observation of the ophthalmological status for two years showed the absence of pathology in patients of group 1 and its increase depending on the severity of PH: in patients of group 2 in 15% of cases, in patients of group 3 in 65.22%. The revealed ophthalmological pathology includes accelerated refractogenesis, refractive errors, pathology of binocular vision, atrophy of the optic nerve, congenital glaucoma. Conclusion. Further study of risk factors for retinopathy of prematurity, methods of its treatment and their influence on the state of ophthalmological status in dynamics is required. Children who have undergone retinopathy need careful observation by an ophthalmologist throughout the entire period of growth and formation of visual functions.

Assessment of the State of the Emotional Sphere and the Dynamics of Cognitive Functions on the Background of Rehabilitation Treatment in the Acute Period Acute Cerebrovascular Disorders

Based on the data of neurological examination and somatic status of 150 patients with ACVA, a plan of rehabilitation measures was drawn up for each patient. In the rehabilitation department, patients received a standard course of rehabilitation treatment for 24 days, including drug therapy and non-drug drugs. The influence of stabilization of the emotional sphere and somatic pathology (arterial hypertension, heart disease) on the prognosis of the outcome of rehabilitation in the early stages was studied. Was found. that the presence of a high level of anxiety in the emotional state of patients, an internal unresolved conflict on the one hand, and the absence of a positive psychological background significantly slow down and complicate the recovery process.

Newborns from women infected with COVID-19: somatic and metabolic status

To date, there are limited data regarding manifestations of new coronavirus infection in infants born of SARS-CoV-2 infected mothers, so the aim of this study is to investigate somatic and metabolic status of newborn infants born to mothers diagnosed with COVID-19. The investigation was carried out on the bases of Laboratory Diagnostic Department of Samara Regional Clinical Hospital named after V.D. Seredavin and the Department of Fundamental and Clinical Biochemistry with Laboratory Diagnostics of Samara State Medical University. Under observation were 85 newborns, including 35 born of healthy mothers and 50 born of COVID-19 mothers.The somatic status of all newborns was assessed using the Apgar scale at the 1st and 5th minutes after birth. Also all newborns had general and biochemical blood tests and newborns from mothers with COVID-19 were tested for the presence of SARS-CoV-2 RNA in oral and nasopharyngeal swabs. Thus, the study of somatic status revealed that of 50 neonates from women infected with COVID-19, only 18% were practically healthy, the rest had signs of prematurity, hypotrophy, perinatal CNS damage, diabetic fetopathy, pulmonary atelectasis, delayed intrauterine development, asphyxia. The metabolic state is characterised by decreased haemoglobin and platelets, increased concentration of total protein, including C-reactive protein, high transaminase activity, decreased sodium and chloride content. These parameters of general and biochemical blood tests can be considered as indicators for the evaluation of the condition of newborns from mothers with COVID-19.

Consumption of Hidden Sugars and Fats in Snacks by Adolescents

Adolescent obesity is a leading global problem in the 21st century. It is increasing due to excess snack consumption, low physical activity, not following mindful eating. Objectives of the research were (1) To study consumption of hidden sugars and fats in snacks by adolescents, (2) To conduct market survey of packaged foods and to assess hidden sugar and fat content, (3) To assess dietary pattern and somatic status of subject. Methodology followed was Purposive random sampling of adolescents both girls and boys of age 16-18 years (N=100), questionnaire was constructed and validated, general information, anthropometric measurements and dietary information was collected, data was analysed statistically. Results and findings of this study were as follows, Majority (87) respondents were non-vegetarians and consumed snacks atleast twice daily. 47 respondents skipped breakfast always. 41 percent of respondents overate when hungry due to skipping previous meal. Mean consumption of fat (26 grams) and sugar (28 grams) from snacks. Body mass index reveals that 37 respondents were in normal category, 21 respondents were underweight, waist hip ratio revealed 89 adolescents were obese. 45 respondents were involved in physical activity every day. 21 respondents binged on snacks at midnight as an effect of disturbed sleep. Skipping breakfast, increased the intake of snacks and low physical activity are contributing factors to increased BMI and abdominal obesity which leads to insulin resistance, diabetes, ischemic heart disease, high cholesterol levels and early morbidity in adulthood. There is a dire need for nutrition awareness among adolescence to make healthy food choices. Key words: adolescent, obesity, snacking, Hidden sugars, fat consumption.