HORMONE LEVEL CHANGES IN ENDOMETRIAL ABNORMALITIES IN THE POSTMENOPAUSAL PERIOD

Background. In recent decades, the increase in life expectancy has led to a significant increase in the duration of the postmenopausal period. Prolonged estrogen deficiency contributes to an increase in the incidence of chronic somatic diseases, including neurovegetative, metabolic-endocrine, and psycho-emotional disorders that define the menopausal syndrome. Aim. To study the prognostic and diagnostic significance of hormone parameters in endometrial abnormalities in the postmenopausal period. Material and methods. Forty-seven women with various clinical manifestations of endometrial pathology in the postmenopausal period were examined. The mean age of the examined women was (58,43±1,1) years. All the patients had luteinizing hormone, follicle-stimulating hormone, progesterone, testosterone, estradiol, dehydroepiandrosterone sulfate, and serum sex hormone-binding globulin measured by enzyme immunoassay. The results obtained were subjected to statistical processing using standard computer programs «Statgraph» designed for parametric and nonparametric methods of calculating mean values. We calculated mean and standard deviation (M±Se), as well as minimum-maximum values for the sample. Differences were considered significant at p<0,05. Results and discussion. As a result of the study the abnormality of the endometrium in the postmenopausal period was determined. Endometritis was observed in 4 (8,5%) of 47 patients, atrophic endometrium in 7 (14,9%) patients, diffuse endometrial hyperplasia in 3 (6,4%) cases, endometrial polyp in 29 (61,7%) cases, and endometrial carcinoma in 3 (6,4%) cases. A significant increase in follicle-stimulating hormone [(65,39±1,27) mmE/ mL], luteinizing hormone [(34,85±0,15] mmE/mL), estradiol [(88,73±2,1) pg/mL], and testosterone [(2,29±0,08) ng/mL] values was registered in the postmenopausal patients, which is an important prognostic and diagnostic criterion in this patient population. Conclusion. The study of hormone parameters in the postmenopausal period is one of the most important methods of early detection of various endometrial abnormalities, allowing timely implementation of appropriate therapeutic and preventive measures.

PREVALENCE AND RISK FACTORS FOR ISCHEMIC STROKE IN LAW ENFORCEMENT OFFICERS

Background. Stroke is the second leading cause of death worldwide and the third leading cause of long-term disability in adults. In law enforcement officers, stress may contribute to the development of cardiovascular disease, exacerbating a number of stroke risk factors. Aim. Study of prevalence and identification of leading risk factors for ischemic stroke in law enforcement workers. Material and methods. A retrospective analysis of case records of patients diagnosed with atrial fibrillation, acute insufficiency of cerebral circulation and transient ischemic attack who received treatment in the Republican Hospital of the Ministry of Internal Affairs of Azerbaijan from 2016 to 2020 (n=1864) was performed. Of these, 225 case records of patients with a concomitant diagnosis of ischemic stroke [(12,07±2,2)%] were selected. We studied such pathological conditions as transient ischemic attack, hypertensive cerebral crisis and chronic forms of cerebrovascular disease as risk factors for stroke. Results and discussion. We found that there were 81 [(36,0±3,2)%] cases of cerebrovascular disease among the 225 examinees, including 64 [(28,44±2,9)%] established and 17 [(7,56±3,6)%] probable cases of cerebrovascular disease. Acute forms of cerebrovascular disease often occurred together with chronic forms. (6,98±3,2)% of patients aged 40–54 years (n=129) and (17,70±3,9)% of patients aged 55–65 years (n=96) had discirculatory encephalopathy. There was a total of 6 cases of transient ischemic attack [(2,67±1,4)%] in the patients examined, of which 2 cases [(0,89±1,2)%] were «definite» and 4 cases [(1,78±0,9)%] were «possible». The overall prevalence of transient ischemic attack in patients was (2,67±1,4)%. In 75,0% of the cases detected, transient ischemic attacks were registered predominantly once. Out of the total number of all detected cases of transient ischemic attack, 4 (66,67%) cases were registered for the first time upon history taking. Arterial hypertension was registered in 198 of 225 [(88,0±2,1)%] patients examined. Hypertensive crisis during ischemic stroke was detected in 14 of 225 patients (6,22% of all patients examined) and in (17,68±2,7)% of patients with arterial hypertension (34 patients). Additionally, there were 15 [(6,67±3,83)%] cases of hypertensive cerebral crisis: 5 (2,22%) established cases of hypertensive cerebral crisis and 10 [(4,44±2,80)%] «possible» cases. Conclusion. A comprehensive study of the clinical features, course, and complications of ischemic stroke will allow us to develop new approaches to solve the urgent research problem, which is the management strategy to be applied to patients in the acute period of ischemic stroke.

HEART RATE TURBULENCE INDICATORS IN CLINICAL PRACTICE

Background. Heart disease is the leading cause of death in developed countries. Approximately half of these fatalities are due to sudden cardiac death. Electrocardiogram recording from the body surface allows stratification of patients according to the risk of cardiac arrest without the use of invasive methods. Arrhythmias, particularly ventricular extrasystole, can affect the sinus rhythm pattern. The change in sinus rhythm that occurs after an extrasystole is defined as heart rate turbulence. This phenomenon is not pathological, but some variants are associated with a risk of fatal arrhythmias. Aim. To analyze the indices and clinical significance of cardiac rhythm turbulence according to Holter monitoring in patients with various cardiological abnormalities at the hospital profile department. Material and methods. The study included 54 patients who were routinely treated in a cardiac hospital. Cardiac rhythm turbulence indices were obtained by Holter monitoring. Patients in severe and moderately severe clinical condition were not included in the study. Concomitant and past somatic diseases affecting the state of heart and cardiovascular system were considered. Results and discussion. Deviations in heart rhythm turbulence indices can be detected both in life- threatening arrhythmias and in benign extrasystoles. They are associated with the influence of the autonomic nervous system, but probably have different mechanisms. Deviations of heart rhythm turbulence indices were associated with left ventricular myocardial hypertrophy of concentric remodeling type and with an increased number of low-risk ventricular extrasystoles. To identify patients with arrhythmias of different risk, various threshold values of cardiac rhythm turbulence indices can be used. Conclusion. Factors likely to affect the indices of cardiac rhythm turbulence such as left ventricular myocardial remodeling and hypertrophy were revealed, as well as changes in autonomic nervous system regulatory function, including those associated with the constitutional features of the patient.

ANALYSIS OF THE SPECIFIC FEATURES OF THE USE OF PHYSIOTHERAPEUTIC METHODS IN PATIENTS WHO UNDERWENT ARTHROSCOPIC OPERATIONS ON THE KNEE JOINT IN 2018–2019 AT THE MEDICAL UNIT OF THE MINISTRY OF INTERNAL AFFAIRS OF RUSSIA IN THE REPUBLIC OF TATARSTAN

Background. Diseases of the musculoskeletal system are the most common cause of disability in the modern world, and the prevalence of these diseases is increasing at an alarming rate. Currently, various types of arthroscopic operations on the knee joint are performed – for meniscus damage (including meniscus suture), instability of the knee joint, damage to the cruciate complex, articular cartilage, patellar instability, free joint bodies, pathological folds, synovitis, knee arthrosis, and rheumatoid arthritis. Medical rehabilitation after arthroscopic surgery traditionally includes administration of nonsteroidal anti-inflammatory drugs, opioids, local anesthetics, therapeutic exercise using isometric active exercises, hydrokinesis therapy, and various physical therapy methods. Aim. Study of the use of physiotherapeutic methods in the treatment of patients who underwent atroscopic surgery on the knee joint in the physiotherapy department at the Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2018–2019. Material and methods. The frequency of prescription of therapeutic physical factors for patients who underwent arthroscopic surgeries on the knee joint at the physiotherapy department at the Medical Unit of Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2018–2019 was investigated. The patients were accordingly divided into two groups: in 2018, 37 patients were prescribed physiotherapeutic procedures, in 2019 there were 48 patients. The age of the patients in 2018 was (33,9±9,4) years, in 2019 it was (34,2±9,1) years. Statistica 6 software package by StatSoft was used for statistical processing. Differences were considered statistically significant at p<0,05. Results and discussion. Paraffin therapy, treatment using Nuga-Best bed, amplipulse therapy, UHF therapy, cryotherapy, oxygen cocktails containing medicinal herbs were prescribed with less frequency in the treatment of patients operated for knee joint injuries in 2018 than in 2019. Despite the proven effectiveness of whirlpool baths and darsonvalization in treating musculoskeletal disorders were not prescribed for the rehabilitation of patients who underwent atroscopic surgeries at the physiotherapy department of Medical Unit of Ministry of Internal Affairs of Russia for the Republic of Tatarstan Clinical Hospital in 2019. Conclusion. When rehabilitating patients who have undergone arthroscopic intervention on the knee joint, it is advisable to thoroughly consider the use of therapeutic physical factors to improve the operation of the physiotherapy department.

MINIMAL CHANGE DISEASE IN THERAPEUTIC PRACTICE

The disease of minimal changes occurs in 10–15% of adult patients with idiopathic nephrotic syndrome, it often has a relapsing course. Glucocorticoids are effective in achieving remission, but in some patients steroid resistance and progressive course of the disease are observed. Recent studies have investigated the mechanismsof minimal change disease development for the purpose of estimating the prognosis of the disease and the efficacy of immunosuppressive therapy. Aim. The aim of the present study was to review current data on the diagnosis, pathogenetic therapy of minimal change disease, and to demonstrate the clinical case of a relapsed disease in steroid resistant patient. Material and methods. A review of original research in the foreign and domestic literature on the subject over the past 5 years was conducted. Results and discussion. Minimal change disease is clinically manifested by rapid, almost sudden development of nephrotic syndrome (proteinuria, hypoalbuminemia, marked hypercholesterolemia, and massive generalized edema). Arterial hypertension and microhematuria occur occasionally. Glucocorticoids are being prescribed to achieve early remission even before morphological verification of the diagnosis. The course of the disease is mostly benign. The majority of patients with steroid sensitivity have long-term preserved renal function, while steroid resistance is associated with a progressive course leading to terminal renal failure. The presented clinical case is interesting because the unfolded picture of the disease of minimal changes including severe nephrotic syndrome and steroid-resistance, appeared in the patient a year after the disease debut. After receiving combined immunosuppressive therapy for 16 weeks incomplete remission was achieved. Conclusion. Unfortunately, at present, there are no available reliable methods to predict the development of steroid resistance and there are no effective therapies guaranteeing the achievement of remission in such cases.

COVID-19 OUTCOMES: DRUG TREATMENT OPTIONS

Background. Since December 2019 there has been a rapid spread of the COVID-19 pandemic across most of the world. This has determined the enormous burden on the global economy. The burden of the new coronavirus infection is determined not only by the costs directly related to the treatment of the acute phase of the disease, but also by the successful rehabilitation of patients after COVID-19, risk reduction and timely management of adverse outcomes for optimal patient recovery. Aim. The aim of the study was to analyze the adverse outcomes of COVID-19 and to estimate the possibility of their correction and prevention. Material and methods. We analyzed the PubMed database for 2020–2021 using the keywords «COVID-19, pulmonary outcomes and treatment», as well as the online meetings of chief pulmonologists of the Volga Federal District (VFD) in April 2021, where we heard about the regional experience in prevention and correction of COVID-19 adverse outcomes. Results and discussion. More and more publications are appearing on the so-called «postdrome» after COVID-19. Postdrome problems are becoming increasingly important as more and more treated patients are discharged from hospitals. To date, there are already over 103 million COVID-19 survivors. In patients with severe or critical manifestations of the disease, widespread and progressive endothelial thrombosis with diffuse microvascular thrombosis is increasingly evident as the final stage of the proinflammatory cytokine storm. Adequate anticoagulant therapy primarily using heparins with direct antiviral activity, preventing venous thromboembolism, being used for pulmonary thrombosis, is relevant in the prevention of adverse outcomes. Many authors note long-lasting residual changes on lung CT after the acute phase of COVID-19. At the same time, unlike post-inflammatory pneumosclerosis in the outcome of bacterial pneumonias, these changes can often regress within 6–12 months after a viral infection. Along with the effects of optimal anticoagulant therapy in the prevention of adverse COVID-19 outcomes, the available literature discusses the possibility of different regimens of glucocorticosteroid therapy. At the expert council of pulmonology specialists of the Volga Federal District the regional experience of using a domestic drug bovgialuronidase azoximer (Longidase) with official indications for treatment of fibrosis was covered in the therapeutic complex of patients with severe forms of COVID-19. Conclusion. Accumulating the evidence base of different ways of prevention and correction of residual changes in COVID-19 patients, which significantly deteriorate patients’ ability to work as well as their quality of life, can be considered one of the main priorities of modern COVID-19 medicine.

COMPARISON OF THE STATE OF THE MAXILLARY SINUSES IN A NEW CORONAVIRUS INFECTION COVID-19 AND ACUTE RESPIRATORY VIRAL INFECTION

The aim of the study was to identify possible changes in the maxillary sinuses during new coronavirus infection in comparison with the changes in the sinuses occurring during acute respiratory infections and to correlate the gender structure of the study groups. Material and methods. The study included 40 patients (18 women and 22 men) with a confirmed new coronavirus infection, hospitalized at the Covid Hospital Clinics of Samara State Medical University in 2020. All patients underwent multispiral computed tomography of the paranasal sinuses on a Ge revolution Evo 128 tomograph on the 10th day after the appearance of the first clinical symptoms. We also examined a control group of patients with acute respiratory infections with similar complaints of impaired sense of smell, rhinorrhea, and upper maxillary sinus discomfort. This group also included 40 people (24 women and 16 men). Statistical processing of the study results was performed using Microsoft Excel software package, the Mann – Whitney method of statistical significance calculation was used. Results and discussions. In 18 (45%) patients with a confirmed new coronavirus infection, a slight mucosal thickening along the lower wall of the maxillary sinuses was found symmetrically on both sides. Six (15%) of them were women and 12 (30%) were men. The age of the examined patients ranged from 31 to 83 years. Chronic sinusitis was noted in the history of 8 (20%) of the examined patients. In 6 (15%) patients with chronic sinusitis no abnormalities were detected in the maxillary sinuses at the time of examination. Two of them had parietal thickening of the mucous membrane along the lower wall of the maxillary sinuses. In the control group, there was significant symmetric parietal thickening of the mucous membrane of the paranasal sinuses in 24 (60%) examined patients (14 women and 10 men). There were no statistically significant differences in the prevalence of changes in the studied and control groups. Conclusion. According to the results of this study, there were no data on the pattern of occurrence of changes in the mucosa of the maxillary sinuses in new coronavirus infection with gender background or the presence of chronic inflammation of the maxillary sinuses in the history compared with the control group of examined patients after acute respiratory infections.

DEPARTMENTAL MEDICAL SERVICE OF THE MINISTRY OF INTERNAL AFFAIRS OF THE RUSSIAN FEDERATION IS 100 YEARS OLD

The article reflects the historical aspects of the development of the medical service of the Ministry of Internal Affairs of the Republic of Tatarstan. The operation of the unit, including the functioning of all subdivisions, is described. The organization of activities on medical service provision at large-scale sporting events of international level is disclosed. The strategic goals of the institution and directions for increasing the quality and availability of medical care in the near future are determined. The article also gives a set of preventive measures taken by the medical unit in the fight against a new coronavirus infection.

THE INFORMATIVE VALUE OF PELVIC ULTRASONOGRAPHY IN RECURRENT EXTERNAL GENITAL ENDOMETRIOSIS

Background. In the structure of gynecological diseases, endometriosis ranks II after inflammatory diseases of the genitals and uterine myoma. The incidence of genital endometriosis is 92–94%, with an annual incidence ranging from 0,1% to 0,3%. The disease is characterized by tumor-like type of growth, affection of adjacent organs, and severe complications that lead to disability in patients. Aim. To study the informative value of ultrasound examination of the reproductive system organs in recurrent external genital endometriosis. Material and methods. Forty-eight patients with recurrent external genital endometriosis were examined. The mean age of the patients was (34,96±1,1) years. The history of endometriosis was in the range of (10,0±1,41) years (9–11). Recurrence rate averaged (2,02±0,44) years (1–4). The duration of remission averaged (6,1±0,84) years (1–15). All the patients underwent ultrasound examination with a transvaginal transducer. The length, width, anteroposterior uterine size, M-echo, and length and width of both ovaries were determined. Echographic features of endometrioid ovarian cysts and retrocervical endometrioid infiltrate were evaluated during ultrasound examination. The findings were compared with the echographic findings in women (n=20) with no history of endometriosis (comparison group). Results and discussion. Transvaginal ultrasonography in recurrent external genital endometriosis showed a significant increase in the echographic dimensions of uterine length (54,3±0,41) mm, width (47,9±0,13) mm, anteroposterior dimension (56,1±0,18) mm, endometrial thickness (6,6±0,09) mm, and increased echographic dimensions of both ovaries (p<0,05). Transvaginal ultrasound examination is informative in the diagnosis of endometrioid ovarian cysts. In 75,6% of patients, it manifests as a fluid mass with a heterogeneous suspension. In 75% of patients, retrocervical endometrioid infiltrate manifests as a heterogeneous, hypoechogenic, painful mass located behind the uterus. Conclusion. Transvaginal ultrasound is informative in the diagnosis of endometrioid ovarian cysts. Echographic diagnosis of endometrioid infiltrates of the vesicoureteral peritoneal fold, sacroiliac, broad uterine ligaments, and pelvic peritoneum presents difficulties, which justifies the necessity of laparoscopic diagnosis.

DEVELOPMENT OF ANTIBIOTIC RESISTANCE IN THE ASPECT OF OUTPATIENT SERVICES

Background. Antibiotic resistance is a worldwide problem that is the main cause of the increase in the number of purulent-inflammatory diseases and postsurgical complications. Aim. The aim of the present study was to monitor antibiotic resistance of microorganisms isolated in the course of microbiological study in otorhinolaryngological and surgical patients of the outpatient department of a single preventive health institution. Material and methods. A statistical analysis of the results of microbiological studies, excretions of patients undergoing outpatient treatment in surgical and otorhinolaryngological departments of outpatient clinic No1 of the state budget institution «City Clinical Hospital No 7» of Tver is presented. We processed 280 findings of microbiological studies of ear, nose, pharynx and wound surface cultures for 2019. Results and discussion. It was found that the spectrum of dominant microorganism species in 2019 detected during swabbing of surgical and otorhinolaryngological patients treated in the outpatient clinic included gram-negative Escherichia coli and Klebsiella pneumonia and gram-positive Staphylococcus aureus and Streptococcus pyogenes microorganisms. Among the microorganisms presented, strains with multiple resistance to the action of antimicrobial drugs were identified. According to the total number of resistant microorganisms it was found that among antibacterial drugs, antibiotics of Aminopenicillin class, including those protected by protease inhibitors, as well as fluoroquinolones of the 2nd generation have the lowest clinical efficacy in the given medical institution. Conclusion. The findings of the present study indicate a rapid rate of spread of resistance genes among nosocomial strains of microorganisms, which necessitates continuous monitoring of antibiotic sensitivity by various specific laboratory methods. The results of laboratory studies should be used when prescribing antibiotic therapy for a particular patient, and the results of this study should be considered when selecting an empirical antibiotic, since they reflect the resistance of the most common pathogens. Key words: antibiotic resistance, antibiotics, cephalosporins, fluoroquinolones.