Vol 24, No 2 (2023): Опубликован 27.06.2023

Cardiovascular pathology is considered one of the leading reasons for the professional unfitness of locomotive crew workers (LCW). Cardiac arrhythmias and elevated blood pressure numbers create prerequisites for the occurrence of cardiovascular catastrophes. Therefore, it seems relevant to investigate the structure of cardiovascular pathology and its pharmacotherapy in LCW from the standpoint of the safety of the use of various drugs among this group of patients. In the course of the study, a retrospective analysis of 100 medical records (machinists and their assistant) of the cardiology department of the Private healthcare institution “Clinical Hospital "Russian Railways-medicine" Voronezh" was carried out. The results obtained indicate that various specified rhythm disturbances (41%) and hypertension (30%) in LCW. Holter ECG monitoring detects various types of rhythm and conduction disturbances in almost all the examined patients (supraventricular extrasystole — in 94%, ventricular — 51%). Analysis of the lipid spectrum confirms the presence of hypercholesterolemia, dyslipidemia. Among the drugs used there are those that belong to class I or II of the list "Medicines and traffic safety", but at the time of separation of the driver / assistant driver from work, their appointment is possible. There is a tendency to replace medications at discharge with safer ones (class III).

In patients suffering from various variants of purulent-inflammatory diseases (GVZ), changes in the parameters of the immuno-metabolic spectrum are formed, which have diagnostic significance and require the appointment of certain therapy regimens. Basic treatment of diseases causes unstable positive dynamics of these indicators, which requires correction by additional prescription of the metabolite Mexidol to patients. Statistical processing of primary data indicates that laboratory spectrum indicators have correlations with immunological and metabolic indicators. This serves as confirmation of the unity of the mechanisms for the formation of antioxidant stress.

Inflammatory bowel diseases (IBD) occupy a leading position in the structure of diseases of the gastrointestinal tract (GIT), as they are a progressive chronic pathology with an autoimmune type of inflammation. Changes in indicators of genus - species biodiversity can determine morphological changes at the latent stage of the disease. Target. Evaluation of the role of genus - species biodiversity of microbiota in patients with IBD. Materials and methods. Performed 16s-rRNA sequencing of the gut microbiota in 15 patients with confirmed ulcerative colitis (UC) and 3 patients with Crohn's disease and 20 healthy controls. Also, an analysis of the parameters of the general blood test (CBC), biochemical blood test (C - reactive protein (CRP)) was carried out. Statistical data processing was carried out using Statistics programs. Results. Among the studied laboratory parameters in patients with IBD, there was a significant increase in CRP - 19.6±1.5 mg/l, leukocytosis - 11.4±0.68 g/l, including neutrophilosis - 74±2,1% according to compared with the control group. As a result of sequencing of the intestinal microbiota, there was a decrease in the normobiota, as well as an increase in the representatives of the pathogenic cluster. Conclusion. A decrease in the biodiversity of the microbiota in patients with IBD compared with the control group, a significant change in the pathogenic cluster, an imbalance in the representatives of Bacteroidetes and Firmicutes were revealed, which confirms the role of the intestinal microbiota in the development of IBD.

The clinical effectiveness of two therapy regimens of patients with one of the diseases pyoderma, adnexitis or soft tissue infection complicated by purulent processes was assessed. The first scheme provided for the use of basic therapy according to clinical recommendations, the second was supplemented by the metabolist Mexidol.

The results of analysis of pharmacotherapy of 162 patients divided into groups according to the nosological affiliation of diseases and subhorupa according to the therapy regimen were used.

It has been found that the additional prescription of Mexidol metabolic to patients to the standard significantly increases the effectiveness of complex treatment.

During the 3 years of the COVID-19 pandemic, the proportion of children, including children of the first year of life, increased in the structure of cases. The aim of the study is to study the features of COVID-19 in children of the first year of life during the period of active involvement of children of this age in the epidemic process. The article presents a comparative analysis of the clinical and laboratory features of COVID-19 in two observation groups: 49 children aged 1 month to one year and 61 children aged one to 10 years. Clinical symptoms of COVID-19 in infants in most cases are characterized by moderate catarrhal manifestations, normal or subfebrile temperature, absence of clinical signs of lower respiratory tract lesions and respiratory failure. According to CT scans of the chest organs, almost half of the children have lung tissue damage (mainly CT-1). According to the results of laboratory examination, the majority of patients (51-82%) have an increase and long-term preservation of pathological parameters of intracellular enzymes (ASAT, CPK, especially LDH) up to 2-3 norms, blood lactate, D-dimer. Thus, there is a discrepancy between the clinical manifestations of the disease and the detected laboratory parameters.

The development of a child in infancy represents a critical time window for the formation of future health due to the extraordinary plasticity at this stage of various organs and their sensitivity to nutrition and other environmental factors. Children born prematurely are a vulnerable link for many pathological conditions, while their anatomical and physiological features of metabolism are not able to fully control the internal processes of self-regulation. And while the views of many experts are focused on the development of new methods of respiratory support, one should not forget about the special need of this group of children for micronutrients. The purpose of this work was to familiarize a wide range of readers with the metabolic status and its relationship with some pathological conditions in premature newborns, depending on the substrate of enteral nutrition.

In 2020-2022, the pandemic of the novel coronavirus infection became the main medical, economic, and political concern in the world. Disregulated immune system, unbalanced cytokine production is one of the distinctive characteristics of SARS-CoV-2 influence on human organism. Immunological aspects of the infection are still understudied. The main prognostic biomarkers of the novel coronavirus infection course are Interleukin 6 and ferritin. Their role in the development of antiviral response is so far unclear. Thus, further studies of clinical, pathophysiological and immunological developmental variants of the novel coronavirus infection are currently important.

COPD is one of the leading causes of death worldwide and a serious burden on the health system. Exacerbations are a critically important feature of COPD. In GOLD (2022), a strategy was proposed for clinical practice based on «treatable traits», which include persistent dyspnea and exacerbations. Their assessment underlies the algorithm of pharmacological treatment, but there are many more pulmonary and extrapulmonary signs united by common pathogenetic mechanisms and the role of biomarkers, as well as behavioral/social risk factors that deserve individual attention and treatment. Thus, medical professionals need to take a proactive position in the search for individual «treatable traits» to reduce the risk of disease exacerbations and an unfavorable prognosis of life in COPD patients.

Purpose. To assess the clinical efficiency of using of risk prognostic model for COPD exacerbations in personalized rehabilitation programs development.

Materials and methods. 106 patients with COPD aged 18 to 80 years were examined. The examination of patients included an assessment of outpatient exacerbations and hospitalizations to medical organizations number, an assessment of COPD Assessment Test (CAT), a subjective assessment of the insomnia severity according to Insomnia Severity Index, an assessment of laboratory parameters – IL-4, IL-6, IL-8, CRP, TNF-α, surfactant protein D, melatonin in urine. Statistical data processing by STATGRAPHICS 18.

Results. In according to GOLD (2023), 90 patients (84.9%) were classified as «high risk of exacerbations» – group E. Using the original regression equation, the probability index of COPD exacerbation during 1 year of follow-up was calculated, which turned out to be high, i.e. 2 or more exacerbations of COPD were predicted during 1 year of follow-up (Prog_ex_COPD = 8,2183±1,13). As a prevention of possible COPD exacerbations, individual rehabilitation programs were applied during 1 year of follow-up: modification of therapy, personalized programs to optimize physical activity, vaccination against influenza and pneumococcal infection, course intake of melatonin. After 1 year of follow-up, the analysis of the assessed indicators in patients with COPD showed a significant positive trend (p˂0.05). The calculation of Prog_ex_COPD according to the original regression equation showed a low risk of COPD exacerbations with the number of exacerbations less than 2 times a year and was 3.6235±1.24.

Conclusions. The developed risk prognostic model for COPD exacerbations has shown clinical efficacy and can be used in the management of COPD patients with frequent exacerbations. The addition of melatonin improves the quality of sleep, which has a positive effect on reducing the symptoms and exacerbations of COPD. For COPD patients with frequent exacerbations, it is advisable to develop individual rehabilitation programs to improve control, taking into account «treatable traits».