Journal «MEDICINA» 1/2021

To date, there is no doubt that the study of the features of vascularization of choroidal melanoma using modern methods of instrumental diagnostics is not only of diagnostic value, but also determines the choice of treatment tactics and allows predicting the course of the tumor process. Purpose. To study the diagnostic capabilities of various research methods in visualization of the neovascular network of small and medium-sized choroidal melanoma. Material and methods. 5 patients (45 eyes) with choroidal melanoma (19 men, 26 women), aged 22 to 84 (56.03 ±15.29) years, underwent complex diagnostics using various methods of studying the blood supply to the tumor: ultrasound in the color Doppler mode mapping, indocyanine green angiography and spectral optical coherence tomography-angiography. Results. The different diagnostic significance of instrumental methods for the identification of neovascular vasculature in «small» and «medium» choroidal melanomas was established: indocyanine green angiography – 89%, OCT angiography – 71%, ultrasound – 77%. In case of «small» choroidal melanomas, indocyanine green angiography (83%) and OCT angiography (79%) are highly diagnostic in detecting tumor blood supply, while the first type of angioarchitectonics of the neovascular bed was diagnosed with a significantly higher frequency. In case of «medium» melanoma of the choroid, the informative value of angiography with indocyanine green and ultrasound examination was highly significant and made it possible to diagnose the vascular network in all the cases studied. Choroidal melanomas of these sizes are characterized by the presence of predominantly the second type of angioarchitectonics (81%), in which the hypervascular nature of blood flow was significantly more often determined. Conclusion. The results of this study demonstrate that the use of an integrated diagnostic approach provides a high diagnostic value in the study of blood supply to choroidal melanoma, which determines the prospects for continuing this study with the aim of a detailed study of the angioarchitectonics of choroidal melanoma.

Key words: choroidal melanoma, Doppler ultrasound imaging, ultrasound in ophthalmology, ophthalmic oncology, blood supply to choroidal melanoma, angioarchitectonics of choroidal melanoma, indocyanine green angiography, optical coherence tomography angiography

Currently, home monitoring of patients' health with delayed consultations is becoming one of the main methods of telemedicine. However, the lack of scientific research prevents the widespread introduction of home health monitoring into health care practice. The paper analyzes the inclusion of home health monitoring of patients suffering from chronic diseases, functional disorders and other conditions in the existing health care system. A case with a delayed doctor's consultation is considered. The mathematical modeling of monitoring was carried out considering the periodicity of observations. It is shown that the more reliable home monitoring detects critical conditions and the smaller the proportion of conditions not detected by it, the less often stationary observations are required. Accordingly, with the same expenses for clinical examination, the quality of examinations can be significantly improved. Methods for calculating the period between observations for a given probability of missing life-threatening conditions are proposed.

Key words: home monitoring, telemonitoring, delayed mode, mathematical modeling, probability of critical condition, observation period

The article presents new laser technology in the treatment of glaucoma using a Micro-Pulse laser. It describes the technique, optimal energy regimes, differential indications, contraindications, timing of laser intervention, effectiveness of treatment, and possible complications. It also compares a number of advantages, alternatives and safety of this method in comparison with other traditional laser cyclodestructive interventions. It essentially concludes that this technology is highly effective and safe in the treatment of primary open-angle glaucoma at various stages and refractory forms of glaucoma is based on date of clinical and morphological studies described in literature. This work also advocates further extended study of microimpulse transscleral cyclophotocoagulation in the treatment of combined glaucoma and other forms of ocular pathology as well as further extended study of microimpulse transscleral cyclophotocoagulation in the treatment of glaucoma-associated pathology and other eye diseases.

Key words: glaucoma, refractory glaucoma, cyclodestructive procedures, micropulse transscleral cyclophotocoagulation

The Russian clinical guidelines «Arterial hypertension in adults» (2020) contain a statement according to which elderly (≥65 years) patients should be screened for frailty using «Vozrast ne pomeha» (verbatim – «Age is not a hindrance») questionnaire, since the identification of frailty can affect drug treatment strategy and level of target blood pressure. The paper presents a critical analysis of this statement, which shows that recommendation to use «Vozrast ne pomeha» questionnaire for frailty screening is insufficiently evidence based and does not fully take into account the problem of geriatric care availability.

Key words: frailty, senile asthenia syndrome, elderly, arterial hypertension, screening

Introduction. In the absence of preventive vaccinations against the varicella-zoster virus in the National Vaccinations calendar, in recent years, Russia has experienced an epidemic rise in the incidence of varicella-zoster as an unmanageable infection It takes the leading place among drip infections and causes significant socio-economic damage. High morbidity, the likelihood of severe and complicated course dictates the need for mandatory specific active prevention. Purpose: To assess the incidence of chickenpox, requiring a call to the local pediatrician, in children and adolescents aged 0-17 years for 12 months in Barnaul. Materials and methods. Materials of the study were data from a predetermined log cases of chickenpox and of the extract from the ambulatory record filled on the basis of «Medical record of the patient receiving care in the polyclinic setting» (form 025/y), in Children's city polyclinic № 3, Barnaul and Children's city polyclinic № 9, Barnaul for 1 year period (July 2019-June 2020), medical archive documentation of the children's infectious diseases Department of the City clinical hospital No. 11, Barnaul for the same period. Data processing was performed using the calculation of intensive and extensive indicators, calculating the arithmetic mean (X) and standard error of the mean (m). Statistical analysis was performed using Microsoft Excel. Results. Morbidity rates at the primary health care stage are high 720.8⁰/0000. The incidence of chickenpox was characterized by an unusual season of epidemic upswing associated with the spread of COVID-19 and the emergence of new foci of chickenpox in pre-school educational facilities and schools. The age structure of morbidity was dominated by children aged 3-6 years; girls were more often ill. The disease was characterized by a classic clinical picture, but it was severe. There was an increase in complications of chickenpox and the frequency of hospitalization. Conclusions. The increase in the incidence of chickenpox is manifested by a broad clinical polymorphism of the disease, with the appearance of extremely severe forms and an increase in the frequency of hospitalization, which leads to a high burden on the primary health care system.

Key words: chicken pox, epidemiology, polyclinic, primary health care

A brief historical overview of visual acuity measurement methods is presented. The main methods of visual acuity data notation, formulas for translating data from one notation to another are analyzed. The problem of non-linearity of these transformations is highlighted, prohibiting direct comparison of similar studies, in case the statistical analysis was carried out in different notations. Decimal notation is traditionally used in the Russian school of ophthalmology, while logarithmic notation prevail in most of English-language publications. This fact prevents an adequate comparison of results in Russian and foreign studies.

Key words: visual acuity, ETDRS, decimal scale, logarithmic scale

The objective is to standardize the content of β-carotene – one of the principal active substances with sufficient hypolipidemic activity in the resultant original product. Search for natural biologically active substances having a hypolipidemic effect is one of the topical questions in modern pharmacy. Most of the research is carried out by means of isolating individual substances from the plant object. We propose to study a native phytocomplex obtained from pumpkin pulp – a dry extract of pumpkin pulp juice. The following materials and methods were used: laboratory-obtained dry extract of pumpkin pulp juice and methods used to determine the qualitative and quantitative content of β-carotene in an individual substance. It was possible to adapt the methods applied to the analysis of an individual substance in relation to the resulting phytocomplex containing both lipophilic and hydrophilic fractions. The rapid method of quantitative determination of β-carotene described in the scientific literature was corrected. An effective alternative method for spectrophotometric determination of β-carotene in the phytocomplex has been developed. Phytocomplexes standardized for the main active substances can be used to obtain effective drugs and biologically active additives with minimal side effects. In addition, the expansion of the search for alternative natural objects containing complexes haaving a hypolipidemic effect is currently relevant. Based on the literature data, in the future it is planned to conduct a pharmacological study to establish the anti-inflammatory effect of the resulting complex on the state of the vascular wall.

Key words: isolation and individualization, native phytocomplex, standardization of the active substance, special system of solvents, spectrophotometer

This article is a continuation of a series of studies on the optimization of techniques and methods of surgical operations for hernias of the esophageal aperture of the diaphragm and is based on the use of the author’s development of a model of a two-layer biocarbon mesh implant. The purpose of this study is to highlight the immediate and long-term results of using a double-layer biocarbon mesh implant in comparison with the standard method of using a polypropylene implant when operating patients with large and giant hiatal hernia. All patients were split into 2 research groups that underwent alloplasty with various implants: Group I of 221 patients who underwent alloplasty with a polypropylene mesh implant (171 patients with large hernias of 10-20 cm²) and 50 patients with giant hernias of the esophageal orifice with the area of the hernial defect exceeding 20 cm²); Group II of 79 patients who underwent an original alloplasty with a bi-layer biocarbon mesh implant (50 patients with large hernias and 29 patients with giant hernia of the esophageal orifice). Postoperative complications were classified according to the Clavien-Dindo scale. De Meester index was used as a comparison criterion. The article discusses the results of operations of 300 patients for large and giant hernias of the esophageal aperture of the diaphragm, of which 79 were operated on using a prototype biocarbon double-layer mesh implant according to the author's patent. The paper presents immediate and long-term results. The results of surgical treatment are pilot and representative, which determine the further tactics and direction of improving operations to remove large and giant hernias of the esophageal opening of the diaphragm. For the first time, data on the use of the author's development of a bi-layer biocarbon mesh implant are presented and compared with a polypropylene mesh implant during an «on-line» plastic repair of large and giant hiatal hernia. Significant differences were obtained in relapses of all types in favor of a biocarbon mesh implant (5,6 versus 22,8%; p < 0,0001; Fisher's exact test).

Key words: large hernias of the esophageal aperture of the diaphragm, giant hernias of the esophageal aperture of the diaphragm, alloplasty, «onlay» plastic, biocarbon double-layer mesh implant, polypropylene mesh implant, surgery technique

Introduction: analytical study of issues related to thromboembolic complications in surgical diseases, as well as the possibilities of modern tests, methods and technologies to clarify diagnostic and therapeutic-preventive tactics. Objective of research is to perform a brief analytical review of some of the causes of thromboembolic complications and modern methods of diagnosing them. Methods of research: A critical analysis of the data of scientific works of Russian and foreign authors published in the period 1992-2018 concerning the issues of optimization of diagnostic and therapeutic tactics for thromboembolic complications. Results of research: The main problems and causes of thromboembolic complications in surgical diseases have been identified, and the capabilities of modern tests, methods and technologies have been assessed, indicating the direction for further work. Conclusion: The perspectives of targeting research of problems of diagnostics and treatment of thromboembolic complications in surgical practice were outlined.

Key words: thromboembolic complications, causes, methods of diagnosis

Diabetic ketoacidosis is a frequent complication of type 1 diabetes mellitus in children and adolescents. One of the leading causes of death in this pathology is cerebral edema. This complication is often asymptomatic, which makes it difficult to diagnose. The main risk factors for cerebral edema in children include the true factors (low partial pressure of carbon dioxide, high blood urea nitrogen, concomitant psychiatric pathology, etc.) and iatrogenic factors (large volume of infusion therapy, rapid decrease in blood glucose levels, administration of bicarbonate, etc.). The pathophysiology of this complication is not yet fully understood. The main pathophysiological elements of cerebral edema in children with DKA include the disruption of blood-brain barrier permeability, edema of brain cells, and dysfunction of cell membranes. Important roles are also played by hypercapnia and reduction of osmotic pressure. Based on the character of pathophysiologic changes, cerebral edema in children and adolescents with DKA is subdivided into vasogenic and cytotoxic. Gaining a better understanding of the pathophysiological mechanisms of this complication will increase the quality of care provided in pediatric practice.

Key words: diabetes mellitus, diabetic ketoacidosis, cerebral edema, children and adolescents