Journal «MEDICINA» 2/2023

In the scientific review, elibrary.ru and the MEDLINE electronic databases were studied to form concepts about persons committing sexual delicts through the Internet. More than 100 scientific publications were identified, about 70 articles containing duplicate information were excluded from analysis. The results of the most significant studies revealing the features of this category of persons are presented. The role of the Internet is highlighted as a unique environment that predisposes to the implementation of abnormal sexual urges.

Key words: Internet, sexual disorders, virtual crimes, paraphilia, abnormal sexual behavior

The article is devoted to a study to identify factors that influence the results of a medical examination on the state of intoxication of sober drivers. A continuous study was conducted of 867 medical examination reports drawn up during the year in relation to sober drivers in one of the offices of the medical examination department for intoxication in Moscow. The socio-demographic characteristics of doctors and sober drivers examined by them were studied. Statistically significant differences were found between the conclusions about the presence or absence of intoxication and its severity among sober drivers, depending on the gender of the doctor who conducted the examination, as well as the duration of the general medical experience. An analysis was made of the relationship between the identified clinical signs of intoxication in sober drivers and the conclusions made about the severity of intoxication. The main possible causes of clinical signs of intoxication in relation to sober drivers are considered. The results of the study indicate the existence of a problem of subjective assessment by doctors of those examined as part of a medical examination for the state of intoxication.

Key words: medical examination, state of intoxication, diagnosis of intoxication, intoxication of the driver, clinical signs of intoxication, vehicle, drug

The development of new drugs is a time consuming and costly process, so the use of approved drugs for new indications (repurposing) is a promising area of development for the pharmaceutical industry. There are two main approaches for drug development: experimental and computational. Currently, due to the availability of large data sets, computational methods, including those based on the use of artificial intelligence, are being actively developed. The widespread use of genetic data in drug development and repurposing has led to the development of such a field of science as pharmacogenetics. The availability of genome-wide association analyses and transcriptome data allow the Mendelian randomization method to be applied to determine the potential for drug repurposing. This article briefly describes the Mendelian randomization method and provides examples of its application to assess the effect of drugs on various diseases.

Key words: repurposing, drugs, pharmacogenetics, Mendelian randomization

The widespread use of macrolide antibiotics in clinical practice emphasizes the need to address issues related to their safety and the possible development of adverse drug reactions (ADRs). One of the common methods of identifying ADRs through retrospective analysis of medical records is the global trigger tool (GTT) proposed in 2003. Objective. Study aimed to conduct a retrospective analysis of medical records of patients of the infectious hospital for the detection of triggers of ADRs. Material and methods. A retrospective study of medical records of 150 patients who were treated at the Infectious Clinical Hospital No.1 in 2020-2022, using the GTT was carried out. The selection of medical records to search for the triggers was performed by random sampling from the records with established diagnoses of lower respiratory tract infections (bronchitis, pneumonia) and upper respiratory tract infections (sinusitis, tonsillitis). Results. After an analysis of 150 case histories, 36 triggers and 22 cases of ADRs were identified by two independent investigators. It was found that the most frequently used antibiotic from the macrolide group was azithromycin, which was prescribed in 131 cases (87.3%). In the remaining 19 patients, erythromycin was prescribed (12.7%). Discussion. All of the identified ADRs were classified as having been temporarily detrimental to the patients’ health. Most of the detected ADRs occurred during the use of standard treatment regimens and were not preventable. Conclusion. It was found that the application of GTT in clinical practice will allow to identify implicit adverse events and simplify their search in general.

Key words: global trigger tool; adverse events; adverse drug reactions; therapy safety; macrolides

The article considers the epidemic situation of tuberculosis in the Republic of Mordovia for the period 2017-2021. The aim of the study is to analyze the epidemic situation of tuberculosis in the Republic of Mordovia. In this work, statistical data of Mordovia Statistics (territorial body of the Federal State Statistics Service for the Republic) are used. The incidence rate of active tuberculosis among the permanent resident population in the reporting year increased by 4.3% and amounted to 16.8 per 100 thousand population, 131 cases of newly detected active tuberculosis were registered. The total mortality from tuberculosis in 2021 increased by 12.5% and amounted to 1.8 per 100 thousand population or 14 cases. The detection rate of active tuberculosis by the population in 2021 increased and amounted to 42%. Preventive checks for tuberculosis in 2021 involved 610143 persons or 79.5% of the total population of the Republic. In the course of a retrospective analysis of the epidemiological situation in the Republic of Mordovia for the periods 2017-2021, positive changes were identified due to the quality of anti-epidemic measures and the level of etiological verification of pulmonary tuberculosis. At the same time, negative trends have also been identified, due to the pathomorphosis of tuberculosis of the respiratory organs at the present stage of the epidemic process, which require further studies to provide solutions.

Key words: tuberculosis, morbidity, mortality, epidemic situation, Republic of Mordovia

The non-systematic literature review describes the mechanisms by which breastfeeding prevents the development of the metabolic syndrome and socially significant diseases associated with it: obesity, diabetes type 2 and atopic diseases. One of the mechanisms of metabolic programming is the effect of breast milk on the development of the infant's intestinal microbiota. Human milk oligosaccharides can stimulate the growth of commensal bacteria. Cytokines, secretory immunoglobulins, leukocytes, lactoferrin and lysozyme can prevent colonization by pathogenic microorganisms and prevent an increase in the permeability of the intestinal barrier, the absorption of bacterial metabolic products, including lipopolysaccharide, and the development of systemic inflammation, including inflammation adipose tissue. Polyunsaturated fatty acids from breast milk prevent adipocyte hypertrophy at an early age and the development of obesity in the adults. Adiponectin prevents insulin resistance, other hormones that are part of breast milk influence the eating habits of children and prevent weight gain in adulthood. The inclusion of breast milk components in artificial mixtures has the potential to prevent the development of many socially significant diseases.

Key words: breastfeeding, human milk, metabolic syndrome, microbiota, prebiotics, probiotics

Sepsis is a topical problem in medicine, especially in the course of the epidemic of a new coronavirus infection. Sepsis is based on the reaction of the body to infection in the form of generalized inflammation. The article describes a case of septic myocarditis and septicopyemia after infection with SARS-CoV-2. Description of the case. Patient S.S., born in 1976 was treated in the infectious diseases department with a diagnosis of new coronavirus infection COVID-19, severe course. Complications of the underlying disease: Bilateral interstitial pneumonia. ARDS. Sepsis. Complaints at admission: shortness of breath; heart palpitations and irregularities in the heart rhythm. He noted an increase in body temperature up to 38.2-38.5⁰C. In connection with the deteriorating conditions, he called an ambulance and was admitted to the emergency department. Objective status: BP – 85/55 mm Hg. Heart rate – 111. Oxygen saturation – 64%. The assessment of the state on the NEWS2 scale is 11 points. Complete blood count: Leukocytes: 17.8 (3.39-8.86) 10 * 9/l, segmented neutrophils: 87% (40-68%), lymphocytes: 16% (19-37%), ESR: 69 (2-15) mm/hour. C-reactive protein (CRP): 24.5 mg/l (0-6) mg/l, Procalcitonin: 9 (0-0.064) ng/ml. CT of the chest revealed signs of bilateral viral interstitial pneumonia with a lesion area of 62%. ECG: nonspecific changes. SARS antigen – CoV-2 in swabs from the mucous membrane of the oropharynx by ICA: SARS coronavirus: detected. Despite treatment, the patient died. Sectional examination revealed signs of viral-bacterial pneumonia. In the heart – signs of acute heart failure; diffuse cellular infiltrates in the myocardium. In the spleen – plethora and leukocytosis of the red pulp. Conclusion: the patient had changes in the lungs in the form of viral-bacterial pneumonia and signs of septicopyemia with septic myocarditis and acute heart failure.

Key words: COVID-19, viral-bacterial pneumonia, sepsis, septicopyemia, septic myocarditis, septic spleen

Prostate cancer is one of the most common oncological diseases affecting men and causing an increase in the mortality rate among men worldwide. Russia has also seen a significant increase in morbidity and mortality in recent years. Currently, there is no absolutely effective method of treating prostate cancer. It is necessary to search for new economically justified methods with minor side effects or without them. The purpose of this article is to compare the methods of radiation therapy, to determine the advantages of innovative methods improving results and minimizing side effects in the treatment of patients with prostate cancer. We reviewed the current state of remote radiotherapy (EBRT/DLT) in high-risk cases, including the use of androgen deprivation therapy (ADT/ADT), the role of hypofractionation and stereotactic radiotherapy (SBRT/STLT), new data on combination therapy. An analysis of publications has shown the feasibility of combining long-term ADT and remote radiotherapy in patients with high-risk prostate cancer for maximum disease control and increased overall survival compared with treatment without this combination. Randomized data suggest that increasing the dose with LDR brachytherapy may be more effective than increasing the dose with EBRT alone. Over the past decade, advances in technology, imaging capabilities, and improved radiobiological understanding have profoundly changed radiation therapy for prostate cancer, allowing for increased dose and widespread introduction of hypofractionation. In addition, the integration of magnetic resonance imaging (MRI) and improved physical accuracy of dose delivery gave impetus to additional targeting of intra-static tumor lesions previously independent of the traditional concept of determining the target of radiation therapy.

Key words: prostate cancer, radiation therapy, low dose rate brachytherapy (LDR/HMBT), high dose rate brachytherapy (HDR/HMBT), androgen deprivation therapy (ADT/ADT), hypofractionation, stereotactic radiation therapy (SBRT/STLT), intensity modulated radiation therapy (IMRT/LTMI)