Journal «MEDICINA» 2/2024

Purpose. To determine dynamic changes of macular pigment optical density against the background of vitreal cavity tamponade with gas-air mixture and silicone oil during vitreoretinal intervention for proliferative diabetic retinopathy. Material and methods. 82 patients (82 eyes) with proliferative diabetic retinopathy were included in the study. The patients were divided into 2 groups: the first group consisted of 38 patients (38 eyes), who underwent vitrectomy with gas-air tamponade of vitreal cavity (16% hexafluoroethane C2F6, Acreole (ARCAD)), second group – 44 patients (44 eyes) with similar scope of surgery and silicone oil tamponade of vitreal cavity (5700 cSt, Oxane 10ml Syringe (Bausch&Lomb)). Control examinations with determination of macular pigment optical density were performed before treatment, 1, 3 and 6 months after vitreoretinal interventions. The observation period was 6 months. Results. In 1 month after vitreoretinal intervention in the first group of patients there was a significant increase in the optical density of macular pigment in 1.1 times, in the second group – in 1.26 times, respectively (p < 0.01 in comparison with the data before treatment). After 3 months, there was an increase of this index by 1.07 times in the first group, with its decrease by 1.02 times in patients of the 2nd group (p <0.01 compared with data 1 month after surgery). In 6 months after surgical treatment, the average macular pigment optical density increased 1.5 times in first group (p <0.01 compared with data before surgery) and was 1.09 times higher compared with the results obtained in the second study group (p<0.01). This parameter also significantly increased in second group of patients by 1.43 times (p <0.01 to the data before surgery). Conclusion. After vitreoretinal intervention, in all cases there was a significant increase average index of macular pigment optical density, regardless of the used tamponade of the vitreal cavity. However, in the group with gas-air tamponade, this parameter was significantly higher in comparison with the data obtained in the group with silicone oil tamponade, and after its removal.

Key words: macular pigment optical density, proliferative diabetic retinopathy, vitreoretinal intervention, vitreal cavity tamponade, gas-air mixture, silicone oil

For patients undergoing carbamazepine treatment, measuring its concentration in serum and urine may be appropriate to guide treatment. Objective. To validate the developed technique for the quantitative determination of carbamazepine in blood serum and urine. Materials and methods. In the work, biological fluids (blood serum and urine) were used as research objects. Quantitative determination of carbamazepine was carried out in the concentration range from 0,50 to 50,0 mcg/ml on a high-performance liquid chromatograph with diode-matrix detection (Agilent Technologies 1200) by absolute calibration method. To assess linearity, calibration graphs were constructed and the concentrations of the model mixtures were recalculated. The correctness and precision of the developed methodology was determined on the basis of sample analysis data. Results of the study and their discussion. The calibration dependences for blood serum and urine in the range of carbamazepine concentrations of 0,5 – 50,0 mcg/ml are linear. Reverse recalculation of concentrations according to the calibration schedule showed that the deviations of carbamazepine concentrations from the actual values did not exceed 15%. The limit of quantification was 0,5 mcg/ml. At validation of the method, the calculated values of the relative standard deviation do not exceed 6%, relative error – 10,2%. Specificity of the method in relation to carbamazepine was confirmed by the absence of peaks interfering with the determination of chromatograms relative to «blank» samples. Conclusion. The obtained results showed that the method of determination is sensitive, accurate, provides analytical range of measurement from 0,5 to 50,0 mcg/ml with satisfactory expressiveness of work. The technique provides a practical solution for therapeutic monitoring of carbamazepine content, determination of its concentration in forensic chemical practice.

Key words: carbamazepine, therapeutic monitoring, forensic toxicology, blood serum, urine, validation, absolute calibration

Iron deficiency conditions have many dangerous consequences, especially in childhood. The purpose of the article is to assess the diagnostic significance of some new calculated hematological parameters (low hemoglobin density) in the diagnosis of abovementioned conditions. The study was carried out on biological material from patients undergoing examination at the Rostov-on-Don Regional Clinical and Diagnostic Centre using standard hematological, biochemical and immunological techniques. The results obtained indicate the high diagnostic value of the indicator.

Key words: iron deficiency conditions, low hemoglobin density

Introduction. Studying the influence of risk factors (RF) for cardiovascular diseases (CVD) is a promising direction, since reducing their degree of influence can lead to an increase in overall life expectancy. The least studied of the RFs are confounders. Aim. To find out the influence of confounders in the chain of events of the cardiorenal continuum (CRC) using the example of a group of initially healthy 7,959 male workers of locomotive crews of the Trans-Baikal Railway aged 18-66 years. Materials and methods. Using 22 items of clinical and anamnestic data of a 6-year follow-up of a natural professional population of 7,959 men, multivariate statistical analysis was used to determine predictors of microalbuminuria (MAU), creatininemia (CR), reduced glomerular filtration rate (GFR), retinopathy (RP) and sudden cardiac death (SCD), which made it possible to construct a CRC from the prepared symptomatic blocks applying the synthesis method. The Cox proportional hazard model was used to determine the influence of all predictors of these symptoms on the increased risk of consecutive CRC events. The time of formation of MAU, RP, CR, reduced GFR, SCD, and the stages of endothelial dysfunction was found out using Kaplan-Meier (K-M) curves. The effects of damage to the endothelium by RFs, including confounders, were assessed by «failures» in K-M models. Results. Depending on the place of implementation in the CRC vascular bed, confounders manifest themselves by synergistic/additive and stabilizing processes caused by them in the endothelium. 1. They increase the risk of cardiovascular disease (CVD) / target organ damage (TOD) and the number of «failures» of the outcome being studied; 2. They increase the risk of CVD/TOD, but do not affect the number of «failures» of the outcome being studied; 3. They do not affect the increase in the risk of CVD/TOD, but increase the number of «failures» of the studied outcome; 4. They are associated with CVD/TOD, but do not affect the increase in risk and increase in the number of «failures» of the outcome being studied. Conclusion. Confounders of the CRC have four types of destructive effects. It is necessary to conduct targeted biochemical and morphological studies in order to finally clarify the processes of damage in the endothelium caused by risk factors and confounders and to resist their influence before the irreversible changes occur in the endothelial cell. 

Key words: risk factors, confounders, chronic kidney disease, continuum, sudden cardiac death, endothelial dysfunction

Introduction. Rapid changes are taking place in the illegal drug market, characterized by dominant positions of new psychoactive substances. In order to describe the structure of the consumption of narcotic drugs and other psychoactive substances in the Sverdlovsk region, it is relevant to study the data obtained during chemical-toxicological researches as part of a medical examination for intoxication, in laboratory diagnostics of acute poisoning and forensic chemical examinations. Aim of the study. Retrospective assessment of the detection of cases of use of various types of narcotic drugs, psychotropic substances and new psychoactive substances during chemical-toxicological and forensic chemical studies in the Sverdlovsk Region in 2021-2023. Materials and methods. Logical, retrospective, comparative and content analysis of data from the results of chemical and toxicological studies of the Regional Narcological Clinic (Ekaterinburg), Sverdlovsk Regional Clinical Psychiatric Hospital and Psychiatric Hospital No. 7 for 2021-2023 was carried out. Statistical processing of the results was performed using MS Excel for Windows and Statistica for Windows. Results. The leading position among the substances detected during a medical examination for intoxication is occupied by synthetic cathinones and cannabinoids. The largest number of acute poisonings is associated with the use of narcotic drugs, psychostimulating substances (α‑pyrrolidinovalerophenone and mephedrone), as well as opiates and opioids. Discussion. A retrospective analysis of the results of chemical and toxicological studies of biological fluids of drug users showed that the detectability of various compounds changes over time in the Sverdlovsk region according to data for 2021-2023. During a medical examination for intoxication and during the diagnosis of acute poisoning, «traditional» narcotic drugs are still identified in all areas of chemical and toxicological research, but at present new psychoactive substances of synthetic origin predominate in illegal circulation. Conclusion. Analysis of the results of chemical-toxicological in the Sverdlovsk region in 2021–2023 allowed us to conclude that the detection of new psychoactive substances is prevalent while the detection of «traditional» drugs is stable.

Key words: chemical-toxicological researches, narcotic drugs, new psychoactive substances

The search for new herbal diuretics with minimal risks of undesirable side effects is promising. In traditional medicine, the herb of the Alchemilla is used to treat diseases of the urinary system. The purpose of the study is to investigate the diuretic activity of the herb juice of Alchemilla. The subjects of the study were native juice of Alchemilla vulgaris fresh herb and juice of Alchemilla vulgaris fresh herb subjected to cold stimulation for 7 and 14 days. The diuretic activity of the juices was determined in white male outbred rats. The concentration of sodium and potassium electrolytes in the urine was determined by X-ray fluorescent method. Differences in the manifestation of diuretic activity of juices were identified. Diuretic activity was detected in the Alchemilla vulgaris fresh herb juice, subjected to cold stimulation for 7 days. Exposure of raw material to cold and its duration affects the manifestation of diuretic activity of juices.

Key words: diuretic activity, Alchemilla vulgaris, lady's mantle, juice, cold stimulation

The aim of the study is to conduct an analytical review of modern foreign works aimed at studying the phenomena of depression and suicidal behavior associated with somatic diseases. Materials and methods: 50 sources were analyzed. The search was carried out in specialized medical databases, namely: RusMed, Medline, PubMed, and Web of Science, eLibrary.ru, CyberLeninka and the Library of dissertations and abstracts of Russia dslib.net. Materials that dealt with the relationship between depression, suicidal behavior and somatic pathology were analyzed. Results: An attempt has been made to study the phenomena of depression and suicidal behavior in patients with somatic diseases. A significant gap was found in research on depression, suicidal behavior in patients with somatic diseases; the theoretical and methodological basis and principles of comorbidity in connection with depression and suicidal behavior have not been formed; there are no uniform standards for the management of this group of patients, as well as a lack of unified point of view on terminology and methods for diagnosing suicidal behavior in depression-associated somatic diseases, there are still unexplored questions regarding the clinical-psychological, clinical-psychopathological and clinical-dynamic features of depression, suicidal behavior in patients with a somatic profile. Conclusion: Further study of the issues of diagnosis, clinical-psychopathological and clinical-psychological features of depression and suicidal behavior, as well as therapy and evaluation of the effectiveness of preventive programs for the prevention of depressive and suicidal states associated with somatic diseases is required.

Key words: depression, suicide, somatic diseases, prevention

Background. Alcohol use affects many aspects of the functioning of the cardiovascular system. It causes an increased risk of: hypertension; pathological conditions caused by disorders of generation and conduction of electrical signals in the myocardium; cardiovascular diseases such as ischaemic and haemorrhagic strokes. Aim of the study. To study the prevalence of alcohol consumption among acutely ill cardiac patients, not requiring intensive care, hospitalized in a multidisciplinary urban clinical hospital, using screening self-questionnaires (AUDIT-4) and a highly sensitive and specific marker of chronic alcohol intoxication phosphatidylethanol (PEth). Materials and Methods. Using AUDIT-4 and PEth, we studied the prevalence of alcohol use in cardiac patients with regard to their socio-demographic characteristics. Statistical analysis was performed using IBM SPSS Statistics 25.0 software. We applied descriptive statistics and logistic regression model to estimate adjusted odds ratio for socio-demographic and diagnostic cofactors associated with alcohol abuse. Study results. PEth values in peripheral blood of 0.3 µmol/l or more, indicating excessive alcohol consumption during 2-4 weeks prior to hospitalization, were noted in 8.9% of patients. At the same time, 3.0% of patients admitted the fact of alcohol consumption during the day preceding hospitalization. The presence of only one patient with a diagnosis of alcoholic cardiomyopathy is noteworthy. Negatively associated with PEth level ≥0.3 μmol/L were patients in age group ≥71 compared with patients aged 18-40 as the reference group, (AOR 0.058; CI 95% 0.009-0.379; p<0.003) and women compared with men (AOR 0.227, CI 95% 0,113-0,445; р<0,001). There was a positive association with PEth level ≥0.3 μmol/L for patients who defined their marital status as divorced/separated compared to the reference group married/married/civil partnership (AOR 2.535; CI 95% 1.218-5.276; p=0.013). A significant positive association with a PEth level ≥0.3 μmol/L (AOR 6.668; CI 95% 2.592-17.155; p<0.001) was observed in those who admitted drinking alcoholic beverages within 24 hours before hospitalization compared with the reference group who denied it. Diagnostic groups had no statistically significant associations with the outcome variable. Conclusions. Our findings support the need for brief anti-alcohol interventions by primary care physicians, especially when diagnosing alcohol-associated conditions in cardiac patients. It seems necessary to aim internists to work more carefully with diagnoses of alcohol-associated and alcohol-attributable conditions.

Key words: alcohol consumption, AUDIT-4, phosphatidylethanol, alcoholic cardiomyopathy, alcohol-associated disease, cardiological pathology, brief intervention