Medical Alliance

Identification of the spatial relationship between cases of aerogenically transmitted diseases in various municipalities

I. Kuznetsov — 2025-06-02

In large metropolitan areas, there are districts with a high number of reported cases of airborne diseases. The occurrence of tuberculosis, COVID-19 and pneumonia cases in the same spatially limited territories can be a marker of epidemic and social processes. The purpose of this study is to develop a comprehensive geoinformation model for the spread of three aerogenic diseases to support the quality of surveillance, and to assess the possibilities for predicting the development of the epidemic process in a megalopolis. Materials and methods. 6,111 places of residence and registration of tuberculosis patients, 33,270 cases of COVID-19 and 33,346 places of residence of patients diagnosed with pneumonia were geocoded in St. Petersburg. All spatial data were saved in GeoPackage format in the EPSG 4326 coordinate system. Statistical spatial analytics was performed using the GeoDa and NextGIS software. Absolute values have been standardized (normalization method — Z-score). The results of statistical analysis using the local Goethis-Ord and Moran index were transformed into thematic maps using NextGIS GIS. Territories (clusters) with high values of standard deviations in the number of cases of the disease and the spatial connectivity index were classified as high-risk areas of the disease, and vice versa. To assess the social characteristics of the territories, data on the price of housing were used, 1,596 advertisements for sale were analyzed: 1,049 residential apartments and 547 individual houses. As a result of the conducted research, a comprehensive geoinformation model of the spread of three diseases across the municipalities of St. Petersburg has been created. There is a positive spatial relationship between the number of cases of tuberculosis and COVID-19, and a number of territories are simultaneously located in clusters with high index values for various diseases. Statistically significant differences between the cost of apartments and residential housing in territories with high and low risk of the studied respiratory diseases indicate the existence of an economic and social nature of clustering territories by disease risk.

The effectiveness of managing hepatotoxic reactions when treating patients with anti-tuberculosis drugs

M. Pavlova — 2025-06-02

The incidence of hepatotoxic reactions on the background of chemotherapy, based on publications, varies from 5.4 tо 85.7% [1–4]. Chemotherapy is number one when treating patients with tuberculosis. Seeking new highly efficient hepatoprotective agents is one of the main tasks of treatment. Оne of such drugs had been registered in July 2007 by the Ministry of Health of the RF as a highly efficient hepatoprotector to treat chronic liver diseases; the name of the drug being polyprenols’ concentrate ROPREN which stands for Russian prenols [8]. Aim of study: raise the efficiency of managing hepatotoxic reactions in patients with lung tuberculosis by using polyprenols’ concentrate. Маterials and methods: 64 patients with lung TB had been assessed. 59 patients (90.6%) received chemotherapy with 1^st line anti-tuberculosis drugs (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol). 6 patients (9.4%) with multiple drug resistance received medications in accordance with data on M. tuberculosis drug susceptibility. While on therapy, 64 patients demonstrated the following side effects from the liver, ALT and AST increase not less than 2.5–3 times higher the upper limit of normal. All patients, depending on the hepatoprotective agents prescribed, have been divided into 2 groups: 1^st group (37 patients) received polyprenols’ concentrate 6 drops 3 times a day for a month; control group (27 patients) received Phosphogliv 1 capsule 3 times a day for a month. Mean transaminases’ increase prior to hepatoprotective therapy in the main group were as follows: АLТ 200.56±125.9 U/l, АSТ 147.68±73.8 U/l; and in control group: АLТ 209.5±102.6 U/l, АSТ 164.0±91.9 U/l, respectively. Results. 2 weeks after the start of polyprenols’ concentrate intake a significant decrease of blood biochemical values were registered: АLТ tо 77.25±47.4 U/l and АSТ tо 53.06±28.9 U/l; 1 month after the start of therapy: АLТ tо 44.88±20.7 U/l and АSТ tо 41.37±23.1 U/l. Bilirubin values stayed within the normal limits, р<0.05. In the group receiving Phosphogliv the blood biochemical values decreased as follows: 2 weeks after the start of therapy: АLТ tо 106.0±46.5 U/l and АSТ tо 71.23±33.3 U/l; 1 month after the start of therapy: АLТ tо 54.4±30.0 U/l and АSТ tо 40.41±15.6 U/l (р <0.05). Conclusion. The use of polyprenols’ concentrate leads to decrease of ALT significantly frequently compared to the control group 2 weeks after the start of therapy. By day 30 of therapy no significant difference between the groups was detected. There were no major adverse events throughout the period of drugs intake.

Дорогие коллеги!

P. Yablonskiy — 2025-06-02

Pathophysiological mechanisms of cachexia in patients with pancreatic cancer

A. Zenkevich — 2025-06-02

Unintentional weight loss in patients with pancreatic cancer is common and contributes to poor therapeutic tolerability, reduced quality of life and overall mortality. Weight loss in pancreatic adenocarcinoma may be due to anorexia, malabsorption or cachexia, exocrine or endocrine pancreatic insufficiency, or side effects of surgical and chemotherapeutic treatment. In 50–80% of patients with this nosology, there is a marked weight loss as the cancer progresses, which is one of the most alarming and difficult to treat features of pancreatic cancer. Furthermore, available treatment options for cachexia are currently limited and there is a lack of comprehensive understanding of the underlying molecular pathways associated with this condition. Thus, this review aims to provide the underlying molecular mechanisms associated with cachexia and potential therapeutic targets for the development of effective treatments for this condition.

Paroxismal of atrial fibrillation in a patient after successful left-side pneumonectomy (clinical case)

E. Senkina — 2025-06-02

Atrial fibrillation is one of the most frequent complications of pneumonectomy, reaching a frequency of 37% regardless the side of surgical intervention. This enhances respiratory and hemodynamic disorders and increases the duration of intensive care unit stay, as well as the risk of thrombosis, and prolongs the recovery period after surgery. Therefore, it is advisable to identify the main risk factors of atrial fibrillation and develop methods for prevention and long-term recovery of sinus rhythm. In our report we present a clinical case of the atrial fibrillation one day after successful left-side pneumonectomy in a 69 y.o. patient without episodes of arrhythmia before. The consistent administration of antiarrhythmic drugs of different classes resulted in a short-term effect on sinus rhythm recovery. Subsequently, the patient was directed to the radiofrequency pulmonary veins isolation, as a result of which a stable sinus rhythm was achieved.

Acidity and fluoride content in canned children’s food as factors influencing caries-resistance of children’s teeth

S. Sverdlova — 2025-06-02

Introduction. The high intensity and prevalence of dental caries in children remains a significant problem, the solution of which requires the use of complex preventive methods and an interdisciplinary approach, active interaction of dentists and pediatricians. Pediatricians, observing a child from birth, have certain opportunities in terms of correcting the regimen and composition of the child’s diet to reduce the influence of the alimentary factor, as one of the leading ones in the pathogenesis of dental caries in children. Purpose: to substantiate the need for interdisciplinary interaction between pediatricians and dentists to reduce the influence of the alimentary factor in the pathogenesis of dental caries in young children. Materials and methods. A survey of pediatricians was conducted using a questionnaire posted on the Internet (Google survey). 170 pediatricians took part in the survey. The results of a survey of 344 parents accompanying their children to preventive dental examinations at the St. Petersburg State Budgetary Healthcare Institution «City Polyclinic No. 24» and the St. Petersburg State Budgetary Healthcare Institution «City Children’s Dental Polyclinic No. 6» were used. Results. It was found that the level of knowledge of pediatricians about the etiopathogenesis of caries, cariogenic factors of baby food products, caries-protective properties of drinking water and oral hygiene is insufficient, at the same time, most pediatricians recognize the possibility of effective prevention of dental caries in children. Conclusions. In order to increase the effectiveness of preventive work and reduce the possible cariogenic effects of nutrition, close interaction between pediatricians and dentists is necessary, as well as the organization of communication between pediatricians and dentists in professional blogs and at scientific and practical conferences on issues of preventing caries in primary teeth, including early visits to the dentist, recommendations for oral hygiene, monitoring fluoride intake into the body and rational, balanced nutrition for children.

Transbronchial endosonography of mediastinal lymph nodes in the differential diagnosis of tuberculosis and other diseases

I. Zaitsev — 2025-06-02

Mediastinal lymphadenopathy poses a significant challenge in the differential diagnosis of numerous diseases, including tuberculosis. Transbronchial biopsy under endosonographic guidance (EBUS-TBNA) is a minimally invasive diagnostic method, widely recognized as a preferred approach for invasive diagnostics. However, in the Russian Federation this method is taken with caution, and videothoracoscopic biopsy is often preferred. Aim: to investigate the diagnostic value of endosonographic patterns identified during transbronchial endosonography of mediastinal lymph nodes in the differential diagnosis of tuberculous involvement. Materials and methods: a retrospective analysis was conducted on a prospectively recruited cohort of 185 patients with mediastinal lymphadenopathy who underwent EBUS-TBNA followed by videothoracoscopic biopsy for diagnostic verification. Ultrasonographic characteristics of lymph nodes, including shape, margins, echogenicity, presence of central structures, signs of necrosis, calcification, and lymph node fusion, were analyzed. An economic evaluation was performed using a cost-minimization approach to compare EBUS-TBNA and videothoracoscopic biopsy. Results. Tuberculosis of intrathoracic lymph nodes was confirmed in 23 patients (12.4%), sarcoidosis stages 1–2 in 137 (74.1%), metastatic involvement in 11 (5.9%), and lymph node hyperplasia in 11 (5.9%). Statistically significant predictors of tuberculous involvement included oval/irregular shape (p=0.009), unclear margins (p=0.012), necrosis (p=0.038), and lymph node fusion (p=0.020). The combination of these features increased the likelihood of tuberculosis by 3.1–4.8 times (positive predictive value 30.2%), with a negative predictive value of 93%. The median cost of videothoracoscopic biopsy was 123.6 c.u., compared to 72.3 c.u. for EBUS-TBNA. Conclusion. Characteristic endosonographic patterns of tuberculous mediastinal lymph node involvement were identified, serving as additional differential diagnostic criteria. The absence of these patterns reliably excludes tuberculosis. However, definitive verification requires morphological and/or molecular-genetic confirmation, which is significantly more cost-effective than initial videothoracoscopic biopsy.

Optimizing position of patellar tendon graft in anterior cruciate ligament reconstruction

P. Trachuk — 2025-06-02

ACL graft may take a non-optimal position even in correctly drilled tunnels, being one of the possible causes of residual instability. Aim: to study the possibility and evaluate the efficiency of the graft position improvement directly in the ACL footprints. Material and methods. Prospective study of 30 patients, divided in 2 equal groups, who have undergone two-incised ACL reconstruction with BTB autograft. The first group of patients received traditional surgical technique, while in the second group a cortical bony fragment from anterior tibial margin was fixed to graft to create tight contact with medial margin of tibial aperture. Graft and tunnels length parameters, interarticular distance were measured intraoperatively. Postoperative radiographs and CT, 6 months follow-up CT, and 12 months follow-up MRI were performed. Median follow-up with IKDC score was 23.5 months (Q₁=18; Q₃=25). Results. Graft axis in the first study group was more vertically with mean deviation from native ACL axis 6,2? (SD=1.8) in anteroposterior view, and 6,7? (SD=2.1) in lateral view. In the second group ax-es difference was minimal in both anteroposterior view (M=0.7?; SD=0.4) and lateral view (M=2,1?; SD=0,6). Intergroup differences were statistically significant (p <0,05). Tunnels, graft bone blocks and additional bony fragment position remained unchanged; bone healing was observed in 6 months. In the second group tibial tunnel aperture with graft lying next to medial wall had anatomical “C”-shape. Patients in both study groups had normal range of motion. There were 6 patients with “glide” and 1 with “clunk” positive pivot-shift tests in the first study group, and only one with “glide” test in the second study group (p=0.045). Conclusion. Creation of fulcrums for patellar tendon graft and its firm fixation at the ACL attachment sites promotes better anatomical and functional treatment outcomes.

The effect of the antimicrobial spacer composition on the effectiveness of the sanitizing stage of treatment of chronic periprosthetic infection caused by gram-negative bacteria

S. Bozhkova — 2025-06-02

Periprosthetic infection is one of the most serious complications after primary endoprosthetics. Infection with gram-negative bacteria is particularly difficult to treat. Aim: to conduct a comparative analysis of the clinical efficacy of the sanitizing stage of a 2-stage method for the treatment of patients with chronic PJI (hip joint) caused by gram-negative pathogens using a combination of highly dispersed silver, aztreonam and vancomycin for additional impregnation of an antimicrobial spacer. Materials and methods. The study is based on an analysis of the treatment outcomes of 44 patients with PJI caused by gram-negative bacteria, who received antimicrobial spacers of various compositions during the rehabilitation stage. In group 1 (n=17), bone cement was additionally impregnated with vancomycin and highly dispersed silver, in group 2 (n=27), aztreonam was added to the impregnation composition. The follow-up period was 6 months. The nonparametric Mann Whitney test was used to analyze the intergroup differences in quantitative parameters, and the Fisher test was used for relative indicators. The differences were considered significant at р <0.05. Results. The groups did not differ by gender or age of the patients. In group 2, a pronounced normalization of CRP was observed in the postoperative period (р <0.05). The leading pathogens in both groups were Pseudomonas aeruginosa and Klebsiella pneumoniae, which accounted for more than 75% of the pathogen spectrum. About 40% of cases were represented by polymicrobial infection. The recurrence rate of PJIs in groups 1 and 2 was 35.3% and 14.8%, respectively (p=0.115). Conclusion. The conducted study demonstrated the clinical effectiveness of using a combination of vancomycin, aztreonam and highly dispersed silver as part of bone cement and can be considered as a local etiotropic antibacterial therapy in the treatment of chronic PJI, including those caused by gram-negative pathogens and microbial associations.

Back to the question of forearm fractures in children: tradition and contemporary view (literature review)

I. Makogonov — 2025-06-02

In recent decades, the incidence of bone fractures in children has increased. Forearm bone fractures are one of the most common childhood injuries, often occurring during the period of metaphyseal growth, which coincides with puberty. For many decades, both in this country and abroad, the choice of treatment tactics for forearm bone fractures in children remains relevant and regularly becomes a subject of discussion among specialists. The aim of the study is to analyze statistics and modern trends in the epidemiology of forearm bone fractures in children and adolescents. Full-text publications of clinical studies and reviews, publicly available in the Web of Science Core Collection, Scopus; PubMed, RSCI databases, were subjected to analysis. The incidence of forearm bone fractures is 411 cases per 100,000 population per year. They are regularly observed in children, accounting for about 74% of upper limb bone fractures, are seasonal in nature and predominate in the period from May to August. They are more common at school age, and the severity correlates with the child’s age. The most common fractures in children are fractures of the distal forearm bones. The typical mechanism of injury is falling down at home or during sports’ activities. The diagnosis is made by the totality of clinical and radiological appearance. Open growth plates, high regenerative potential, and spontaneous bone remodeling in young children determine the efficiency of conservative fracture treatment tactics. Casting provides bone fusion and remodeling, which are maximum in case of fractures near the growth plate.

Preoperative imaging of thyroglossal duct cysts and branchial cleft cysts with magnetic resonance and computed tomography

I. Voydak — 2025-06-02

Background. Visualization of thyroglossal duct cysts and branchial cleft cysts at the preoperative stage of examination is important for planning the tactics and scope of surgical intervention. Purpose. To evaluate the diagnostic effectiveness of magnetic resonance imaging and computed tomography in identifying the distinctive features of thyroglossal duct cyst and branchial cleft cyst. Materials and methods. The study included data from 34 patients hospitalized in the clinic of maxillofacial surgery of the First Pavlov State Medical University of St. Petersburg with a preliminary diagnosis of a thyroglossal duct cyst or branchial cleft cyst for surgical treatment, among whom there were 23 women and 11 men. At the first stage, the patient’s complaints, the results of a physical examination were assessed, and anamnesis data studied. On the second stage we used radiological methods: computed tomography (CT) supplemented with contrast enhancement, contrast injection in the cystic cavity, and magnetic resonance imaging (MRI). At the stage of choosing treatment tactics, data from puncture biopsy and cytological examination of the punctate were analyzed. Statistical processing of data was carried out using the following techniques: Shapiro-Wilk W test, Student’s t test, Fisher’s test, in cyst size using Welch’s t test due to unequal variances when Levene’s test was used. Results. As a result of our study, among 34 (n=34; 100%) patients hospitalized with suspected сystic masses of neck, our study identified 23 (n=23; 67,6%) cases with thyroglossal duct cysts and 11 (n=11; 32,4%) with branchial cleft cysts. According to CT and MRI studies, the contents of the visualized formations corresponded to the cystic component obtained as a result of a puncture biopsy. CT visualized homogeneous formations with an X-ray density indicator corresponding to cystic (fluid) contents (10–25 HU); MRI showed high signal intensity on T2-weighted images; signal intensity on T1-weighted images depends on the protein content or hemorrhagic component. After intravenous contrast enhancement (both CT and MRI), in some cases, intense enhancement of the cyst wall was observed, which indicates infection of the cyst. Conclusions. The combined analysis of the obtained MRI and CT results makes it possible to adequately plan surgical intervention, leading to a decrease in the number of complications and relapses.