Vol 41, No 6 (2024)

Objective. To determine the risk factors for the development of new coronavirus infection (NCVI) in patients with hypertension (AH) and to assess the condition of target organs depending on the course of NCVI.

Materials and methods. A screening clinical observational comparative study is presented. For a 2-year period 186 patients with a history of AH or with a first-time BP increase who consulted a general practitioner in an outpatient department were sequentially included into the study in accordance with the inclusion and non-inclusion criteria. The patients were divided into two groups depending on the presence of NCVI: the first group consisted of 100 patients with AH or first-onset AH who had had NCVI; the second group contained 86 patients with AH or first-time AH without a history of NCVI. All patients with AHunderwent a comprehensive routine clinical examination with an assessment of target organ damage in accordance with clinical guidelines within 14 days after visiting the polyclinic with an assessment of the data of the outpatient card and other medical documents to register concomitant diseases and conditions, as well as the features of the course of NCVI.

Results. Vaccination against NCVI in patients with AH reduces the relative risk (RR) of the development not only of NCVI by 87 %, but NCVI-pneumonia with hospitalization and prolonged post-COVID syndrome as well. It has been proved that obesity with a body mass index of > 30 g/m², atherosclerosis of any localization, type 2 diabetes mellitus increase the RR of the development of various forms of NCVI, including a prolonged course of more than 12 weeks. Newly diagnosed chronic heart failure (CHF), verified not only by clinical symptoms, but also by echocardiography and N-terminal fragment of brain natriuretic propeptide (Nt-proBNP) concentration in the blood, increases the RR of the development of NCVI by 48.2 %, NCVI- pneumonia with hospitalization, and the prolonged course of NCVI by more than 2 times. An increase in Nt-proBNP > 125 pg/ml in patients with AH even without CHF is associated with the development of various forms of NCVI, including post-COVID syndrome. The use of renin-angiotensin-aldosterone system (RAAS) blockers, dual combined antihypertensive therapy in patients with AH reduced the RR of the development of both NCVI, NCVI-pneumonia with hospitalization and the prolonged course of NCVI on an average by 30 to 50 %. The use of sulfonylureas and/or insulin therapy in patients with AH and type 2 diabetes mellitus was associated with an increase in the RR of the development of NCVI by 73.6 %, the RR of the development of NCVI-pneumonia with hospitalization was more than 4 times higher, and a prolonged course of NCVI almost 3 times higher. Average daily pulse blood pressure and abnormal patterns of circadian rhythm of SBP and DBP were associated with an increase in RR of both acute and chronic forms of long-term NCVI. NСVI- pneumonia with hospitalization and post-COVID syndrome are associated with an increase in the RR of pathological changes in all target organs in patients with AH in comparison with patients who did not have any complications after NCVI.

Conclusion. Known risk factors for the development of various forms of NCVI, including its prolonged course in patients with AH, have been confirmed and new ones have been revealed. It has been determined that NCVI with a severe course and post-COVID syndrome are associated with pathological changes in all target organs in patients with AH after NCVI.

Objective. To assess the orientation of changes in the coagulation system in children in the acute and long-term periods after COVID-19 infection.

Materials and methods. The results of the examination of children aged from 1 to 18 with confirmed COVID-19 infection were included in a cohort retrospective study conducted in order to assess the orientation of changes in the coagulation system in children in the acute and long-term period after COVID-19 infection. The set of examinations included indicators for assessing vascular-platelet (platelet count, platelet aggregation) and plasma-coagulation (INR, APTT, thrombin time, fibrinogen level, antithrombin III, SFMC, euglobulin lysis, D-dimer level) links of hemostasis. 130 children comprising the main observation group and 113 children of the control group (healthy children) were examined.

Results. It was determined that the acute period of a new coronavirus infection in children is characterized by changes in the hemostasis system, and disturbances affect all links - vascular platelet, plasma coagulation and fibrinolysis system, not depending on the severity of the infection. The changes persist within 4–4.5 months after the infection.

Conclusion. Younger children (1–5 years old) are the most alert. Both in the debut of COVID-19 and in the postcovid period, the maximum number of abnormalities was revealed in these patients and the largest number of children had these changes. The most favorable state of the blood coagulation system is determined in the older age group (children 11–18 years old). Despite the fact that the onset of the disease in children is accompanied by significant changes in hemostasis indicators, which is typical for COVID-19, in the post-ovarian period, almost all indicators reached their optimal values. The data obtained confirm the opinion that one of the complications of COVID-19 is the development of coagulopathy, which in turn can lead to thrombosis in large and small vessels, and inhibition of fibrinolysis (hypofibrinolysis) can be a predictor of thromboembolic complications. Children who have suffered a new coronavirus infection form a risk group for the development of the above-mentioned complications and require more attention, possibly follow-up for a long period after the disease.

Objective. To assess the quality of life of patients with vestibular (vertigo) and non-vestibular (instability) dizziness.

Materials and methods. 82 patients with dizziness were examined. 47 patients with vestibular dizziness (vertigo) who were diagnosed with peripheral vestibulopathy and 35 patients with non-vestibular dizziness (instability), observed on an outpatient basis with the diagnosis of stage 1-2 dyscirculatory encephalopathy, comparable in gender and age were among them. The assessment of the quality of life was carried out using the Vestibular Rehabilitation Benefit Questionnaire (VRBQ). A comparative analysis of the quality of life in patients with vestibular and non-vestibular dizziness due to various causes using VRBQ was carried out for the first time. Statistical data processing was performed by the Statistica 12.0 program, nonparametric methods were used, taking into account the abnormal sample distribution.

Results. A significant decrease in the quality of life in any type of dizziness relative to the health was revealed. In vestibular dizziness, a deterioration in the quality of life by 53.2 [30.4; 73.0] % was noted, in non-vestibular dizziness – by 39.5 [33.4; 51.7] %. In patients with vestibular dizziness (vertigo), the symptom of rotational vertigo itself, regardless of the duration of the attack, (66.7 [50.0; 72.3] %; p = 0.002), as well as the fact of restriction of daily motor activity, causing provocation of vertigo (40.1 [30.1; 63.5] %; p = 0.005), affected more significantly. The role of psychoemotional discomfort (anxiety associated with the symptom developed) in patients with vestibular dizziness (33.4 [16.7; 55.6] %) was equivalent (р = 0.815) to that in patients with non-vestibular dizziness (33.4 [27.8; 50.0] %). In case of non-vestibular dizziness (instability), a positive correlation between the total quality of life deficit and anxiety was noted (r = 0.598; p 0.05), this fact can indicate an increased risk of development of functional disorders with dizziness on the initial stages of dyscirculatory encephalopathy.

Conclusions. It is recommended to study the quality of life of patients with dizziness symptom of various etiology using the VRBQ in order to improve the quality of therapy and prevent development of functional disorders timely.

Objective. To describe the topographic anatomy of the esophagus after thyroidectomy.

Materials and methods. The data of pre- and postoperative magnetic resonance imaging of the soft tissues of the neck were studied in 61 patients operated on for multinodular colloid goiter, autoimmune thyroiditis, diffuse toxic goiter with a thyroid volume of more than 100 cm³. All the patients underwent thyroidectomy. On tomograms before the surgery, two, six and twelve months after it, the topography of the esophagus was assessed in three planes: axial, frontal and sagittal. Transverse, antero-posterior and angular disposition of the esophagus were measured quantitatively. The displacement was estimated relative to the horizontal and vertical lines drawn through the middle of the body and the anterior edge of the cervical vertebra. Skeletotopically, the section was referred to the sixth, seventh cervical vertebrae and the first thoracic one. The numerical indicators ​​obtained during the measurements were analyzed dynamically. Statistical analysis was performed using the Statistica 6.0 program.

Results. The lumen of the esophagus in the postoperative period increased in the antero-posterior direction and shifted to the left lateral wall of the trachea. The organ took a spherical shape. In 73% of cases, the esophagus was parallel to the trachea 12 months after thyroidectomy.

Conclusion. Within a year after thyroidectomy, changes in the shape, diameter and topography of the cervical part of the esophagus occur. 12 months after thyroid removal, the anteroposterior size of the esophagus becomes six times larger in comparison with the preoperative one, it shifts to the left lateral wall of the trachea by 2.12 cm relative to the vertical axis. The results obtained can be useful for repeated surgical interventions in this area.

To determine contemporary prospects for the use of non-glycemic effects of sodium-glucose cotransporter-2 inhibitors in comorbid patients, the analysis of existing studies was carried out.

The mechanisms of action of sodium-glucose cotransporter-2 inhibitors discovered during the EMPA-REG OUTCOME study which were previously unknown, encouraged further research on the use of these drugs in other pathological conditions. The authors of the article have analyzed some clinical and preclinical studies on the use of this drug group in such conditions as stroke, cancer, rheumatological diseases, and rhythm disorders, as well as their impact on the development of major adverse cardiovascular events. The effects of oxidative stress suppression in the myocardium and nervous tissue with an increase in the number of mitochondria which reduces the risk of developing rhythm disorders, improves neoangiogenesis in the focus of ischemic necrosis, and has neuroprotective effects are described in the article. In oncological diseases, gliflozins prevent proliferation of tumor cells and oncogenesis through the induction of late apoptosis and also have cardioprotective effects in patients undergoing chemotherapy. The use of these medicines reduces the incidence of major adverse cardiovascular events, as well as restenosis after intravascular interventions. The positive effect on the course of rheumatological diseases was in improving laboratory parameters in a number of diseases and reducing the frequency of exacerbations and visits to a doctor in patients with gout.

With a constant increase in the number of patients with comorbid conditions, it is important to carry out further study of pleiotropic effects of sodium-glucose cotransporter-2 inhibitors for the subsequent introduction of new data into clinical practice.

Objective. The aim of this literature review is to analyze the psychological mechanisms that influence the development of empathy in medical students through interaction with humanoid robots. This study seeks to identify the factors that contribute to the formation of empathy as a personal trait in future physicians.

Main Points. Empathy is a crucial aspect of medical practice, fostering trustful relationships between doctors and patients. Recent research indicates that humanoid robots can be an effective tool for enhancing empathetic skills in medical students. Interaction with these robots activates the same neural networks as human-to-human interactions, including the anterior cingulate cortex, the medial prefrontal cortex, and the mirror neuron system. Cognitive and affective processes, such as emotional intelligence, imitation, and behavioral modeling, play a significant role in shaping empathy. Personal characteristics, such as openness to experience and extraversion, also have a notable impact on students’ ability to empathize when interacting with robots.

Conclusion. Anthropomorphic robots can be effectively integrated into educational programs to foster the development of empathy in students. They provide a safe environment for practicing communication and technical skills, while also encouraging emotional engagement and social cognition. Further research may help refine current technologies and methodologies, allowing for a deeper understanding of the neurobiological foundations of empathy in the context of human-robot interaction.

Objective. To assess the effectiveness of using humanoid robots in preparation for the specialists` accreditation and training of doctors and students of a medical university.

Materials and methods. In a prospective study, two groups of 5^th–6^th-year students of the medical and dental faculties were analyzed in order to find out the success of patient curation. Students were asked to conduct a patient survey and make an initial diagnosis with the nosologies "coronary heart disease" and "Takotsubo cardiomyopathy". The first group was taught by patient`s supervision according to the standard training model, the second group was trained using a simulator robot. At the end of the curation, students were asked to fill in a checklist to assess their success.

Results. Curation on the first clinical scenario was successfully performed in 85 % of cases in group 1 and in 100 % in group 2 (p<0.0001). On the second clinical scenario, successful curation in group 1 was carried out in 11 % of cases and in 100% of cases in group 2 (p<0.0001). When assessing curation according to the checklist, the average number of points in group 1 was 7.3 ± 1.5 points, in group 2 – 8.5 ± 1.6 points (p<0.0001).

Conclusions. The integration of robotic systems into simulated learning increases the effectiveness of teaching in terms of covering more aspects of various topics due to repeated identical reproduction of the situation.

Objective. To analyze the health level of students of Saratov State Medical University named after V.I. Razumovsky on the basis of the respondents' subjective assessment of their well-being, as well as to assess the level of medical students` awareness about the methods of medical rehabilitation (health improvement) and the possibility to undergo it during studies at the educational institution.

Materials and methods. The study comprised data collection by means of an anonymous sociological survey (aimed at subjective assessment of well-being among medical students) using phones or tablets. 152 students of V.I. Razumovsky SSMU of all years and faculties participated in the survey. The survey was conducted using a specially created questionnaire in electronic format via Google Form. For mathematical processing, the results of the study were initially added to an electronic database; the results of the study were analyzed using the descriptive statistics method.

Results. It was determined during the study that most students assess their health as satisfactory and above average, while they often have chronic diseases, mainly those of the digestive organs, musculoskeletal, nervous and respiratory systems. It was also found out that the majority of students were familiar with various methods of medical rehabilitation, but not all of them had experience of using these methods.

Conclusions. Students are interested in rehabilitation methods and are willing to use them to improve their health, but most of the students are not aware of the recreational opportunities provided by the university and are eager to benefit from it for free and with a convenient schedule.

Objective. To carry out a comprehensive hygienic assessment of the working conditions of miners of underground polymetallic ores mining, taking into account various technological operations to predict the risk of the development of health disorders and to optimize labor.

Materials and methods. The object of the study was the miners of the underground ore mining of the Zhezkent mining and processing plant (MPP) of Kazakhmys Corporation LLP in the East Kazakhstan region. Comprehensive hygienic studies on working conditions of various professional groups included an evaluation of microclimatic parameters, illumination, vibroacoustic factors in accordance with the Methodological Recommendations "Hygienic criteria for the assessment and classification of working conditions according to the indicators of harmfulness and danger of the working environment factors, severity and intensity of the labor process".

Results. The results of the hygienic studies of the working conditions of miners of underground polymetallic ore mining of the Zhezkentsky MPP of the Kazakhmys Corporation demonstrated a number of unfavorable production factors. Thus, the relative air humidity varied within 96.1%, the dust content in the air of the working area exceeded the maximum permissible concentration (MPC) by 4.5 times, the noise and general vibration indicators exceeded the MPC from 11dB to 28dB.

Conclusions. The results of a comprehensive hygienic assessment of the working conditions of miners of the underground polymetallic ore mining of the Zhezkentsky MPP allowed us to establish that the working conditions of engineers for mining equipment management by the degree of harmfulness corresponded to the 3rd class of the 3rd degree, and the work of miners of auxiliary professions - to the 3rd class of the 2nd degree.