Vol 29, No 5 (2023)

BACKGROUND: The preventive direction of medicine has become increasingly popular in recent years. The government has paid much attention to the health of the population and preventive examinations. Among the main priorities of the state, the health of the pediatric population remains a guarantee of a healthy nation.

AIM: To assess the health status of the pediatric population of the new territories of the Russian Federation and develop measures to further improve medical care at the regional level.

MATERIAL AND METHODS: The study enrolled children aged 0–17 years living in the new territories of the Russian Federation, namely, the Donetsk People’s Republic, Luhansk People’s Republic, Zaporozhye oblast, and Kherson oblast. A total of 32 teams of specialists from 30 territories of the Federation have been formed to conduct in-depth preventive medical examinations of the pediatric population of these new territories.

RESULTS: The study participants were predominantly children aged 0–14 years. The overall morbidity in all regions was dominated by diseases from the five classes according to ICD-10, namely, diseases of the musculoskeletal system and connective tissue; endocrine, nutritional, and metabolic diseases; of the eye and adnexa; and disorders of the nervous system, respiratory system, and psychological development. Half of the study participants were diagnosed with a disease for the first time in their lives.

In the Russian Federation, the high proportion of healthy children is due to the contingent of the child population, and the third group of health with better detection of diseases due to the in-depth nature of preventive medical examinations. The distribution into groups for physical education corresponded to health groups. According to the preventive medical examinations results, more than a third of the total number of examined children was transferred to dispensary supervision. Emergent and urgent cases and mental disorders require measures under stable conditions.

CONCLUSION: The results of the preventive medical examinations can be the basis for subsequent therapeutic, diagnostic, and rehabilitation work by medical organizations and preventive and health-improving activities by educational institutions.

BACKGROUND: Soft tissue wound treatment in open tibial fractures requires complex clinical approach. New cellular methods of wound treatment must be compared with the gold standard split-thickness skin grafting.

AIM: To compare the esthetic results of wound management with the living skin equivalent and skin grafting.

MATERIAL AND METHODS: A comparative study included 108 patients with open tibial fractures and soft tissue defects who underwent staged surgical treatment. In group 1 (n=51), the living skin equivalent was used, which is a bioengineered three-layer construction containing keratinocytes, fibroblasts, and collagen matrix. In group 2 (n=57), standard split-thickness skin grafting was used for wound repair. The surgery duration, complete epithelialization period, hospital stay, Vancouver Scar Scale (VSS) after 3, 6, and 12 months, and self-reported esthetic results 1 year after surgery were compared.

RESULTS: Living skin equivalent procedures were performed significantly faster than skin grafting (18.2±4.8 min vs. 35.5±14.8 min, р <0.001), and wound healing took longer (25.5±6.3 days vs. 19.6±4.7 days, р=0.035). The overall VSS score was significantly lower at all follow-up visits in group 1 than in group 2 (6.23±0.81 points vs. 8.12±0.98 points after 3 months, р <0.001; 5.17±1.18 points vs. 6.76±1.31 points after 6 months, р <0.001; 4.54±1.07 points vs. 5.09±0.65 points after 12 months, р=0.038). Moreover, 74.5 and 68.4% of the patients were satisfied with the appearance of the limb after treatment with living skin equivalent and skin grafting, respectively (р=0.023).

CONCLUSION: The cosmetic results of wound treatment in open tibial fractures with living skin equivalents are significantly better than those of split-thickness skin grafting.

The review discusses the structure and physiology of the oxygen supply functional system and its self-regulatory potential and role in maintaining the body’s optimal metabolic homeostasis level of blood gases. Up-to-date data on the functioning of peripheral (arterial) and central (medullary) chemoreceptors, molecular mechanisms of the oxygen and carbon dioxide content and pH perception, and their association with afferent nerve endings are presented. The paths and centers of the chemosensory reflex in various brain regions, effector elements, and reverse afferentation mechanisms are shown. Response patterns to exogenous and endogenous hypoxic stimuli from the various elements of the oxygen supply system are described. The role of intracellular HIF-dependent and HIF-independent pathways in adaptive reactions for maintaining an optimal intracellular metabolism is demonstrated. Cell mechanisms with adaptive roles in hypoxia/reoxygenation under the conditions of interval normobaric hypoxic therapy are discussed.

The review of current concepts and analysis of research results on the physiology of the oxygen supply functional system, its structural and functional status, and its molecular regulation under exogenous hypoxic conditions will draw attention to the expediency of further randomized clinical trials on interval normobaric hypoxytherapy as a rehabilitation method for patients with chronic cardiovascular diseases

The study analyzes current data on syncope in children and adolescents. The study presents the classification of syncope and briefly describes the clinical manifestations of neurally mediated syncope and the main methods of its diagnosis and treatment. Syncopes associated with organic cardiac pathologies and primary cardiac arrhythmias are caused by hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, coronary artery anomalies, primary long QT syndrome, Wolff–Parkinson–White syndrome, and bradyarrhythmias. The diagnostic features of syncope in children and young athletes and modern approaches to treatment and prevention are discussed.

Although most syncopes in athletes are not associated with physical activity and have a neurotransmitter genesis, a thorough medical examination is needed. Factors that induce the development of syncopes in athletes must be identified. A prerequisite for admission to sports is the exclusion of the cardiac and arrhythmogenic reasons of syncopes. The decision to expand the sports regime should be made only after a thorough collection of medical history, including family history, and a comprehensive examination. In addition, the degree of risk in view of injuries, provocation, or fatal events following the loss of consciousness during sports must be estimated. This is extremely relevant for sports such as swimming, complex coordination sports (gymnastics and acrobatics), auto and motor sports, and alpine skiing.

Although syncopes are common problems in pediatric practice, with only a few cases with cardiac causes based on structural or primary electrical myocardial diseases, they pose the greatest danger in sports medicine. Thus, such conditions must be excluded in young athletes because sports load can aggravate cardiac pathologies, which cause syncopes, due to untimely diagnosis before the start of a sports career.

A systematic review was performed in PubMed using the following keywords “monofocal IOLs”, “monofocal IOLs with extended depth of focus (sharpness)”, “EDOF”, “cataract phacoemulsification”, “visual acuity”, and “quality of life”. Studies were selected in accordance with the criteria for prospective or retrospective studies. In a comparative analysis of clinical efficacy, the results of binocular IOL implantation and lens material from the same manufacturer were analyzed as the main sources. In total, 234 studies were analyzed using systematic review filters and authors’ knowledge of the topic. The duration of the retrospective analysis was 8 years (2017–2023). A total of 234 papers were analyzed over the last 8 years (2017–2023), further using systematic review filters and the authors’ knowledge of the topic.

Data obtained indicated that traditional monofocal IOLs acted like bifocal lenses because they formed two main focal points for far and near vision, which did not provide the required level of visual acuity at an intermediate distance. The basic optical principle of EDOF (extended depth of focus) was to create a focal point for distance vision and an elongated focal point to increase the depth of field near and at intermediate distances. The results of the literature analysis indicated that the use of EDOF (compared with monofocal IOL) was associated with a higher level of visual acuity at intermediate and near distances and comparable distance visual acuity and increased depth of field, which generally provides a more natural range of vision and less use of glasses. Light phenomena, spectacle independence, and patient satisfaction were comparable among EDOF types.

Given the above advantages, EDOF implantation can be considered a variant of an individual approach to the selection of IOLs, taking into account the possibility of using it in patients whose professional activity is associated with long-term visual work at intermediate distances (e.g., users of personal computers). In the context of the role and place of EDOF in the general system of aphakia correction following cataract phacoemulsification, further accumulation of clinical material is necessary, taking into account the IOL model and patient’s professional visual activity level.