Vol 29, No 6 (2023)

BACKGROUND: Despite the modern development of dentistry, the frequency of purulent inflammatory diseases of complicated caries tends to increase. Up to 60%–70% of patients had odontogenic phlegmon in maxillofacial hospitals. With the spread of the process to the neck and mediastinum, mortality reaches 60%, and with the generalization of infection leading to septic shock, it increases to 90%. This study aimed to examine the state of rheological parameters and blood microcirculation in cases of acute purulent inflammation in patients with maxillofacial phlegmon based on blood viscosity, analysis of the microcirculatory bed according to laser Doppler flowmetry, and concentration of the antibiotics in the blood. This study will allow us to analyze pathophysiological changes and coordinate adequate drug therapy.

AIM: To examine the state and rheological properties of blood in the microcirculation and antibiotic concentration in cases acute purulent inflammation in patients with maxillofacial phlegmon to improve the effectiveness of treatment.

MATERIALS AND METHODS: The study enrolled 20 patients. Their age ranged from 28 to 62 years, and there were 13 (65%) men and 7 (35%) women. The average body weight of the patients in the study group was 79–95 kg. All patients under endotracheal anesthesia underwent phlegmon dissection. During the operation and treatment, microcirculation, blood viscosity, and laser Doppler flowmetry were evaluated, and the antibiotic concentration in the inflammation area was assessed.

RESULTS: The results of the study of 20 patients were analyzed. As a result of studying the rheological parameters of blood obtained from the peripheral vein in patients with phlegmon of the maxillofacial region of various localization, changes in blood viscosity towards thickening compared with normal values were revealed.

CONCLUSION: With acute purulent inflammation of the maxillofacial region, pathophysiological changes occur in the microcirculatory bed, which must be considered when prescribing adequate antibacterial therapy.

BACKGROUND: Lipedema is a chronic disease characterized by abnormal growth of subcutaneous fatty tissue. More than 10% of women have varying degrees of lipedema. Despite the high prevalence of this pathology, to date, there are no full-fledged clinical guidelines, and only sporadic publications have devoted to this disease in the literature.

AIM: To determine the level of immersion of members of the professional community in the diagnosis and treatment of lipedema.

METHODS: Within the framework of the online educational event “Lipedema: 2023” held on the platform “Actual Phlebology” on 22.08.23, 74 physician participants anonymously answered 14 questions on the diagnosis and treatment of patients with lipedema.

RESULTS: In this study, 83.8% of the respondents adhered to the hereditary theory of lipedema development. Only one obvious feature of lipedema, the presence of bilateral symmetrical disproportionate proliferation of adipose tissue on the extremities, was reported by the absolute majority (98.6%) of the specialists interviewed. Less than half of the professional participants noted features such as a feeling of tightness and an excessive tendency to hematoma formation with worsening of symptoms overnight. More than half of the respondents (54.1%) admitted that they were unfamiliar with the classification of lipedema. The main method of conservative treatment of lipedema was considered therapeutic exercise by 74.3% of the respondents. The most popular method of surgical treatment of lipedema is lymphatic liposuction, and which 56.8% of the participants of the professional community are ready to offer this to their patients.

CONCLUSION: The professional community is not sufficiently immersed in the diagnosis and treatment of patients with lipedema. The diversity of current scientific evidence on lipedema requires that it be structured in the development of up-to-date national clinical guidelines.

BACKGROUND: The problem of the prevention and control of infections associated with the provision of medical services in the forensic medical examination bureau (FME) remains relevant. In connection with the spread of new coronavirus and other infections, it is of interest to study the compliance of the regulatory and methodological framework with new challenges from the point of view of hygienic and organizational aspects of forensic work, including examination, disease prevention, and reduction of the effect of risk factors on workers.

AIM: To analyze the current state of the regulatory framework of the activities of the forensic medical examination service.

MATERIALS AND METHODS: The regulatory documents at the federal and departmental levels regulating the activities of the forensic medical service were studied. Documents regulating a set of measures aimed at maintaining sanitary and epidemiological well-being and compliance with sanitary norms and rules in relation to the divisions of the FME bureau were analyzed. Emphasis was placed on identifying sanitary and hygienic measures to ensure that FME bureau workers are safe from infectious contamination.

RESULTS: The organization of the activities of the FME bureau is regulated by relevant legal acts that consider the procedure for organizing and conducting forensic medical examinations and are developed in strict accordance with the requirements of federal laws and orders. Some questions related to individual stages of the forensic medical examination, such as the location of the incident, transportation of the corpse to the medical examiner’s office, storage of a corpse, conducting an autopsy, and collecting biomaterial for examination, require solutions to improve the safety and quality of forensic medical examination. The protection of employees of the FME bureau from infectious contamination, organization of preventive measures, and prevention of risks of infection of medical personnel require the development of regulatory legal acts.

CONCLUSION: The results obtained indicate the need to improve the legal regulation of individual stages of forensic medical examinations and improve the quality of anti-epidemic measures that ensure the safety of FME bureau workers from infectious diseases. The recommendations are aimed at improving the forensic medical examination service in the country, improving the equipment of morgues, and ensuring conditions for the implementation of the right of personnel of forensic medical institutions to health protection.

In recent times, accumulating scientific data prove that in patients who have suffered an anterior cruciate ligament injury, their stability of the knee joint can be restored by a properly constructed rehabilitation program, including motor retraining, compliance with tissue healing time, and an innovative approach in physical therapy by long-term immobilization of the knee joint in a special orthosis within 4 weeks, followed by a complete return of the extent of joint movements by 10 weeks of rehabilitation. In addition, numerous cadaveric, histological, and magnetic resonance imaging studies have proved that the anterior cruciate ligament is capable of self-healing after partial or complete disruption. In connection with the new findings, revising the established modern protocols of surgical treatment in the context of its needs for different cohorts of patients is necessary. This article discusses the need for surgical treatment and modern possibilities of conservative therapy after an anterior cruciate ligament injury, rules of inclusion and exclusion of patients for surgical treatment, and key aspects in the physical therapy of patients with anterior cruciate ligament injury.

BACKGROUND: COVID-19 can affect the eyes and both the anterior and posterior segments of the eye. Retinal complications associated with COVID-19 have been reported.

CLINICAL CASE DESCRIPTION: We present a clinical case of age-related macular degeneration that developed during the acute period of coronavirus infection. A patient with COVID-19 and pneumonia (CT-1) experienced sudden decrease in visual acuity within 1 month. A dark spot appeared in front of the left eye, which did not disappear despite eye movements, and distortion of objects was observed. The disease was manifested acutely. A complete ophthalmological examination revealed a sharp decrease in visual acuity and a positive Amsler test (distortion of lines at a distance of 30 cm). In the field of view, scotomas were noted in the center. Ophthalmoscopy revealed light and dark foci in the central macular zone of the retina. Cptical coherence tomography with an angiographic mode detected severe changes at the level of the neuroepithelium and retinal pigment epithelium with the formation of gray tissue. Aflibercept (approved for use in the Russian Federation, No. LP-003544) was intravitreally prescribed according to the clinical guidelines for treating age-related macular degeneration. After treatment with positive dynamics, visual acuity increased to 1.0, and the thickness of the retina decreased by 102 microns.

CONCLUSION: The key objective in making a correct diagnosis was the use of optical coherence tomography with an angiographic mode. This method allows the visualization of the retinal layers without invasion The angiography mode allows the assessment of the state of the foveolar avascular zone and the density and perfusion of blood vessels, which enable the diagnosis of age-related macular degeneration and choroidal neovascularization. Timely antiangiogenic treatment, that is, a single intraocular injection, completely restored the visual acuity and visual field and normalized the state of the retina according to objective data of optical coherence tomography with angiography mode.

The article describes the life path of Professor Serdyukov Anatoly Gavrilovich. Reflects the important stages of the formation of his scientific, pedagogical and social activities, and presents his key contribution to the study of the main directions of public health and healthcare in the Astrakhan region.

This message announces the All-Russian information and educational action “Health Train ˝Together Against Diabetes˝“, which aims to raise awareness of the importance of preventive medical examinations; risk factors for chronic non-communicable diseases, including diabetes; and popularize a healthy lifestyle. The results of this action, launched on September 10, 2023 by “Russian Railways“ company and “RZD-Medicine” within the framework of the announced Year of Health in the company, will be published in forthcoming issues of the journal.