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Extreme Medicine

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Vol 25, No 4 (2023)
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5-9 58
Abstract

Encephalitis is a group of acute infectious diseases affecting the substance of the brain. They often lead to disability or death, and, therefore, require urgent medical attention. The article discusses the etiology, pathogenesis, and clinical picture of encephalitis, with special attention to the course of this disease after the COVID-19 pandemic. We note the growing number of encephalitis cases, especially of autoimmune variety and those caused by herpes. The possible reason behind this trend is the disruption of operation of the immune system brought by COVID-19, which manifests as a cytokine storm, neuroinflammation, and autoimmune reactions. There are cases of COVID-19-dependent encephalitis described. The pathways taken by SARS-CoV-2 to penetrate into the cells of the central nervous system have not yet been fully studied, although there are hypotheses that this happens both trans-synaptically through mechanoreceptors and chemoreceptors of the respiratory system into the medulla oblongata, and through receptors of the angiotensin converting enzyme 2.

10-19 38
Abstract

The treatment of multiple myeloma is inextricably linked to the need for assessment and monitoring of the minimal residual disease (MRD). Assessment of the MRD allows evaluating the efficacy of therapy and obtaining significant prognostic information; it is an indicator of the degree of eradication of the tumor clone. The methods for detecting residual tumor cells evolve constantly, which translates into updates of the criteria reflecting the scale of response to therapy. There is no single MRD detection technique; common recommendations suggest seeking for pathological cells both intramedullary and extramedullary. This review describes current MDR determination methods, including imaging, next generation multiparametric flow cytometry, and methods based on DNA analysis — allele-specific oligonucleotide polymerase chain reaction and next generation sequencing. We compare their advantages, limitations, disadvantages, clinical significance, and show the necessary sensitivity thresholds of the described methods and the conditions that make this or that approach ideal in the context of detection of MRD.

20-25 24
Abstract

Tolerance to food antigens is essential for body’s sustainable development under constant antigenic load. Specific IgG against food antigens have been extensively studied in the literature over the recent years. The presence of those associated with various disorders and introduction of elimination diets for certain food products result in good treatment outcomes related not only to the gastrointestinal tract. Investigation of the impact of the long-term IgG-mediated hypersensitivity to food antigens associated with the increased blood-brain barrier permeability is also relevant when studying pathogenesis of the central nervous system disorders. However, identification of specific IgG in the generally healthy people having no history of allergy or inflammation currently provides no clear understanding of their nature and functional significance. Specific IgG are of great interest in terms of predicting the development of functional disorders, remission and treatment of disorders, changes in susceptibility to food antigens at certain age. The results of specific IgG studies are equivocal, which confirms the need to study their structure, epitopes capable of activating autoimmune processes considering the combined effects of medication, environmental conditions and social living conditions. The paper provides the analysis of the currently available research focused on studying specific IgG against food antigens. The data on identification of specific IgG in individuals with various disorders are provided, as well as the gender-related and age-related differences in antibody detection, the relationship between the antibody levels and the rate of food product consumption.

26-38 31
Abstract

Latex, made from Hevea brasiliensis sap, is the material used to make many medical products, including catheters, balloons and gloves. Hundreds of allergens from natural rubber latex have been identified, and 15 of them were numbered, from Hev b1 to Hev b15. Natural proteins in rubber cause both asymptomatic sensitization and type I IgE-mediated hypersensitivity. Treatment of latex makes use of chemical antioxidants that can also bring about type IV hypersensitivity reactions. Latex allergy is one of the most common causes of anaphylaxis in the operating room, and its prevalence has been growing since 1980s, together with the popularity of latex gloves. It is a well-known problem among medical professionals, with gloves and inhaled aerosol particles being the sources thereof. This study aimed to review the current scientific research and practical data in this only partially investigated area. In addition, increasing the awareness of doctors and patients minimizes the existing risks of latex allergy.

39-47 39
Abstract

Staphylococcus aureus is a bacterial pathogen that is frequently associated with drug resistance and causes serious infectious diseases. The challenge in treating staphylococcal infections arises not only from the strains resistance to antibacterial drugs but also from the bacteria's capacity to form biofilms. As an alternative to traditional antibiotic therapy, phage therapy, employing virulent bacteriophages, is being explored. Research on bacteriophage's effectiveness against S. aureus encompasses both individual use and their combination with antibiotics. The combined approach appears most promising, enhancing therapeutic efficacy substantially through the synergistic action of both the antibiotic and the phage. This review discusses the effects of using both agents together and the methodologies for their evaluation. It summarizes the latest in vitro and in vivo research on the combined approach against S. aureus, including experiments focused on biofilm elimination. Special emphasis is placed on clinical case studies in treating patients.

48-55 27
Abstract

Stroke prevalence is one of the most acute problems in the medical and social aspects of society: strokes are the second most common in the mortality statistics of the population. In the Russian Federation, stroke occurs annually in almost 500,000 people and is the first among the causes of death from neurological diseases and the second most common cause of death after heart disease. The most common consequences of stroke are motor disorders of varying severity, manifested as changes in muscle tone, paresis and paralysis, and impaired walking function. This paper is an overview of the current state of robotic rehabilitation devices used for post-stroke limb paresis and of expected trends of their development. The existing variants of their construction, conditions of kinesiotherapy sessions for obtaining the greatest effect are considered. The authors are of the opinion that the nearest prospect for the development of high-tech devices of this type is not only complex stationary universal complexes for clinics, but also simple mobile specialized simulators with remote medical control for outpatient use.

56-62 44
Abstract

The fact that the disease sequelae can limit the development of the growing child’s activity is the feature of pediatric medical rehabilitation, that is why there is a need for repeated courses of rehabilitation or habilitation, where each subsequent course is a continuation of the previous one. The specialist’s mission is to determine indications for rehabilitation. The paper reports phenomenology and methods to diagnose abnormal activity and participation in convalescent children after infectious diseases in order to set the rehabilitation goals in the International Classification of Functioning, Disability and Health domains (categories). The use of method to estimate activity and participation from the point of view of both child and parent or caregiver is considered. The paper provides information useful for specialists dealing with the issues of rehabilitation of children after infectious diseases.

63-69 11
Abstract

DNA methylation plays an important role in carcinogenesis; there are many studies that investigate the degree of methylation of the entire genome, gene promoters, and non-coding elements in cancer cells, but much less information about changes of the methylation patterns in blood cells and links with the development of malignant neoplasms (MN). This study aimed to investigate the degree of methylation of promoter regions of cell cycle control and apoptosis genes (BAXMDM2TP53NFkB1) in peripheral blood cells of persons chronically exposed to radiation with MN developing latently. The study included 200 persons chronically exposed to radiation from the Techa River, contaminated with nuclear wastes dumped into it. The level of methylation was assessed by real-time PCR. The participants were divided into exposed and control groups; comparing them, we found that in the former, the distribution of exposed individuals with latent MN by the degree of methylation of promoter regions of BAXMDM2 and NFkB1 genes was significantly different from that in the latter (< 0.001; < 0.001; = 0.004, respectively). It was established that, compared to the control group, the share of the test group participants with subsequent MN who had up to 10% of the BAX gene promoter regions methylated was significantly higher, and amounted to 98%, while in the control group this figure did not exceed 73% (< 0.00001).

70-76 19
Abstract

It is well-known that ionizing radiation is among factors increasing the rate of chromosomal rearrangements. The inversion rate was poorly understood due to difficulty of inversion identification by the conventional differential staining method. A comprehensive study of chromatin and its complex rearrangements has become possible with the use of the high-tech molecular genetic method, fluorescence in situ hybridization (FISH). The study was aimed to assess frequency of inversions involving the chromosome telomeric regions in 36 residents of the South Urals, almost all of them were affected by combined chronic exposure. The calculated individualized cumulative external and internal doses were 0.0001–4.7 Gy. Inversions were identified by fluorescence staining of the chromosome telomeric region. It was found that chromatid inversions were more abundant than chromosomal variants (9 : 0.3 per 100 cells (< 0.001). No relationship between the studied parameters and the absorbed dose, sex and age at the time of the examination was revealed.

77-85 14
Abstract

Radiation exposure of recipients before hematopoietic stem cell transplantation can cause gastrointestinal (GI) stasis. It is associated with complications of myeloablative radiation therapy: delayed vomiting, excess bacterial growth, endotoxicosis, systemic inflammation, and sepsis. The study was aimed to assess the possibility of GI stasis prevention by intragastric administration of cystamine dihydrochloride when using radiation-induced myeloablation. The severity of GI stasis, levels of enterocyte markers in the small intestinal tissues and the indicator of intestinal endotoxicosis, urinary indican excretion, were assessed in rats 72 h after the single total-body X-ray exposure to the dose of 9.64 Gy (1.1 LD99/30); the animals’ whole body oxygen consumption was recorded daily. Irradiation caused GI stasis with predominant gastric stasis, the 1.5–4.8-fold decrease in the cholinesterase and alkaline phosphatase activity in the small intestinal tissues, doubled the urinary indican excretion, the whole body oxygen consumption reduction by 17–32%. Cystamine administration generally prevented gastric stasis, but had no significant effect on the characteristics of radiation-induced enterocytopenia and did not prevent accumulation of chyme in the caecum, hyperindicanuria, radiation-induced spleen hypotrophy, and decrease in gas exchange rate. Cystamine is promising for testing in large animals as a selective agent for emergency prevention of gastric stasis during myeloablative radiation therapy.

86-97 23
Abstract

The red bone marrow (RBM) exposure due to bone-seeking radionuclides can lead to grave medical consequences. In particular, the increased risk of leukemia in people exposed due to contamination of the Techa River in 1950s is associated with the RBM exposure due to 89,90Sr. Improvement of the internal RBM dosimetry methods includes the development of computational phantoms that represent 3D models of the skeletal sites. Modeling radiation transport within such phantoms enables estimation of conversion factors from the radionuclide activity in the bone to the RBM dose rate. This paper is an extension study focused on generating a set of computational phantoms representing skeletons of individuals of different ages. The aim was to develop a computational phantom representing a 5-year- old child for internal RBM dosimetry from incorporated beta emitters. The phantoms of the skeletal sites with active hematopoiesis were created using the original Stochastic Parametric Skeletal Dosimetry (SPSD) method. With this method, every such site represented a set of smaller phantoms of simple geometric shape. RBM distribution across the skeleton, bone size, characteristics of bone micro-architecture, as well as density and chemical composition of the simulated media (RBM, bone) were determined based on the published data. As a result, a computational phantom of the major skeletal sites with active hematopoiesis representing a 5-year-old child was generated that included 43 phantoms of bone fragments. Linear dimensions of phantoms were within 3–75 mm. Micro-architecture parameters varied greatly: BV/TV ratio —13–52%, Tb. Th. — 0.09–0.29 mm, Tb. Sp. —0.48–0.98 mm.

98-105 23
Abstract

The prospects of deep space exploration necessitate modification of the principles and methods underlying the system designed to prevent negative impact of weightlessness on the human body. This work aimed to determine how fast running, as part of locomotor training during a space flight (SF), helps maintain physical ability of a person. The study involved 10 cosmonauts; their physical performance was assessed at all stages of the SF with the help of the Individual Strategies Test (IST). The parameters registered when the participants were doing the IST included heart rate (HR), gas exchange, capillary blood lactate concentration. The cosmonauts were divided into two groups based on the differences in the mean distance covered while fast running on a treadmill (single session). Group A (= 4) run 949 m/day on average, group B (= 6) — 2669 m/day. After SF, HR in group A increased at speeds from 5 to 8 km/h (< 0.05), pulmonary ventilation indicators grew at speeds from 8 to 15 km/h (< 0.05), and the capillary blood lactate concentration measured during the post-test recovery period increased by 37% (= 0.03). Moreover, after SF, the pulse sum recorded under load and during recovery was 14% (= 0.02) and 15% (= 0.03) in group A, respectively, while in group B we registered no differences. Thus, our hypothesis that fast running triggers sensory reactions simulatingEarth conditions for the body, which consequently activates physiological mechanisms counteracting the negative effects of weightlessness, has been confirmed in a space experiment.

106-115 34
Abstract

Winter swimming implies extreme cold stress, which can cause respiratory disorders, arrhythmias, and elevated blood pressure even in generally healthy people. Pre-training examinations for athletes practicing winter swimming should include additional criteria evaluating reaction of the cardiovascular system (CVS) to cold water. This study aimed to determine the risk of pathological abnormalities in the examined individuals exhibiting different CVS reactions to immersion in cold water. We assessed reactivity of CVS with the help of a cold-hypoxic test (CHT), following a previously developed algorithm. The subjects of the analysis were CVS reactions to CHT and physical data collected after swimming in cold water. The study involved 255 female and 205 male participants, all of them almost healthy, aged 18–25 years. They participated in testing in a laboratory setting. Poly-Spektr-8/E cardiograph was used to record ECGs, and GraphPad Prism 8 package for Windows 10 for statistical analysis. Findings: in highly reactive and reactive participants, CHT causes lengthening of the PQ interval, with its value in the initial state (IS) equal to 158 ± 7.2, and with CHT — 178 ± 9.1 (< 0.01); in subjects of he paradoxical type, CHT, against the background of higher pulse, triggered increase of QTc, which in the IS was 405 ± 7.1, with CHT — 420 ± 7.5 (< 0.05). As for blood pressure, on average, CHT made it grow, SBD by 17.4 ± 4.3 mmHg, DBP by 12.9 ± 3.1 mmHg (< 0.05). Swimmers adapted to cold, when swimming in cold water, had QTc above normal in 50% of cases: e.g., if IS of QTc was 434 ± 24 s, after swimming it increased to 492 ± 25 s. After a 200 m swim at = 1.5–2 °C, the average blood pressure in the group, compared to IS, increased, with SBD growing by 16.9 ± 3.1 mmHg, and DBP — by 12.3 ± 2.3 mmHg (< 0.05). Having analyzed the data, we conclude that CHT can be the basis of additional criteria extending examinations for athletes seeking admittance to cold water swimming.

116-122 22
Abstract

Adaptation to the extreme living conditions of the North causes dyslipidemia, a risk factor for cardiovascular diseases (CVD), in people working there. This study aimed to assess the level of lipids and C-reactive protein (CRP), a marker of inflammation in CVD cases, in the blood of men staying in the Arctic and Subarctic zones of Russia. Accordingly, the sample was divided into two group, Arctic and Subarctic, the former included 51 participants, aged 35.7 ± 0.6 years, the latter — 54 individuals, aged 34.2 ± 0.9 years (= 0.167); the duration of their work/stay in the Arctic and Subarctic zones was 7.1 ± 0.2 and 6.4 ± 0.6 years (= 0.447), respectively. We sampled blood of the participants and measured triglycerides, total cholesterol, low (LDL) and high (HDL) density lipoproteins, atherogenic index (AI), CRP content. Arctic group had higher levels of triglycerides (1.71 ± 0.03 and 1.38 ± 0.14 mmol/l, = 0.021), total cholesterol (6.15 ± 0.08 and 5.47 ± 0.14 mmol/l, =0.001), HDL (1.5 ± 0.06 and 1.1 ± 0.04 mmol/l, = 0.001); the values of LDL did not differ significantly between the groups (4.07 ± 0.08 and 4.1 ± 0.15 mmol/l, p = 0.88), and AI and CRP values (3.41 ± 0.18 and 4.18 ± 0.2, p = 0.007; 3.41 ± 0.18 and 4.91 ± 0.22 mg/l, p = 0.006, respectively) were greater in the Subarctic group. By triglycerides, dyslipidemia was diagnosed in 49.0% and 18.4% of Arctic and Subarctic participants, respectively, by total cholesterol — in 98.0% and 57.8%, by LDL — in 94.1% and 88.0%. As for HDL, their level was lower than normal in 2.0% of the Arctic group subjects and 36.7% of the Subarctic group subjects, which means a higher risk of cardiovascular diseases in the Subarctic region. The level of CRP indicated that 90% of the Arctic group participants were at risk of CVD (moderate risk for 23.5%, high risk for 66.7%), and in the Subarctic group this number was 100% (moderate risk for 7.7%, high risk for 88.5%). The likely reasons behind this are the specifics of nutrition and living conditions. Program of prevention of CVD in the Arctic zone should include lipid profile and CRP tests as part of every periodic medical examination, regardless of age. It is necessary to implement dyslipidemia alimentary correction measures.

123-130 26
Abstract

Despite the prospects of the approach to cell therapy of cartilage damage in humans involving autologous chondrocytes, similar technologies are just beginning to be introduced into medical practice in the Russian Federation. In this regard, the development of biomedical cell products (BCPs) for cartilage tissue repair is quite topical, while the use of organoid technology is the most close to the native tissue conditions. According to requirements of legislation of the Russian Federation, it is necessary to assess biodistribution characterizing migration potential of the cells, their tropism for body tissues following implantation within the framework of preclinical trials. The study was aimed to assess biodistribution of novel BCP based on human chondrocytes in the form of chondrospheres after subcutaneous implantation in Balb/c nude mice. Implantation to 12 mice was performed during the first phase, along with administration of saline to 12 control animals. Weighting and follow-up were conducted for 90 days. Then mice were withdrawn from the experiment to collect samples of organs and tissues for histological analysis of the implant, estimation of its viability, integration. During the second phase biodistribution was assessed by PCR in order to detect human DNA in the organ and tissue samples. Chondrospheres successfully integrated in the tissues surrounding the inoculation zones and formed cartilage tissue. No significant (< 0.05) changes in weight were reported. No human DNA found in chondrosphere implantation zones was detected in the samples collected from other organs and tissues. BCP demonstrated no biodistribution across other tissues and organs of mice 90 days after implantation, which suggested that the product developed was safe. Keywords: biomedical cellular product, chondrocytes, biodistribution, preclinical trials, chondrospheres

131-136 26
Abstract

Various local hemostatics (based on collagen, gelatin, cellulose, etc.) are used to stop bleeding from parenchymal organs of the abdominal cavity. In the context of an acute in vivo experiment, this study aimed to comparatively assess the time and volume of bleeding from a trauma of abdominal cavity's parenchymal organs covered with a new collagen-based spongy hemostatics combined with Na-CMC. We used new multicomponent polymer sponge implants (MPSI) based on marine collagen and carboxymethyl cellulose sodium salt, Na-CMC; the components were mixed in the ratios of 15/85, 25/75, 50/50. Hemostatic activity of the samples was assessed by bleeding time and blood loss volume. For the experiments, rats underwent laparotomy and resection of the left lobe of liver (series 1) and lower pole of spleen (series 2). In both series of experiments, the controlled parameters (bleeding time and blood loss volume) were smallest in group 6, where the MPSI were 50/50 Na-CMC/collagen. The hypothesis of higher efficacy of composite local hemostatic agents (namely, made of Na-CMC and deep-sea squid collagen) in cases of trauma of the parenchymal organs was confirmed experimentally, and same experiment has also shown that collagen in the composition of MPSI boosts bleeding arrest (for liver injury, the smallest blood loss and hemorrhage control time was 41 s, for spleen injury — 57 s, respectively; ≤ 0.05).

137-143 29
Abstract

Currently, treatment of contaminated skin wounds aggravated by ischemia of superficial soft tissues is a problem that presents certain difficulties. The search for the new ways of treatment and drugs possessing a multidirectional effect is a relevant problem. In this study, we aimed to explore the peculiarities of wound evolution and the effectiveness of the designed combination of medicines and magnetic therapy in a contaminated skin wound case. For the experiment, we divided male Wistar rats into 3 groups and modeled a contaminated skin wound in each of the animals. In the first group, no treatment was performed, in the second, we used the developed combination (benzalkonium chloride, dexpanthenol, pentoxifylline and carboxymethylcellulose sodium salt, combined with magnetic therapy), in the third — ointment with dioxomethyltetrahydropyrimidine + chloramphenicol and magnetic therapy. Planimetry, acid-base balance registration, measurements of microhemocirculation and local temperature of the wound bed underpinned monitoring assessment of the wounds. At the end of the study, the wound area in the second group was 10.7 and 3.7 (< ; 0.05 ) times smaller than in the first and third groups, respectively, and healing rate — 2.6 and 1.3 (< 0.05 ) times faster. The maximum values of microhemocirculation and the lowest pH were registered in the second group. Thus, combination of drugs and magnetotherapy we designed promoted healing of a contaminated skin wound, which allows recommending this treatment method for further study at the preclinical level.

144-151 10
Abstract

The paper reports a familial case of HHV-6A chromosomal integration being an important and relevant issue of genetics and medicine. The study was aimed to test the hypothesis of HHV-6A chromosomal integration and vertical transmission in patient with persistent virus detection during recurrent respiratory diseases and the asymptomatic period when there were no health complaints. Sequencing of the patient’s father genome DNA was performed, and a phylogenetic tree was constructed by aligning 270 HHV-6A/B genome assemblies from the GenBank database. As a result, a familial case of ciHHV-6A transmission was identified. It was found that the detected ciHHV-6A observed on the phylogenetic tree was closely related to other two chromosomally integrated HHV-6A sequences reported by Moscow researchers. The study confirmed HHV-6A chromosomal integration. Further precise chromosome mapping of ciHHV-6A would be useful in terms of excluding probable somatic disorders associated with the chromosome structure alteration following HHV-6, particularly HHV-6A, integration, as well as for identification of insertion sites specific for various geographic locations.

152-158 23
Abstract

Community-acquired pneumonia (CAP) is a major cause of pediatric morbidity and mortality. Currently, there is no common approach to determination of CAP severity in children, which hampers early diagnosis and treatment of the disease. The study was aimed to determine clinical and laboratory predictors of severe CAP in children under 4 years of age. Analysis of clinical data, parameters of complete blood count (CBC), C-reactive protein (CRP) using nonparametric methods for hypothesis testing, univariate correlation analysis, cross-tabulation (Statistica 10.0), logistic regression, and ROC analysis (SPSS Statistics 20.0) was performed in 72 children aged 1 month to 3 years 11 months admitted to hospital due to CAP. Severe CAP was diagnosed in 16.7% of children. Causes of severe CAP included respiratory distress (moderate — 58.3%, severe — 16.7% of cases) and sepsis (25%). We identified significant clinical predictors of severe CAP: vomiting (OR 4.2), tachypnea (OR 28.3), chest wall retractions (OR 6), wheezing (OR 4), and the absence of rhinitis (OR 0.21). Isolated assessment of the CBC and CRP did not allow to predict CAP severity. We have developed a prediction model predicting severe CAP in children under 4 years of age based on the presence of rhinitis, tachypnea, as well as leukocyte count (sensitivity and specificity 91.7%). Thus, currently the main cause of severe CAP in children under 4 years of age is respiratory distress, in which wheezing predominates. Physical examination with an emphasis on detection of rhinitis and respiratory distress is essential for diagnosing severe CAP. The use of a pneumonia severity prediction model may contribute to improvement of management of CAP in patients under 4 years of age.

159-167 31
Abstract

The growing proportion of antibiotic-resistant Klebsiella pneumoniae strains raises challenges to the healthcare system and requires the development of alternative treatment options. Bacteriophage therapy is one of such options. The study was aimed to isolate and describe bacteriophages effective against K. pneumoniae strains of clinically significant capsular types. The bacteriophages were isolated from the sewage and river water samples using the enrichment culture technique. The spectrum of lytic activity of the phages was tested on the collection of K. pneumoniae clinical isolates (= 279). The studied bacteriophages lysed 52.8–100% of K. pneumoniae strains of respective capsular types: phage VKV295 lysed 100% of strains with the capsular type KL1, SAA231 — 52.8 of strains with KL2, NNK-G4 — 100% of strains with KL39, VSG32 — 66.7% of strains with KL41, NKA196 — 87.5% of strains with KL47, Rappa3 — 87.5% of strains with KL57, PEA128 — 95.5% of strains with KL64, and ChM-G5 — 69.6% of strains with KL102. Whole-genome sequencing and subsequent bioinformatic analysis revealed that the phages belong to the Autographiviridae family and are classified into three genera.The lytic spectrum of phages was limited to specific capsular types due to the presence of specific receptor-binding proteins, polysaccharide depolymerases. The isolated bacteriophages were strictly virulent, did not carry harmful genetic determinants, and had a specific host range, making them applicable in therapeutic practice for combating antibiotic-resistant infections caused by K. pneumoniae.

168-173 50
Abstract

The problem of iron deficiency among donors is relevant and directly affects the provision of hemocomponents to the blood service. Donors, being a risk group for the development of iron deficiency, are examined before donation, including a study of hemoglobin levels. However, there is no information about the state of iron stores, when depleted, iron deficiency anemia develops. In turn, anemia is a contraindication to donation and, therefore, leads to medical exemptions from donation. The purpose of the study was to evaluate the main indicators of iron metabolism in donors of blood and (or) blood components at risk of developing latent iron deficiency. The examination of 174 donors included a hemogram, assessment of the level of hemoglobin, serum ferritin (SF), transferrin, and soluble transferrin receptors. When assessing the intensity of changes in reserve and transport iron indicators, 228 deviations from the reference range were analyzed. The criterion for the risk of developing iron deficiency was hemoglobin values at the lower limit of normal (130–135 g/l in men and 120–125 g/l in women) and the threshold level of ferritin (30 μg/l in male donors and 20 μg/l in women). The risk group included 58.3% of young donors — women who donate blood 1–2 times during the year (< 0.01) and 66.6% (< 0.01) of donors — men who donate blood regularly throughout 4 and > years. The average ferritin level in male donors was 27.37 μg/l (< 0.02) and lower than the reference values. It is concluded that it is advisable to assess the indicators of iron metabolism in donors in the case of borderline hemoglobin levels, in women of reproductive age after 2 blood donations and in men with the number of donations ≥ 10. To replenish the iron depot in the body, when iron deficiency is detected in donors, it is necessary to consider the issue of prevention.

174-183 29
Abstract

The spread of COVID-19 in Russia has led to restrictive measures. The stress associated therewith had a noticeable psychoemotional effect on the population, which could not but affect the numbers and patterns of acute chemical poisonings (ACP). This study aimed to investigate the patterns of ACP in Moscow in the context of the COVID-19 pandemic. We analyzed data describing cases admitted with ACP to N.V. Sklifosovsky Research Institute for Emergency Medicine in 2019–2021, factoring in the dynamics COVID-19 prevalence as diagnosed with RT-PCR tests. The results of the analysis were processed using nonparametric methods and GraphPad Prism 9 software. Within the considered period, 2020 was the peak year. The number of acute poisonings (AP) with ethanol and its surrogates in 2020 was 109.7% greater than in 2019 (both sexes; the figure for women alone was 286.2%). Male patients suffered AP with drugs and corrosive substances more often than female (< 0.0001). The number of drug abuse cases in 2019–2021 varied slightly, increasing by 2.4 and 6.7% annually. Synthetic narcotic substances were most common: methadone, cathinones, psychostimulants, and mixtures of substances. We discovered parallel trends in dynamics of ethanol intoxication and COVID-19 cases, and no such between drug poisonings and the said morbidity. Thus, the identified specifics of ACP patterns in the capital of Russia associated with the COVID-19 pandemic are a spike in alcohol abuse (especially among women), and lack of noticeable effect of the disease on use of drugs.

184-189 8
Abstract

Head and neck reconstruction surgery is a challenging area of surgery that requires the surgeon to be familiar with various reconstructive options. Achieving both functionality and aesthetic harmony of facial proportions constitutes one of the most important aspects of the head and neck defect elimination. For that various methods are used involving application of local, regional and free flaps on vascular pedicles. The reconstructive method is selected based on the defect size, location, composition, as well as on the age, comorbidity, surgeon’s and patient’s preferences. Submental flap is a regional flap that has proven to be a reliable fasciocutaneous flap, the tissues of which are identical to that of the lower face in width, texture, and color. Long vascular pedicle ensures wide flap rotation arc, thereby allowing one to use the flap for elimination of defects of the upper and lower lips, mental region, tongue, floor of the mouth, and preauricular area. Damage to the donor site is minimal, it is cosmetically invisible due to the scar hidden in the mental region. The paper presents the results of surgical treatment of the 38-year-old female patient with the soft tissue defect of the lower third of the face and the lip resulting from trauma. The wound did not heal for more than six months, no improvement was observed. It was decided to eliminate the defect using a rotation submental flap. The patient was followed up for a year after surgery. We managed to achieve complete aesthetic and functional rehabilitation of the patient.



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ISSN 2713-2757 (Print)
ISSN 2713-2765 (Online)