FREQUENCY OF EMOTIONAL DISORDERS AND BEHAVIOR DISTURBANCES IN CHILDREN AND ADOLESCENTS OF AGINSKIY DISTRICT OF BURYAT REGION

Aimed at studying the prevalence of emotional disorders and behavior disturbances in children and adolescents of Aginskiy district of Buryatskiy region (okrug), we had been examining 2 572 schoolchildren picked up by random (1 487 primary schoolchildren and 1 085 adolescents). We were using M.Ratter's questionnairy (B2 scale for teachers). Frequency of emotional disorders and behavior disturbances in primary school children was 8.6 %, and in adolescents it was 7.3 %. We marked disorders in boys 2-4 times more frequent than in girls. The shares of behavior disturbances and hyperkinetic disturbances are the largest in the structure

PSYCHO-PATHOLOGIC BASES OF SUICIDAL BEHAVIOR IN ADOLESCENTS OF NATIVE PEOPLE OF SIBERIA

In order to study the peculiarities of emotion sphere and reactions under stress situations, we examined 556 adolescents of indegenion peoples of Siberia, inhabitants of three districts, located in Siberian region. Control was represented by 315 alien adolescents of Siberia. We implemented the technique of «Self-evaluation of psychic disorders» and determined the level of anxiety, frustration, aggression, private rigidity. Wefound out that psycho pathologic basis of suicidal behavior in native adolescents of Siberia is the increased level of anxiety, decreased tolerance to stress, blocked activity under stress situation

Anterior Abdominal Wall Pain

Aim: to present modern approaches to the differential diagnosis and treatment of anterior abdominal wall pain.Key points. Pain in the anterior abdominal wall is a common reason for visiting a gastroenterologist and is often misinterpreted. Signs that distinguish it from visceral and parietal pain include local character, a positive Carnett sign and the effectiveness of local anesthetic injection. Among the main causes, it is necessary to highlight diseases that are not accompanied by a palpable mass in the anterior abdominal wall (anterior cutaneous nerve entrapment syndrome, ilioinguinal nerve syndrome, slipping rib syndrome, radiculopathy and myofascial pain syndrome). Another group of causes of pain in the anterior abdominal wall is represented by diseases in which areas of infiltration (tumors, endometriosis, infections) or hernial protrusions are determined, in which radiation methods play an important role in diagnosis.Conclusion. Knowledge of pathognomonic clinical and instrumental signs is the basis for differential diagnosis and choice of treatment strategy for pathology of the anterior abdominal wall

Clinical characteristics of a chronic endometritis

There were studied clinical features of a chronic endometritis in 152 patients of a childbearing age depending on activity degree of inflammation in a mucosa of the uterus revealed at morphological study. It was established the high frequency of an asymptomatic current of a chronic endometritis, with the presence of inflammatory changes in the mucous uterus by morphological study. Consequently clinical features of chronic endometritis do not serve as a criterion for prescription of antibacterial therapy.Изучены особенности клинического течения хронического эндометрита у 152 пациенток репродуктивного возраста в зависимости от степени активности воспалительного процесса в слизистой оболочке матки, выявленной при морфологическом исследовании. Установлено, что большая частота бессимптомного течения хронического эндометрита, даже при воспалительных изменениях в слизистой матки, выявленных при морфологическом исследовании, свидетельствует о том, что нельзя в полной мере полагаться только на клинические проявления заболевания как критерий для назначения антибактериальной терапии

Diagnostic Algorithm for Joint Pain in Patients with Inflammatory Bowel Disorders

Aim. An algorithm development for joint pain differential diagnosis in patients with inflammatory bowel disorders (IBD) and its validation in clinical practice.Materials and methods. A total of 349 IBD patients hospitalised for gastroenterological complaints at the Chelyabinsk Regional Clinical Hospital during 2017–2020 have been examined.Results. Upon survey, 97 (27.8%) IBD patients complained of joint pain. Ulcerative colitis (UC) predominated (79 patients; 81.4%), Crohn’s disease (CD) had a 18.6% incidence. In survey, 27% UC and 32.1% CD patients reported joint pain (p = 0.26). Among IBD patients, 52.6% had mechanical, and 47.4% — inflammatory pain. The inflammatory back pain (IBP) rate in survey cohort was 23.7%. Use of a diagnostic algorithm allowed concomitant rheumatic disease detection in 7 (7.2%) patients from the IBD–joint pain cohort: 2 patients were diagnosed with psoriatic spondyloarthritis, 2 — rheumatoid arthritis, 1 — gout and 2 — with ankylosing spondylitis. IBD-associated arthritis was diagnosed in 41 (42.3%) cases, osteoarthritis — in 38 (39.2%) IBD patients with joint pain, arthralgia with no objective inflammation, impaired joint function or lesions in X-ray and/or ultrasound — in 13 (13.4%) patients.Conclusion. Joint pain complaints are common in IBD patients and require a multispecialty rheumatologists-involving approach to proceed with differential diagnosis and opting for treatment tactics. A clinically verified algorithm coupled with laboratory tests and instrumental imaging facilitates diagnosis and optimal therapy selection in IBD patients with complaints of joint pain

Profile of antiphospholipid antibodies and complement system in COVID-19 patients of different severity

COVID-19, a severe acute respiratory syndrome caused by SARS-CoV-2, may predispose to thrombotic events, especially when combined with antiphospholipid antibodies (aPL). However, there are limited data on prevalence and antigenic specificity of aPL in COVID-19. Complement activation is assumed to play an important role in pathogenesis of COVID-19-associated coagulopathy. During the SARS-CoV-2 pandemic, it is necessary to identify important biomarkers for predicting severe course of COVID-19 and risk of thrombotic complications. Our objective was to evaluate the aPL profile, quantitative content and activity of complement and its components in COVID-19 patients graded by severity in the course of time. IgM and IgG antibodies to cardiolipin (CL), phosphatidylserine (PS), β2-glycoprotein-I (β2-GP-I), prothrombin (PT), annexin V (An V), as well as C1q complement component, content of its C3 and C4 components and total complement activity were determined in blood serum using ELISA approach. 141 patients with COVID-19 were included in the study. Group 1 consisted of 39 patients with mild form, group 2 (65 patients) presented with moderate form, and group 3 included 37 patients with severe form of COVID-19. Blood samples were obtained on day 3-7 of the disease (1st point) and after 14-28 days (2nd point). The results were as follows: aPL were detected in 29.1% of the total COVID-19 cohort, frequency of aPL detection by the severity grade did not differ (33.3%, 24.6% and 32.4%). In 8.5% of the patients, aPL were detected only at the 1st time point; in 14.2%, only at the 2nd point; and in 6.4% of the cases, at the both time points. Antibodies to PT (16.3%) and An V (11.3%) were revealed more frequently. The detection frequency of antibodies to PT was significantly higher than antibodies to CL and PS (7.1%), β2-GP-I (7.8%). The prevalence of aPL in groups 1 and 3 did not differ. At the 1st point in group 3, increased levels of C4 (89.2%) and C3 (24.3%) in blood, and a decrease in complement activity (35.1%) were more often observed than in group 1. At the 2nd time point in group 3, a decrease in complement activity was often detected (59.5%). The C3 levels exceeding 720 μg/ml were found to predict a 2.6-fold increased risk of severe COVID-19, and this risk became 3.3 times higher at C4 levels of > 740 μg/ml. The antibodies to PT and An V are often detected in COVID-19 patients, along with low prevalence of antibodies to CL and β2-GP-I. These antibodies can be involved in pathogenesis of COVID-19-associated coagulopathy, being detectable at the late stage of the disease, and they may trigger APS in predisposed patients and reconvalescents. Although presence of aPL antibodies is not associated with COVID-19 severity, their persistence over the period of convalescence may be an additional risk factor for thromboembolic complications. The COVID-19 patients are characterized by activation of the complement system, which increases in severe cases, and manifests with increased or decreased levels of C3 complement component, increased levels of C4 component in blood, and a decreased total complement activity. Quantitative determination of C3 and C4 complement components over the period of COVID-19 progression is of prognostic value, with respect to severity of the disease

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ТРЕБОВАНИЙ К ОЦЕНКЕ КАЧЕСТВА ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ, СОДЕРЖАЩИХ ЭТИНИЛЭСТРАДИОЛ И ЛЕВОНОРГЕСТРЕЛ

The article compares test methods and levels of requirements laid out in the world’s leading pharmacopoeias and in manufacturers’ specifications with regard to the quality of levonorgestrel and ethinyl estradiol containing medicinal products used as oral contraceptives. The study analysed medicines containing a combination of levonorgestrel and ethinyl estradiol (Vezantra, Melleva, Microgynon, Minisiston, Modelle Libera etc.) that were tested at the FSBI «SCEEMP» of the Ministry of Health of the Russian Federation as part of premarketing evaluation. The comparison of the obtained data revealed that the test methods recommended by foreign pharmacopoeias and manufacturers’ specifications for quality control of medicines containing levonorgestrel and ethinyl estradiol are in line with the current trends in the pharmaceutical analysis and make it possible to adequately assess the quality of this group of medicines that are authorised in the Russian Federation. Manufacturers’ specifications include additional parameters, such as «Related impurities», «Microbiological purity», and, in some cases, «Identification of colouring agents» (titanium dioxide, iron oxide), «Average weight», «Disintegration», «Water», and «Residual organic solvents». The study showed that the requirements included into manufacturers’ specifications meet the requirements of the world’s leading pharmacopoeias or even exceed them, as in the case of the «Assay» parameter.Представлены результаты сравнительной оценки методов контроля и уровня требований, предъявляемых ведущими зарубежными фармакопеями и нормативными документами производителей к качеству комбинированных лекарственных препаратов, содержащих левоноргестрел и этинилэстрадиол, применяемых в качестве пероральных контрацептивов. В ходе исследования анализировали препараты, содержащие комбинацию левоноргестрела и этинилэстрадиола (Везантра, Меллева, Микрогинон, Минизистон, Модэлль Либера и др.), которые поступали на экспертизу качества в ФГБУ «НЦЭСМП» Минздрава России. На основании сопоставления полученных данных установлено, что методы контроля качества препаратов, содержащих левоноргестрел и этинилэстрадиол, приведенные в зарубежных фармакопеях и нормативных документах производителей, соответствуют современному уровню развития фармацевтического анализа и позволяют в полной мере оценить качество лекарственных препаратов данной группы, зарегистрированных в Российской Федерации. Нормативные документы производителей включают оценку дополнительных показателей: «Родственные примеси», «Микробиологическая чистота», а в отдельных случаях — «Подлинность красителей» (титана диоксида, железа оксида), «Средняя масса», «Распадаемость», «Вода», «Остаточные органические растворители». Полученные результаты свидетельствуют о том, что требования нормативных документов производителей соответствуют уровню требований ведущих зарубежных фармакопей, а по показателю «Количественное определение» превосходят его

The persistence of papillomavirus infection in women with chronic cervicitis

Were examined and treated of 245 women with chronic cervicitis associated with HPV - infection. The aim of the study was to identify clinical - laboratory criteria for persistence forecast HPV- infection in women with chronic cervicitis. All the patients were divided into two groups: I group consisted of 198 patients who have HPV from cervical canal eliminated within 6 months after treatment, II group - 47 women with persistent HPV infection. Found, that HPV infection in women with chronic cervicitis is persistent over 19% of cases. Patients with persistent HPV infection significantly more likely to have two or more sexual partners during the last year, significantly more likely to have respiratory pathology, endocrine system and diseases of the gastrointestinal tract, often complained of contact bleeding and had burdened heredity of malignant disease of the cervix. Past colposkopical studies indicate that, significantly more likely in patients with persistent HPV detected stippling and iodine the negative zone. Found, that women with persistent HPV significantly more likely chronic inflammation of the cervix combined with dysplasia of the cervix. Higher viral load was significantly more frequently observed in women with persistent HPV infection, even so the persistence observed in patients with chronic inflammation of the cervix associated with 18 types of HPV.Проведено обследование и лечение 245 женщин с хроническим цервицитом, ассоциированным с папилломавирусной инфекцией. Целью исследования явилось выявление клинико-лабораторных критериев прогноза персистенции папилломавирусной инфекции у женщин с хроническим цервицитом. Все больные были разделены на две группы: I группу составили 198 пациенток, у которых ВПЧ из цервикального канала элиминировал через 6 месяцев после лечения, II группу - 47 женщин с персистирующей ВПЧ-инфекцией. Установлено, что ВПЧ-инфекция у женщин с хроническим цервицитом имеет персистирующее течение в 19% случаев. Больные с персистирующей ВПЧ-инфекцией достоверно чаще имели двух и более половых партнеров в течение последнего года, достоверно чаще имели патологию дыхательной, эндокринной систем и заболевания желудочно-кишечного тракта, чаще предъявляли жалобы на контактные кровотечения и имели отягощенную наследственность по злокачественным заболеваниям шейки матки. При кольпоскопическом исследовании выявлено, что достоверно чаще у пациенток с персистенцией ВПЧ выявляется пунктация и йоднегативная зона. Установлено, что у женщин с персистенцией ВПЧ достоверно чаще хронический воспалительный процесс шейки матки сочетался с дисплазией шейки матки. Повышенная вирусная нагрузка достоверно чаще была отмечена у женщин с персистирующей ВПЧ-инфекцией, при этом персистенция наблюдалась у больных с хроническим воспалительным процессом шейки матки, ассоциированным с 18 типом ВПЧ

The influence of dipiridamol on the cytokine profile and blood interferons in women with herpes virus infection (HVI 1,11) and threat of miscarriage in the first trimester of pregnancy

There has been done clinico-laboratory study of 100 pregnant women with herpes virus infection (HVI I, II) and threat of miscarriage in the first trimester of pregnancy. All patients were divided into groups: the first group — 45 pregnant women with infection in the activation stage, the second one — 55 pregnant women with infection in the latent stage. The control group comprised 30 practically healthy pregnant women. The influence of dipiridamol on the cytokine profile and blood interferons in women with threat of miscarriage in the first trimester of pregnancy and herpes virus infection (HVI I, II) in the activation and latent stages was investigated. The results of the study show the decrease in the level of proinflammatory cytokines whilst the increase of the antiinflammatory cytokine level, as well as positive dynamics in the clinical symptomatology after the course of treatment in women with herpes virus infection (HVI I, II) and threat of miscarriage in the first trimester of pregnancy. Thus the usage of dipiridamol both with antiaggregatory activity and immunomodulatory properties is pathogenetically proved to be correct and validated for a treatment of pregnant women with herpes virus infection (HVI I, II) and threat of miscarriage in the first trimester of pregnancy.Проведено клинико-лабораторное обследование 100 беременных женщин с герпетической (ВПГ I.II) инфекцией и угрозой прерывания в первом триместре, по результатам которого было произведено разделение пациенток на группы (первая группа — 45 беременных женщин с инфекцией в стадии активации, вторая группа — 55 беременных женщин с инфекцией в латентной стадии). В группу контроля были включены 30 практически здоровых беременных женщин. Было изучено влияние дипиридамола на цитокиновый профиль и интерфероны крови у беременных женщин с угрозой прерывания в первом триместре и герпетической (ВПГ I, II) инфекцией в активной и латентной стадиях. Результаты исследования свидетельствуют о том, что у женщин с герпетической (ВПГ I, II) инфекцией и угрозой прерывания в первом триместре беременности после лечения дипиридамолом наблюдалось понижение уровня провоспалительных цитокинов на фоне повышения уровня цито-кинов противовоспалительного действия, а также имелась положительная динамика в клинической симптоматике. Поэтому для лечения беременных с герпетической (ВПГ I, II) инфекцией и угрозой прерывания в первом триместре патогенетически оправдано и обосновано применение дипиридамола, обладающего не только антиагрегационным действием, но и иммуно­ модулирующими свойствами

Effect of COVID-19 vaccination on the immune status and autoantibody profile in women of reproductive age

In the context of the COVID-19 pandemic, scientific interest is growing in studying the impact of the proposed vaccination on women’s reproductive health. As is known, alterations in the state of the immune system and activation of an autoimmune response can lead to reproductive failure in women and potential complications of subsequent pregnancy. Objective: to evaluate the effect of the “Gam-COVID-Vac” on the immune status parameters, the relationship of their changes and the specific immune response to vaccination with the dynamics of the level of autoantibodies in women of reproductive age.The prospective study included 120 women who were vaccinated against COVID-19 with the “Gam-COVIDVac”. The criteria for inclusion in the study were: the age from 18 to 49 years, the absence of COVID-19 in the anamnesis, a negative result of a study on SARS-CoV-2 by PCR and negative results of tests for antibodies of classes G and M to SARS-CoV-2 before vaccination, the absence of pregnancy and serious somatic diseases. The patients were examined twice: immediately before vaccination and 90-100 days after the introduction of the 1st component of the vaccine. The level of IgG antibodies to SARS-CoV-2 after vaccination was assessed using ELISA. Before and after vaccination, the levels of antiphospholipid, anti-nuclear, organ-specific and antihormonal autoantibodies were determined, peripheral blood lymphocytes were immunophenotyped to determine the main subpopulations (CD3, CD4, CD8, CD19, CD5, CD16, CD56), as well as the expression of activation markers of lymphocytes (HLA-DR, CD25, CD147) using monoclonal antibodies.The effectiveness and safety of the combined vector vaccine against COVID-19 were high. Specific IgG antibodies to SARS-CoV-2 were produced in 98.3% of vaccinated women, no serious adverse reactions were observed. After vaccination, there was an increase in the level of some autoantibodies within the reference ranges, only IgM antibodies to phosphatidylethanolamine (PE) and IgG antibodies to DNA increased above the reference values. However, this increase was transient. After vaccination, the following changes in the parameters of the immunogram were observed: an increase in the content of cells with CD3+CD25+, CD19+ phenotype in peripheral blood and a decrease in the content of cells with CD56+CD16+ phenotype within the reference ranges, a decrease in CD147+/CD3+. Weak correlations were noted between these changes in immunogram parameters and the levels of some autoantibodies. The specific antiviral immune response to vaccination did not correlate with the autoimmune response.Vaccination with “Gam-COVID-Vac” is effective and safe and does not lead to disorders in the immune system. The observed increase in the level of autoantibodies to PE and DNA is transient. Changes in the parameters of the immune status within the reference ranges may be due to vaccination and the development of a specific antiviral immune response