The incidence of complications associated with local anesthesia in the practice of a dentist

The introduction of new technologies and modern local anesthetics into dental practice has significantly increased the effectiveness and safety of anesthesia on an outpatient basis. Local anesthesia has become so firmly an integral part of modern dental practice that sometimes the doctor forgets about possible complications during its implementation. Most researchers note that, unfortunately, there is no accurate statistics of errors and complications during local anesthesia. A survey of 37 dentists was conducted. All respondents in their practical work observed the development of General and local complications after the introduction of local anesthetics. Among the General complications more often (89%) dentists observed toxic effects after the use of local anesthetic. Submucosal, subcutaneous hematoma (49%), tissue ischemia (30%) – the most frequently noted local complications during anesthesia at the dental reception among the interviewed dentists. At the same time, 78% of respondents administered a local anesthetic with vasoconstrictor in 1:100,000 dilution.Внедрение в стоматологическую практику новых технологий и современных местных анестетиков значительно повысили эффективностьи безопасность обезболивания на амбулаторном приеме. Местная анестезия настолько прочно стала неотъемлемой частью современной стоматологической практики, что иногда врач забывает о возможных осложнениях при ее проведении. Большинство исследователей отмечают, что, к сожалению, не ведется точная статистика ошибок и осложнений при проведении местной анестезии. Проведено анкетирование 37 врачей-стоматологов. Все респонденты в своей практической работе наблюдали развитие общих и местных осложнений после введения местных анестетиков. Среди общих осложнений чаще (89%) стоматологи наблюдали токсические эффекты местных анестетиков. Подслизистая, подкожная гематома (49%), ишемия тканей (30%) – наиболее часто отмеченные местные осложнения при проведении анестезии. При этом 78% респондентов вводили местный анестетик с вазоконстриктором в разведении 1:100000

Способы хирургического лечения сочетанных стенозов сонных и коронарных артерий. Систематический обзор

Aim of study. To determine the optimal tactics of surgical treatment of patients with combined stenosis of the carotid and coronary arteries by comparing the results of the simultaneous and staged approach according to the literature.Material and methods. A systematic literature search was performed in the PubMed and MEDLINE databases to compare the results of simultaneous and staged interventions for combined stenosis of the carotid and coronary arteries. The following keywords were used as a search query: (“combined coronary and carotid artery stenosis and simultaneous”), (“combined coronary and carotid artery stenosis and staged”), (“combined coronary and carotid artery stenosis and cost”). We compared the results of simultaneous (interventions on the vessels of both systems are performed simultaneously) and staged operations (interventions are performed alternately, with a time interval from 2 to 160 days). References from included studies were also manually reviewed. The search was conducted by two independent experts (S.L., S.N.), and any disagreement was resolved by the clinical expert (A.A.).Results. A literature search identified 198 potentially relevant studies. A total of 13 studies met the inclusion criteria, of which 5 included two interventions. This systematic analysis includes the results of treatment of 43,758 patients with combined stenosis of the carotid and coronary arteries, who underwent staged or simultaneous revascularization of the vessels of the carotid and coronary flow. Perioperative neurological complications in the group of staged operations were observed somewhat more often than in the group of simultaneous interventions (3.2% versus 4.22%; p=0.8), myocardial infarction was observed with a frequency of 1.5% in the group of simultaneous interventions, and 2.5% (p=0.5) in the group of staged interventions. The mortality rate after simultaneous and staged interventions was 3.9% and 3.6%, respectively, with a fairly high spread in the study groups (p=0.5). Data analysis showed that simultaneous interventions did not affect the incidence of neurological, cardiac complications, and deaths (OR (odds ratio) 1.02; 95% CI (confidence interval) — 0.98–1.14, p = 0, 69; OR — 1.26; 95% CI — 0.66-2.41; p=0.48; and OR — 0.97; 95% CI — 0.67-1.38; p=0.85 — respectively).Conclusion. 1. The cumulative incidence of neurological and cardiac complications and mortality in staged tactics, according to observational studies included in this systematic review, is 4.2%; 2.6% and 3.6%, respectively (p>0.05). 2. The cumulative incidence of neurological and cardiac complications and mortality with simultaneous tactics according to observational studies included in this systematic review is 3.3%; 1.5% and 3.9%, respectively (p>0.05). 3. Given the relatively low risk of developing myocardial infarction (OR — 1.26; 95% CI — 0.66–2.41; I2 — 94%), the low risk of developing neurological complications (OR 1.02; 95% CI — 0,98–1.14; I2=75%), and deaths (OR — 0.97; 95% CI — 0.67–1.38; I2 — 76%) — (p>0.05), with simultaneous interventions, it can be concluded that simultaneous interventions may be the method of choice for surgical treatment for combined stenosis of the carotid and coronary arteries.Цель исследования. Определить оптимальную тактику хирургического лечения пациентов с сочетанными стенозами сонных и коронарных артерий путем сравнения результатов симультанного и этапного подхода по данным литературы.Материал и методы. Выполнен систематический поиск литературы в базах данных PubMed и MEDLINE для сравнения, данных результатов симультанных и этапных вмешательств при сочетанных стенозах сонных и коронарных артерий. В качестве поискового запроса использовали следующие ключевые слова: (“combined coronary and carotid artery stenosis and simultaneous”), (“combined coronary and carotid artery stenosis and staged”), (“combined coronary and carotid artery stenosis and cost”). Сравнивали результаты симультанных (вмешательства на сосудах обоих бассейнов выполняются одновременно) и этапных операций (вмешательства выполняются поочередно, с интервалом времени от 2 до 160 суток). Ссылки из включенных исследований были также рассмотрены вручную. Поиск проводили двое независимых специалистов (С.Л., С.Н.), любые разногласия разрешались клиническим экспертом (А.А.).Результаты. Поиск литературы позволил выявить 198 потенциально подходящих исследований. В итоге 13 исследований соответствовали критериям включения, из которых 5 содержали две интервенции. Данный систематический анализ включает результаты лечения 43 758 пациентов с сочетанными стенозами сонных и коронарных артерий, которым произведена этапная или симультанная реваскуляризация сосудов сонного и коронарного русла. Периоперационные неврологические осложнения в группе этапных операций наблюдались несколько чаще, чем в группе симультанных вмешательств (3,2% против 4,22%; р=0,8), инфаркт миокарда отмечен с частотой в группе симультанных вмешательств 1,5%, и в группе этапных вмешательств — 2,5% (р=0,5). Частота летальности после симультанных и этапных вмешательств составила 3,9% и 3,6% соответственно при достаточно высоком разбросе в группах исследования (р=0,5). Анализ данных показал, что симультанные вмешательства не влияют на частоту развития неврологических, кардиальных осложнений и смертельных исходов (ОШ (отношение шансов) 1,02; 95% ДИ (доверительный интервал) — 0,98–1,14, p=0,69; ОШ — 1,26; 95% ДИ — 0,66–2,41; р=0,48; и ОШ — 0,97; 95% ДИ — 0,67–1,38; р=0,85 — соответственно).Выводы. 1. Кумулятивная частота неврологических и кардиологических осложнений и летальности при этапной тактике по данным обсервационных исследований, включенных в данный систематический обзор, составляет 4,2%; 2,6% и 3,6% соответственно (р>0,05). 2. Кумулятивная частота неврологических и кардиологических осложнений и летальности при симультанной тактике по данным обсервационных исследований, включенных в данный систематический обзор, составляет 3,3%; 1,5% и 3,9% соответственно (р>0,05). 3. Учитывая относительно низкий риск развития инфарктов миокарда (ОШ — 1,26; 95% ДИ — 0,66-2,41; I2 — 94%), низкий риск развития неврологических осложнений (ОШ 1,02; 95% ДИ — 0,98-1,14; I2=75%) и летальных исходов (ОШ — 0,97; 95% ДИ — 0,67–1,38; I2 — 76%) — (р>0,05) при симультанных вмешательствах, можно сделать заключение: симультанные вмешательства могут являться способом выбора хирургического лечения при сочетанных стенозах сонных и коронарных артерий

Сравнительная эффективность симультанных и этапных операций у пациентов с атеросклеротическим поражением сонных и коронарных артерий

Objective: comparative systematic analysis of clinical trials of staged and simultaneous approaches in the surgical treatment of combined carotid and coronary stenosis based on the literature search.Material and methods. A systematic literature search was performed in PubMed/MEDLINE, Google Scholar and Scopus using predefined acceptance criteria. To compare data of simultaneous and staged surgery cumulative indicators of heart attack, stroke and mortality, expressed as percentages and absolute numbers, were analyzed; the Mantel–Hensel formula and the χ2 method were used to assess the relative risk of major adverse cardio-cerebral events development and mortality.Results. The analysis included 7 studies containing one intervention (4 simultaneous and 3 stage methods). The risk of developing myocardial infarction was RR 0.13 (95% CI 0.02–0.67) for simultaneous tactics, and RR 7.79 (95% CI 1.5–40.43) for staged tactics (p˂0.005). The risk of stroke developing was RR 1.29 (95% CI 0.56–2.99) for a simultaneous approach, and RR 0.78 (95% CI 0.33–1.8) for stage approach (p˃0.05). The risk of mortality was RR 0.77 (95% CI 0.31–1.88) for simultaneous procedures, and RR 1.3 (95% CI 0.53–3.18) for staged procedures (p˃0.05).Conclusion. Staged tactics for combined carotid and coronary stenosis may be accompanied by a significantly higher risk of myocardial infarction. There was no statistically significant difference between the groups in terms of the risk of stroke and mortality, but there was a trend towards a higher risk of stroke in the simultaneous group and a higher risk of death from all causes in the staged group.Цель: сравнительный анализ клинических исследований этапного и симультанного подходов в хирургическом лечении сочетанных поражений каротидного и коронарного русла по данным литературы.Материал и методы. Был выполнен систематический поиск литературы в базе данных PubMed/MEDLINE, Google Scholar и Scopus с помощью предварительно определенных критериев приемлемости. Сравнивая данные симультанной хирургии с этапной хирургией, анализировали кумулятивные показатели частоты инфаркта, инсульта и летальности, выраженные в процентах и абсолютных цифрах. Для оценки относительного риска (related risk, RR) развития осложнений использовали формулу Мантеля–Хензеля и критерий χ2.Результаты. В анализ вошли 7 исследований, которые содержали одно вмешательство (4 симультанных и 3 этапных метода). Риск развития инфаркта миокарда: при симультанной тактике – RR 0,13 (95% ДИ 0,02–0,67), при этапной – RR 7,79 (95% ДИ 1,5-40,43) (р˂0,005). Риск развития инсульта: при симультанном подходе – RR 1,29 (95% ДИ 0,56–2,99), при этапном – RR 0,78 (95% ДИ 0,33–1,8) (р˃0,05). Риск летальности: при симультанных операциях – RR 0,77 (95% ДИ 0,31–1,88), при этапных – RR 1,3 (95% ДИ 0,53–3,18) (р˃0,05).Заключение. Этапная тактика при сочетанных стенозах каротидного и коронарного русла может сопровождаться достоверно более высоким риском развития инфаркта миокарда. В отношении риска развития инсульта и летальности статистически достоверной разницы между группами выявлено не было, но отмечена тенденция к более высокому риску инсульта в симультанной группе и более высокому риску смерти от всех причин в этапной группе

Zoning of the Territory of the Republic of Kazakhstan by the Degree of Intensity of the Epizootic Situation on Plague in Camels

The aim of the study was to improve epizootiological monitoring and increase the effectiveness of preventive (anti-epidemic) measures for camel plague control in Kazakhstan.Materials and methods. We used the data on epizootiological and epidemiological monitoring in natural plague foci of Kazakhstan, long-term measurements and indicators for the period of 2000–2020 of the anti-plague and veterinary services of the Republic for the analysis. To process the evidence, epidemiological, epizootiological, microbiological, and statistical research methods, as well as GIS technology were applied.Results and discussion. The number of camels has increased by 2.2 times in Kazakhstan over the past 20 years.  Where there were 98.2 thousand heads in 2000, it amounted to 216.4 thousand heads in 2020. Over the past 10 years, 152 camels died of unknown causes in the focal area of the country, but laboratory tests for plague turned out negative. According to the hazard criteria, the territory of the country has been conditionally divided into three zones: five regions with a high degree of hazard with a total area of 953.15 sq. km, five regions with medium degree of hazard with a total area of 1230.72 sq. km, and with a low degree of hazard – four regions and three cities of republican significance with a total area of 541.1 sq. km. Constant epizootiological monitoring over plague in camels is a necessity for the system of preventive measures

Demarcation of the Boundaries of the Central Asian Desert Natural Focus of Plague of Kazakhstan and Monitoring the Areal of the Main Carrier, <I>Rhombomys opimus</I>

The aim of the study was to clarify the boundaries of the Central Asian natural plague focus of Kazakhstan and the modern boundaries of the areal of the great gerbil (Rhombomys opimus) in order to improve epizootiological monitoring and increase the effectiveness of preventive (anti-epidemic) measures.Materials and methods. Data from the epizootiological monitoring of the great gerbil populations in 14 autonomous foci of the Central Asian desert natural plague focus in the Republic of Kazakhstan between 2010 and 2020 were used for the analysis. An epizootiologic survey of an area of 875350 km2 was carried out. When processing the data, epidemiological, epizootiological, statistical research methods, as well as GIS technologies were used.Results and discussion. An increase in the total area of the Central Asian desert natural plague focus of the Republic of Kazakhstan by 79710 km2 (9.98 %) has been established for the period of 1990–2020. It is noted that the change in the area of plague-enzootic territory was a consequence of the ever changing areal of the main carrier of plague pathogen – the great gerbil – under the influence of climatic and anthropogenic factors. The most significant changes were found in the southeastern part of the plague-enzootic territory, including those for the Betpakdala (50 %), Balkhash (34.3 %), Taukum (13.3 %) and Mojynkum (0.32 %) autonomous foci. The area of the Aryskum-Dariyalyktakyr autonomous focus decreased by 2100 km2 (4 %). In 2000–2002, new Alakol’sky and Ili intermountain autonomous foci with a total area of 26759 km2 were discovered. It is shown that due to the regression of the Aral Sea, the areal of the great girbil expanded and the area of the North Aral and Kyzylkum natural plague foci increased by 10500 km2 (29.2 %) and 560 km2 (0.4%), respectively. The areas of the Aral-Karakum and UralEmba desert autonomous foci, on the contrary, decreased by 2000 km2 (2.6 %) and 12300 km2 (17.6 %), respectively. Passportization and landscape-epizootiologic zoning of the territory of the Central Asian desert natural plague focus of the Republic of Kazakhstan has been completed

Hemispheric Asymmetry in White Matter Connectivity of the Temporoparietal Junction with the Insula and Prefrontal Cortex

The temporoparietal junction (TPJ) is a key node in the brain's ventral attention network (VAN) that is involved in spatial awareness and detection of salient sensory stimuli, including pain. The anatomical basis of this network's right-lateralized organization is poorly understood. Here we used diffusion-weighted MRI and probabilistic tractography to compare the strength of white matter connections emanating from the right versus left TPJ to target regions in both hemispheres. Symmetry of structural connectivity was evaluated for connections between TPJ and target regions that are key cortical nodes in the right VAN (insula and inferior frontal gyrus) as well as target regions that are involved in salience and/or pain (putamen, cingulate cortex, thalamus). We found a rightward asymmetry in connectivity strength between the TPJ and insula in healthy human subjects who were scanned with two different sets of diffusion-weighted MRI acquisition parameters. This rightward asymmetry in TPJ-insula connectivity was stronger in females than in males. There was also a leftward asymmetry in connectivity strength between the TPJ and inferior frontal gyrus, consistent with previously described lateralization of language pathways. The rightward lateralization of the pathway between the TPJ and insula supports previous findings on the roles of these regions in stimulus-driven attention, sensory awareness, interoception and pain. The findings also have implications for our understanding of acute and chronic pains and stroke-induced spatial hemineglect

Baseline characteristics and outcome of stroke patients after endovascular therapy according to previous symptomatic vascular disease and sex

AimThe aim of this study was to investigate baseline characteristics and outcome of patients after endovascular therapy (EVT) for acute large vessel occlusion (LVO) in relation to their history of symptomatic vascular disease and sex.MethodsConsecutive EVT-eligible patients with LVO in the anterior circulation admitted to our stroke center between 04/2015 and 04/2020 were included in this observational cohort study. All patients were treated according to a standardized acute ischaemic stroke (AIS) protocol. Baseline characteristics and successful reperfusion, recurrent/progressive in-hospital ischaemic stroke, symptomatic in-hospital intracranial hemorrhage, death at discharge and at 3 months, and functional outcome at 3 months were analyzed according to previous symptomatic vascular disease and sex.Results995 patients with LVO in the anterior circulation (49.4% women, median age 76 years, median admission NIHSS score 14) were included. Patients with multiple vs. no previous vascular events showed higher mortality at discharge (20% vs. 9.3%, age/sex − adjustedOR = 1.43, p = 0.030) and less independency at 3 months (28.8% vs. 48.8%, age/sex − adjustedOR = 0.72, p = 0.020). All patients and men alone with one or multiple vs. patients and men with no previous vascular events showed more recurrent/progressive in-hospital ischaemic strokes (19.9% vs. 6.4% in all patients, age/sex − adjustedOR = 1.76, p = 0.028) (16.7% vs. 5.8% in men, age-adjustedOR = 2.20, p = 0.035). Men vs. women showed more in-hospital symptomatic intracranial hemorrhage among patients with one or multiple vs. no previous vascular events (23.7% vs. 6.6% in men and 15.4% vs. 5.5% in women, OR = 2.32, p = 0.035/age − adjustedOR = 2.36, p = 0.035).ConclusionsPrevious vascular events increased the risk of in-hospital complications and poorer outcome in the analyzed patients with EVT-eligible LVO-AIS. Our findings may support risk assessment in these stroke patients and could contribute to the design of future studies

Современный взгляд на проблему постхолецистэктомического синдрома (по материалам Экспертного совета, состоявшегося 4 мая 2019 г. в городе Алматы, Казахстан)

Gallstone disease is revealed in 10–20% of the population with a clear tendency to affect the younger population. In a clinically manifested course, cholecystectomy remains the treatment of choice. Symptoms and signs persist or even become more severe after gallbladder surgery in 10-15% of cases (“postcholecystectomy syndrome”). Postcholecystectomy syndrome includes heterogeneous disorders of liver, pancreas, duodenum, sphincter of Oddi, etc. that can be associated with errors or negative consequences of surgical intervention. Often, symptoms may persist because of previously unrecognized chronic diseases of neighboring organs. The spectrum of effective conservative measures is rather limited. The Advisory Board was held on May 4, 2019, in Almaty (Kazakhstan) to re-estimate the definitions and categories related to the issue of the postcholecystectomy syndrome and to develop the diagnostic and treatment algorithm for patients with the postcholecystectomy dysfunction of the sphincter of Oddi. The statements discussed by the interdisciplinary team of gastroenterologists and surgeons were addressed to general practitioners, therapists, gastroenterologists, and surgeons. The Advisory Board emphasized that organic and functional biliary diseases manifest mainly by biliary pain, main characteristics of which were defined in the Rome IV consensus based on the statistical analysis of a large pool of clinical data. For a more accurate bile duct system assessment and the exclusion of cholelithiasis, the examination algorithm was proposed, which included abdominal ultrasound investigation, endoscopic ultrasound investigation of the pancreatobiliary area, and magnetic resonance cholangiopancreatography. Diagnostic algorithm for differentiation of functional biliary disorders from organic gastrointestinal pathology was developed. Sphincter of Oddi dysfunction may be considered as a postcholecystectomy syndrome manifestation in 1.5-3% of cases. Apart from rational nutrition, conservative management of functional gastrointestinal diseases implies  pharmacological therapy. The efficacy of non-steroidal anti-inflammatory drugs, prokinetics, nitrates, antispasmodics, calcium channel antagonists, botulinum toxin, and hymecromone was demonstrated in previous studies. Papillosphincterotomy is not effective in relieving biliary pain in cases of the sphincter of Oddi dysfunction. The proposed algorithm for the management of patients with the postcholecystectomy syndrome was presented.Желчнокаменная болезнь выявляется у 10–20% населения и имеет четкую тенденцию к «омоложению». При наличии клинических симптомов основным методом лечения остается холецистэктомия, после которой у 10–15% пациентов клинические проявления сохраняются либо усиливаются (для обозначения таких ситуаций применяют термин «постхолецистэктомический  синдром»). Постхолецистэктомический синдром объединяет неоднородные расстройства, включая  нарушения функции печени, поджелудочной железы, двенадцатиперстной кишки, сфинктера Одди  пр., которые могут быть связаны с погрешностями или последствиями хирургических манипуляций. Зачастую причиной сохранения жалоб оказываются ранее нераспознанные хронические заболевания других органов. Арсенал эффективных средств медикаментозной и  немедикаментозной коррекции относительно невелик. С целью стандартизировать определения и  категории, касающиеся проблемы постхолецистэктомического синдрома, и разработать алгоритм обследования и лечения пациентов с постхолецистэктомической дисфункцией сфинктера  Одди 4 мая 2019 г. в городе Алматы (Казахстан) состоялся совет экспертов – представителей  междисциплинарной команды из гастроэнтерологов и хирургов. Целевая аудитория – врачи общей  практики, терапевты, гастроэнтерологи, хирурги. Согласно решению Экспертного совета, основным  клиническим проявлением органических и функциональных заболеваний желчных путей  является билиарная боль, подробные характеристики которой были выделены в материалах IV Римского консенсуса на основании статистического анализа большого объема клинических данных. Для более точной оценки состояния протоковой системы и исключения желчнокаменной болезни в план обследования включают ультразвуковое исследование органов брюшной полости,  эндоскопическое ультразвуковое исследование панкреато-билиарной зоны, магнитно-резонансную  холангиопанкреатографию. Функциональные билиарные расстройства необходимо дифференцировать с органическими заболеваниями органов пищеварения; с этой целью  рекомендован план обследования пациентов. Дисфункцию сфинктера Одди можно рассматривать как вариант постхолецистэктомического синдрома; на долю таких случаев приходится 1,5–3%. Консервативное ведение при функциональных заболеваниях органов пищеварения, помимо  рационального питания, подразумевает лекарственную терапию. Показана эффективность  нестероидных противовоспалительных препаратов, прокинетиков, нитратов, спазмолитиков, антагонистов кальциевых каналов, ботулотоксина и гимекромона. Папиллосфинктеротомия при  дисфункции сфинктера Одди не обладает должной эффективностью в купировании билиарной  боли. Разработан алгоритм ведения пациентов при появлении билиарной боли и другой  симптоматики после холецистэктомии

The Use of Modern Technologies in the Russian Language Lessons in the Development of Communicative Competencies of Students

Teaching the Russian language in a modern educational institution is carried out in the conditions of significant changes in the entire education system. These changes are due to the need to bring the quality of the latter in line with the requirements of modern society. But it should be noted that students have poorly formed speech development skills. Students are not always able to freely argue their speeches, draw generalized conclusions, or simply freely and arbitrarily communicate with each other. Often they try to replace lively, cultural speech with standard everyday facial expressions and gestures, i.e. primitive non-verbal ways of communication. Students find it difficult to create independent, coherent, generalized oral and written statements. Students make a large number of speeches, spelling and punctuation errors. The purpose of the article is to consider the means of communication technologies from the point of view of their influence on the development of oral speech in Russian language lessons