Vol 21, No 1 (2024)

Seizar (lamotrigine) is an approved treatment for bipolar affective disorder that has shown significant results in maintenance therapy and prevention, yet it remains underappreciated in russian psychiatry. Primarily, the controversy over lamotrigine prescribing is related to its side effect profile – namely, risks of potentially dangerous rash. The aim of this review is to analyse the efficacy of the drug, its side-effect profile and frequency of side-effects, and to compare it with other pharmacotherapies. We made a literature review of russiam and foreign databases. Seizar shows a good safety and efficacy profile, improving patients’ quality of life in the long term and halving the recurrence rate. The risk of rash in 8% of patients within 4 months of treatment initiation is associated with uncorrected drug titration, combination with valproate; however, these risks must be compared with the much more common risks associated with untreated BD.

A prototype of an automated laser system (0,81 μm) was tested with a laser power from 100 to 300 mW using the fundus eye model. We studied the time of formation of coagulates with a brightness from 5 to 70 % of the background level, their homogeneity, and the correspondence of the planned and actual brightness of the coagulates. To obtain coagulates with a brightness of 5–10 % of the background level (grade 1 according to L’Esperance), the most optimal laser power is from 100 to 180 mW: the time of coagulate formation did not exceed 100 ms, brightness variability is less than 7,5 %. Laser power in the range from 200 to 300 mW is optimal when obtaining coagulates with a brightness of 20–40 % and 50–70 % of the background level (grades 2 and 3 according to L’Esperance): the time of coagulate formation in the range of 100–250 ms, brightness variability less than 4 %. The greatest correspondence between the actual and planned brightness of coagulates for the brightness range of 5–70 % of the background level was found at a laser power of 140–180 mW.

This paper presents the results of the search for probable causes of dislocations of the intraocular lens-capsular bag complex (CICB) after uncomplicated minimally invasive age-related cataract surgery in patients with initial absence of Zinn’s ligament weakness by analyzing the cases of CICB dislocations over a 7-year period from 2016 to 2022 in 580 patients (580 eyes). Out of 580 cases of CICB dislocation after PE of age-related cataract, initially optimal conditions occurred in 86 cases, II–IV degrees of ICM dislocation were diagnosed among 86 patients, in 39.5 % of cases, dislocation of the CICB was accompanied by 2nd and 3rd stages of varicose veins of the lower extremities.

The results of pyramidal sensory wavefront aberrometry with the construction of refractive topographic maps (Peramis, SCHWIND eye-tech-solutions GmbH, Germany) were analyzed in 67 patients (108 eyes) with artifacia (with various types of IOL). The values of the spherical component of refraction of the eye, established by autorefractometry and pyramidal aberrometry of the wavefront, have a high correlation coefficient (r = 0.921, p < 0.0001). The construction of refractive topographic maps of intraocular structures of the eye is a method of customized diagnosis in patients with artifacia and has significant prospects in application.

The results of intravital morphological and laboratory diagnostics of superficial betaherpesvirus keratitis of 26 people (26 eyes) were analyzed. As a result of ELISA, an increase of Immunoglobulin M (IgM) to CMV or HHV-6 was found in 11,5 % of patients. 69,2 % of patients had level of Immunoglobulin G (IgG) both to CMV and HHV-6 exceeding the reference values. 30,8 % had exceeding the norm level of Immunoglobulin G (IgG) only to CMV or HHV-6 separately. As a result of the performed PCR of a tear and saliva of patients of a surveillance group in 15,4 % of cases HCMV DNA was found; in 53,8 % cases – HHV-6 DNA was found. As a result of performed confocal microscopy specific pathognomonic to betaherpesvirus owl’s eye cells was found in 86,7 % of surveillance group.

The study included 196 patients (250 eyes) with overmature cataracts. The patients were divided into 2 groups (125 eyes in each group). In all patients, the type of overmature cataract was determined intraoperatively using I-OCT integrated into the operating microscope [Hi-R NEO (HAAG STREIT, Germany)]. In the first group, femto-support for cataract surgery was performed according to a developed algorithm with optimized parameters of femtolaser exposure depending on the type of overmature cataract according to I-OCT data, in the second group, femto-support was performed using a standard method. When using the developed algorithm with optimized parameters of femtolaser exposure in comparison with femtoassistance, performed according to the standard method, the frequency of incomplete femtocapsulotomy at 2 (2.5 % vs 17.4 %, respectively) and 3 (4.9 % vs 21.6 %, respectively)) types of overmature cataract according to I-OCT data, as well as the frequency of capsulorhexis escape in type 3 (2.4 % vs 16.2 %, respectively) were statistically significantly lower in the first group of patients. The developed algorithm with optimized parameters of femtolaser exposure at the stage of anterior capsulorhexis, taking into account the type of overripe cataract according to intraoperative OCT data, ensures high quality of this stage of surgery and expands the possibilities of practical application of femtolaser support for cataract surgery in complicated cases.

Twenty-two samples of silicone oil after vitreal tamponade were analyzed for fatty acid content using gas chromatography. The silicone oil samples showed the presence of saturated and unsaturated fatty acids. During emulsification of silicone the ratio of fatty acids changed: the content of stearic fatty acid in the samples of emulsified oil was higher than in the samples without emulsification by 16.7 % (p = 0.03); there was a tendency to increase the content of linolenic acid against the tendency to decrease myristic, palmitic, palmitoleic, oleic and docosadiene acids. Intravitreal silicone oil is not completely biologically inert and is able to absorb lipophilic substances.

The profession of ballet dancers is always associated with excessive physical exertion, which in turn leads to increased muscle tension in all parts of the body, including the muscles of the facial skeleton. This, in turn, can lead to various occlusal disorders of the teeth, and subsequently functional and structural changes in the TMJ. Materials and methods: Examination and dental treatment of 15 ballet dancers with identified TMJ dysfunction was carried out. Results: Ballet dancers are particularly noted for the restriction of mouth opening and pain of varying intensity. The main patological changes of the TMJ are arthritis, arthrosis, synovitis, displacement of the position of the intra-articular disc, injuries, complete or partial dislocations, ruptures of the ligamentous apparatus. Conclusions: Splint therapy is effective for eliminating functional and structural changes in the TMJ in ballet dancers.

Objective: To improve the results of treatment of patients with advanced peritonitis. Material and methods: 42 patients with widespread peritonitis were under observation. 30 patients of the control group received surgical and postoperative treatment according to the standard scheme with enterosorption using glucose-salt solution. In the main group of 12 patients, the abdominal rehabilitation program additionally included NO-therapy with the Plason device together with enterosorbents Enterodez and Enterosgel. The effectiveness of the treatment was evaluated according to the results of laboratory studies of LII, MSM, CRP, APACHE II and SOFA. Results: Comparison of the effects of inclusion of NO-therapy with the Plason apparatus together with enterosorbents Enterodez and Enterosgel in the abdominal rehabilitation program in patients with diffuse purulent peritonitis of the main group on the severity of the patients' condition revealed significant differences in patients who received treatment of the abdominal cavity with nitrogen monoxide (NO-therapy) with the Plason apparatus together with enterosorbents Enterodesis and Enterosgel on the APACHE II and SOFA scales, and on the SOFA scale, the combination of Enterosgel with NO-therapy with the Plason device significantly differed from the values of the control group. Conclusion: A study of the results of combined therapy using enterosorbents Enterodez and Enterosgel, together with NO-therapy in patients with grade I–II peritonitis, showed positive results.

Determination of the activity of expression of cytokeratins 7 and 14 in the ectocervix and foci of endocervicosis in women with cervical intraepithelial neoplasia detected by routine histological examination using hematoxylin-eosin staining. Material and methods: Cervix with identified cervical intraepithelial neoplasia caused by infection with human papillomavirus (HPV) of varying degrees of pathogenicity (low-risk human papillomavirus (LR–HPV) – types 6 and 11 (n = 9), intermediate – types 26, 53, 66 (n = 25), as well as high-risk viruses oncogenic risk (HPV) – 16, 18, 31, 33 types (n = 19). The comparison group consisted of fragments of the cervix without cervical intraepithelial neoplasia confirmed by routine histological examination (n = 20). The expression of cytokeratin-7 and 14 in the ectocervix and foci of cervical endocervicosis was evaluated using a standard immunohistochemical method. Results: LSIL/CIN-1, associated with infection with LR-HPV types 6 and 11, is characterized by the absence of expression of SC-7 and weak, in some cases moderate expression of SC-14. HSIL/CIN-2, associated with infection with HPV types 26, 53, 66, is characterized by weak expression of SC-7 and moderate expression of SC-14. HSIL/CIN-3, associated with infection with HPV types 16, 18, 31, 33, is characterized by moderate expression of SC-7 and high expression of SC-14. In the control group of comparison, in the vast majority of cases, negative or weak expression of CC-7 and SC-14 is noted. Conclusion: Features of the expression of SC-7 and SC-14 in the ectocervix, the transformation zone and foci of cervical endocervicosis with HPV infection detected should be taken into account as morphological criteria for diagnosis. These criteria should be considered as the principle of standardization of morphological examination of the cervix, since using this method shows a sufficiently high reliability of early detection of precancerous diseases.

Patients were phenotyped with the identification of four main phenotypes and a variant of the COPD + bronchial asthma (BA) phenotype. For a comprehensive assessment of the condition of COPD patients, the indices of disease severity – ADO and comorbidity – Charlson were calculated. A moderate positive correlation was established between the ADO and Charlson indices in patients with emphysematous (r = 0.407, p < 0.04) and mixed (r = 0.537, p < 0.001) phenotypes. The severe degree of the disease (p < 0.01) was noted in emphysematous and mixed phenotypes, respectively 65 and 54 %. With bronchitis and COPD+In the phenotypes, the similar severity of the disease was 31 and 28 %. When analyzing the features of the construction of personalized pharmacotherapy in patients with different COPD phenotypes, clinically significant disadvantages of the treatment process in the region were established. A stereotypical mistake in the tactics of prescribing bronchodilators is the insufficiency of basic therapy in outpatient settings, which amounted to 34.7 % of cases, mainly in bronchitic (42.9 %) and mixed (54 %) phenotypes, which, in turn, leads to a decrease in the main goal of COPD treatment. Personalization of pharmacotherapy of patients of various phenotypes with chronic obstructive pulmonary disease optimizes the ten-year prognosis of patient survival.

Morphological characteristics of the internal pyramidal layer of the primary somatosensory cortex of the brain under conditions of experimental type 1 diabetes mellitus (DM) and with pharmacological correction using a cyclic GABA derivative – succicard, were studied. DM was induced in white non-breed laboratory rats by administering streptozotocin (60 mg/kg, i.p.). Six months post-induction, the animals were divided into three groups: intact (no DM), a group with DM without treatment, and a group with DM that received succicard. Treatment lasted for 30 days. Subsequent morphometric analysis of the brain cortex in rats with untreated DM revealed pathomorphological changes in the structures of the primary somatosensory cortex, most pronounced in the external granular and external pyramidal layers, accompanied by an increase in the number of damaged hyperchromic and shrunken hyperchromic neurons. In the group treated with the studied compound, these alterations were less pronounced, indicating a partial restoration of the structural characteristics of neurons and neuropil in the brain cortex.

The article presents the results of pharmacoepidemiological monitoring of allergic rhinitis (AR) therapy in children. Aim: Identification of current trends in the diagnosis and therapy of allergic rhinitis in children, comparison of the results of a pharmacoepidemiological study with data obtained in 2001 and 2009 in the Volgograd region. Materials and methods: A two-stage retrospective study was conducted. At the first stage, data from the Territorial Compulsory Medical Insurance Fund (hereinafter TCMIF) of the Volgograd region on the number of primary and repeated referrals during 2019–2020 of patients under the age of 17 years with a diagnosis of allergic rhinitis (J30.1, J30.2, J30.3 J30.4) were analyzed. The structure of patients' referral to specialists was assessed different profiles. At the second stage of the pharmacoepidemiological study, a retrospective descriptive study was conducted using data from 280 outpatient records of patients observed by allergists in 7 children's polyclinics in Volgograd in the period from January to December 2020, aged 1 to 17 years with a diagnosis of allergic rhinitis (J30.1, J30.2, J30.3 J30.4). Results: According to the TCMIF data, 2.2 % (in 2019) and 2.4% (in 2020) were registered among the children's population of the Volgograd region with primary complaints diagnosed with allergic rhinitis. There was a low (less than 40%) repeated referral of patients with allergic rhinitis to outpatient specialists for 2 years. Among the medicines recommended for the treatment of allergic rhinitis, antihistamines (AHD) were most often prescribed – 91.6 % of patients (compared with 56 % in 2009) and intranasal glucocorticosteroids (INGCS) – 86.6 % of patients (compared with 22% in 2009). At the same time, the rational duration of treatment was noted in 52.1 % of patients, and the rational choice of combination therapy corresponding to the severity of the disease was noted in 46.8% of patients. Conclusion: As a result of pharmacoepidemiological monitoring, positive trends in the selection of drugs for the treatment of allergic rhinitis were established. Doctors began to prescribe AHD of the 2nd generation and INGCS more often. At the same time, problems of pharmacotherapy remain – there is a tendency towards long-term administration of AGP of the 1st generation, short-term therapy with INGCS, and the rare use of combination therapy in patients with moderate to severe AR.

A clinical observation of gossypiboma in a young woman who underwent surgical treatment for a pelvic mass is presented. During the control examination, a similar neoplasm was verified, initially regarded as a relapse of the disease. During the in-depth examination, the nature of the alleged early recurrence was not established.