HERALD of North-Western State Medical University named after I.I. Mechnikov
ISSN (print): 2618-7116, ISSN (online): 2618-9704 Founders: Eco-Vector LLC, I.I. Mechnikov North-Western State Medical University Editor-in-Chief: Mazurov Vadim Ivanovich, Academician of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor Frequency / Access: 4 issues per year / Subscription Included in: White List (4th level), Higher Attestation Commission List, RISC
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Basic principles for organizing secondary fracture prevention in patients hospitalized with proximal femoral fracture
To reduce the incidence of osteoporotic fractures, Fracture Liaison Services are being established worldwide, which have demonstrated high clinical and cost-effectiveness. However, in patients hospitalized with a fracture of the proximal femur, the implementation of this system presents a number of specific features and difficulties. This is due to the severity of the condition and multimorbidity of the patients, as well as difficulties in accessing medical services due to reduced mobility and dependence on external assistance. The most effective approach to organizing secondary fracture prevention in these patients is the implementation of measures for the diagnosis and initiation of osteoporosis therapy within the framework of orthogeriatric care already at the inpatient treatment stage. Furthermore, it is necessary to establish a system for transferring patient information to primary care physicians and engaging them in the active management of these patients. The article also discusses controversial issues regarding the need for bone densitometry, prevention of hypocalcemia, correction of possible vitamin D deficiency, active identification of vertebral fractures, as well as ensuring active monitoring and education of patients who have sustained a proximal femoral fracture. The opinion is expressed on the necessity of developing unified standards for the organization of secondary fracture prevention services and establishing quality criteria for evaluating their performance at the national level.
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The prognostic role of cytokines in assessing the course of acute pancreatitis: a systematic review and meta-analysis
Acute pancreatitis (AP) is an inflammatory disease of the pancreas that can lead to potentially severe complications. Despite the availability of clinical scoring systems to predict disease severity, there remains a need for more accurate and rapid tools for early prognostication. A systematic assessment of the significance of serum interleukin levels for predicting disease severity in patients with acute pancreatitis was performed. This study was conducted according to the PRISMA guidelines. A systematic literature search (2013–2024) was performed using PubMed and Google Scholar. Data on the diagnostic accuracy of interleukins, specifically the area under the ROC curve (AUC), sensitivity, and specificity, were extracted and analyzed. The quality of the included studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Meta-regression and sensitivity analyses were also performed. The meta-analysis included 11 studies of interleukin-6 (n = 1377) and 5 studies of interleukin-8 (n = 535). The pooled area under the ROC curve (AUC) for interleukin-6 was 0.84 by the random-effects model with high heterogeneity (I2 = 92%), for interleukin-8 — the pooled AUC was 0.843 (I2 = 80.76%). The area under the hierarchical summary ROC curve was 0.697 for interleukin-6 (sensitivity — 80.9%, specificity — 54.5%) and 0.595 for interleukin-8 (sensitivity — 87.7%, specificity — 39.6%), which indicates a moderate summary accuracy of both markers. A subgroup analysis of interleukin-6 using thresholds of ≥100 pg/mL demonstrated an AUC of 0.852 and a hierarchical summary ROC AUC of 0.621. For interleukin-8, a cut-off value of <39.55 pg/mL the pooled AUC was 0.726 (I2 = 80%), while a cut-off of ≥39.55 pg/mL resulted in an AUC of 0.949 (95% CI 0.904–0.995), I2 = 69.5%. These findings indicate that higher IL-8 thresholds yielded not only more accurate (AUC = 0.95) but also more homogeneous results (I2 reduced from 80% to 69.5%). The dynamics of interleukin-22 levels demonstrated the highest prognostic accuracy among secondary cytokines (AUC = 0.857, sensitivity — 83%, specificity — 85%). Despite signs of publication bias, the results were robust in the sensitivity analysis. Interleukin-6 is the most informative biomarker for the early prediction of severe acute pancreatitis. Interleukin-8 complements the severity assessment by reflecting neutrophil activation, whereas interleukins-10 and -22 indicate the balance of the inflammatory response and hold potential as therapeutic targets. The use of a cytokine profile in conjunction with clinical scoring systems may improve the accuracy of risk stratification and patient outcomes.
Common patterns of aspiration syndrome and factors associated with poor treatment outcomes
BACKGROUND: A review of over 200 publications from the past half-century has revealed that the symptoms of aspiration syndrome are currently not systematized in the literature, and the factors influencing patient treatment outcomes remain poorly studied. AIM: To systematize certain patterns of aspiration syndrome and identify factors that worsen its treatment outcomes. METHODS: An uncontrolled, open-label study was conducted using the medical records of patients hospitalized at the Saint Venerable Martyr Elizabeth City Hospital with a diagnosis of “aspiration syndrome.” The sample consisted of hospital cases. Outcome assessment was performed longitudinally. Patients were selected based on the discharge diagnosis and inclusion criteria. In the retrospective phase (2020–2023), patients in the comparison group were studied. In the retrospective-prospective phase (2022–2023), an original disease severity scale was applied for the analysis of the main group. The main patterns of aspiration syndrome and factors worsening treatment outcomes were identified. RESULTS: The study material included the examination and treatment results of 102 patients. The study identified and systematized the patterns of aspiration syndrome according to disease severity. One non-modifiable risk factor for the development of aspiration syndrome was established: male sex in young, middle, and elderly age groups, and female sex in the old-age and long-livers groups. Modifiable factors of aspiration syndrome that worsen treatment outcomes were identified and systematized. CONCLUSION: Despite the results described in this article, there remains a need for further study and detailed characterization of aspiration syndrome patterns, as well as for the identification of factors that negatively impact treatment outcomes in patients suffering from this syndrome.
Psychological characteristics of patients with irritable bowel syndrome and their dynamics against the background of cytoprotective therapy
BACKGROUND: Irritable bowel syndrome (IBS) is a common functional bowel disorder caused by disruption of the bidirectional brain-gut signaling pathways. While psychological disorders are considered a predisposing factor for the development of IBS, its clinical manifestations significantly contribute to the development and exacerbation of existing psychopathological symptoms. Another significant factor in the pathogenesis of the disease is increased epithelial permeability of the intestinal mucosa. Including the cytoprotector rebamipide in the complex therapy of patients with IBS is promising, as its pharmacological effects are aimed at correcting increased epithelial permeability. Presumably, rebamipide will not only reduce gastrointestinal complaints but also improve the psychological state of IBS patients through its positive impact on their well-being. AIM: Study the clinical and psychological status of IBS patients, the dynamics of gastrointestinal complaints and psychopathological symptoms during therapy with the cytoprotector rebamipide. METHODS: This article presents an excerpt from a single-center, open-label, comparative, randomized, prospective study titled “Mucosal Leakage Syndrome in Functional and Organic Diseases of the Colon (SOCRAT)” that included 120 patients with irritable bowel syndrome. This article describes only a subset of patients from the SOCRAT study, divided into two groups. The main group received rebamipide in addition to antispasmodic therapy, while the comparison group received bismuth tripotassium dicitrate. Gastroenterological complaints were assessed before and after treatment using the Gastrointestinal Symptom Rating Scale (GSRS) and the 7x7 questionnaire (V.T. Ivashkina). All patients also underwent an experimental psychological examination before and after treatment, including an assessment of anxiety, depression, and asthenia using questionnaires. The Hospital Anxiety and Depression Scale (HADS), the Asthenic State Scale (L.D. Malkova, adapted by T.G. Chertova), and the Self-Assessment Anxiety Scale (C.D. Spielberger, Yu.L. Khanina) were used. All patients were consulted by a psychotherapist. RESULTS: To achieve this objective, 52 patients with IBS were recruited from the SOCRAT study. Along with gastrointestinal complaints, anxiety disorders were observed in almost half of the patients, depressive disorders in more than a third, and asthenia in two-thirds of patients. Moreover, patients with constipation-predominant IBS and the mixed type of irritable bowel syndrome demonstrated higher levels of general anxiety than patients with diarrhea-predominant IBS. No significant differences were found in the levels of depression, reactive and trait anxiety, or asthenia across the different clinical types of irritable bowel syndrome. The study patients were divided into two groups: the main group (n = 25) and the comparison group (n = 27), matched by gender, age, and IBS type. During therapy, a decrease in the severity of gastrointestinal complaints was observed in both groups of IBS patients. Patients receiving rebamipide demonstrated more significant positive dynamics. Along with an improvement in the clinical course of irritable bowel syndrome, the rebamipide group also showed a reduction in anxiety, depression, and asthenia. No significant improvement in psychological status was observed in the comparison group. CONCLUSION: Most of the studied patients with IBS were found to have various psychological disorders of varying severity, including increased anxiety, depression, and asthenia. Including the cytoprotector rebamipide in the complex therapy of patients with irritable bowel syndrome not only improves the clinical course of the disease and regresses gastrointestinal complaints, but also indirectly helps reduce these psychopathological symptoms.
Functional characteristics of the temporomandibular joint following registration of centric relation using various anterior deprogrammers
BACKGROUND: The management of temporomandibular joint musculoskeletal disorders is no longer confined to theory but is advancing to a new level with the introduction and adoption of modern diagnostic techniques. The integration of occlusal relationships with the physiological movements of the mandible has now become feasible, generating interest among dental practitioners and gnathologists worldwide. AIM: To conduct a comparative assessment of various types of deprogrammers used for recording the centric relation and to evaluate the dynamic changes in the functional parameters of the temporomandibular joint. METHODS: An interventional (experimental) multicenter prospective selective controlled non-blinded randomized study was performed. To assess the functional parameters of the temporomandibular joint in patients with increased wear of hard dental tissues of grades II–III severity, functional tests of the temporomandibular joint and axiography (in the Arcus Digma II system, KaVo) were performed. One hundred individuals were included, ranked into groups of 20 patients. The assessment was carried out at the diagnostic stage, after the procedure of registering the centric relation and 3 months after orthopedic treatment. During the registration of the centric relation, deprogramming devices (Lucia jig, Koise deprogrammer, leaf gauge, Lucia jig combined with elements of M. Rocabado's cranio-postural kinesiotherapy) were used in each group. The Friedman statistical test was used to assess the dynamics of changes in quantitative indicators in related populations. RESULTS: The study results after registration of the centric relation with preliminary deprogramming of the masticatory and temporal muscles indicate an improvement in the parameters and their approximation to the norm. In the Lucia jig group, changes in the Bennett angle (angle of the transverse condylar path), ISS (angle of immediate side shift), and the Gothic arch angle were observed: the obtained values corresponded to the norm in 98% of cases. In the Koise deprogrammer group, 90% of patients showed correct parameters of mandibular movement. Preservation or minor changes in the parameters were observed in 10% of the patients. In the leaf gauge group, 75% of the participants showed correct parameters of mandibular movement. The remaining 25% of patients demonstrated preservation of the numerical values of mandibular movement after the registration of the centric relation using the deprogrammer. The results in the group combining the Lucia jig and elements of M. Rocabado’s gymnastics corresponded to normal values in 100% of cases. The obtained dynamic indicators point to the presence of a positive effect of kinesiotherapy for patients with manifestations of temporomandibular joint dysfunction. CONCLUSION: All the methods for registering the centric relation used in this study are applicable in clinical practice to eliminate the “accidental” selection of the mandibular position and, consequently, incorrect prosthetic rehabilitation. It is necessary to consider the specifics of each clinical situation and to choose a deprogramming appliance according to the severity of the temporomandibular joint pathology, patient comfort, and the planned prosthetic procedures.
Comparative study of the results of radiofrequency echographic multispectrometry and dual-energy X-ray absorptiometry in determining bone mineral density
BACKGROUND: Osteoporosis is a systemic metabolic skeletal disease characterized by decreased bone mass and impaired bone microarchitecture, leading to bone fragility and low-trauma fractures. Osteoporotic fractures represent a significant public health concern in the Russian Federation, reducing patients' quality of life and being associated with disability and high mortality. Timely diagnosis of a high fracture risk is crucial in the management of osteoporosis. AIM: To investigate the comparability of the results from dual-energy X-ray absorptiometry (DXA) and radiofrequency echographic multi-spectrometry (REMS) in assessing bone status in postmenopausal women. METHODS: A cross-sectional study was conducted on the basis of the Clinical Rheumatology Hospital No. 25 named after V.A. Nasonova and the North-Western State Medical University named after I.I. Mechnikov. DXA of the lumbar spine (L1–L4) and proximal femur (femoral neck and total hip) was performed using a Lunar Prodigy Advance machine (USA). REMS was carried out using a specialized echographic device EchoStation (Echolight Spa, Italy). RESULTS: The study included 50 women with postmenopausal osteoporosis, the median age was 73.0 [48.0; 77.0] years. The mean T-score values for the spine and femoral neck assessed by DXA and REMS were comparable and amounted to: –2.4 standard deviations (95% confidence interval from –2.7 to –1.8) versus –2.2 standard deviations (95% confidence interval from –2.7 to –2.0) and –0.045 ± 0.084 g/cm2 (95% CI from –0.069 to –0.021) versus –0.210 ± 0.084 g/cm2 (95% CI from –0.233 to –0.186), respectively. When assessing the correlation between REMS and DXA in the spine, a high positive correlation was found between the T-scores of REMS and DXA (r = 0.769; high strength of association according to the Chaddock scale; p < 0.001). A high positive correlation was also found between the T-scores of REMS and DXA for the femoral neck (r = 0.873; high strength of association according to the Chaddock scale; p < 0.001). When evaluating the DXA and REMS results using the Bland-Altman method, a sufficiently high degree of comparability of the two methods was found, although a small proportional bias was observed in both areas. REMS on average showed higher bone mineral density values than those with DXA. CONCLUSION: The results of REMS and DXA are comparable, which allows their use for the diagnosis of osteoporosis.
Medical and social consequences of osteoporotic proximal femoral fracture in residents of Yekaterinburg
BACKGROUND: The most severe complication of osteoporosis is a fracture of the proximal femur. High mortality, disability, and economic costs determine the significance of fractures at this site for healthcare. Repeat fractures following a proximal femoral fracture, associated with low levels of osteoporosis diagnosis and treatment, play a significant role in adverse outcomes. AIM: To assess the medical and social consequences of osteoporotic proximal femoral fractures and the frequency of secondary fractures, as well as the rate of osteoporosis detection and treatment in individuals at high risk of fractures, in order to inform subsequent changes in healthcare delivery approaches for this patient category. METHODS: A retrospective cohort study was conducted of patients aged 50 years and older, hospitalized at the Traumatology Department of Yekaterinburg Central City Clinical Hospital No. 23 during 2021 with a diagnosis of “proximal femoral fracture.” The study was performed in two stages. The first stage involved assessing surgical activity and in-hospital mortality in patients with osteoporotic proximal femoral fractures over a 12-month period. The second stage consisted of assessing the medical and social consequences, the detection and treatment of osteoporosis, and the frequency of repeat osteoporotic fractures one year after the proximal femoral fracture. RESULTS: The study included 514 patients with osteoporotic proximal femoral fractures. Of these, 72 (14%) individuals were transferred to hospitals repurposed for the treatment of the novel coronavirus infection. Surgical treatment was performed on 396 (89.6%) patients: arthroplasty — 157 (39.6%), osteosynthesis — 239 (60.4%). One year after the proximal femoral fracture, 351 (75.3%) were alive, and 115 (24.7%) had died. Medical and social consequences of the proximal femoral fracture were known for 178 individuals. Of these, 5.6% of patients remained immobilized, 53.4% had their activity limited to their apartment, and 41% had resumed an active lifestyle. Repeat fractures within one year occurred in 15.7% of patients. Only 10 (5.6%) individuals were taking anti-osteoporotic medication. CONCLUSION: The assessment of medical care for osteoporotic proximal femoral fractures showed satisfactory surgical activity, which led to a reduction in mortality after fractures at this site, but also revealed delayed timing of surgical treatment. Insufficient attention to osteoporosis as a cause of fractures and the rare prescription of anti-osteoporotic drugs were identified, indicating the necessity of implementing a system for the prevention of repeat fractures.
Prognostic value of risk factors for different clinical presentations of upper gastrointestinal tract diseases in military personnel
BACKGROUND: The medical and social significance of upper gastrointestinal tract diseases is determined by their high prevalence and annual increase in morbidity. Military personnel have specific risk factors for the development of these pathologies that have not previously been studied in terms of their prognostic significance. AIM: Тo assess the role of various risk factors in the development of uncomplicated and complicated upper gastrointestinal tract pathology in military personnel participating and not participating in combat operations. METHODS: From February 2022 to December 2023, 256 military personnel aged 21 to 65 years with various mild surgical and therapeutic comorbidities and a significant gastrointestinal history were examined. All patients underwent esophagogastroduodenoscopy with testing for Helicobacter pylori. The analysis of the prevalence of gastrointestinal tract pathology was conducted in contingency tables based on morbidity data. The epidemiological significance of risk factors was evaluated by the attributable fraction (etiologic fraction), population attributable fraction, and attributable risk. RESULTS: The main group, which included military personnel participating in combat operations, consisted of 118 individuals, while the control group, which did not participate in combat operations, comprised 138. The prevalence of upper gastrointestinal tract pathology in combatants was characterized by acute erosive and ulcerativevlesions of the mucous membrane of the esophagus, stomach, and duodenum as well as chronic duodenal ulcers, which were observed primarily in career officers — 93 cases (79%) — and by delayed complications in contract servicemen (5%), manifested as gastrointestinal bleeding. in the group not participating in hostilities, the main findings were uncomplicated duodenal ulcer and acute erosions (29%). Assessment of the significance of risk factors using the attributable fraction (etiologic fraction) and population attributable fraction, in the combatant group revealed a predominance of modifiable risk factors over non-modifiable ones, with ratios of 1.6 and 2.1, respectively. CONCLUSION: The assessment of the role of various risks in the development of the studied upper gastrointestinal tract pathology in military personnel demonstrated the absence of dependence on the established traditional factors, with a predominance of modifiable risk factors (55.6%) due to their high prevalence. This finding has prognostic significance, since even a minor reduction in the prevalence of modifiable risk factors could lead to a significant population-level effect — a decrease in upper gastrointestinal tract diseases among military personnel.
Diagnostic significance of computer optical posturography in dentistry
One of the pressing issues in dentistry is the assessment of the functional state of the masticatory apparatus and the development of an individual treatment plan for various categories of dental patients. In recent years, through the collaboration of dentists with osteopaths, orthopedists, and neurologists, it has become evident that the temporomandibular joint and occlusion are functionally interconnected not only with each other but also with the musculoskeletal system as a whole. The state of the masticatory apparatus can significantly influence posture by altering the tone of muscles involved in maintaining body balance. The significant impact of dental pathology on the general state of the body justifies the need to include additional integral methods of functional diagnostics in the comprehensive examination algorithm for dental patients with concomitant general diseases. Currently, technologies have emerged that allow for a comprehensive assessment of the entire musculoskeletal system. An example of such a technology is spinal diagnostics using computer optical topography. This method is based on the principle of video raster stereography and represents three-dimensional visualization of an object based on the analysis of two or more video images taken from different angles. The study results in a three-dimensional image of the human skeleton without the use of X-ray radiation. The article presents a clinical case demonstrating the possibility of using computer-optical topography and statodynamic balancemetry methods in dentistry to assess the influence of dental pathology on the state of the musculoskeletal system. Indicators characterizing the state of the spine (pelvic tilt and rotation, thoracic kyphosis angle, lumbar lordosis angle) that are sensitive to changes in the state of the masticatory apparatus during stress tests have been determined. The clinical case showed that the use of computer-optical posturography and statodynamic balancemetry methods in dentistry makes it possible to assess the mutual influence of dental pathology and the state of the musculoskeletal system, as well as to increase the effectiveness of dental patient rehabilitation through the development of an individual treatment plan.