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ORIGINAL RESEARCH

Prognostic value of serum NETosis indices in advanced ovarian cancer Abakumova T.V. (Russia, Ulyanovsk), Antoneeva I.I. (Russia, Ulyanovsk), Myagdieva I.R. (Russia, Ulyanovsk), Gening S.O. (Russia, Moscow), Dolgova D.R. (Russia, Ulyanovsk), Zaineeva R.Sh. (Russia, Ulyanovsk), Gening T.P. (Russia, Ulyanovsk), Protasova A.G. (Russia, Ulyanovsk) P. 7

Medical and social problems of families raising children with bronchial asthma and comorbid pathologies Ayushin E.I. (Russia, Moscow), Konovalov O.E. (Russia, Moscow), Deeva E.V. (Russia, Moscow), Ovsyannikov D.Yu. (Russia, Moscow), Shulaev A.V. (Russia, Kazan), Shikaleva A.A. (Russia, Moscow) P. 14

A relation between daily blood-pressure profile and blood biomarkers in elderly patients with arterial hypertension and obstructive sleep apnea Vasilyeva L.V. (Russia, Voronezh), Brezhneva N.A. (Russia, Voronezh), Kuptsov M.A. (Russia, Voronezh), Popov S.Yu. (Russia, Voronezh), Suslova E.Yu. (Russia, Voronezh), Gosteva E.V. (Russia, Belgorod), Klyushnikov N.I. (Russia, Voronezh) P. 22

Comparative analysis study of major joint injuries from street and home accidents Giyasov Z.A. (Uzbekistan, Tashkent), Gulyamov D.E. (Uzbekistan, Tashkent), Zokirova Z.D. (Uzbekistan, Tashkent) P. 31

Managing pregnant women with aortic valve defects: Clinical analysis, modern approaches, and recommendations Ilyasova E.U. (Russia, Simferopol), Marulova A.V. (Russia, Simferopol), Rumyantseva Z.S. (Russia, Simferopol), Goryanskaya I.Y. (Russia, Simferopol), Sulima A.N. (Russia, Simferopol), Reznichenko ,N.A. (Russia, Simferopol), Kondratyuk D.V. (Russia, Simferopol) P. 37

Gender differences in cardiometabolic risk factors, metabolic profile, adipokines, and cytokines among young people Lenets E.A. (Russia, Chelyabinsk), Chulkov V.S. (Russia, Veliky Novgorod), Minina E.E. (Russia, Chelyabinsk), Chulkov V.S. (Russia, Chelyabinsk) P. 43

Status of the renal transplantation system in Samara Region Mironov A.A. (Russia, Samara), Myakotnykh M.N. (Russia, Samara) P. 50

Developing a quantification procedure for ethylmethylhydroxypyridine succinate in an injection solution Nikiforova E.B. (Russia, Moscow), Davitavyan N.A. (Russia, Krasnodar), Shevchenko A.I. (Russia, Krasnodar), Yakuba Yu.F. (Russia, Krasnodar) P. 56

Laboratory and morphological manifestations of tuberculous inflammation in patients with pulmonary tuberculoma, multiple and pre-extensive drug-resistant mycobacteria, and diabetes mellitus under different durations of chemotherapy Polushkina E.G. (Russia, Moscow), KomissarovaO.G. (Russia, Moscow), Lepeha L.N. (Russia, Moscow), Abdullaev R.U. (Russia, Moscow) P. 63

Experience in customer inquiry management in public healthcare organizations (exemplified by the Altai Krai) Semina O.L. (Russia, Barnaul), Treshutin V.A. (Russia, Barnaul), Popov D.V. (Russia, Barnaul), Batrak T.A. (Russia, Barnaul) P. 71

Epidemiological situation related to behavioral risk factors for cardiometabolic diseases in the youth population Chulkov V.S. (Russia, Veliky Novgorod), Gavrilova E.S. (Russia, Chelyabinsk), Derevyanchenko M.V. (Russia, Volgograd), Efremova E.V. (Russia, Ulyanovsk), Lyapina I.N. (Russia, Kemerovo), Tolmacheva A.A. (Russia, Novosibirsk), Rubanenko A.O. (Russia, Samara), Rubanenko O.A. (Russia, Samara), Gubareva E.Y. (Russia, Samara), Kercheva M.A. (Russia, Tomsk), Makarova I.V. (Russia, Moscow), Sevastyanova D.I. (Russia, Tomsk), Barannikov S.V. (Russia, Blagoveshchensk), Khaukasheva I.A. (Russia, Nalchik) P. 80

Features of the new-onset pulmonary tuberculosis course in patients with insulin resistance Shorokhova V.A. (Russia, Moscow), Komissarova O.G. (Russia, Moscow), Merzlikina P.D. (Russia, Moscow), Abdullaev R.Yu. (Russia, Moscow) P. 90

Histopathological differences in the left atrial myocardium according to chronic heart failure phenotype Shchekin V.S. (Russia, Ufa),Teregulov I.I. (Russia, Ufa), Valinurov T.I. (Russia, Ufa), Plotnikova M.R.(Russia, Ufa), Lakman I.A. (Russia, Ufa), Pushkareva A.E. (Russia, Ufa), Dolganov A.A. (Russia, Ufa), Mihaylov P.S. (Russia, Ufa), Mustafina I.A. (Russia, Ufa), Efremova E.V. (Russia, Ulyanovsk), Zagidullin N.Sh.(Russia, Ufa) P. 97

REVIEWS

Proactive strategic management of the regional drug abuse situation: Foresight analysis, 2030 scenarios, and interagency cooperation architecture Akhokhova A.V. (Russia, Nalchik), Mustafaeva G.K. (Russia, Nalchik), Istamulova Kh.R. (Russia, Nalchik), Nyrov A.A. (Russia, Nalchik), Chaplaeva Dz.A. (Russia, Nalchik) P. 107

Etiotropic therapy of aggressive periodontitis: Contemporary antibiotic regimens and their effectiveness Gaybullaev E.A. (Uzbekistan, Tashkent) P. 118

Pathogenetic mechanisms of idiopathic pulmonary fibrosis: A modern view on the role of genetic and epigenetic factors Kokaev R.I. (Russia, Vladikavkaz), Kornieva S.S. (Russia, Vladikavkaz), Kerimova I.A. (Russia, Vladikavkaz), Dashiev T.B. (Russia, Nadterechnoye Village), Kudukhova Z.M. (Russia, Vladikavkaz), Malikova A.A. (Russia, Vladikavkaz), Khabrakova A.A. (Russia, Vladikavkaz), Satueva F.V. (Russia, Vladikavkaz), Sadulaeva Kh.Ya. (Russia, Vladikavkaz), Bukhieva A.Kh. (Russia, Vladikavkaz), Amirov A.A. (Russia, Saratov), Ezerbiev Dz.M. (Russia, Saratov) P. 123

ORGANIZATION OF HEALTHCARE

Challenges in the organization and delivery of dental implantation and principles for its enhancement Astafyev A.A. (Russia, Moscow), Kopetsky I.S. (Russia, Moscow), Konovalov O.E. (Russia, Moscow), Shulaev A.V. (Russia, Kazan), Guseva O.Yu. (Russia, Moscow) P. 133

Clinical and organizational challenges of providing specialized medical care to patients with rectal cancer Kostin A.A. (Russia, Moscow), Ryabov M.M. (Russia, Yaroslavl), Konovalov O.E. (Russia, Moscow), Shulaev A.V. (Russia, Kazan), Shikaleva A.A. (Russia, Moscow) P. 141

PRACTICAL EXPERIENCE

Severe hyponatremia in a patient with panhypopituitarism Ivanova L.A. (Russia, Krasnodar), Korol I.V. (Russia, Krasnodar), Kovalenko Yu.S. (Russia, Krasnodar), Fomenko A.A. (Russia, Krasnodar), Shirokov A.A. (Russia, Krasnodar), Ruzhitskaya L.V. (Russia, Krasnodar), Tanin I.Y. (Russia, Krasnodar), Mesinova A.V. (Russia, Krasnodar) P. 147

A familial case of multiple endocrine neoplasia type 2A syndrome: Medullary thyroid cancer and pheochromocytoma Lyan N.I. (Russia, Tomsk), Samoilova Yu.G. (Russia, Tomsk), Matveeva M.V. (Russia, Tomsk), Shuliko L.M. (Russia, Tomsk) P. 157

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ORIGINAL RESEARCH

УДК 616-006.6 DOI: 10.20969/VSKM.2026.19(1).7-13

 Prognostic value of serum NETosis indices in advanced ovarian cancer

Tatyana V. Abakumova1, Inna I. Antoneeva1,2, Ilseya R. Myagdieva1, Snezhanna O. Gening3, Dinara R. Dolgova1, Roza Sh. Zaineeva1, Tatyana P. Gening1, Anna G. Protasova1

1Ulyanovsk State Medical University, 42 Leo Tolstoy str., 432017 Ulyanovsk, Russia

2Regional Clinical Oncology Dispensary, 90 12-September str., 420017 Ulyanovsk, Russia

3Luchi Zdorovye LLC, 7, Nobel str., 121205 Moscow, Russia

Abstract. lntroduction. Increased formation of neutrophil extracellular traps (NETosis) by activated neutrophils causes the development of a number of pathological processes, i.e., NETopathy. The role of neutrophil traps in the progression of malignant tumors of various localizations has been shown. NETosis indicators may have prognostic signifcance in ovarian cancer. Aim. Evaluation of the prognostic signifcance of serum NETosis indices in advanced ovarian cancer. Materials and Methods. In the circulating blood of patients with stage III and IV malignant neoplasms and benign ovarian tumors, the neutrophil extracellular trap parameters were assessed, as well as the level of vascular endothelial growth factor (VEGF) - A, interleukin (IL) - 1β, neutrophil elastase (NE), and neutrophil-lymphocyte ratio (NLR) by ELISA. For statistical processing, the Statistica 13.0 and Jamovi 2.4.14 software programs were used. Results and Discussion. In patients with advanced ovarian cancer, the levels of IL-1β, VEGF-A, NE, and NLR signifcantly increase, in comparison with both the control and the values in patients with benign ovarian tumors. In multivariate Cox analysis, progression-free time (PFT) depended on the number of neutrophil extracellular traps (HR 0.61, 95% CI 0.46-0.81, p=0.001), NLR (HR 0.82, 95% CI 0.72-0.93, p=0.002), and VEGF level (HR 1.29, 95% CI 1.09-1.53, p=0.034) in blood plasma in women with ascites (HR 2.81, 95% CI 1.33-5.94, p=0.007) over 69 years old (HR 3.57, 95% CI 1.40-9.10, p=0.008). Ovarian cancer metastasis risk increases with an increase in VEGF and the number of neutrophil traps in the blood (R2 = 0.589, х2 = 47.3, p = 0.001) (specifcity = 0.929, sensitivity = 0.867). When the number of neutrophil traps increases (cut points=3), the median PFT is 9.3 [6.4 - 34.5, 95% CI] months; when the level of VEGF-A in the blood increases (cut point=849), the median PFT is 7.6 [3.6 - 27.7, 95% CI] months. Conclusions. In advanced ovarian cancer, the following NETosis indices change signifcantly in the blood serum: NE, VEGF-A, and NLR, which can be used to assess the time without progression, differential diagnosis of stages III and IV ovarian cancer, and risk of relapse.

Keywords: neutrophil extracellular traps, neutrophil elastase, vascular endothelial growth factor, neutrophil-lymphocyte ratio, ovarian cancer, prognosis

For citation: Abakumova, T.V.; Antoneeva, I.I.; Myagdieva, I.R.; et al. Prognostic value of serum NETosis indices in advanced ovarian cancer. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 7-13. DOI: 10.20969/VSKM.2026.19(1).7-13.

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УДК: 616.211-002.193-053.2:364.652:614.253.89 DOI: 10.20969/VSKM.2026.19(1).14-21

 Medical and social problems of families raising children with bronchial asthma and comorbid pathologies

E.I. Ayushin1, O.E. Konovalov1, E.V. Deeva2, D.Yu. Ovsyannikov1,2, A.V. Shulaev3, A.A. Shikaleva3,4,5

1 Patrice Lumumba Peoples’ Friendship University of Russia (RUDN), 6 Miklouho-Maclay str., 117198 Moscow, Russia

2 Morozov Children’s City Clinical Hospital, 1/9 4th Dobryninsky Lane, 119049 Moscow, Russia

3 Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia

4 Russian Medical Academy of Postgraduate Education, 2/1 Barrikadnaya str., 125993 Moscow, Russia

5 Kazan State Medical Academy – Branch of the Russian Medical Academy of Postgraduate Education, 36 Butlerov str., 420012 Kazan, Russia

Abstract. lntroduction. Bronchial asthma is one of the most common chronic diseases, which affects about 10-15% of the child population in different countries. Aim. To analyze the medical and social problems of families raising children with bronchial asthma and a comorbid pathology. Materials and Methods. A sociological survey was conducted among the mothers of 412 children with proven bronchial asthma, hospitalized in a multidisciplinary hospital in Moscow in 2024-2025. Results and Discussion. Average age at which bronchial asthma was diagnosed in children was 7.8 ± 4.12 years. In 70.8% of children, the disease was frst diagnosed before the age of 10. Most children (77.7%) were hospitalized on a planned basis and 22.3% were hospitalized urgently, the latter circumstance being associated with poor adherence to therapy. The study found that diseases of the respiratory and digestive systems were the most common concomitant pathologies. Among the problems related to the health and future of the child, the most important for parents were fear of disease progression with a threat to life, decrease in the quality of life, problems with career guidance and future opportunities, and limitations regarding sports and other activities. In the context of the growing asthma incidence in the child population, solving medical and social problems and helping families with an asthmatic child represent one of the most important tasks and requires thorough scientifc analysis and search for new approaches. Conclusions. The information obtained can provide a basis for developing programs aimed at preventing adverse outcomes and concomitant diseases in asthma in children.

Keywords: children, bronchial asthma, comorbid pathology, family problems

For citation: Ayushin, E.I.; Konovalov, O.E.; Deeva, E.V.; et al. Medical and social problems of families raising children with bronchial asthma and comorbid pathologies. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 14-21. DOI: 10.20969/VSKM.2026.19(1).14-21.

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УДК 616.12-008.331.1: 616.24-008.444-06-0.53.9 DOI: 10.20969/VSKM.2026.19(1).22-30

 A relation between daily blood-pressure profile and blood biomarkers in elderly patients with arterial hypertension and obstructive sleep apnea

Ludmila V. Vasilyeva1, Natalia A. Brezhneva2, Mikhail A. Kuptsov3, Sergei Yu. Popov4, Ekaterina Yu. Suslova1, Elena V. Gosteva1,6, Nikolaj I. Klyushnikov5

1Voronezh State Medical University named after N.N. Burdenko, 10 Studencheskaya str., 394036 Voronezh, Russia

2Voronezh City Clinical Polyclinic No. 1, 23 Timiryazev str., 394087 Voronezh, Russia

3Voronezh City Clinical Hospital of Emergency Medical Care No. 1, 23 Patriotov Ave, 394065 Voronezh, Russia

4 Aldomed Medical Center, 55 Karl Marx str., 397500 Buturlinovka, Voronezh Region, Russia

5Voronezh City Clinical Hospital of Emergency Medical Care No. 8, 90 Rostovskaya str., 394090 Voronezh, Russia

6Belgorod State University, 85 Victory str., 308015 Belgorod, Russia

Abstract. lntroduction. Approximately 50% of patients with arterial hypertension have concomitant obstructive sleep apnea syndrome. Aim. To determine the association of infammatory blood biomarkers with the pathological blood pressure profle (non-dipper) in patients with arterial hypertension and obstructive sleep apnea. Materials and Methods. The study included 106 patients aged 60-74 years (60 men and 46 women) with a degree of nighttime blood pressure reduction during 24-hour monitoring ranging from 0% to 20%. The frst group consisted of 57 individuals (53.8%) with a "dipper' daily profle, and the second group included 49 individuals (46.2%) with a "non-dipper' profle. The following indices were calculated: Quantitative neutrophils (N) to lymphocytes (L) ratio (NLR) = N/L; platelets (P) to lymphocytes (L) (PLR) = P/L; monocytes (M) to lymphocytes (L) (MLR) = M/L; and the systemic infammatory index (SII) = platelets х neutrophils / lymphocytes. Statistical analysis was performed using StatTech v.4.7.1. The х2 test (Fisher's exact test) was used for data comparison. For non-normally distributed quantitative data, results are presented as median and interquartile range (IQR), and the Mann-Whitney U test was used for comparison. For assessing the discriminatory ability of biomarkers to differentiate between dipper and non-dipper participants, ROC analysis was conducted with the area under the ROC curve (AUC) being calculated. A p-value of <0.05 was considered statistically signifcant. Results and Discussion. The medians of NLR and MLR were signifcantly higher in group 2 than in group 1 (p = 0.006 and p = 0.045). Additionally, in elderly patients with arterial hypertension and obstructive sleep apnea with a non-dipper daily profle, there was a moderate direct correlation between NLR and the non-dipper profle (р = 0.377, p < 0.001), as well as between MLR and non-dipper (р = 0.404, p < 0.001). At the same time, the AUC values for NLR (0.654), MLR (0.619), and PLR (0.635) were below 0.7, indicating moderate accuracy as a non-dipper hypertension predictor. The median SII was higher in elderly patients with non-dipper hypertension than in those with dipper hypertension (p= 0.008), indicating an enhanced infammatory response in non-dipper hypertension. Correlation analysis showed a strong direct relationship (р = 0.776, p < 0.001) between SII and the non-dipper pattern, and the AUC and ROC curve analysis indicated SII as a criterion with high accuracy as a non-dipper hypertension predictor. Conclusions. Patients with arterial hypertension and obstructive sleep apnea with a non-dipper blood pressure profle have higher levels of infammatory biomarkers, which increases their risk of cardiovascular complications and requires a comprehensive approach to diagnosis and treatment.

Keywords: arterial hypertension, infammatory biomarkers, non-dipper.

For citation: Vasilyeva, L.V.; Brezhneva, N.A.; Kuptsov, M.A.; et al. The relationship between the daily profle of blood pressure and blood biomarkers in elderly patients with arterial hypertension and obstructive sleep apnea. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 22-30. DOI: 10.20969/VSKM.2026.19(1).22-30.

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УДК: 616.126-007.271-089 DOI: 10.20969/VSKM.2026.19(1).31-36

 Comparative analysis study of major joint injuries from street and home accidents

Zainitdin A. Giyasov1, Dilshod E. Gulyamov1, Ziyoda D. Zokirova1

1 Tashkent State Medical University, 2 Farobiy str., Admazar District, 100109 Tashkent, Uzbekistan

Abstract. lntroduction. Major joint injuries are an important medico-social and forensic problem requiring deeper study of their features in different injury types to improve expert methods for identifying injury mechanisms and circumstances and to increase objectivity and accuracy in assessing harm to health. Aim. To perform a comparative forensic study of major joint injuries in street and home accidents, considering sex, age, time of occurrence and nature of injuries. Materials and Methods. The study used materials of forensic examinations of major joint injuries, performed at the Tashkent City Branch of the Republican Scientifc and Practical Center of Forensic Examination in 2021. A total of 350 examinations (3.3% of all mechanical injury cases) of living persons were analyzed, of which 34 (9.7%) were related to street accidents and 20 (5.7%) to home accidents. In each case, circumstances, medical records, expert examination fndings, and additional study fndings were comprehensively analyzed. The data were systematized by 15 parameters and subjected to statistical processing using specialized software. Results and Discussion. Analysis of the forensic materials showed that major joint injuries were observed predominantly in men (62.3%), especially in street incidents (76.5%), whereas home accidents showed a regular sex distribution. Age differences were evident: Street trauma predominated in people aged 30-39 years, while home trauma was common in those aged 30-39 and over 50. The highest frequency of injuries was recorded in spring, mainly in the second half of the day. In most cases, the injury was isolated (94.1% for street and 75% for home accidents) and more often resulted from conficts or falls from standing height. Morphologically, street injuries more often involved contusions and tears of periarticular tissues, whereas home injuries more often involved fractures with soft-tissue damage. Severity also differed: Home traumas were more often classifed as severe (35.0%), while street traumas were more often of moderate severity (41.2%). Conclusions. Although home and street traumas represent a limited portion of the overall pattern of major joint injuries, they show distinct gender-age and temporal differences, are predominantly associated with confict situations and isolated injuries, and home trauma is characterized by a higher share of cases classifed as grievous bodily harm.

Keywords: major joint injuries, home trauma, street trauma, forensic examination.

For citation: Giyasov, Z.A.; Gulyamov, D.E.; Zokirova Z.J. Comparative analysis study of major joint injuries from street and home accidents. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 31-36. DOI: 10.20969/VSKM.2026.19(1).31-36.

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2. Ковалев А.В., Момот Д.В., Самоходская О.В., Забродский Я.Д. Специфика проведения судебно-медицинских экспертиз пострадавших в дорожно-транспортных происшествиях с учётом современного развития систем безопасности автомобиля // Судебно-медицинская экспертиза. - 2020. - № 2. - С. 14-18. Kovalev AV, Momot DV, Samokhodskaya OV, Zabrodskiy УaD. Spetsifka provedeniya sudebno-meditsinskikh ekspertiz postradavshikh v dorozhno-transportnykh proisshestviyakh s uchyotom sovremennogo razvitiya sistem bezopasnosti avtomobilya [Specifcs of conducting forensic medical examinations of victims in road traffc accidents considering the modern development of vehicle safety systems]. Sudebno-meditsinskaya ekspertiza [Forensic Medical Examination]. 2020; (2): 14-18. (In Russ.)

3. Туманов Э.В., Кильдюшов Е.В. Спорные вопросы применения медицинского критерия «стойкая утрата общей трудоспособности» при определении тяжести вреда, причиненного здоровью человека // Судебно-медицинская экспертиза. - 2022. - № 6. - С. 16-20. Tumanov EV, Kildyushov EV. Spornyye voprosy primeneniya meditsinskogo kriteriya «stoykaya utrata obshchey trudosposobnosti» pri opredelenii tyazhesti vreda, prichinennogo zdorov'yu cheloveka [Controversial issues of applying the medical criterion "persistent loss of general work capacity' in determining the severity of harm to human health]. Sudebno-meditsinskaya ekspertiza [Forensic Medical Examination]. 2022; (6): 16-20. (In Russ.)

4. Клевно В.А., Тарасова Н.В. Судебно-медицинская оценка рентгенологических признаков повреждений костей и крупных суставов применительно к пунктам медицинских критериев вреда здоровью // Медико-социальная экспертиза и реабилитация. - 2017. - № 4. - С. 208-213. Klevno VA, Tarasova NV. Sudebno-meditsinskaya otsenka rentgenologicheskikh priznakov povrezhdeniy kostey i krupnykh sustavov primenitel'no k punktam meditsinskikh kriteriyev vreda zdorov'yu [Forensic medical assessment of radiological signs of bone and major joint injuries in relation to the medical criteria of harm to health]. Mediko-sotsialnaya ekspertiza i reabilitatsiya [Medical-Social Examination and Rehabilitation]. 2017; (4): 208-213. (In Russ.)

5. Кузин С.Г., Суханов С.Г., Казаков Я.В., Пятлин А.В. Особенности биомеханических качеств опорных структур тканей человека // Судебно-медицинская экспертиза. - 2018. - № 2. - С. 48-52.

   Kuzin SG, Sukhanov SG, Kazakov УaV, Pyatlin AV. Osobennosti biomekhanicheskikh kachestv opornykh struktur tkaney cheloveka [Features of the biomechanical qualities of the supporting structures of human tissues]. Sudebno-meditsinskaya ekspertiza [Forensic Medical Examination]. 2018; (2): 48-52. (In Russ.)

6. Искандаров А.И., Индиаминов С.И., Жураев И.Г. Судебно-медицинская характеристика суставных травм // Судебно-медицинская экспертиза. - 2023. - № 5. - С. 29-32. Iskandarov AI, Indiaminov SI, Juraev IG. Sudebno-meditsinskaya kharakteristika sustavnykh travm [Forensic medical characteristics of joint injuries]. Sudebno-meditsinskaya ekspertiza [Forensic Medical Examination]. 2023; (5): 29-32. (In Russ.) DOI: 10.17116/sudmed20226506116

7. Куликов С.Н. «Невидимость» тяжкого вреда здоровью в морфологии перелома-вывиха костей предплечья. Продолжение противостояния // Судебная медицина. - 2015. - Т. 1, вып.12. - С. 41-46. Kulikov SN. «Nevidimost'» tyazhkogo vreda zdorov'yu v morfologii pereloma-vyvikha kostey predplech'ya. Prodolzheniye protivostoyaniya [The "invisibility' of severe harm to health in the morphology of forearm bone fracture-dislocation. Continuation of the confrontation]. Sudebnaya meditsina [Forensic Medicine]. 2015; 1(12): 41-46. (In Russ.)

8. Морозов С.Ю., Тучик Е.С., Морозов Ю.Е. Судебно-медицинские аспекты оценки переломов костей, составляющих локтевой сустав у детей // Медицинская экспертиза и право. - 2015. - № 1. - С. 31-35.

   Morozov SУu, Tuchik ES, Morozov УuE. Sudebno-meditsinskiye aspekty otsenki perelomov kostey, sostavlyayushchikh loktevoy sustav u detey [Forensic medical aspects of assessing fractures of the bones forming the elbow joint in children]. Meditsinskaya ekspertiza i pravo [Medical Examination and Law]. 2015; (1): 31-35. (In Russ.)

9. Жураев И.Г. Судебно-медицинская характеристика повреждений структуры суставов у лиц, пострадавших при различных видах тупых механических травм: автореферат диссертации доктора философии медицинских наук. - Ташкент, 2023. - 50 с. Juraev IG. Sudebno-meditsinskaya kharakteristika povrezhdeniy struktury sustavov u lits, postradavshikh pri razlichnykh vidakh tupykh mekhanicheskikh travm: avtoreferat dissertatsii doktora flosofi meditsinskikh nauk [Forensic medical characteristics of joint structure injuries in individuals injured by various types of blunt mechanical trauma: dissertation abstract for the degree of Doctor of Philosophy in Medical Sciences]. Tashkent [Tashkent]. 2023; 50 p. (In Russ.).

10. Булешова А.М. Эпидемиология травматизма в г. Шымкент Южно-Казахстанской области Республики Казахстан: обоснование необходимости создания муниципального регистра травм // Экология человека. - 2016. - № 6. - С. 55-61. Buleshova AM. Epidemiologiya travmatizma v g. Shymkent Уuzhno-Kazakhstanskoy oblasti Respubliki Kazakhstan: obosnovaniye neobkhodimosti sozdaniya munitsipal'nogo registra travm [Epidemiology of trauma in Shymkent, South Kazakhstan region of the Republic of Kazakhstan: justifcation for creating a municipal trauma registry]. Ekologiya cheloveka [Human Ecology]. 2016; (6): 55-61. (In Russ.) DOI: 10.33396/1728-0869-2016-6-55-61

11. Лядова М.В., Тучик Е.С. Проблемы экспертного применения «Медицинских критериев определения степени тяжести вреда, причиненного здоровью человека» при закрытой травме плечевого сустава // Судебно-медицинская экспертиза. - 2023. - Т. 66, вып. 5. - С. 29-32. Lyadova MV, Tuchik ES. Problemy ekspertnoho primeneniya «Meditsinskikh kriteriyev opredeleniya stepeni tyazhesti vreda, prichinennogo zdorov'yu cheloveka» pri zakrytoy travme plechevogo sustava [Problems of expert application of the "Medical criteria for determining the severity of harm to human health' in closed shoulder joint injury]. Sudebno-meditsinskaya ekspertiza [Forensic Medical Examination]. 2023; 66(5): 29-32. (In Russ.) DOI: 10.17116/sudmed20236605129

12. Гулямов Д.Э. Особенности судебно-медицинской экспертизы повреждений крупных суставов // Инновационные исследования в современном мире: теория и практика. - 2024. - Т. 3, вып. 13. - С. 71-72. Gulyamov DE. Osobennosti sudebno-meditsinskoy ekspertizy povrezhdeniy krupnykh sustavov [Features of forensic medical examination of major joint injuries]. Innovatsionnye issledovaniya v sovremennom mire: teoriya i praktika [Innovative Research in the Modern World: Theory and Practice]. 2024; 3(13): 71-72. (In Russ.)

13. Индиаминов С.И., Шопулатов И.Б. Судебно-медицинская характеристика закрытых переломов костей кисти // Судебная медицина. - 2023. - Т. 9, вып. 1. - С. 5-17.

    Indiaminov SI, Shopulatov IB. Sudebno-meditsinskaya kharakteristika zakrytykh perelomov kostey kisti [Forensic medical characteristics of closed fractures of hand bones]. Sudebnaya meditsina [Forensic Medicine]. 2023; 9(1): 5-17. (In Russ.) DOI: 10.17816/fm732

14. McGuigan FH, Culp RW. Surgical treatment of intra-articular fractures of the trapezium. J Multicenter Study. 2002; 27(4): 697-703. DOI: 10.1053/jhsu.2002.33705

15. Pulos N, Kollitz KM, Bishop,AT, Shin AУ. Free vascularized medial femoral condyle bone graft after failed scaphoid nonunion surgery. J Bone Joint Surg Am. 2018; 100(16): 1379-1386. DOI: 10.2106/JBJS.17.00955

 

УДК: 618.2:616.132:612.171.7 DOI: 10.20969/VSKM.2026.19(1).37-42

 Managing pregnant women with aortic valve defects: Clinical analysis, modern approaches, and recommendations

Edie U. Ilyasova1, Alina V. Marulova1, Zoya S. Rumyantseva1, Irina Y. Goryanskaya1, Anna N. Sulima1, Natalia A. Reznichenko1, Denis V. Kondratyuk2

1 Order of the Red Banner of Labor Medical Institute named after S. I. Georgievsky, 5/7 Lenin Blvd., 295051 Simferopol, Russia

2 Perinatal Center, Republican Clinical Hospital named after N. A. Semashko, 8 Semashko str., 295017 Simferopol, Russia

Abstract. lntroduction. Aortic valve defects in pregnant women are still a critical problem due to the risk of cardiovascular complications and adverse perinatal outcomes. Congenital anomalies, including bicuspid aortic valve, dominate the structure of pathology, increasing the hemodynamic load during pregnancy. Aim. To assess the characteristics of pregnancy progress, childbirth, and outcomes in patients with aortic valve defects, based on clinical data. Materials and Methods. A retrospective analysis was performed regarding 20 cases out of 580 medical records of pregnant women observed at the Perinatal Center in Simferopol (2020-2024). Inclusion criteria: Presence of isolated or combined aortic valve defects. Transthoracic/transesophageal echocardiography, fetal ultrasound, and cardiac monitoring were used. Statistical processing included frequency analysis, х2 and t-test. Results and Discussion: 65% (13 patients) had congenital defects (85% had a bicuspid aortic valve). Surgical correction was performed before pregnancy only in 15% (3 cases). Complications were recorded in 25% (5 patients): Premature birth (80%) and fetal hypoxia (20%). Myocardial hypertrophy was detected in 40% (8 cases), and a decrease in the left ventricle ejection fraction was found in 5% (1 case). Natural childbirth is permissible in 20% of patients under 28 years with mild forms of defects. Caesarean section was performed in 80% of cases due to hemodynamic decompensation. Conclusions. Favorable pregnancy outcomes in aortic valve defects are associated with early diagnosis, age of patients (<30 years), and absence of concomitant pathologies. Key risk-reducing factors are multidisciplinary monitoring (cardiologist, obstetrician), dynamic hemodynamic monitoring, and timely choosing the delivery method. Introducing 3D echocardiography and individual therapy protocols increases the effectiveness of management of this category of patients.

Keywords: aortic valve defects, pregnancy, childbirth, management, fetal hypoxia.

For citation: Ilyasova, E.U.; Marulova, A.V.; Rumyantseva, Z.S., et al. Managing pregnant women with aortic valve defects: Clinical analysis, modern approaches, and recommendations. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 37-42. DOI: 10.20969/VSKM.2026.19(1).37-42.

REFERENCES

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3. Стрюк Р.И., Бунин Ю.А., Гурьева В.М. [и др.]. Диагностика и лечение сердечно-сосудистых заболеваний при беременности 2018. Национальные рекомендации // Российский кардиологический журнал - 2018. - № 3 (155). - С. 91-134. Stryuk RI, Bunin УuA, Guryeva VM, et al. Diagnostika i lechenie serdechno-sosudistyh zabolevanij pri beremennosti 2018: Nacional'nye rekomendacii [Diagnosis and treatment of cardiovascular diseases during pregnancy 2018: National recommendations]. Rossijskij kardiologicheskij zhurnal [Russian Cardiology Journal]. 2018; 3 (155): 91-134. (In Russ.) DOI: 10.15829/1560-4071-2018-3-91-134

4. Dawson J, Rodriguez У, De Marchena E, Alfonso CE. Aortic balloon valvuloplasty in pregnancy for symptomatic severe aortic stenosis. Int J Cardiol. 2019; 162(1):12-13. DOI: 10.1016/j.ijcard.2019.04.143

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6. Боровкова Н.Ю., Токарева А.С., Савицкая Н.Н., [и др.]. Современное состояние проблемы сердечно-сосудистых заболеваний в Нижегородском регионе: возможные пути снижения смертности // Российский кардиологический журнал. - 2022. - Т. 27, № 5. - С. 5024. Borovkova NУu, Tokareva AS, Savitskaya NN, et al. Sovremennoe sostoyanie problemy serdechno-sosudistyh zabolevanij v Nizhegorodskom regione: vozmozhnye puti snizheniya smertnosti [The current state of the problem of cardiovascular diseases in the Nizhny Novgorod region: possible ways to reduce mortality]. Rossijskij kardiologicheskij zhurnal [Russian Journal of Cardiology]. 2022; 27(5):5024. (In Russ.) DOI: 10.15829/1560-4071-2022-5024

7. Горохова С.Г., Морозова Т.Е., Аракелянц А.А., [и др.]. Алгоритм эхокардиографического исследования у беременных // Российский кардиологический журнал. - 2018. - Т. 23, № 12. - С. 75-82. Gorokhova SG, Morozova TE, Arakeliants AA, et al. Algoritm ekhokardiografcheskogo issledovaniia u beremennykh [Algorithm of echocardiography in pregnant women]. Rossijskij kardiologicheskij zhurnal [Russian Journal of Cardiology]. 2018; (12): 75-83. (In Russ.) DOI: 10.15829/1560-4071-2018-12-75-83

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10. Ducas RA, Javier DA, D'Souza R, et al. Pregnancy outcomes in women with signifcant valve disease: a systematic review and meta-analysis. Heart. 2020;106(7):512-519. DOI:10.1136/heartjnl-2019-315859

11. Рудаева Е.В., Мозес В.Г., Кашталап В.В., [и др.]. Врожденные пороки сердца и беременность // Фундаментальная и клиническая медицина. - 2019. - Т. 4, № 3. - С. 102-112. Rudaeva EV, Mozes VG, Kashtalap VV, et al. Vrozhdennye poroki serdca i beremennost' [Congenital heart disease and pregnancy]. Fundamental'naya i klinicheskaya medicina [Fundamental and Clinical Medicine]. 2019; 4 (3): 102-112. (In Russ.)

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13. Aluru JS, Barsouk A, Saginala K, et al. Valvular Heart Disease Epidemiology. Med Sci. 2022;10(2):32. DOI: 10.3390/medsci10020032

14. Иртюга О.Б., Мгдесян К.О., Моисеева О.М. Особенности ведения беременности и родов у пациенток с патологией аорты и аортального клапана // Российский кардиологический журнал. - 2017. - № 2. - С. 80-86. Irtyuga OB, Mgdesyan KO, Moiseeva OM. Osobennosti vedeniya beremennosti i rodov u pacientok s patologiej aorty i aortal'nogo klapana [Features of pregnancy and childbirth management in patients with pathology of the aorta and aortic valve]. Rossijskij kardiologicheskij zhurnal [Russian Journal of Cardiology]. 2017; 2: 80-86. (In Russ.) DOI: 10.15829/1560-4071-2017-2-80-86

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УДК: 616.12-06:616-008.9-08-055 DOI: 10.20969/VSKM.2026.19(1).43-49

 Gender differences in cardiometabolic risk factors, metabolic profile, adipokines, and cytokines among young people

Elizaveta A. Lenets1,3, Vasilii S. Chulkov2,3, Elena E. Minina1, Vladislav S. Chulkov1,3

1 South-Ural State Medical University, 64 Vorovsky str., 454141 Chelyabinsk, Russia

2 Yaroslav-the-Wise Novgorod State University, 41 Bolshaya Sankt-Peterburgskaya str., 171003 Veliky Novgorod, Russia

3 City Clinical Hospital No. 11, 17a Dzerzhinsky str, 454129 Chelyabinsk, Russia

Abstract. lntroduction. Contemporary cardiometabolic risk concept is based on the synergistic effect of traditional risk factors on the risk of developing cardiovascular diseases and type 2 diabetes mellitus. Among young people, there is a high incidence of behavioral risk factors and cardiometabolic diseases, causing cumulative health harm throughout their life. There are active discussions about the importance of visceral and white adipose tissue playing key roles in the synthesis of adipokine and cytokines and being involved in maintaining the hormonal balance of the body. Aim. To compare the frequency of cardiometabolic risk factors, metabolic parameters, adipokine, and cytokines in blood serum in young men and women. Materials and Methods. The cross-sectional study based on a prospective cohort study included 251 participants over the period of 2013-2016: 124 men (average age 27 [21-36] years) - group 1; 127 women (average age 35 [26-41] years) - group 2. All participants underwent clinical and laboratory examinations. Results and Discussion. Every second man and every ffth woman had hyperuricemia. No differences were found in the frequency of hypertension, abdominal obesity, hyperlipidemia, hyperglycemia, smoking, and hereditary hypertension between the study groups. Metabolic syndrome was detected in every third man (36.3%) and every fourth woman (28.3%). The most pronounced differences were found in anthropometric, such as body mass index and waist circumference, and biochemical parameters, such as glycated hemoglobin, triglycerides, high-density lipoprotein cholesterol, urea, creatinine, alanine aminotransferase, and aspartate aminotransferase. Уounger women had higher serum leptin and adiponectin levels, whereas men had signifcantly higher serum concentrations of plasminogen activator type 1 inhibitor. In young men with metabolic syndrome, higher levels of tumor necrosis factor-а were recorded against the background of the serum values of leptin and adiponectin levels being lower than in young women. Conclusions. The gender differences found in cardiometabolic risk factors emphasize the need for an individual approach to young people's risk management and monitoring. Clinical signifcance of some biomarkers varies by gender, but it remains to be seen whether these features lead to different effects on cardiovascular risk and morbidity, as well as on new treatment approaches.

Keywords: gender differences, arterial hypertension, abdominal obesity, cardiometabolic risk factors, carbohydrate metabolism disorders, young age

For citation: Chulkov, V.S.; Lenets E.A.; Minina E.E.; Chulkov V.S. Gender differences in cardiometabolic risk factors, metabolic profle, adipokines, and cytokines among young people. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 43-49. DOI: 10.20969/VSKM.2026.19(1).43-49.

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УДК: 616.61(02):61 DOI: 10.20969/VSKM.2026.19(1).50-55

 Status of the renal transplantation system in Samara Region

Alexey A. Mironov1, Maxim N. Myakotnykh1

1Samara State Medical University, 89 Chapaevskaya str., 443099 Samara, Russia

Abstract. lntroduction. Prevalence of end-stage renal disease continues to grow, while access to renal replacement therapy (RRT) remains limited. Kidney transplantation is the most effective treatment modality; however, its implementation is signifcantly constrained by donor shortages and organizational challenges, particularly at the regional level. Aim. To analyze the results of the kidney transplant system in Samara Region. Materials and Methods. Kidney transplants (n=734) performed in the Samara region in 2006-2024 were analyzed retrospectively. Availability of donor resources was assessed, and we also compiled a clinical profle of patients on the kidney transplant waiting list (n=127). The results obtained were processed statistically using Microsoft Offce Excel. Descriptive statistical methods were employed, namely: Qualitative and categorical indicators were described as absolute values (n) and percentages (%). Proportion indicators were used to calculate event rates and compare them with published data. Results and Discussion. Between 2006 and 2024, a total of 734 kidney transplantations were performed in the region, with the majority of transplants (97.8%) being taken from deceased donors. Graft function was preserved in 84.2% of cases, and impaired in 6.0%. Postoperative complications occurred in 26.7% (n=196) of patients, predominantly non-urological (surgical, infectious, hemorrhagic, etc.) in 17.3% (n=127), urological in 6.7% (n=49), and mixed in 2.7% (n=20). Repeat surgical interventions were required in 24.8% of cases. The overall post-transplant mortality rate was 12.3%, with infectious complications, including sepsis, being the leading cause of death. Analysis of the waiting list (n=127) revealed a predominance of middle-aged males (mean age: 45 years), with chronic glomerulonephritis, chronic kidney disease, and polycystic kidney disease being the most common underlying conditions. Donor shortage remains a critical issue with more than two potential recipients per one effective donor. The estimated donor rate was 9.0 per million population, compared to the required donor rate of 41 per million. Conclusions. Despite the high clinical effcacy of kidney transplantation, access remains limited. The experience of the Samara region demonstrates positive progress but emphasizes the persistent shortage of donors and the need for improving the organizational solutions regarding transplant care.

Keywords: kidney transplant, kidney donation, chronic kidney disease, waiting list

For citation: Mironov, A.A.; Myakotnykh, M.N. Status of the renal transplantation system in Samara Region. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 50-55. DOI: 10.20969/VSKM.2026.19(1).50-55.

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УДК: 615.012/.014:001.89 DOI: 10.20969/VSKM.2026.19(1).56-62

 Developing a quantification procedure for ethylmethylhydroxypyridine succinate in an injection solution

Elena B. Nikiforova1, Naira A. Davitavyan2, Anastasia I. Shevchenko2, Yuri F. Yakuba3

1 Synergy University, 27 Partizanskaya str., 121351 Moscow, Russia

2 Kuban State Medical University, 4 M. Sedin str., 350063 Krasnodar, Russia

3 North-Caucasus Federal Scientific Center of Horticulture, Viticulture and Winemaking, 39 The 40th Anniversary of Victory str., 350901 Krasnodar, Russia

Abstract. lntroduction. Ethylmethylhydroxypyridine succinate is a unique medicinal product developed by Russian scientists. It is widely used in clinical practice as a drug with antioxidant and membrane-stabilizing properties. Manufacturing the ethylmethylhydroxypyridine succinate-based drugs is classifed as a full-cycle process encompassing the entire pharmaceutical substance synthesis through to the fnal dosage form. Ethylmethylhydroxypyridine succinate-based drugs are available on the pharmaceutical market in solid and liquid dosage forms as mono- and combined medications. The most clinically popular dosage form is ethylmethylhydroxypyridine succinate solution for intravenous and intramuscular injections (50 mg/ml), which has the best pharmacokinetic properties. In this regard, the therapeutic signifcance of ethylmethylhydroxypyridine succinate injection solution and the widespread use of this drug on the pharmaceutical market necessitate a thorough assessment of its quality, primarily regarding the quantitative content of the active ingredient. Currently, the State Pharmacopoeia of the Russian Federation regulates the quantitative determination of ethylmethylhydroxypyridine succinate in injection solution by ultraviolet spectrophotometry. Furthermore, the results of studies have been published regarding the development of a quality control procedure for the ethylmethylhydroxypyridine succinate injection solution using high-performance liquid chromatography. Capillary electrophoresis may serve as an alternative quantitative procedure for detecting the ethylmethylhydroxypyridine succinate in an injection solution. Aim. To develop an electrophoretic quantitative procedure for ethylmethylhydroxypyridine succinate in an injection solution. Materials and Methods. The object of the study was a medicinal product, i. e., an intravenous and intramuscular injection solution of ethylmethylhydroxypyridine succinate, registered in the Russian Federation under the trade name "Mexidol, solution for intravenous and intramuscular administration, 50 mg/ml' (Armavir Biofactory FKP, Russia). Electrophoretic determination and detection were carried out using the Kapel-105M capillary electrophoresis system (OAO NPF Lumex, Russia) equipped with a spectrophotometric detector, at a wavelength of 297 nm. An aqueous solution containing a 0.48% solution of boric acid, 0.1 M of sodium hydroxide solution, and a 1.0% solution of ethylmethylhydroxypyridine succinate, acted as the leading electrolyte. Results and Discussion. In determining the validation parameters, it was found that the proposed method is characterized by specifcity, linearity in the concentration range from 0.4% to 1.0% (y = 955.07x-16.132; r = 0.996), correctness for ethylmethylhydroxypyridine succinate content levels of 80-120% (R = 98.71%-101.09%), and precision (RSD = 0.372-0.815%). Conclusions. A procedure has been developed and validated for determining the quantitative content of ethylmethylhydroxypyridine succinate in an injection solution by capillary electrophoresis.

Keywords: capillary electrophoresis, ethylmethylhydroxypyridine succinate, injection solution, quantitative determination.

For citation: Nikiforova, E.B.; Davitavyan, N.A.; Shevchenko, A.I.; Уakuba, У.F. Developing a quantifcation procedure for ethylmethylhydroxypyridine succinate in an injection solution. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 56-62. DOI: 10.20969/VSKM.2026.19(1).56-62.

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УДК:1024032600106-9-3.2.7 DOI: 10.20969/VSKM.2026.19(1).63-70

 Laboratory and morphological manifestations of tuberculous inflammation in patients with pulmonary tuberculoma, multiple and pre-extensive drug-resistant mycobacteria, and diabetes mellitus under different durations of chemotherapy

Ekaterina G. Polushkina1, Oksana G. Komissarova1,2, Larisa N. Lepeha1, Rizvan U. Abdullaev1

1 Central Research Institute of Tuberculosis, 2 Yauzskaya Alley, 107564 Moscow, Russia

2 Pirogov Russian National Research Medical University, 1 Ostrovityanov str., 107564 Moscow, Russia

Abstract. lntroduction. Patients with tuberculosis, multiple and pre-extensive drug resistance, and concomitant diabetes mellitus represent a diffcult cohort for treatment, which is why the search for optimal approaches to the comprehensive treatment of this category of patients is a topical task. Aim. To investigate laboratory markers of systemic infammation prior to surgical intervention and the morphological pattern of the tuberculous process in resection specimens in patients with pulmonary tuberculoma, multiple and pre-extensive drug-resistant Mycobacterium tuberculosis, and diabetes mellitus under different durations of chemotherapy. Material and Methods. The study included thirty-three patients with pulmonary tuberculomas and concomitant diabetes mellitus and thirty-seven patients with pulmonary tuberculomas without diabetes mellitus, who underwent combined treatment including a surgical method. Activity of systemic infammation was assessed by the severity of leukocytosis, elevation of the erythrocyte sedimentation rate, and levels of C-reactive protein and fbrinogen. The tuberculous infammation activity degree in the resection specimens was evaluated by morphological examination. Statistical processing was performed using parametric and nonparametric tests. Results and Discussion. In patients with diabetes mellitus in the preoperative period, an increase of the erythrocyte sedimentation rates and the fbrinogen levels were recorded signifcantly more often, and the values of these parameters were substantially higher. Leukocytosis was noted somewhat more frequently in the group of patients with diabetes mellitus, however without statistically signifcant differences. In both groups examined, more than half of the patients had elevated C-reactive protein levels, and there was no signifcant difference between the groups. According to the morphological examination of the resection specimens, patients with moderate and high activity of tuberculous infammation prevailed in all groups. An increase in the proportion of patients with low activity was noted in the group of patients without diabetes mellitus who received antituberculosis therapy for nine to twelve months; however, no statistically signifcant differences were found. In the morphological study among patients with diabetes mellitus who received chemotherapy for nine to twelve months, the infammatory process reactivation phenomena were observed in twenty-fve percent of patients. Conclusions. In patients with tuberculosis and concomitant diabetes mellitus, laboratory and morphological signs of infammatory activity persist for a prolonged period, and phenomena of tuberculosis reactivation are frequently observed where accompanied by the organization of the specifc process.

Keywords: tuberculosis, multiple and extensive drug resistance, diabetes mellitus, tuberculosis infammation activity.

For citation: Polushkina, E.G.; Komissarova, O.G.; Lepeha, L.N.; Abdullaev, R.U. Laboratory and morphological manifestations of tuberculous infammation in patients with pulmonary tuberculoma, multiple and pre-extensive drug-resistant mycobacteria, and diabetes mellitus under different durations of chemotherapy. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 63-70. DOI: 10.20969/VSKM.2026.19(1).63-70.

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УДК: 616.127-005.4-073.756.8 DOI: 10.20969/VSKM.2026.19(1).71-79

 Experience in customer inquiry management in public healthcare organizations (exemplified by the Altai Krai)

Olga L. Semina1, Vladimir A. Treshutin2, Dmitry V. Popov1, Tatiana A. Batrak1

Ministry of Health of the Altai Krai, 95A Krasnoarmeysky Ave., 656031 Barnaul, Russia

2 Altai State Medical University, 40 Lenin Ave., 656038 Barnaul, Russia

Abstract. lntroduction. Customer inquiries regarding medical care issues to authorities at all levels are an important indicator of medical care availability and quality, as well as of inquiry management level and, ultimately, of the customers' satisfaction with medical care in general. That is why it is important to effectively manage customer inquiries, primarily at the level of subordinate healthcare organizations. The existing approaches to customer inquiry management do not allow controlling the ratio of incoming inquiries to the level of healthcare organizations and government authorities, as well as the changes in the timeframes of processing them. Aim. To improve customer inquiry management in healthcare, aimed at increasing the effciency of managerial decisions and customers' satisfaction with medical care in the region. Materials and Methods. Materials were the offcial data provided by the Ministry of Health of the Altai Krai regarding the registration and analysis of written and oral inquiries and messages from customers. Research methods: Mathematical and statistical; analytical (comparative, quantitative, structural). Results and Discussion. This article presents the experience of the Ministry of Health of the Altai Krai in achieving an increase in the share of customer inquiries at the level of subordinate medical organizations and, accordingly, a decrease in the share of inquiries to public authorities at all levels and to supervisory organizations, as well as reducing the time taken by processing the inquiries. The results of activities are presented aimed at the introduction and expansion of the project titled Chief Physician on Duty. Conclusions. In the period from 2022 to 2024, thanks to systematic customer-inquiry management, it was possible to signifcantly improve the inquiry processing quality and effciency. This includes an increase in the share of inquiries processed at the level of healthcare organizations, a decrease in the share and number of written inquiries to public authorities, and a reduction in the processing timeframes. The above-mentioned activities, together with the adoption of other managerial decisions based on the results of the analysis of customer inquiries, allowed improving medical care availability and quality and, consequently, the customers' satisfaction with healthcare in the region.

Keywords: customer inquiries, satisfaction with medical care, chief physician on duty, time limits for processing the inquiries.

For citation: Semina, O.L.; Treshutin, V.A.; Popov, D.V.; Batrak, T.A. Experience in customer inquiry management in public healthcare organizations (exemplifed by the Altai Krai). The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 71-79. DOI: 10.20969/VSKM.2026.19(1).71-79.

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УДК: 616.12-008.331.1-008.9-036.3-053.8 DOI: 10.20969/VSKM.2026.19(1).80-89

 Epidemiological situation related to behavioral risk factors for cardiometabolic diseases in the youth population

V.S. Chulkov1, E.S. Gavrilova2, M.V. Derevyanchenko3, E.V. Efremova4, I.N. Lyapina5, A.A. Tolmacheva6, A.O. Rubanenko7, O.A. Rubanenko7, E.Y. Gubareva7, M.A. Kercheva8, I.V. Makarova9, D.I. Sevastyanova10, S.V. Barannikov11, I.A. Khaukasheva12

1 Yaroslav the Wise Novgorod State University, 41B St. Petersburg str., 173003 Veliky Novgorod, Russia

2 South-Ural State Medical University, 64 Vorovsky str., 454141 Chelyabinsk, Russia

3 Volgograd State Medical University, 1 Pavshikh Bortsov Sq., 400066 Volgograd, Russia

4 Ulyanovsk State University, 42 Lev Tolstoy str., 432017 Ulyanovsk, Russia

5 Research Institute for Complex Issues of Cardiovascular Diseases, 6 Academician L.S. Barbarash Blvd., 650002 Kemerovo, Russia

6 Novosibirsk State Medical University, 52 Krasny Ave., 630091 Novosibirsk, Russia

7 Samara State Medical University, 89 Chapaevskaya str., 443099 Samara, Russia

8 Cardiology Research Institute, 10 Ushaiki River Embankment, 634050 Tomsk, Russia

9 N.I. Pirogov Russian National Research Medical University, 1 Ostrovityanov str., 117997 Moscow, Russia

10 Siberian State Medical University, 2 Moskovsky Tract, 634050 Tomsk, Russia

11 Amur State Medical Academy, 95 Gorky, 675001 Blagoveshchensk, Russia

12 Kabardino-Balkarian State University named after H.M. Berbekov, 173 Chernyshevsky str., 360004 Nalchik, Russia

Abstract. lntroduction. Cardiometabolic diseases are highly prevalent among the adult population of all age groups and all regions worldwide. It seems relevant to produce data on risk factors in the youth population, including in the study many regions of the Russian Federation and increasing the study population. Aim. To assess the epidemiological situation in terms of the prevalence of the main behavioral risk factors for cardiometabolic diseases among students. Materials and Methods. A total of 3,296 students from 19 higher educational institutions in 16 cities, i. e., Blagoveshchensk, Vladivostok, Volgograd, Kemerovo, Moscow, Nalchik, Novosibirsk, Pyatigorsk, Rostov-on-Don, Samara, Surgut, Ryazan, Tomsk, Ulyanovsk, Chelyabinsk, and Уaroslavl, participated in the simultaneous study. The survey was conducted using a pre-designed questionnaire. The questionnaire data included gender, age, average academic performance, and year of study. Burdened heredity was assessed for cardiovascular diseases, diabetes mellitus, and cancer. Status of smoking, alcohol consumption, nutrition, and physical activity levels were recorded. The fndings were analyzed statistically and visualized using the R 4.3.1 environment for statistical calculations. Results and Discussion. High levels of the main risk factors for cardiometabolic diseases were found in young people, such as family history, smoking and alcohol consumption, low physical activity, and unhealthy nutrition. Women are more likely to have a family history of cardiovascular diseases and cancer, low physical activity, and wine and sweets consumption. Men are more likely to smoke heavily, drink beer, and consume alcohol excessively. The study showed a high prevalence of behavioral risk factors for cardiometabolic diseases among student-age population in various regions of Russia. Conclusions. This study demonstrated a high prevalence of the main risk factors for cardiometabolic diseases among young individuals. Women are more likely to have a family history of cardiovascular diseases and cancer, low physical activity, and increased wine and sweets consumption. Men are more likely to smoke heavily, drink beer, drink strong alcoholic beverages, and generally consume excessive amounts of alcohol. The data obtained indicate the need for developing and implementing gender-specifc prevention programs aimed at reducing the prevalence of risk factors and forming sustainable healthy habits among young people.

Keywords: epidemiology, risk factors, smoking, alcohol, physical activity, nutrition, youth, cardiometabolic diseases.

For citation: Chulkov, V.S.; Gavrilova, E.S.; Derevyanchenko, M.V.; et al. Epidemiological situation related to behavioral risk factors for cardiometabolic diseases in the youth population. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 80-89. DOI: 10.20969/VSKM.2026.19(1).80-89.

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25. C. Antza, A. Gallo, C. Boutari, et al. Prevention of cardiovascular disease in young adults: Focus on gender differences. A collaborative review from the EAS Уoung Fellows. Atherosclerosis. 2023; 384: 117272. DOI: 10.1016/j.atherosclerosis.2023.117272

 

УДК: 616.24-002.5-006:616.379-008.64 DOI: 10.20969/VSKM.2026.19(1).90-96

 Features of the new-onset pulmonary tuberculosis course in patients with insulin resistance

Violetta A. Shorokhova1, Oksana G. Komissarova1,2, Polina D. Merzlikina1, Rizvan Yu. Abdullaev1

1 Central TB Research Institute, 2 Yauzskaya Alley, 107564 Moscow, Russia

2 N.I. Pirogov Russian National Research Medical University, 1 Ostrovityanov str., 117997 Moscow, Russia

Abstract. lntroduction. Insulin resistance not only underlies some metabolic diseases, but is also closely associated with the development of infectious diseases. When an infection develops, a person initially develops physiological insulin resistance to provide the body with energy. However, in some patients, after recovery from the infection, insulin resistance persists and becomes pathological, predisposing the hosts to type 2 diabetes mellitus and vascular damage. Considering that type 2 diabetes mellitus contributes to the aggravation of the tuberculosis process in patients with combined pathology, it is of great interest to study the effect provided by insulin resistance on the course of tuberculosis. Aim. To study the characteristics of the course of new-onset pulmonary tuberculosis in patients with insulin resistance. Material and Methods. A prospective cross-sectional cohort study was performed in 449 patients with new-onset pulmonary tuberculosis. The patients were divided into 3 groups: 243 patients with insulin resistance, 151 patients without insulin resistance, and 55 patients with type 2 diabetes mellitus. The presence of insulin resistance was identifed by the triglyceride-to-glucose ratio. Demographic, clinical, radiological, and laboratory manifestations of pulmonary tuberculosis were studied. Data were processed statistically using the SPSS Statistics Version 27 software package. Results and Discussion. In the groups with insulin resistance and type 2 diabetes mellitus, slightly more than half were males. Over a half of the patients in the groups with insulin resistance and type 2 diabetes mellitus were over 40 years old, and in the group of tuberculosis patients without these pathologies, the majority were people under 40 years. Pulmonary tuberculomas were signifcantly more common in the groups with insulin resistance and type 2 diabetes mellitus, while infltrative tuberculosis was signifcantly more common in the group of tuberculosis patients without these pathologies. Cavities in the lung tissue and bacterial excretion were signifcantly more common in the groups of patients with insulin resistance and type 2 diabetes mellitus compared to the group of tuberculosis patients without these pathologies. Multiple drug resistance of M. tuberculosis was signifcantly more common in the groups with insulin resistance and type 2 diabetes mellitus compared to the group of tuberculosis patients without these pathologies. Moderate and severe tuberculosis intoxication was signifcantly more often detected in groups with insulin resistance and type 2 diabetes mellitus compared to the group of tuberculosis patients without these pathologies. Conclusions. Course of new-onset pulmonary tuberculosis in patients with insulin resistance is, in terms of its basic characteristics, closer to that of tuberculosis in patients with type 2 diabetes mellitus.

Keywords: tuberculosis, insulin resistance, diabetes mellitus, bacterial excretion, drug resistance

For citation: Shorokhova, V.A.; Komissarova, O.G.; Merzlikina, P.D.; Abdillaev, R.U. Features of the new-onset pulmonary tuberculosis course in patients with insulin resistance. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 90-96. DОl: 10.20969/VSKM.2026.19(1).90-96.

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УДК 616.12-008.46-091.8 DOI: 10.20969/VSKM.2026.19(1).97-106

 Histopathological differences in the left atrial myocardium according to chronic heart failure phenotype

Vlas S. Shchekin1, Ildar I. Teregulov1, Timur I. Valinurov1, Marina R. Plotnikova1, Irina A. Lakman2, Alfia E. Pushkareva1, Arkadiy A. Dolganov1, Pavel S. Mihaylov1, Irina A Mustafina1, Elena V. Efremova3, Naufal Sh. Zagidullin1

1 Bashkir State Medical University, 3 Lenin str., 450008 Ufa, Russia

2 Ufa University of Science and Technology, 32 Zaki Validi str., 450076 Ufa, Russia

3 Ulyanovsk State University, 42 Lev Tolstoy str., 432017 Ulyanovsk, Russia

Abstract. lntroduction. Chronic heart failure remains a pressing issue in modern internal medicine, necessitating the development of individualized prognostic algorithms. Chronic heart failure phenotypes, according to the ejection fraction, exhibit distinct morphological changes in the myocardium. Biopsy of the left atrial appendage during coronary artery bypass grafting allows studying chronic heart failure morphological substrates, identifying progression markers, and developing personalized therapies. Aim. To investigate the histomorphological and morphometric characteristics of the left atrial appendage according to chronic heart failure phenotype. Materials and Methods. A consecutive, non-randomized, uncontrolled study was conducted on 300 patients (median age 65 (60-71) years, 213 (71%) men) with coronary artery disease who underwent coronary artery bypass grafting. Of these, 73 patients (24.33%) formed the control group without chronic heart failure, 150 patients (50%) comprised the group having сhronic heart failure with preserved ejection fraction (Group I) and 77 patients (25.67%) formed the group having chronic heart failure with ejection fraction under 50% (Group II). A standard histotechnical procedure was performed to prepare left atrial appendage specimens. Morphometric analysis of the specimens scanned included measuring muscle and fbrous tissue areas and their ratio. Results and Discussion. Differences between chronic heart failure phenotypes were only identifed in the proportion of hypertrophied cell nuclei, including through log-linear regression modeling. In patients with chronic heart failure with preserved ejection fraction, the proportion of hypertrophied cell nuclei was increased by 49.6% (43.1; 57.0), while in patients with ejection fraction under 50%, it increased by 57% (48.5; 66.9) compared to the control group. In men, proportion of hypertrophied cell nuclei was 45.6% (40.0; 51.7) higher than in women. History of myocardial infarction did not signifcantly affect the proportion of hypertrophied cell nuclei changes. Conclusions. Irreversible dystrophic changes in cardiomyocytes were the morphological substrate of chronic heart failure with ejection fraction below 50% as compared to chronic heart failure with the preserved ejection fraction.

Keywords: chronic heart failure, histopathology, left atrial appendage, ejection fraction, cardiomyocytes, nuclear hypertrophy, fbrosis, morphometry, coronary artery bypass grafting.

For citation Shchekin, V.S.; Teregulov, I.I.; Valinurov, T.I.; et al. Histopathological differences in the left atrial myocardium according to chronic heart failure phenotype. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 97-106. DOI: 10.20969/VSKM.2026.19(1).97-106.

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REVIEWS

УДК: 614 DOI: 10.20969/VSKM.2026.19(1).107-117

 Proactive strategic management of the regional drug abuse situation: Foresight analysis, 2030 scenarios, and interagency cooperation architecture

Azis V. Akhokhova1,2, Gyulabatyn K. Mustafaeva1, Khadizhat R. Istamulova1, Aslan A. Nyrov1, Dzhamilya A. Chaplaeva1

1Kabardino-Balkarian State University named after Kh. M. Berbekov, 173 Chernyshevsky str., 360004 Nalchik, Kabardino-Balkarian Republic, Russia

2Republican Clinical Center of Psychiatry and Narcology, 15 Naloev str.., 360032 Nalchik, Kabardino-Balkarian Republic, Russia

Abstract. lntroduction. Given the increasing complexity of drug menaces and the growing uncertainty of the socio-economic environment, there is a pressing need for a scientifc substantiation of an interagency cooperation strategy for regional drug use prevention. This study utilizes the Foresight approach and scenario modeling to address this need. Aim. The research aims to defne the strategic direction of interagency cooperation in drug use prevention within the Kabardino-Balkarian Republic, based on a Foresight analysis and scenario modeling of emerging drug addiction trends. Materials and Methods. The study employs the Foresight methodological toolkit, including PESTLE analysis, scenario forecasting, identifcation of drivers and bifurcation points, and the "Popper's Diamond' framework. Analytical database comprises statistical data from drug addiction services, international and federal reports, and expert assessments. Results and Discussion. The study identifes key trends, such as the rise of polysubstance abuse, the increased prevalence of synthetic drugs, the lowering average age of drug users, and the digitalization of the drug market. Probable and potential development scenarios are defned, i.e., inertial, optimistic, crisis, and innovative ones. Furthermore, the study identifes drivers and bifurcation points capable of radically altering the trajectory of the drug situation. The fndings justify a shift from a predominantly punitive (repressive) approach toward prevention and rehabilitation. This shift involves integrating digital monitoring technologies and developing individualized preventive pathways. Conclusions. Based on the fndings, it is concluded that Foresight analysis in anti-drug prevention is an effective tool for proactive risk management, enabling the alignment of federal and regional strategies. For the Kabardino-Balkarian Republic, the development of a "meso-strategy' is of particular importance. Such a strategy should be based on interagency cooperation, leveraging ethno-confessional resources, as well as educational and cultural potential. Scenario modeling provides the capacity to prepare for potential threats and establish a sustainable trajectory for reducing drug risks and strengthening public health through 2030.

Keywords: Foresight, scenario modeling, Popper's diamond, drug addiction in society, drug prevention.

For citation: Akhokhova, A.V.; Mustafaeva, G.K.; Istamulova, Kh.R.; et al. Proactive strategic management of the regional drug abuse situation: Foresight analysis, 2030 scenarios, and interagency cooperation architecture. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 107-117. DOI: 10.20969/VSKM.2026.19(1).107-117.

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УДК: 616.314-002.4-085.33:615.33 DOI: 10.20969/VSKM.2026.19(1).118-122

 Etiotropic therapy of aggressive periodontitis: Contemporary antibiotic regimens and their effectiveness

Elbek A. Gaybullaev1

1 EMU University, 7/1 Mukimi str., 100104 Tashkent, Uzbekistan

Abstract. lntroduction. Aggressive periodontitis is a rapidly progressing periodontal disease characterized by swift destruction of the periodontal complex tissues with minimal clinical signs of infammation. Despite the paucity of symptoms, the disease is accompanied by signifcant bone loss, which often leads to diagnostic challenges. Aim. To conduct a systematic analysis of contemporary antibiotic regimens for the treatment of aggressive periodontitis, evaluating their effcacy, pharmacological characteristics, and clinical advantages based on global literature data. Materials and Methods. A comprehensive search and critical analysis of scientifc publications indexed in Scopus, Web of Science, and PubMed was performed. The study included publications focused on etiotropic therapy for patients with various forms of aggressive periodontitis, published between 2015 and 2025, with a minimum follow-up duration of six months. Experimental studies and case reports were excluded. In total, 55 publications were analyzed. Results and Discussion. It was found that in clinical practice, the most frequently used antibiotics for the treatment of aggressive periodontitis include macrolides (500 mg once daily for 3 days), fourth-generation fuoroquinolones (400 mg once daily for 7 days), as well as combination regimens comprising β-lactam antibiotics with nitroimidazoles, with dosage and course duration varying across studies. The preference for macrolides and fuoroquinolones is primarily based on their favorable pharmacokinetic properties, particularly their ability to penetrate deeply into infamed tissues and accumulate within innate immune effector cells. Combination of amoxicillin and metronidazole demonstrates a pronounced synergistic effect, including suppression of matrix metalloproteinase production and broad-spectrum antibacterial coverage encompassing both aerobic and anaerobic pathogens. Interregional variations observed in microbial composition underscore the necessity of personalized etiotropic therapy tailored to local microbial profles and pathogen susceptibility. Conclusions. Despite extensive research into the etiotropic management of aggressive periodontitis and endorsement of the antibacterial approach by leading professional associations, a standardized treatment protocol has not yet been established. The synthesized evidence emphasizes the importance of individualized antibiotic therapy, taking into account the microbial spectrum, clinical course, and pathogen sensitivity. Future research prospects involve enlarging sample sizes and conducting comparative analyses of different antibiotic regimens to enhance the effcacy of aggressive periodontitis management.

Keywords: aggressive periodontitis, antibiotic therapy, etiotropic treatment, microbial spectrum, macrolides, fuoroquinolones, clinical effcacy

For citation: Gaybullaev, E.A. Etiotropic therapy of aggressive periodontitis: contemporary antibiotic regimens and their effectiveness. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 118-122. DOI: 10.20969/VSKM.2026.19(1).118-122.

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УДК: 616.24-004(048.8) DOI: 10.20969/VSKM.2026.19(1).123-132

 Pathogenetic mechanisms of idiopathic pulmonary fibrosis: A modern view on the role of genetic and epigenetic factors

Romesh I. Kokaev1, Saida S. Kornieva1, Iman A. Kerimova1, Tamerlan B. Dashiev2, Zarina M. Kudukhova1,

Amina A. Malikova1, Asiyat A. Khabrakova1, Fatima V. Satueva1, Khalimat Ya. Sadulaeva1, Aminat Kh. Bukhieva1, Amir A. Amirov3, Dzhamaldin M. Ezerbiev3

1North-Ossetian State Medical Academy; 40 Pushkinskaya str., 362019 Vladikavkaz, Russia

2Nadterechnaya Central District Hospital – Gvardeyskaya District Hospital, w/o No. Gagarin str. 366809 Nadterechnoye Village, Russia

3Saratov State Medical University, 112 B Kazachya str., 410012 Saratov, Russia

Abstract. lntroduction. Idiopathic pulmonary fbrosis is one of the most complex and understudied diseases of the pulmonary system. This pathological process is characterized by progressive lung tissue fbrosis leading to the irreversible deterioration of respiratory function and a signifcant reduction in patients' quality of life. In recent decades, there is an increase in the incidence of idiopathic pulmonary fbrosis observed, highlighting the need for an in-depth study of its pathogenesis. Despite signifcant advances in the diagnosis and treatment of respiratory diseases, the pathogenesis of idiopathic pulmonary fbrosis remains understudied. Modern research focuses on the molecular and cellular mechanisms underlying this disease, including genetic and epigenetic factors that may play a key role in its development and progression. Aim. To provide up-to-date information on idiopathic pulmonary fbrosis and analyze the latest existing data regarding the role of genetic and epigenetic mechanisms in the pathogenesis of idiopathic pulmonary fbrosis in 2008-2025. Genetic and epigenetic factors were chosen for investigation in this review due to their signifcant impact on the molecular mechanisms underlying idiopathic pulmonary fbrosis. Materials and Methods. The literature search was conducted according to the PRISMA 2020 (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Selection was only carried out among original articles and reviews in Russian and English. 497 publications were identifed. Publications included in the review: n=66. Publications excluded due to not meeting the inclusion criteria: n=431. Results and Discussion. The analysis performed showed that IPF results from a complex interaction of genetic predisposition, environmental factors, and epigenetic changes. It was established that a key role in the pathogenesis is played by repeated damage to the alveolar epithelium and its pathological reprogramming according to the "double-hit' hypothesis mechanism. Hereditary risks are largely determined by the polymorphism of the MUC5B gene and mutations in telomere and surfactant protein genes, leading to cellular senescence and impaired repair. These processes trigger a cascade of fbrogenic reactions, including the epithelial-mesenchymal transition and excessive deposition of extracellular matrix. The data obtained underscore idiopathic pulmonary fbrosis as a multifactorial disease. Conclusions. Genetic mutations and polymorphisms can determine predisposition to the disease, while epigenetic changes regulate gene expression, infuencing the development and progression of fbrotic processes in the lungs.

Keywords: idiopathic pulmonary fbrosis, tissue remodeling, fbroproliferation, two-hit hypothesis, genetics and epigenetics.

For citation: Kokaev, R.I.; Kornieva, S.S.; Kerimova, I.A.; et al. Pathogenetic mechanisms of idiopathic pulmonary fbrosis: A modern view on the role of genetic and epigenetic factors. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1),123-132. DOI: 10.20969/VSKM.2026.19(1).123-132.

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ORGANIZATION OF HEALTHCARE

УДК: 616.314-089.843:614.2 DOI: 10.20969/VSKM.2026.19(1).133-140

 Challenges in the organization and delivery of dental implantation and principles for its enhancement

Alexander A. Astafyev1, Igor S. Kopetsky2, Oleg E. Konovalov1, Alexey V. Shulaev3, Olga Yu. Guseva2

1 Patrice Lumumba Peoples’ Friendship University of Russia, 10 Miklukho-Maklay str., Bldg. 2, 117198 Moscow, Russia

2 Russian National Research Medical University, 1 Ostrovityanov str., 117997 Moscow, Russia

3 Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia

Abstract. lntroduction. Dental implantation is increasingly used today, which necessitates the development of methodological approaches to and proposals for improving its organization and delivery. Aim. To scientifcally substantiate proposals for improving the provision of prosthetic dental care to patients requiring dental implantation, based on a comprehensive medico-social and clinical-organizational study. Materials and Methods. We performed assessment of staffng for providing prosthetic dental care to the population of Moscow using offcial statistics; content analysis of the existing dental implantation regulatory framework; expert review of medical records related to specialized dental examinations; and a survey of patient opinions on measures to enhance dental implantation. Results and Discussion. An unfavorable situation was identifed regarding the availability and qualifcations of both physicians and middle-grade medical personnel providing prosthetic dental care to Moscow residents. Not only a downward trend was noted but also levels lower than those throughout Russia and within the Central Federal District. It was found that many legislative acts containing sections regulating dental implantation in Russia are not in force despite recent amendments. There is no unifed regulatory framework governing the organizational aspects of dental implantation. Expert evaluation of medical records of the specialized dental examination (Form No. 043/у) revealed defects in the presentation of anamnesis, clinical-diagnostic and treatment data, and in the completion of all its sections. In the patient survey, the top-ranked organizational measures were: Improving specialists' qualifcations, using more advanced equipment and facilities, enhancing services in dental institutions, and including the latest treatment methods. Conclusions. The proposals developed are medico-social and organizational in nature and aimed at enhancing the quality and accessibility of dental care for patients requiring dental implantation at the present stage.

Keywords: dental implantation, staffng, legislative framework, sociological survey.

For citation: Astafyev, A.A.; Kopetsky, I.S.; Konovalov, O.E.; et al. Challenges in the organization and delivery of dental implantation and principles for its enhancement. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 133-140. DOI: 10.20969/VSKM.2026.19(1).133-140.

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УДК 614.2:616.351-006.04-08 DOI: 10.20969/VSKM.2026.19(1).141-146

 Clinical and organizational challenges of providing specialized medical care to patients with rectal cancer

Andrey A. Kostin1, Mikhail M. Ryabov2, Oleg E. Konovalov1, Alexey V. Shulaev3, Anastasia A. Shikaleva3,4,5

1Patrice Lumumba Peoples’ Friendship University of Russia (RUDN), 6 Miklouho-Maclay str., 117198 Moscow, Russia

2Yaroslavl State Medical University, 5 Revolutsionnaya str., 150000 Yaroslavl, Russia

3Kazan State Medical University, 49 Butlerov str., 420012 Kazan, Russia

4Russian Medical Academy of Postgraduate Education, 2/1 Barrikadnaya str., 125993 Moscow, Russia

5Kazan State Medical Academy – Branch of the Russian Medical Academy of Postgraduate Education, 36 Butlerov str., 420012 Kazan, Russia

Abstract. lntroduction. Currently, optimizing the organization of oncological care for patients with rectal cancer (RC) remains a pressing issue. Aim. To analyze the clinical and organizational challenges of providing oncological care to patients with RC. Materials and methods. A single-center retrospective study was conducted. Data of 302 electronic medical records of patients diagnosed with RC were analyzed, who underwent treatment for the underlying disease in the inpatient department of the Уaroslavl Regional Clinical Oncology Hospital in 2017-2018. Statistical processing was performed using parametric and nonparametric criteria. Results and Discussion. Extensive-stage RC detection rate was 42.1% in the sample. At the time of the rectal neoplasia detection, 35 (11.6%) patients had distant hematogenous metastases. Of them, the majority, 20 (6.6%), were localized in the liver. On average, the outpatient stage for cancer patients before their admission to a specialized hospital lasted 41 (37; 43) days. Overall survival in the entire sample of patients was 2140 (933; 2523) days. Only stage 4 patients (p <0.05) had signifcant differences from the rest in overall survival. The main weaknesses of the system providing specialized medical care to cancer patients with rectal neoplasms are primary care physicians' low awareness of the correct routing of patients, a high percentage of late rectal cancer diagnosis, low active detection rates, and high mortality rates within the frst year of life after the diagnosis verifcation. Conclusions. Analysis of the clinical material confrmed the challenges of providing oncological care to patients with rectal cancer available in the literature and outlined the key areas for improving the situation.

Keywords: rectal cancer, cancer patient, antitumor treatment, screening.

For citation: Kostin, A.A.; Ryabov, M.M.; Konovalov, O.E.; et al. Clinical and organizational challenges of providing specialized medical care to patients with rectal cancer. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 141-146. DOI: 10.20969/VSKM.2026.19(1).141-146.

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10. Приказ Минздрава России от 27.04.2021 N 404н (ред. от 19.07.2024) «Об утверждении Порядка проведения профилактического медицинского осмотра и диспансеризации определенных групп взрослого населения» (Зарегистрировано в Минюсте России 30.06.2021 N 64042).

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12. Мерабишвили В.М., Беляев А.М. Состояние онкологической помощи в России: однолетняя выживаемость больных злокачественными новообразованиями и летальность на первом году жизни по всем локализациям опухолей. (популяционное исследование на уровне федерального округа) // Вопросы онкологии. - 2023. -№ 69 (1) - С. 55-66. Merabishvili, VM, Belyaev, AM. Sostoyanie onkologicheskoj pomoshchi v Rossii: odnoletnyaya vyzhivaemost' bol'nyh zlokachestvennymi novoobrazovaniyami I letal'nost' na pervom godu zhizni po vsem lokalizaciyam opuholej (populyacionnoe issledovanie na urovne federal'nogo okruga) [The state of oncological care in Russia: one-year survival of patients with malignant neoplasms and mortality in the frst year of life in all tumor localizations. (Federal District Population Study)]. Voprosy onkologii [Oncology issues].2023. 69(1): 55-66. (In Russ.)

13. Апанасевич В.И., Волков М.В., Гурина Л.И., [и др.]. Двухэтапный скрининг колоректального рака: итоги первого года внедрения // Общественное здоровье и здравоохранение. - 2021. - №70(2) - С. 27-32. Apanasevich, VI, Volkov, MV, Gurina, LI, et al. Dvuhetapnyj skrining kolorektal'nogo raka: itogi pervogo goda vnedreniya [Two-Stage Colorectal Cancer Screening: Results of the First Уear of Implementation]. Obshchestvennoe zdorov'e I zdravoohranenie [Public health and healthcare]. 2021; 70(2): 27-32. (In Russ.)

 

PRACTICAL EXPERIENCE

УДК: 616.127005.4073.756.8  DOI: 10.20969/VSKM.2026.19(1).147-156

 Severe hyponatremia in a patient with panhypopituitarism

Lyudmila A. Ivanova1, Inna V. Korol1, Yulia S. Kovalenko1, Anton A. Fomenko1, Andrey A. Shirokov1, Lydia V. Ruzhitskaya1, Ivan Y. Tanin1, Anna V. Mesinova1

1Kuban State Medical University, 4 Mitrofan Sedin str., 350063 Krasnodar, Russia

Abstract. lntroduction. Hyponatremia is one of the most common electrolyte imbalances, affecting 15-30% of hospitalized patients, particularly those with chronic conditions. This condition is characterized by a serum sodium level of below 135 mmol/L, accompanied by a wide range of clinical symptoms, from mild weakness to life-threatening neurological complications. Aim To demonstrate steps of the diagnosis, differential diagnosis, and treatment of severe hyponatremia in a patient with panhypopituitarism. Materials and Methods. A 64-year-old male patient was admitted to the emergency department of a regional clinical hospital in Krasnodar with severe weakness, heaviness in the right lumbar region, deferred reactions, infrequent urination, nausea, and vomiting. The severity of his condition was attributed to severe hyponatremia. His clinical diagnosis was set as follows: "Pituitary macroadenoma (intra-, supra-, and parasellar growth). Panhypopituitarism: Secondary hypocorticism, secondary hypothyroidism, secondary hypogonadism in a state of decompensation. Hyperprolactinemia. Secondary renal arterial hypertension. Bilateral nephrosclerosis. Primary nephropathy. Chronic kidney disease Stage 3a (glomerular fltration rate: 46 mL/min/1.73 m2). Сhronic heart failure: Stage I, Functional Class 2. Aortal atherosclerosis. Infrarenal abdominal aortic aneurysm. Iron-defciency anemia of moderate severity.' Results and Discussion. The patient received treatment with glucocorticoids and mineralocorticoids, levothyroxine, and underwent infusion therapy. With the treatment administered during hospitalization and continued on an outpatient basis, the patient's sodium levels normalized, and his overall condition improved signifcantly. Conclusions. Exemplifed by this clinical case, we may conclude that, once severe hyponatremia is detected in hospitalized patients, its type, severity and duration must be identifed correctly to take a differentiated approach to treatment.

Keywords: hyponatremia, panhypopituitarism, hypocorticism, hypothyroidism.

For citation: Ivanova, L.A.; Korol, I.V.; Kovalenko, У.S.; et al. Severe hyponatremia in a patient with panhypopituitarism. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 147-156. DOI: 10.20969/VSKM.2026.19(1).147-156.

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УДК: 616.4-006.6-056.7 DOI: 10.20969/VSKM.2026.19(1).157-165

 A familial case of multiple endocrine neoplasia type 2A syndrome: Medullary thyroid cancer and pheochromocytoma

Nikolay I. Lyan1, Yuliya G. Samoilova2, Mariia V. Matveeva2, Lyudmila M. Shuliko2

1 Siberian State Medical University, 2 Moskovsky trakt str., 634050 Tomsk, Russia

2 Tomsk Regional Oncology Hospital, 115 Lenin Ave., 634050 Tomsk, Russia

Abstract. lntroduction. Multiple endocrine neoplasia type 2a is a hereditary syndrome associated with a mutation in the RET proto-oncogene, characterized by highly aggressive endocrine tumors, a high risk of recurrence, and sudden life-threatening conditions. Main components of the syndrome are medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism. Aim. To describe the clinical, diagnostic, and therapeutic features of a familial case-based multiple endocrine neoplasia type 2a syndrome and to analyze the manifestation patterns of the syndrome according to the RET gene mutation type. Materials and Methods. We present two clinical cases of late sequential diagnosis of the multiple endocrine neoplasia type 2a syndrome with different clinical manifestations in two sisters aged 39 and 42 years. In the younger sister, medullary thyroid carcinoma was detected incidentally during an examination for arterial hypertension. In the second patient, a thyroid tumor was identifed during a diagnostic workup following genetic testing of the younger sister, which revealed a RET gene mutation, Cys634Ser, in exon 11. This mutation is associated with a high risk of aggressive disease progression and early manifestation of medullary thyroid carcinoma. Results and Discussion. Both patients underwent total thyroidectomy with central lymph node dissection for medullary thyroid carcinoma. Dynamic monitoring of calcitonin and carcinoembryonic antigen levels in the blood, combined with imaging methods, demonstrates good effcacy of surgical treatment. During preoperative evaluation, the younger sister was found to have a right adrenal mass and the elevated blood metanephrine levels. First-degree relative screening revealed the elevated calcitonin levels and the sonographic signs of thyroid nodules in the 12-year-old daughter of the older sister. This clinical case illustrates the variable expressivity of the multiple endocrine neoplasia type 2a syndrome, which does not exclude the possibility of combined mutations in the RET proto-oncogene. Conclusions. Multiple endocrine neoplasia type 2a syndrome requires a multidisciplinary approach to both diagnosis and treatment. Patients with multiple endocrine neoplasia type 2a must be screened for the syndrome components on a lifelong basis. First-degree relatives of such patients should undergo genetic testing regardless of the initial case fndings.

Keywords: multiple endocrine neoplasia type IIA, Sipple syndrome, pheochromocytoma, medullary thyroid carcinoma, RET, Cys634Ser

For citation: Lyan, N.I.; Samojlova, Уu.G.; Matveeva, M.V.; Shuliko, L.M. A familial case of multiple endocrine neoplasia type 2A syndrome: Medullary thyroid cancer and pheochromocytoma. The Bulletin of Contemporary Clinical Medicine. 2026, 19 (1), 157-165. DOI: 10.20969/VSKM.2026.19(1).157-165.

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