Journal «MEDICINA» 2/2025

Introduction. Cerebral stroke is an important unsolved problem. An employee of a locomotive crew operating a locomotive cannot perform his functions and ensure the safety of the transportation process in case of a cerebral stroke. Medical expert commissions do not guarantee the absence of a cerebral stroke in an employee during his work. Aim. To assess the quality of the screening test for predictors of stroke using statistical quality control of the verified diagnostic test (with binary outcomes). Materials and methods. 19 cases of cerebral stroke were registered among the respondents during the 2008-2013 follow-up of 22 clinical and anamnestic items of 7,959 initially healthy men who were employees of locomotive crews of the Trans-Baikal Railway aged 18-66 years old. Statistical analysis identified the following predictors of cerebral stroke: smoking, hyperglycemia, arterial hypertension, left ventricular myocardial hypertrophy, excessive alcohol consumption, pulse wave velocity over 12 m/s, age 46-66 years, as well as critical age periods of 46 and 60 years old, the latter being studied as separate factors. DiagStat software evaluated their predictive ability for use in screening tests. Results. Predictors of cerebral stroke have high and moderate specificity regarding the absence of latent stroke formation in those who do not have them with a probability of 99.6-99.9%. The «age of 60 years old» predictor increases the odds of stroke occurrence by 68.8 times, against its absence, after the patient receives a positive result of a verified diagnostic test in a patient. Conclusion. When making a decision regarding an employee who operates a locomotive, one should focus on both the probability of a stroke and the absence of this probability in the presence or the absence of the risk factor cerebral stroke in a patient. It is necessary to carry out a targeted search for the predictors of a cerebral stroke such as a pulse wave velocity of more than 12 m/s and excessive alcohol consumption, since the detection of these factors among workers of locomotive crews is not stipulated. Other predictors of cerebral stroke need to be identified and eliminated, as there are techniques for this.

Key words: cerebral stroke, predictors, smoking, arterial hypertension, pulse wave velocity, hyperglycemia, left ventricular hypertrophy, prediction, alcohol, age, screening

The Anticholinergic Cognitive Burden (ACB) scale, developed in the United States and the United Kingdom in 2008/2012, has been recommended for use in national clinical practice since 2016. Comparison with the original ACB scale shows that in the national educational and methodological literature of 2016/2018 it has been presented in a significantly shortened and partially distorted form. In the 2024 methodological guide, the previously presented national version of ACB scale has been modified again by further reducing the list of drugs with the score of 1 and including in the list of drugs with score of 3 those with strong anticholinergic properties from the 2023 Beers criteria list. In all publications, the ACB scale description has been accompanied by incorrect bibliographic references, and the feasibility of its practical application has been justified by the study of another scale (ARS: Anticholinergic Risk Scale), as well as by the incorrectly presented results of the ACB scale studies. As a consequence, the readers remain uninformed that the use of drugs with the score of 1, primarily cardiovascular drugs, was not associated with the increased risk of developing cognitive impairment in the ACB scale studies.

Key words: anticholinergics, Anticholinergic Cognitive Burden (ACB) scale, Anticholinergic Risk Scale (ARS), Beers criteria

Chagas disease, caused by Trypanosoma cruzi, remains one of the most important tropical diseases despite more than a century of study. The disease affects about 6-8 million people worldwide, including regions where it was not previously endemic due to globalization and migration. Transmission of the pathogen is through vectors (triatom bugs), blood transfusions, organ transplants, and vertically from mother to child. Chagas disease includes two phases: acute, often asymptomatic, and chronic, which may be accompanied by severe cardiologic and gastroenterologic complications. Chronic cardiomyopathy, as one of the most severe manifestations, significantly impairs the quality of life of patients and requires significant resources for treatment, including heart transplantation. Diagnosis of the disease ranges from parasitologic methods in the acute phase to serologic tests in the chronic phase. Current treatment approaches include the use of benznidazole and nifurtimox, which are effective in the early stages but are limited due to side effects. Prospects for therapy include the use of gene therapy, vaccines and combined methods (vaccination and chemotherapy). Prevention of transmission, especially through donated blood and organs, remains important, it has already been successfully implemented in a number of countries. The epidemiologic features, clinical manifestations, modern methods of diagnostics and treatment of Chagas disease, as well as promising directions of its study are considered in the article. Special attention is paid to the global spread of the disease and control measures in non-endemic regions.

Key words: Chagas disease, Trypanosoma cruzi, epidemiology, parasitology, trypanosome, tropical diseases

Background. Studying the user experience of the target audience for whom digital services are being developed is important both for assessing the potential use of information and communication technologies and for engaging patients in using specialized mobile applications. Purpose of the study. To examine the influence of socio-demographic characteristics of patients undergoing inpatient treatment at an addiction clinic on their use of mobile phones and smartphones. Materials and methods. A cross-sectional study of a non-deterministic sample of SUD patients (n = 1168) hospitalized at the Moscow Scientific and Practical Center for Addictions of the Moscow Department of Health. Research Results. High penetration of mobile phones and smartphones was observed in the studied population, with a tendency among patients to retain their phone numbers even when switching devices. Conclusions. The penetration rate of mobile phones in the population of narcological patients is close to 97%, which justifies the recommendation to develop and use specialized mobile applications as a tool for remote work with patients outside the inpatient narcological care setting. Addiction doctors should consider the potential use of modern communication technologies in their practice.

Key words: drug treatment hospital, patient, information and communication technologies, socio-demographic characteristics, mobile phone, smartphone

Cataract surgery is one of the oldest operations described in medical literature. Although numerous articles on this topic have been published over time, we will highlight key moments in the long history of cataract surgery. In our historical overview, we discovered fascinating details that influence modern trends in phaco surgery. The progress achieved in this field is remarkable. The earliest procedures were performed using primitive instruments, but today, advanced phacoemulsification techniques combined with femtosecond laser technology deliver excellent outcomes, restoring vision to our patients.

Key words: eye, cataract, extracapsular extraction, intraocular lenses, phacoemulsification, femtosecond laser

Introduction. Phlomoides tuberosa (Phlomis tuberosa), is a perennial herbaceous plant of the Lamiaceae family. It is widely distributed in the temperate climate of the European part of Russia, as well as in Europe and Asia. The herb and roots of Phlomoides tuberosa are widely used in traditional medicine as an anti-inflammatory, tonic, restorative, wound healing agents, as well as a hepatoprotective and antispasmodic remedies. Infusions and decoctions are used for the treatment of otitis, bronchitis, and other respiratory diseases. It is an understudied plant and is not included in the pharmacopoeia. Objective. To establish the characteristic macroscopic and microscopic features of the Phlomoides tuberosa plant and to qualitatively determine the content of fatty and essential oils by staining the root with «Sudan III». Materials and Methods. Collection and herbarization of the herb in the territory of the «I.I. Sprygin Zhiguli State Nature Biosphere Reserve » on 05.07.2023. Habitat: gentle slope. Preparation of micro-preparations according to the State Pharmacopoeia XIV. Staining of plant root preparations was carried out with Sudan III. Microscopic examination was performed using an inverted microscope. Results. As a result of the study, the external features of the plant were described and characteristic micro-signs of individual parts of the raw material were identified. The epidermis of the leaf includes stomata of the anomocytic type. Trichomes of various types are marked on the upper part of the epidermis: simple unicellular and bicellular, with a unicellular head. The lower epidermis additionally features jointed trichomes. Microscopy of the cross section of the root and stem was performed, and xylem vessels were isolated. During staining with Sudan III, drops of essential and fatty oil were detected in the root. Inclusions are marked on the surface of the epidermis of the root. Microscopy of the flower revealed trichomes: multicellular, with a unicellular head and stellate. Conclusions. The established microscopic and macroscopic characteristics of the structure of the root, stem, flowers, and leaves of Phlomoides tuberosa can be used for further determination of the authenticity of the plant in order to distinguish it from other related representatives having similar anatomical-diagnostic features. The widespread distribution of the plant and the high content of pharmacologically active compounds justify further research for potential medical applications.

Key words: Phlomoides tuberosa, Phlomis tuberosa, microscopy, trichomes, coloring by Sudan III

The paper analyzes the features of using fitness trackers and similar devices to monitor health during responsible self-medication and medical self-prevention. The methodological basis of the study was the analysis of scientific publications and generalized practical experience. The characteristics of fitness trackers and similar devices are considered. It is shown that fitness trackers and similar devices cannot be used independently as medical measuring devices due to insufficient accuracy, however, they can be elements of a home monitoring system for responsible self-medication. A home monitoring system for responsible self-medication (fitness trackers, smartphones and stationary medical measuring devices) ensures observation of the required indicators both at rest and in dynamics, which allows for automatic assessment of the condition, support for patient decision-making and further recommendations, in particular, on the need to visit a doctor. A visit to a doctor with existing data allows him/her to make a diagnosis and take the necessary therapeutic or preventive actions with greater accuracy. Practical recommendations for choosing fitness trackers are given.

Key words: fitness trackers, responsible self-medication, health monitoring, home monitoring, home monitoring system, measurement of physiological parameters

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in December 2019 leading to staggering economic impact and human suffering. The unique structure of SARS-CoV-2 and its underlying pathogenic mechanism have caused a global pandemic. In addition to the direct damage caused by the virus, SARS-CoV-2 induces an abnormal immune response leading to a cytokine storm culminating in acute respiratory distress syndrome and other fatal diseases, posing a significant challenge to clinicians. Therefore, potential treatment should not only focus on eliminating the virus but also on alleviating or controlling acute immune/inflammatory responses. Current treatment strategies for COVID-19 include preventive measures and supportive care, while the role of the host immune/inflammatory response in disease progression has been largely ignored. Understanding the interactions between SARS-CoV-2 and its receptors, as well as the underlying pathogenesis, has proven useful for disease prevention, early recognition of disease progression, vaccine development, and interventions aimed at reducing immunopathology that have shown to reduce adverse clinical outcomes and improve prognosis. Moreover, several key mutations in the SARS-CoV-2 genome sequence result in increased host cell receptor binding affinity or induce immune escape, resulting in either increased viral transmissibility or virulence of variants harboring these mutations. The review characterizes the structural features of SARS-CoV-2, its variants, and their interactions with the immune system, highlighting the role of dysfunctional immune responses and cytokine storm in disease progression.

Key words: SARS-CoV-2, COVID-19, pathogenesis, immunity, cytokine storm