Background. Older age is associated with the presence of geriatric syndromes, whose effect on the safety of direct oral anticoagulants in atrial fibrillation patients is studied extensively. Scientific literature focuses on the prevention of major bleeding, while clinically relevant non-major bleeding occurs much more frequently and can have a significant impact on the patient’s condition. Objective. To assess the potential of geriatric factors for predicting the risk of clinically relevant non-major bleeding on direct oral anticoagulants in nonvalvular atrial fibrillation patients aged 80 years and older. Methods. The article presents the results of an observational prospective cohort study that included 367 atrial fibrillation patients aged 80 years and older on direct oral anticoagulants. The study was conducted at a multi-specialty inpatient clinic in Moscow from January 2019 to December 2022 and reflected real clinical practice. The medical records were prospectively analyzed for the presence of clinically relevant non-major bleeding; the observation period lasted 12 months. The patients were divided into groups: the main group comprising patients with clinically relevant non-major bleeding (n = 195), with a median age of 84 [82; 87] years, and the control group consisting of patients without clinically relevant non-major bleeding (n = 172), with a median age of 84 [82; 88] years. The groups were comparable in terms of key bleeding risk factors. In order to identify geriatric risk factors, a comprehensive geriatric assessment was performed in four main domains: physical status; mental and emotional status; functional capacity; identification of social problems. Statistical data processing and visualization were performed in the R software environment, version 4.4.0 (R Foundation for Statistical Computing, Vienna, Austria). Differences were considered statistically significant at p < 0.05. Results. The performed analysis identified risk factors for clinically relevant non-major bleeding in all four domains of the comprehensive geriatric assessment: social (living in a family, number of household members, legal marriage, and church attendance); mental and emotional (Geriatric Depression Scale); physical and functional (balance tests, Lawton IADL scale, use of assistive devices, senile asthenia as per the Age is No Barrier questionnaire, SPRINT (Systolic Blood Pressure Intervention Trial) frailty index, p < 0.05). In the course of a multiple-factor analysis, a multiple-factor logistic regression model was created to predict clinically relevant non-major bleeding, and a prognostic nomogram was derived to estimate the probability of clinically relevant non-major bleeding (prognostic accuracy of 59.9%, sensitivity of 48.9%, and specificity of 72.4%). The predictors were as follows: number of household members, Barthel ADL score, Lawton IADL score, Timed Up and Go Test, and use of any assistive device. Conclusion. In the study, socially active, emotionally stable, mobile, and robust patients were shown to have a higher risk of developing clinically relevant non-major bleeding events. The authors identified geriatric factors that may serve as predictors of clinically relevant non-major bleeding on direct oral anticoagulants in atrial fibrillation patients aged over 80 years. Given the active AI implementation in clinical practice, the obtained data can be integrated into clinical decision support systems.

Background. Multiple chemical sensitivity is an acquired and multifactorial syndrome characterized by a set of debilitating symptoms and triggered by low doses of environmental chemicals that are harmless to most people. The consequences of multiple chemical sensitivity have been studied to some extent; however, there are currently no studies specifically focused on multiple chemical sensitivity in the context of reproductive dysfunction. Objectives. To investigate the prevalence and characteristics of multiple chemical sensitivity syndrome in women with reproductive dysfunction. Methods. A pilot survey single-center prospective study was conducted at the consultative and diagnostic center of the clinic at Kuban State Medical University. The study involved 64 female patients with reproductive dysfunction and was carried out from September to December 2023. The primary endpoint of the study was to identify statistically significant associations between the presence of multiple chemical sensitivity and reproductive dysfunction in women. To assess the presence and severity of multiple chemical sensitivity symptoms, as well as their impact on daily life, a customized Russian-language version of the validated Quick Environmental Exposure and Sensitivity Inventory (QEESI) questionnaire was used. The questionnaire includes three subscales, each consisting of a block of 10 questions. Each question is scored from 0 to 10 points, with a maximum total score of 300 across all three subscales. The survey was conducted using the digital service EcoMedic (version 1.1 EcoKubMed), developed as part of the project. A diagnosis of multiple chemical sensitivity was established if the total score across all three subscales was 40 points or higher. Thus, two groups were formed: Group 1 — individuals diagnosed with multiple chemical sensitivity (n = 19), and Group 2 — individuals without multiple chemical sensitivity (n = 45). To assess reproductive dysfunction and metabolic disorders, laboratory tests were additionally performed. Statistical analysis of the study results was conducted using the Statistica 10.0 software package (StatSoft Inc., USA). When testing hypotheses, a significance level of p < 0.05 was considered statistically significant. Results. Among the types of chemical exposure, patients in Group 1 most frequently reported tobacco smoke, inhalation of car exhaust fumes, and the use of cleaning agents, with total scores of 189, 159, and 151 out of 190, respectively. When analyzing the second subscale, i.e., impact on daily life, in Group 1 patients, it was found that the most affected areas were the ability to work and study (175 out of 190), eating habits (154 out of 190), and the ability to do cleaning and other routine tasks (125 out of 190). The symptoms of multiple chemical sensitivity in Group 1 patients were most commonly related to the respiratory system (n = 11/19, 57.9%), the nervous system (n = 5/19, 26.3%), and the gastrointestinal tract (n = 3/19, 15.8%). The prevalence of abdominal obesity determined by the waist-to-hip ratio was higher in Group 1 patients compared to Group 2 patients (100% vs. 28.8%; χ2 = 7.514; p = 0.04, respectively). The correlation analysis revealed a moderate positive correlation between body mass index and QEESI questionnaire scores (r = +0.347, p = 0.02). Arterial hypertension and allergic diseases were reported significantly more often in Group 1 compared to Group 2 (χ2 = 6.354, p = 0.001 and 31.5% vs. 15.6%, χ2 = 5.17, p = 0.001, respectively). Statistically significantly higher levels of C-reactive protein (3.2 ± 0.1 mg/L vs. 1.9 ± 0.3 mg/L, p < 0.001), aspartate aminotransferase (24.7 ± 4.9 U/L vs. 14.5 ± 1.6 U/L, p < 0.001), homocysteine (7.8 ± 2.1 vs. 5.2 ± 1.2, p < 0.001), and a higher prevalence of dyslipidemia (31.5% vs. 13.3%, χ² = 5.514, p = 0.001) were observed in Group 1 compared to Group 2. Conclusion. According to test results, multiple chemical sensitivity syndrome was identified in 29.6% of female patients with reproductive disorders. A characteristic feature of the syndrome in this patient group was a higher prevalence of metabolic disorders.

Background. Lobectomy is one of the most performed procedures in thoracic surgery. The fact that domestic literature does not provide an analysis of long-term outcomes after lobectomy and bilobectomy prompted us to conduct this study and identify factors that have a reliably negative effect. Objective. To evaluate postoperative complications occurring within 90 days after lobectomy and bilobectomy performed for malignant neoplasms and to identify their risk factors. Methods. The cohort single-center retrospective study included 277 patients who underwent open and thoracoscopic lung resection (lobectomy and bilobectomy) from January 2021 to December 2023 at the Surgical Oncology Department No. 3 of the Republican Clinical Oncology Center (Ministry of Health of the Chuvash Republic). The patients were divided into two groups: the first group (n = 232) comprised patients without complications, and the second group (n = 45) consisted of patients with complications. The overall postoperative case fatality rate within 90 days after the performed surgical procedure was evaluated. Hospital readmissions and all outpatient visits were analyzed. All clinical complications within 90 days after lobectomy and bilobectomy were recorded, and their risk factors were identified. The obtained results were statistically analyzed using Statistica 10 (StatSoft, USA). Results. The study analyzed 90-day postoperative complications in patients after lung resection (lobectomy and bilobectomy). The rate of complications amounted to 16.25% (45/277). Within 90 days after the procedure, the overall case fatality rate amounted to 6.5% (18/277), with the inpatient and posthospital case fatality rates reaching 1.81% (5/277) and 4.69% (13/277), respectively. In the present study, the hospital readmission rate was 7.22% (20/277), which is lower than in other known similar studies conducted abroad, where the reported values ranged from 9.3 to 24.8%. In the second group, patients predominantly had an ECOG2 performance status (Eastern Cooperative Oncology Group). The main risk factor for complications was the extent of surgery. Thoracotomy with rib resection and marginal pulmonary artery resection increased the rate of complications. Conclusion. The conducted study comprehensively analyzed the rate and composition of postoperative complications within 90 days after lobectomy and bilobectomy performed for malignant neoplasms. The key risk factors for complications were identified, which include marginal pulmonary artery resection and thoracotomy with rib resection, as well as ECOG status and the presence of complications of the primary disease (e.g., atelectasis and pneumonia). No effect of conventional parameters such as age, sex, and smoking was found on the rate of complications. The absence of significant differences in complication rates between thoracoscopic and open resection requires further study on larger samples of participants. The study results highlight the need for prospective studies aimed at a more in-depth analysis of postoperative complications and their risk factors

Background. The time of onset of voice mutation in adolescent boys varies among different peoples and depends on their weight, as well as genetic, geographic, and socioeconomic conditions. Boys from the South experience voice mutation at the ages of 12–13 years, while in boys from the North, it begins at the ages of 14–15 years. Although Irkutsk belongs to the southern regions of Eastern Siberia (lying in the same latitude as Saratov and Orenburg), in terms of its sharply continental climate, it is similar to the northern regions. The lack of data on the onset of voice mutation in Siberian adolescents, the effect of excess weight on its onset, the relationship between the vocal fold length and other anthropometric measures during puberty, and the possibility of an accurate measurement of the vocal fold length in adolescents prompted the present study. Objective. To determine the age of voice mutation onset in Irkutsk adolescents; vocal fold length and thyroid cartilage angle prior to, during, and after mutation, as well as the relationship between these parameters and weight, height, foot length, and neck circumference. Methods. An observational single-center cohort study was conducted by the specialists of the Otolaryngology Department of the Irkutsk State Medical University in March–May 2024; the study included 77 boys and 70 girls (6th–8th graders from two Irkutsk schools), whose vocal fold length and thyroid cartilage angle were measured via laryngeal ultrasound by means of a ChisonSonoEye P2 ultrasound machine (Chison, China) with a 10 MHz linear probe. The boys’ voices were evaluated by ear by a panel of three otolaryngologists, after which they were divided into groups according to the stage of voice mutation: pre-mutation (n = 29), mutation (n = 24), and post-mutation (n = 24). The age of voice mutation onset was determined; height, weight, neck circumference, and foot length were measured, and body mass index was calculated. For a comparative analysis of these measures in boys and girls, all study participants were distributed by age without taking voice changes into account: Group 1A comprising adolescent boys aged 12 years (n = 20); Group 2A comprising adolescent boys aged 13 years (n = 30); Group 3A comprising adolescent boys aged 14 years (n = 27); Group 1B comprising adolescent girls aged 12 years (n = 16); Group 2B comprising adolescent girls aged 13 years (n = 15); Group 3B comprising adolescent girls aged 14 years (n = 39). Statistical processing of data was performed using Statistica 10.0 (StatSoft, Tulsa, USA). Differences were considered to be statistically significant at an error level of p < 0.05. Results. Irkutsk boys were found to experience voice mutation at the ages of 12–13 years, with the vocal fold length exceeding 2 cm. Significant correlation coefficients were found between vocal fold length in adolescent boys and age (r = 0.66, p = 0.03), weight (r = 0.53, p = 0.04), height (r = 0.68, p = 0.02), foot length (r = 0.63, p = 0.04), neck circumference (r = 0.39, p = 0.03), body mass index (r = 0.28, p = 0.04), and thyroid cartilage angle (r = −0.43, p = 0.04); in adolescent girls, between vocal fold length and age (r = 0.59, p = 0.04), weight (r = 0.37, p = 0.02), and body mass index (r = 0.32, p = 0.04). At the age of 14 years, the girls’ vocal folds measured 20.1 ± 2.1 mm, i.e., were significantly longer (p = 0.001) than at 12 (17.2 ± 1.8 mm) and 13 years of age (17.7 ± 1.9 mm). At the age of 12 years, the boys had a smaller thyroid cartilage angle (94.2 ± 9.4°, p = 0.036) than the girls (105.1 ± 8.6°). From the age of 13 years, adolescents of both sexes already differed in vocal fold length (19.3 ± 2.6 mm in boys and 17.7 ± 1.9 mm in girls, p = 0.049), foot length (26.2 ± 2.3 and 23.7 ± 1.2 cm, respectively, p = 0.001), and neck circumference (31.6 ± 2.8 and 28.9 ± 1.1 cm, p = 0.001); from the age of 14 years, also in weight (68.3 ± 14.3 and 55.1 ± 10.7 kg, p = 0.001) and height (175.7 ± 7.4 and 162.4 ± 8.8 cm, p = 0.001). Conclusion. Irkutsk adolescent boys experience voice mutation at the ages of 12–13 years due to a decrease in the thyroid cartilage angle, with a vocal fold length of over 2 cm, which can be measured via ultrasound. From the age of 13 years, a difference is observed in the vocal fold length between boys and girls, correlating with increased weight and body mass index in both sexes

Background. Iliopsoas abscess constitutes a rare pathology, and few studies on this topic are available in Russia. The literature describes only single observations, thus limiting statistical data analysis. Iliopsoas abscess mortality amounts to 12–15% and shows no signs of decreasing. The diagnosis is made using radiological imaging methods together with clinical and laboratory data to detect the signs of an inflammatory response and assess organ dysfunction and the severity of the condition. Treatment includes antibiotic therapy, abscess drainage, sepsis therapy, and correction of organ dysfunction. However, no uniform clinical guidelines for diagnosis and treatment are available. An analysis of available data on this pathology and study of factors affecting disease progression and prognosis will help to identify ways to improve treatment efficacy in the future. Objective. To conduct a retrospective analysis of the composition of iliopsoas abscess patients admitted to a multi-specialty inpatient care facility over an eight-year period, as well as to assess the results of diagnosis and treatment in this category of patients. Methods. A cohort retrospective study was conducted at the Saint-Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine; the study analyzed the medical records of 116 iliopsoas abscess patients hospitalized from January 01, 2015 to December 31, 2022. The main study parameters included iliopsoas abscess frequency and the composition of iliopsoas abscess patients, as well as their distribution by sex, age, presence of a background disease, etiology, and initial severity of the condition. The diagnostic significance of individual clinical symptoms, laboratory parameters, and imaging methods in iliopsoas abscess patients was assessed. The main study outcome was the identification of factors affecting the disease prognosis under the assumption that iliopsoas abscess mortality is largely affected such factors as individual reactivity and the presence of comorbid conditions. Additionally, the overall rate of postoperative complications was determined. Statistical analysis was performed using jamovi software, ver. 2.4.8.0 (Intel, USA). The effect of individual factors in nominal data comparisons was evaluated using Pearson’s χ2 test; the odds ratio was used as a quantitative measure of effect size, and 95% confidence interval limits were calculated. Differences between groups were considered to be statistically significant at p < 0.05. Results. The median age was 59.5 (45–69) years. The patients included 65 (56.0%) males and 51 (44.0%) females. Primary iliopsoas abscess was diagnosed in 15 (12.9%) patients; secondary, in 101 (87.1%) patients. In the present study, iliopsoas abscesses were most commonly caused (58.6%, 68/116) by suppurative spinal infections. A typical clinical picture of psoas abscess was noted only in 27.6% (32/116) of patients. The disease was accompanied by systemic inflammatory response syndrome in 63.8% (74/116) of patients, severe sepsis in 43.1% (50/116) of patients, and septic shock in 2.6% (3/116) of patients. Most commonly, spiral computed tomography (69.8%, 81/116) was used as the abscess imaging method to establish the diagnosis. In 61.3% (54/88 positive cultures) of cases, Staphylococcus aureus was responsible for the infection, with MRSA (methicillin-resistant Staphylococcus aureus) accounting for 9.3% (5/54). The second most common causes of infection were Klebsiella pneumoniae and Escherichia coli. In primary and osteogenic abscesses, Gram-positive flora was isolated in 70.9% (56/79) of cases. In intestinal abscesses, gram-negative flora was observed in 83.3% (5/6) of cases; polymicrobial flora, in 50% (3/6) of cases. All iliopsoas abscess patients received antibiotic therapy and underwent abscess drainage. In 64.8% (57/88) of cases, the empiric antibacterial therapy matched the culture reports. Open surgery was performed in 93.1% (108/116) of cases and minimally invasive ultrasound-guided drainage was indicated in the remaining cases. A fatal outcome occurred in 14.7% (17/116) of patients. Statistically significant factors affecting a fatal outcome included concomitant diseases of the central nervous, cardiovascular, and respiratory systems; the presence of severe sepsis, multiple infection foci, acute protein deficiency, thrombocytopenia, and a severe initial condition. Conclusion. Iliopsoas abscess is difficult to diagnose. Its treatment requires a multidisciplinary approach, the identification and debridement of all foci of infection, monitoring and correction of organ dysfunction and protein deficiency, and treatment of the concomitant pathology. Charlson Comorbidity Index, SOFA (Sequential Organ Failure Assessment Score), APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS (original Simplified Acute Physiology Score), and C-reactive protein levels can be used to assess the mortality risk

Background. The efficiency of healthcare institutions directly affects the overall level of public health. Analyzing inpatient care performance provides an opportunity to assess the quality of medical services, identify existing organizational issues, and support the rational allocation of resources within the healthcare system. Objectives. To assess the dynamics of key indicators reflecting the efficiency in the use of beds allocated for oncology and radiology/radiotherapy care at the Tomsk Regional Oncology Center over the period from 2016 to 2023. Methods. A observational retrospective study was conducted using non-personalized data on patients treated at the oncology center from 2016 to 2023. Key indicators of hospital bed capacity were assessed for the oncology and radiology beds. The study sample and groups were formed using a continuous sampling method according to the inclusion criterion of having a malignant neoplasm. The data examined for the period 2016–2023 include the number of hospitalized patients, hospitalization rate per 1,000 population, bed availability per 10,000 population, bed occupancy, average length of stay, bed turnover, and bed downtime. These data were obtained from official federal statistical reporting forms. Descriptive statistical methods and mean value calculations were used for the statistical analysis of the obtained results. The analysis of the indicator “average length of hospital stay” included the calculation of the confidence interval, minimum and maximum values, median, and interquartile range for each care. A comparison was conducted with the corresponding (selective) indicators for the Tomsk Oblast. Results. Over the analyzed period, the number of patients treated in the day hospital at the Tomsk Regional Oncology Center tripled, whereas the number of patients hospitalized in inpatient (24-hour) departments increased by 83.8%. The analysis revealed that the availability of oncology beds for 24-hour inpatient care at the Tomsk Regional Oncology Center increased by more than one-third (41.7%). The value of the indicator for bed availability in the day hospital at the Center remained unchanged, whereas the availability of 24-hour inpatient beds in the Tomsk Region decreased by 16.1%. The overall efficiency of hospital bed capacity at the Tomsk Regional Oncology Center improved, primarily due to the more rational use of oncology beds in the 24-hour inpatient hospital setting. Conclusion. The proportion of hospitalizations in the day hospital at the Tomsk Regional Oncology Dispensary increased, which can be regarded as a positive trend toward shifting inpatient care to outpatient and day hospital settings. The average length of stay for oncology patients decreased due to the implementation of modern high-tech treatment methods and strengthened outpatient services

Background. Advances in electrophysiological research have led to a modern understanding of the mechanisms of atrial fibrillation — the most common sustained cardiac arrhythmia, which poses a risk of severe, often disabling, and fatal complications. Although there have also been advances in pharmacology and rapid progress in interventional treatment methods, atrial fibrillation still cannot be completely eliminated in patients. Objectives. To examine the key stages in the development and improvement of medical care for patients with atrial fibrillation from a historical perspective, taking into account the widely accepted rate and rhythm control strategies and using data from both international and Russian scientific literature. Methods. An analysis of literature sources by international and Russian authors dedicated to the issues of diagnosis, pharmacological, and non-pharmacological treatment of atrial fibrillation was carried out. In order to search for the sources, the Russian scientific electronic library eLibrary.ru and the biomedical research search engine PubMed were used. Results. Throughout the 20th and 21st centuries, antiarrhythmic drugs capable of successfully restoring sinus rhythm were developed; however, the challenge of its long-term maintenance with such medications has remained unresolved. The development and increasingly widespread use of surgical, and especially catheter ablation in the left atrium, have the potential to improve the effectiveness of atrial fibrillation treatment. Recently, the importance of individualizing the management strategy for patients with atrial fibrillation has been growing, with mandatory consideration of their clinical characteristics. The main direction for future research could be the development of more effective and safer antiarrhythmic drugs for their rational use in combination with innovative non-pharmacological treatment technologies for atrial fibrillation. Conclusion. This paper presents the most important advances in medical care for patients with atrial fibrillation. It outlines potential approaches to minimizing its negative impact on patients’ quality of life and prognosis