Extreme Medicine

ISSN Print 2713-2757 ISSN Online 2713-2765

Extreme Medicine

SCIENTIFIC AND PRACTICAL REVIEWED JOURNAL OF FMBA OF RUSSIA

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Melnikova EV, Khasanova NM, Skripchenko NV

The fact that the disease sequelae can limit the development of the growing child’s activity is the feature of pediatric medical rehabilitation, that is why there is a need for repeated courses of rehabilitation or habilitation, where each subsequent course is a continuation of the previous one. The specialist’s mission is to determine indications for rehabilitation. The paper reports phenomenology and methods to diagnose abnormal activity and participation in convalescent children after infectious diseases in order to set the rehabilitation goals in the International Classification of Functioning, Disability and Health domains (categories). The use of method to estimate activity and participation from the point of view of both child and parent or caregiver is considered. The paper provides information useful for specialists dealing with the issues of rehabilitation of children after infectious diseases.

Received: 2023-08-14

Published online: 2023-11-09

DOI: 10.47183/mes.2023.045

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VIEWS 512

Danishchuk OI, Nazaryan DN, Karpova EI, Khachatryan AA, Razmadze SS

Head and neck reconstruction surgery is a challenging area of surgery that requires the surgeon to be familiar with various reconstructive options. Achieving both functionality and aesthetic harmony of facial proportions constitutes one of the most important aspects of the head and neck defect elimination. For that various methods are used involving application of local, regional and free flaps on vascular pedicles. The reconstructive method is selected based on the defect size, location, composition, as well as on the age, comorbidity, surgeon’s and patient’s preferences. Submental flap is a regional flap that has proven to be a reliable fasciocutaneous flap, the tissues of which are identical to that of the lower face in width, texture, and color. Long vascular pedicle ensures wide flap rotation arc, thereby allowing one to use the flap for elimination of defects of the upper and lower lips, mental region, tongue, floor of the mouth, and preauricular area. Damage to the donor site is minimal, it is cosmetically invisible due to the scar hidden in the mental region. The paper presents the results of surgical treatment of the 38-year-old female patient with the soft tissue defect of the lower third of the face and the lip resulting from trauma. The wound did not heal for more than six months, no improvement was observed. It was decided to eliminate the defect using a rotation submental flap. The patient was followed up for a year after surgery. We managed to achieve complete aesthetic and functional rehabilitation of the patient.

Received: 2023-08-18

Published online: 2023-11-01

DOI: 10.47183/mes.2023.044

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VIEWS 643

Goleva OV, Danilov LG, Kusakin AV, Eismont YuA, Babachenko IV, Tian NS, Chukhlovin AB, Krylov AV, Glotov OS

The paper reports a familial case of HHV-6A chromosomal integration being an important and relevant issue of genetics and medicine. The study was aimed to test the hypothesis of HHV-6A chromosomal integration and vertical transmission in patient with persistent virus detection during recurrent respiratory diseases and the asymptomatic period when there were no health complaints. Sequencing of the patient’s father genome DNA was performed, and a phylogenetic tree was constructed by aligning 270 HHV-6A/B genome assemblies from the GenBank database. As a result, a familial case of ciHHV-6A transmission was identified. It was found that the detected ciHHV-6A observed on the phylogenetic tree was closely related to other two chromosomally integrated HHV-6A sequences reported by Moscow researchers. The study confirmed HHV-6A chromosomal integration. Further precise chromosome mapping of ciHHV-6A would be useful in terms of excluding probable somatic disorders associated with the chromosome structure alteration following HHV-6, particularly HHV-6A, integration, as well as for identification of insertion sites specific for various geographic locations.

Received: 2023-08-18

Published online: 2023-10-26

DOI: 10.47183/mes.2023.043

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VIEWS 616

Vasilyev VV, Rogozina NV, Markin IV, Ivanova RA, Grineva AA

Cytomegalovirus infection (CMVI) continues to be a serious public health problem, being second to hypoxia and asphyxia in the list of reasons of morbidity and mortality of newborns. This study aimed to analyze therapeutic approaches to management of children with congenital cytomegalovirus with the regimens including an antiviral drug (direct action) and a specific anti-cytomegalovirus immunoglobulin (anti-CMV IG), depending on the clinical form of the disease. The total number of participants was 62, with the first group of children receiving the antiviral drug (n = 21), and the second group — an anti-CMV IG (n = 41). We analyzed the clinical, laboratory and instrumental research methods, and studied the catamnesis of children under 3 years of age. For statistical analysis, we used SPSS Statistics and StatTech v.3.1.6. In the first group, where the regimen included the direct action antiviral drug, the outcome was successful for 28.6% of the participants, and in the second group, which was treated with the anti-CMV immunoglobulin, this figure was 58.5%. Regardless of the regimen, by the age of 3, 50% of the children were practically healthy. Most of the participants tolerated the therapy satisfactorily. However, for 66% of the involved children, we had to shorten the direct action antiviral drug therapy to 14 days because of the problems with venous access, in 4.8% we registered thrombocytopenia, and in 9.5% — increased transaminase activity. Comparing the disease outcomes depending on the therapy initiation day, we established significant differences only for the specific antiviral therapy cases (p = 0.044).

Received: 2023-08-12

Published online: 2023-09-30

DOI: 10.47183/mes.2023.041

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VIEWS 749

Makarov LM, Komolyatova VN, Kiselyova II, Besportochny DA, Akopyan AG, Dmitrieva AV, Aksenova NV

The impact of coronavirus infection (SARS-CoV-2) on cardiac output in underage athletes is uncertain. The study was aimed to determine heart disease in young elite athletes having a history of COVID-19 (SARS-CoV-2). A retrospective analysis of the results of the developed three-phase medical assessment of 236 elite athletes aged 14–17 (16 ± 1), who had had SARS-CoV-2 infection, was performed. The first phase of assessment involved examination, ECG, ECHO, bicycle ergometry (BEM), creatine kinase and creatine kinase MB tests. During the second phase 22 athletes (9.3%) underwent a more thorough assessment that included Holter monitoring (HM) with heart rate turbulence (HRT), microvolt T–wave alternans (MTWA), heart rate variability (HRV) estimation, high-resolution ECG (HRECG), determination of myocardial damage biochemical markers (troponin, NТproBNP) due to alterations revealed. Seven athletes (32%) having alterations revealed during this phase were referred to gadolinium enhancement cardiac magnetic resonance imaging (MRI) (the third phase). Myopericarditis was diagnosed in four cases (1.7% of 236) based on the results. Thus, low (below 2%) myocardial involvement has been revealed in young elite athletes, who have a history of SARSCoV-2 infection. Cardiovascular assessment algorithm has been developed for such athletes. Detection of cardiac arrhythmias by ECG, BEM, and HM is the most informative. HRECG, HRV, HRT, and MTWA can be used as additional methods to determine indications for MRI as a gold standard of the diagnosis of myocarditis.

Received: 2023-07-27

Published online: 2023-09-30

DOI: 10.47183/mes.2023.042

Comments 0

VIEWS 823

Yarkov SP, Tretyakov SI, Shilenko IV, Ishkov YuN, Styazhkin KK

Detection of staphylococcal enterotoxins in food products is an important task of food poisoning prevention. The study was aimed to develop immunochromatography tests (ICTs) for detection of staphylococcal enterotoxins А (SEA) and be В (SEB), as well as to improve sensitivity of immunochromatography detection of staphylococcal enterotoxins (by the example of SEB) in dairy products relative to visual assessment by recording the analysis results with digital video recorders (DVR) using the principle of processing digital immunochromatogram images acquired using illumination in various spectral ranges. ICTs for detection of enterotoxins were designed as sandwich tests based on highly specific monoclonal antibodies (MABs) against staphylococcal enterotoxins. Milk, cream, sour cream, cheese artificially contaminated with SEB were analyzed. The analysis results were recorded visually or by DVR. DVR of immunochromatograms of the enterotoxin-containing dairy products acquired using illumination with white light in the wavelength range of 400–800 nm ensures a 4-fold increase in the SEB detection sensitivity, while that involving illumination with green light in the wavelength range having its maximum at 525 nm ensures a 4–8-fold increase relative to visual recording. The use of the “Reflecom” and “Zondazh” digital video immunochromatogram analyzers multiplies sensitivity of SEB detection by immunochromatography when assessing dairy products relative to visual recording.

Received: 2023-08-24

Published online: 2023-09-30

DOI: 10.47183/mes.2023.039

Comments 0

VIEWS 619

Zemlyakov IYu, Bureev ASh, Golobokova EV, Zhdanov DS, Kosteley YV

Transcranial magnetic stimulation (TMS) stands out among the rapidly developing methods for clinical rehabilitation of patients after cerebral vascular accidents. The method is widely used not only in post-stroke rehabilitation, but also in sports medicine, psychiatry and other fields of medicine. However, there is an unresolved issue related to precise targeting and holding the magnetic field focus on the points of interest in the brain when performing TMS. Unprecise magnetic field focus localization may result in the emergence of side effects during the TMS session. The review provides the existing solutions of these problems, comparison of the commercially available navigation devices for TMS, analysis of their composition and operation algorithms; promising directions of developing hardware for TMS navigation are proposed.

Received: 2023-08-03

Published online: 2023-09-30

DOI: 10.47183/mes.2023.038

Comments 0

VIEWS 759

Konstantinova YuE, Vilnits AA, Bekhtereva MK, Alekseeva LA, Glotov OS, Egorova ES

The review is dedicated to matters related to epidemiology and pathogenesis of multisystem inflammatory syndrome associated with SARS-CoV-2 in children (MIS-C). The majority of the reviewed reports are focused on immunopathogenesis of the disease. The causes of the syndrome related to the features of the virus are listed in the paper, the association with circulating variants is described. The role of the SARS-CoV-2 surface protein as superantigen is considered. The literature data on the likelihood of MIS-C development according to the antibody-dependent enhancement pattern are discussed. The factors of cellular and humoral immune response contributing to hyperinflammation are addressed. Sporadic papers describing genetic mutations that can play a certain role in the MIS-C pathogenesis are provided. Furthermore, the association of vaccination against novel coronavirus infection with the likelihood of MIS-C in vaccinated individuals is discussed.

Received: 2023-08-25

Published online: 2023-09-30

DOI: 10.47183/mes.2023.040

Comments 0

VIEWS 840