Search

Introduction. Despite modern advances in technologies for the treatment and prevention of varicose veins, there is currently no radical treatment for varicose veins. The probability of recurrence of dilated veins, according to various authors, ranges from 5 to 70%. Along with the well-established concept of recurrence of varicose veins, the term progression of varicose veins is increasingly common in everyday life.Aim. To study the current understanding of the term relapse and the practical attitude of specialists involved in the treatment of varicose veins to it.Material and methods. In 2023, a survey of 117 specialists on the recurrence/progression of varicose veins was conducted. The respondents were doctors involved in the treatment of varicose veins: vascular surgeons 22.4%, phlebologists 50%, general surgeons 19.8%, specialists in ultrasound/functional diagnostics 7.8%, X-ray endovascular surgeon 0.85%. The questionnaire included 18 questions regarding the frequency of visits of patients with relapse/progression of varicose veins; views on tactics, as well as the attitude of specialists to the issue of progression and recurrence of varicose veins in patients after its surgical treatment.Results and discussion. The concept of recurrence and progression of varicose veins among specialists dealing with this pathology is not always comparable. There are differences in views both on the predisposing factors for the recurrence of dilated veins, and, accordingly, on the tactics of treatment and preventive measures. In some cases, according to statistics, they are due to specialization.Conclusions. The incidence of relapse and progression at the reception of the respondents has a slight difference. Despite the fact that there are opinions that do not correspond to generally accepted and abhorrent collegiality, mostly specialists try to separate these concepts, see differences in provoking factors and, accordingly, in recommendations.

Аim: to provide basic information on Whipple's disease necessary for timely diagnosis and treatment, using the example of clinical observation.Key points. Whipple's disease is a rare systemic infectious disease that internists, gastroenterologists, rheumatologists, and other physicians may encounter. The incidence of Whipple's disease is extremely low and amounts to 1 case per 1,000,000–10,000,000 people. The low prevalence of pathology can lead to underdiagnosis in favour of more common diseases. This, in turn, may worsen the patient's prognosis, as it will delay the time for establishing the correct diagnosis and initiating the necessary therapy. A 50-year-old man complained of losing 10 kg of weight over 5 months, abdominal pain and bloating, pain in the joints of feet, and shoulders, accompanied by swelling and hyperemia. The disease began with articular syndrome followed by diarrhea and manifestations of malabsorption (iron deficiency anemia, hypoalbuminemia, hypercholesterolemia). The diagnosis was established on the basis of morphological changes in biopsy samples of the postbulbar part of the duodenum. The identified changes were represented by thickening of the villi and accumulations in the stroma of large macrophages (CD68+) with wide light cytoplasm containing abundant accumulations of PAS-positive, negative when stained with carbol fuchsin according to Ziehl — Nielsen and auramine-rhodamine (under microscopy in luminescence mode) short rods, as well as numerous optically empty small and larger cavities. Treatment with intravenous injections of ceftriaxone 2 g per day for 14 days and trimethoprim/sulfamethoxazole 1920 mg per day for 8 months led to improved health, normalization of laboratory parameters, endoscopic and morphological findings. Treatment with trimethoprim/sulfamethoxazole is planned to be continued for up to 12 months or longer if necessary.Conclusion. Timely diagnosis and initiation of antibiotic therapy will help to avoid late complications of the disease, including death.

The purpose of the study was to assess the current epizootic potential of the Transcaucasian high-mountain and Pre-Araks low-mountain natural plague foci on the territory of the Republic of Armenia using GIS technologies. Materials and methods. We used the data from an epizootiological survey, records of the abundance and species composition, spatial distribution of rodents and ectoparasites in the plague-enzootic territories of the Republic of Armenia in 2021. Results and discussion. Based on the results of the research, an electronic database of carriers and vectors of pathogens of natural-focal zoonotic infections in the plague-enzootic territories of the Republic of Armenia has been created. Applying GIS technologies, an assessment of the spatial distribution of carriers and vectors of plague has been made and areas of circulation of tularemia and leptospirosis pathogens identified. The results obtained serve as the basis for improving the efficiency of planning and carrying out preventive measures aimed at ensuring the epidemiological welfare as regards natural-focal infectious diseases in the territory of the Republic of Armenia.

Aim of the study was to assess the current state of implementating key aspects of infection prevention and control (IPC) in Armenian hospitals, defined by the main WHO components, using the survey tool IPCAF (Infection Prevention and Control Assessment Framework). Materials and methods. 113 hospitals were involved in the study. All participants filled out the IPCAF questionnaire, consisting of 8 sections (each rated up to 100 points) devoted to various IPC aspects. Depending on the total final score, IPC programs were divided into the following categories: advanced (601800 points), intermediate (401600 points), basic (201400 points) and inadequate (0200 points). The study conducted a descriptive analysis of the overall IPCAF score as well as score evaluation of the relevant core components and some selected questions of particular interest. Results. The 2021 total average score for all IPCAF components for all hospitals in Armenia is 578.07.9 points, which is currently regarded as an intermediate level. At the same time, 47 (41.6%) hospitals were assigned to the advanced category, 63 (55.7%) to the average category and 3 (2.7%) to the basic category. Analysis of the main IPC components (CC, Core component) revealed that the maximum average scores were obtained for the components CC2 (IPC Guidelines) 80.8 points, CC8 (Creating a safe environment in medical premises, as well as materials and equipment for IPC) 75.5 points and CC7 (Workload, staffing and number of beds) 75.2 points. The lowest average scores were obtained for the key components: CC4 (Surveillance for healthcare-associated infections) with 54.7 points and CC3 (IPC education and training) with 59.5 points. Conclusion. Legislative and practical changes implemented in the real world during the novel coronavirus infection (COVID-19) pandemic have significantly contributed to improved scores for many key components of IPC programs. The study found that the IPCAF is a useful tool for assessing IPC standards and identifying gaps, regardless of a country economic development level. In our opinion, the re-use of IPCAF in all medical institutions should be encouraged, which is important for monitoring changes and trends in IPC, as well as proposing individual strategies in the development and improvement of IPC.

The article deals with the problem of the expediency of a criminal case’s returning to the prosecutor at the stage of appointment and preparation of a court session in Russian criminal proceedings. This problem is relevant to the science of criminal procedure.The purpose of the study is to analyze critically the practice of returning of a criminal case back to the prosecutor in order to correct mistakes made at the pre-trial stages of the proceedings according to the new concept of justice independence and the absence of an accusatory bias in the court functioning.The methodological basis of the study is a set of scientific techniques, focused mostly on the dialectical approach, which made it possible to determine the essential characteristics of the prohibition to turn the criminal proceedings in Russia for the worse. Both general scientific (analysis, synthesis, systematic method) and specific scientific methods (formal-legal, historical-legal, comparative-legal) of knowledge were also used. The analysis helped to formulate the position of understanding the turn for the worse as an independent principle of criminal procedural law, to study the procedural form of the turn for the worse. The synthesis method made it possible to determine the return of the criminal case to the prosecutor at the stage of appointment and preparation of the court session as a holistic institution of the criminal procedure. The systematic approach allowed to determine not only the mixed nature of the mechanism for changing the prosecution to a more serious one, but the investigative organization of pre-trial proceedings and its place in the structure of criminal proceedings, the separation of the investigative and “accusatory powers” of the prosecutors as well as their balance. The historical method let us trace the evolution of the prohibition to turn the Soviet and Russian criminal procedural systems for the worse. The comparative-legal method made it possible to assess the potential of domestic legislators' reception of foreign experience of regulating the prohibition to turn for the worse and formulate proposals to improve the Russian criminal procedural legislation.The main scientific results of this research consist of justification of the conclusion of the conversion expediency of the domestic judicial proceedings to the adversarial model of accusation which is carried out within the trial on the previously filed charge. The presentation of a new charge (criminal action) in court and the procedure of supplementing the charge change it for the worse. This model of re-indictment for the worse for the defendant appears to be fairer and more convenient both for the prosecuting authority and for the legal organization of combating crime. The changeover to the suggested form of implementation of the ban to turn for the worse in the institution of bringing and changing charges in court is possible only in a systematic link with the reform of the preliminary investigation. Conclusion. The institution of the criminal case returning by the court to the prosecutor in order to change the charge to a more serious one when implementing the adversarial model of bringing charges in the criminal procedure system of Russia will fully satisfy the concept of independence of justice administration and the absence of an accusatory bias in the activities of the court, while at the same time with fairly organized the prosecutorial power aimed at countering crime.The section 1 was prepared by N.N. Lysov, section 2 by K.D. Vanyan (together with M.T. Tashilin), section 3 by A.S. Shuisky (together with I.R. Gilmanov), section 4 by V.V. Kosterin.

Aim. The purpose of this research was informational content assessment of the anamnestic data in diagnosing of chronic endometritis before its histologic confirmation and possibility of the timely beginning of complex therapy of pathology.Materials and methods. To achieve the aim of the retrospective analysis of 303 case reports of patients who underwent endometrium papel biopsy as a part of examination plan before assisted reproductive treatment in 2017. A particular interest, in our case, submitted the special anamnesis including consideration of menstrual, sexual and reproductive functions, past gynecologic diseases and interventions.Results. In the analysis of the received results the most constant signs of chronic endometritis: disorders of menstrual and seсretory functions; the high index of intrauterine interventions, considerable frequency of identification of endometrium polyps and the cervical channel (40,1%), pathological cervical neoplasia (30,8%) were noted.Conclusion. Thus, anamnestic data of patients with the verified endometritis, especially extended one, with inclusion of nonconventional, but relevant at the present stage additional signs, have shown high informational content for neoadjuvant diagnosis of pathology of endometrium of inflammatory character. Only against the background of timely initiated complex therapy, numerous endometrial receptivity parameters are restored, which leads to relief of clinical symptoms and lays the foundation for the successful implementation of reproductive function.

Ovarian stimulation protocol and other potential risk factors of poor ovarian response (POR) were analyzed in retrospective case-control study. Due to ESHRE criteria (2011) 150 infertile women of IVF department were divided into the group of cases with POR and the control group with the normal ovarian response. The elder age of the women and the earlier age of menopause in their mothers seemed to be the significant risk factors of POR. Also POR was associated with the history of abortions, ovarian stimulation, and hormonal contraception. Ovarian stimulation protocol did not influence the number of follicles and oocytes in both case and control groups. The pregnancy rate was higher in patients with GnRH antagonists protocol.