Evgeniya A. Medvedeva

Chronic constipation in children is a multifactorial condition characterized by the interplay between the intestine and the brain. Key factors include abnormal intestinal motility, defecation reflex dysfunction, the child’s retention behavior, and alterations in the intestinal microbiota. The updated Rome V criteria (2026) underscore the importance of clinical diagnosis, early detection, and timely initiation of therapy to prevent the chronic progression of the condition and mitigate the risk of complications and relapses. The current management of children with chronic functional constipation should employ an integrated approach that encompasses family education, dietary and lifestyle modifications, a proper duration of pharmacological treatment, and ongoing follow-up. Osmotic laxatives, particularly lactulose, are used as first-line therapeutic agents due to their proven efficacy, favorable safety profile, and prebiotic properties. Implementing an algorithm based on the Rome V criteria and contemporary international clinical guidelines enhances treatment efficacy, reduces relapse rate, and improves quality of life for affected children.

The current stage of technological evolution in healthcare is characterized by the synergy of biomedical sciences and digital technologies, shaping a new paradigm of evidence-based medicine. Generative artificial intelligence (GenAI), with its potential to process heterogeneous data and generate predictive models, is a key driver for the personalization of medical services. This study conducted a multi-level analysis of the institutional and technological aspects of developing a scientific and medical cluster. A scientific-medical educational cluster (SMEC) represents a promising organizational and economic model aimed at consolidating the resources of science, education, practical healthcare, and business to achieve strategic public health goals. Aim: to study modern approaches to the development of scientific-medical educational clusters as a tool for addressing strategic objectives of public health and healthcare organization on the regional level. Material and methods. The study utilized a systems approach, a content analysis method for research data on the issue, and an analytical method for assessing the effectiveness of the cluster model in the context of Russian regions. Results. Key systemic limitations were identified: fragmented management, shortage of personnel and management competencies, and insufficient focus of scientific research on public health priorities. The challenges of forming scientific and medical educational clusters in the current context and ways to address them were identified. Conclusion. Organization of scientific-medical clusters is a key factor in the development of an innovative healthcare ecosystem, ensuring the integration of academic science, educational institutions, the business sector, and government regulation. Key factors for the success of scientific and medical educational clusters in the region include the leading role of the healthcare authority in coordinating all cluster participants; focus on public health priorities determined based on epidemiological analysis and monitoring data; integration of educational programs in artificial intelligence management and healthcare economics into cluster activities to train personnel capable of working in an interdisciplinary environment; investments in innovations with achievable medical, demographic and economic indicators.

Aim – to study the course of the acute period of infection caused by SARS-CoV-2 in healthcare workers in comparison with individuals not engaged in medical activities. Material and methods. A cross-sectional online study was conducted from June to September 2022. To study the frequency of COVID-19 episodes in healthcare workers and individuals of other professions, an internet resource (testograf.ru) was used, based on which anonymous online questionnaires were posted. The questionnaire included three blocks of questions: information about the patient; data on previous NCI and vaccination; data on the recovery period of NCI (presence of complaints, period of occurrence and their duration). The analysis included 22,535 individuals who had COVID-19. Results. In general, during this period, healthcare workers were characterized by a more frequent registration of pneumonia (22.6% vs. 20.5%, p = 0.0002) and the need for oxygen support (6.7% and 5.1%, p 0.0001), the presence of complicated course (7.3% vs. 6.9%, p = 0.2506). Despite the similarity of the clinical picture during the period of circulation of various strains of NCI, features of the clinical course were revealed depending on the circulating predominant strain. The effectiveness of the vaccination against COVID-19 was revealed during the period of dominance of the “Wuhan” and “Delta” genetic variants and the lack of effectiveness during the period of dominance of “Omicron”. Conclusion. A feature of our study was the presentation of data using an internet resource, which allows us to fully reflect the objective reality in the framework of morbidity among healthcare workers. The study revealed the features of the clinical course in healthcare workers.

Клинические изменения со стороны слизистой оболочки полости рта у пациентов с целиакией встречаются часто и могут быть одним из маркеров недиагностированного заболевания и его атипичных форм. Помимо описанных ранее изменений врач может столкнуться с нетипичными проявлениями, требующими в рамках дифференциальной диагностики исключения глютеновой энтеропатии. Представлено описание клинического случая диагностики целиакии у пациентки 10 лет с синдромом Шерешевского–Тернера с жалобами на появление рецидивирующей энантемы твердого нёба в виде бабочки, возникающей в инкубационном периоде или в первые дни разгара острой респираторной инфекции. Результаты лабораторно-инструментального, генетического и морфологического исследования подтвердили наличие глютеновой энтеропатии. На фоне безглютеновой диеты рецидивы энантемы купировались. Описанный новый вид энантемы у ребенка из группы риска по развитию целиакии может рассматриваться как еще один маркер данного заболевания, в связи с чем рекомендуется проводить обследование на целиакию всем пациентам с неясными рецидивирующими энантемами полости рта для своевременной постановки диагноза и начала безглютеновой диетотерапии. Clinical changes in the oral mucosa in patients with celiac disease are common and may be one of the markers of the undiagnosed disease and its atypical forms. In addition to the changes described earlier, the doctor may encounter atypical manifestations that require the exclusion of gluten enteropathy as part of a differential diagnosis. The article describes a clinical case of celiac disease diagnosis in a 10-year-old patient with Shereshevsky–Turner syndrome with complaints of recurrent hard palate enanthema in the form of a butterfly that occurs during the incubation period or in the first days of the onset of acute respiratory infection. The results of laboratory, instrumental, genetic and morphological studies confirmed the presence of gluten enteropathy. Against the background of a gluten-free diet, the recurrence of enanthema was stopped. The described new type of enanthema in a child at risk of developing celiac disease can be considered as another marker of this disease, and therefore it is recommended that all patients with unclear recurrent oral enanthemas be screened for celiac disease in order to make a timely diagnosis and start gluten-free diet therapy.

Obesity is recognized as a global problem, and its prevalence has reached pandemic proportions. Obesity has been found to be a significant risk factor for the development and progression of various pathologies, including NAFLD. Objective. To determine the features of body composition in children with exogenous-constitutional obesity depending on the presence or absence of NAFLD. Materials and methods. The study included 103 children of both sexes (58 boys and 45 girls) aged 12 to 17 years with exogenous-constitutional obesity (SDS BMI> +2.0). Patients were randomized into two age- and gender-matched groups: Group 1 - children with obesity and NAFLD (n = 51), Group 2 - children with obesity without NAFLD (n = 52). Results. In group 1, a reliable predominance of higher values of BMI (Me 34.7 [30.8; 38.2] versus Me 30.5 [28.55; 33.1], p=0.0002) and SDS BMI (Me 3.1 [2.66; 3.69] versus Me 2.74 [2.37; 3.06], p=0.0004) was revealed compared to group 2. Children in group 1 were characterized by statistically significantly higher indicators: FM (Me 39.6 [32.3; 48,1] versus Me 31.65 [26.8; 38.95], p=0.002); IFM (Me 22.6 [16.6; 33.1] vs. Me 16.850 [13.0; 23,7] p=0.004); TM (Me 60.0 [50.1; 70.0] vs. Me 50.50 [45.45; 56.95], p=0.0003); ACM (Me 32.2 [27.2; 37.8] versus Me 27.05 [24.15; 31,55], p=0.0005) and SMM (Me 26.9 [22.7; 33,6] versus Me 23.35 [21.05; 29,2], p=0.02); 36.95 [33.25; 41,65], p=0.0003) and BF (Me18.1 [15.6; 20.8] versus Me 15.6 [14.15; 17.45], p=0.0002). Conclusions. According to bioimpedance analysis, children with exogenous-constitutional obesity and signs of NAFLD have more pronounced changes in body composition, both its fat and lean components, compared to children without NAFLD.

Синдром избыточного бактериального роста при гастроэнтерологических заболеваниях - следствие или причина прогрессирования?

Aim – to clarify the clinical symptoms of COVID-19 in patients with the new coronavirus infection. Material and methods. A total of 156 patients undergoing treatment in COVID-hospitals were included in the study. The patients were examined for the prevalence of COVID-19 clinical symptoms, COVID-19 clinical manifestations in the oral cavity and concomitant diseases. Results. In the structure of general symptoms, the complaints of hyperthermia, general weakness and cough (more often dry) played a leading role. These symptoms were noted in the overwhelming majority of the examined patients. Two-thirds of patients reported body pain. The leading symptoms were also anosmia (in 68.6% of cases) and sweating (64.1%). More than half of the patients complained of shortness of breath (60.2%), difficulty in nasal breathing (55.1%), a feeling of tickling (58.3%) and pain (60.2%) in the throat. Among dental pathology, the loss of taste (57.5%) and hyposalivation (38.5%) were most common in patients. Bleeding gums were detected in 22.4% of the examined patients, which was most likely due to violations of the rheological properties of blood and changes in the hemodynamic provision of the parodontium during COVID-19. Conclusion. The hemostasis disorders characteristic of the new COVID-19 infection certainly influenced the dental status, further destroying periodontal tissues. However, clinical manifestations of pathological effects might not occur immediately, but in the form of long-term complications. In this regard, it is necessary to dynamically monitor the patients who have undergone COVID-19.

Aim – to evaluate the effectiveness of vaccination when using various vaccines against COVID-19 approved for use in Russia among medical staff and faculty of medical higher educational institutions according to online questionnaires. Material and methods. A cross-sectional study was conducted online from January to March 2022 (circulation period of the omicron genovariant). The survey was completed by 6032 respondents, 2114 respondents were excluded from the study. The remaining 3918 respondents were included in the the analysis. Results. 47 (0.1%) medical workers reported COVID-19 incidence within 21 days after the second dose of the vaccine. 616 (16.8%) medical workers reported COVID-19 incidence within 5 months after two vaccinations. 116 (46.4%) unvaccinated respondents reported a laboratory-confirmed new coronavirus infection within 5 months prior to the survey. Lack of vaccination increased the risk of SARS-CoV-2, OR 1.78 ± 0.14 (95% CI 1.34-2.36). It was found that gender and age were not a risk factor for the onset of the disease in the post-vaccination period. The presence of SARS-CoV-2 in medical history increased the risk of developing the disease in the post-vaccination period. Conclusion. The analysis revealed that vaccination had significantly higher protection effect for 1.5 months after vaccination and significantly reduced in 5 months after vaccination.

Background. Irritable bowel syndrome with a predominance of constipation is a common chronic pathology in the population. The main drug therapy for irritable bowel syndrome with a predominance of constipation remains the prescription of laxatives. One of the drugs with proven effectiveness is lactulose. However, taking into account the complaints of patients with irritable bowel syndrome with a predominance of constipation, it seems relevant to use drugs whose action is aimed at influencing several stages of pathogenesis and combating symptoms such as constipation, abdominal pain, bloating. These drugs include a combination drug based on lactulose and simethicone. Objective. The purpose of this study is to compare the effectiveness and safety of a combination drug based on lactulose and simethicone in comparison with a group receiving therapy in the form of a combination of two monotherapy drugs (lactulose and simethicone) and a group receiving lactulose monotherapy patients with irritable bowel syndrome with predominant constipation. Materials and methods. A single-stage open randomized comparative clinical trial was conducted from January 16, 2023 to June 29, 2023. The study included 150 patients diagnosed with irritable bowel syndrome with predominant constipation, aged 18 to 55 years, who were examined and treated for based on the State Budgetary Institution of the Ryazan Region "City Clinical Hospital No. 4", evenly randomized into 3 groups. Results. Fixed combination of lactulose + simeticone is superior in effectiveness to lactulose monotherapy in terms of stool frequency per week, stool shape, flatulence, and relief of abdominal pain. An additional analysis established the superior effectiveness of a drug based on lactulose and simethicone, an oral emulsion, in comparison with a combination of drugs simethicone, 40 mg capsules + lactulose syrup for the treatment of adult patients with irritable bowel syndrome with a predominance of constipation.

Background. One of the vulnerable categories of the population during the COVID-19 pandemic has become employees of medical and educational institutions. Timely and properly organized prevention, based on anti-epidemic measures based on vaccination, is necessary not only to reduce the incidence of the disease, but primarily to reduce the severity in case of its occurrence, reduce the risk of hospitalization. Understanding the effectiveness of preventing SARS-CoV-2 infections among healthcare workers is a critical component of occupational health and safety policy and strategy. Aim — analysis of the incidence of COVID-19 after vaccination among medical staff and teaching staff of medical higher educational institutions. Methods. In the period from January to March 2022, a cross-sectional retrospective single-stage online study was conducted (anonymous questionnaires posted on the Anketologist platform). The survey was completed by 6032 respondents (82% efficiency). According to the criteria, 2114 respondents were excluded from the study. The analysis was carried out according to the questionnaires of 3918 respondents, including an assessment of the incidence after vaccination (n = 3668 respondents). Results. Fell ill after a double vaccination for 5 months — 663 (16.9%). Unvaccinated respondents reported that within 5 months. prior to the survey, 116 (46.4%) had a laboratory-confirmed new coronavirus infection. Lack of vaccination increased the risk of SARS-CoV-2 (OR 1.78 ± 0.14; 95% CI: 1.34–2.36). Efficiency within 5 months post-vaccination period was 55.5% (95% CI: 42.2–57.7%) for Sputnik V; 71.9% (95% CI: 68.1–85.4%) — Sputnik Light. It was found that gender and age were not a risk factor for the onset of the disease in the post-vaccination period. The presence of a history of previous COVID-19 increased the risk of disease in the post-vaccination period in individuals under 35 years of age (OR 2.323 ± 0.102; 95% CI: 1.903–2.836), aged 36–64 years (OR 2.547 ± 0.086; 95% CI: 2.150–3.016), older than 65 years (OR 1.323 ± 0.280; 95% CI: 0.764–2.290). Respondents with a history of a combination of chronic cardiovascular pathology and past COVID-19 had a higher risk of getting sick in the post-vaccination period (OR 1.338 ± 0.160; 95% CI: 0.977–1.832). Conclusion. According to the questionnaire, an important factor affecting the risk of COVID-19 in the post-vaccination period is the presence of SARS-CoV-2 before vaccination, which can increase the chance of developing the disease in the presence of other risk factors (chronic pathology, age, smoking, alcohol consumption).