Perm State Medical Academy

The COVID-19 pandemic has significantly influenced the course and clinical presentation of skin diseases. Literature data indicate frequent lesions of the mucous membranes, skin, and its adnexa following the novel coronavirus infection caused by SARS-CoV-2. The proportion of dermatoses associated with COVID-19 among infected patients reaches 20.4 %. Based on the time of their development, skin lesions associated with coronavirus infection, are classified as early (acute), observed, within 2 to 4 weeks. These include cutaneous angiitis, morbilliform, papulosquamous, and papulovesicular rashes, drug eruptions, urticaria, and factitial lesions. These dermatoses result from the direct effect of SARS-CoV-2, its toxins and metabolites on the skin and mucous membranes and/or from a concomitant drug-induced toxic-allergic reaction. Late (chronic) skin lesions develop from 1 month to 1 year after novel coronavirus infection or within 4 weeks after vaccination. Late skin diseases exacerbated by SARS-CoV-2 include papulosquamous dermatoses, post-COVID alopecia, allergic dermatoses, collagen vascular diseases, acneiform dermatoses, nail plate changes, erythema, bullous dermatoses, and psychogenic dermatoses. The pathological effect of SARS-CoV-2 in the late stages post-infection or post-vaccination is due to the affinity of certain keratinocyte structures for the virus. The virus enters the cell, stimulates T-lymphocyte activation, enhances T-helper cell proliferation, and hyperproduction of proinflammatory cytokines and antibodies. This leads to interleukins synthesis and hyperstimulation of tissue inflammation, impairing skin cell differentiation. A significant proportion of concomitant dermatoses and comorbid pathologies has been identified in patients with late skin lesions that developed within 1 year after SARS-CoV-2 or within 4 weeks after vaccination. Moderate to severe courses of post-COVID dermatoses and complicated clinical cases have been frequently reported. Most clinical observations have shown a predominance of widespread rashes, atypical localization, and atypical clinical presentations, with rare clinical variants being more common. Combinations of two and three dermatological nosologies in a single patient (multimorbidity) have been noted. Pathomorphosis (nosomorphosis) of papulosquamous and autoimmune skin diseases has been observed, manifesting as the evolution of one dermatosis into another.

Objective. To compare the efficacy of various clinical monitoring programs, including a remote monitoring system using automated interactive questionnaire. Materials and methods. The study included 254 patients with COPD, divided into 3 dynamic monitoring groups: the main group of patients (n=77) used a remote monitoring system activities, including an interactive questionnaire; the comparison group (n=75) who used a remote monitoring system activities limited to the assessment of a number of objective parameters: a modified 6-minute walk test (6-MWT test, in steps), daily physical activity (number of steps per day) and peak expiratory flow rate, but the interactive questionnaire was not applied in this group; the control group (n=102), received standard follow-up according to routine clinical practice without remote monitoring in compliance with the Order No. 168n of the Russian Ministry of Health (dated March 15, 2022) “On approval of the Procedure for Dispensary Observation of Adults”. Results. In the main group, where remote monitoring of interactive questionnaire data was combined with the assessment of objective disease criteria, a significant proportion of patient transition from group “E” to group “B” (a course with rare exacerbations) was revealed. In the comparison group, no significant disease rephenotyping was observed. Conversely, in the control group, a significant proportion of patients transitioned from groups “A” and “B” to group “E” (a course with frequent exacerbations). Over the 12 month follow-up period, treatment in the main group was aligned with clinical guidelines; in the comparison group, a less significant redistribution of treatment programs was observed; in the control group, the rate of treatment regimen compliance with clinical guidelines after one year did not exceed 40 %. Conclusions. An approach combining the assessment of subjective (using an interactive questionnaire) and objective criteria for remote monitoring, improves the quality of clinical follow-up in COPD patients, allowing disease rephenotyping, timely detection of disease exacerbations, and achieving symptom control through the prompt adjustment of maintenance therapy, when required.

The management of patients with acute vestibular vertigo (AVV) remains a difficult and pressing problem in modern medicine due to the variety of aetiological factors, the subjective nature of patient complaints, and the insufficient application of existing neurovestibular diagnostic algorithms in real clinical practice. Despite the large number of publications on the management of patients with AVV, certain issues regarding the examination and routing of patients remain unresolved to this day. Approximately a quarter of conditions manifested by AVV are caused by stroke or other life-threatening diseases, therefore emergency diagnosis is always necessary. Due to the insufficient informativeness of neuroimaging methods in patients with isolated vestibular vertigo, clinical diagnosis comes to the fore, requiring special training from doctors. Patients with peripheral causes of acute vestibular syndrome and vestibular migraine often do not receive fully effective treatment and recommendations for further rehabilitation in neurological hospitals, which makes an initially benign cause a trigger for chronic complaints of vertigo, leading to various functional disorders that slow down recovery, cause disability, and significantly reduce patients' quality of life. On 22 November 2025, a council of experts was held to discuss important issues related to the diagnosis, management and rehabilitation of patients with AVV, resulting in a proposed strategy for patient management.

The aim is to present expert-agreed guidelines for the primary prevention of cardiovasculotoxicity of anticancer therapy as part of the Cardioprotection 2025 Consensus of the Russian Society of Cardiology, the Society of Heart Failure Specialists, the Russian Association of Oncologists, and the Eurasian Association of Cardio-Oncologists. The second part of the Consensus focuses on strategies for protecting the myocardium and blood vessels before or at early stages of anticancer treatment. The document addresses the key principles of primary prevention of cardiovasculotoxicity: interdisciplinary collaboration between cardiologists and oncologists at the stage of treatment scheduling, the possibility of managing modifiable risk factors, pharmacological cardioprotection, approaches to preventive screening (including clinical evaluation, biomarkers, and imaging), non-pharmacological prevention (physical activity, nutritional status correction, artificial intelligence, and digital monitoring management), and specific features of prophylaxis in the treatment with key anticancer drug classes (anthracyclines, HER2-targeted agents, tyrosine kinase inhibitors, anti-VEGF agents, immune checkpoint inhibitors). This document aims to optimize patient management to reduce the risk of cardiovascular complications during anticancer therapy.

Objective. To study individual dental and general health parameters in patients with temporomandibular joint dysfunctions to improve the effectiveness of diagnosis and comprehensive treatment of patients with degenerative diseases of the craniomandibular complex. Materials and methods. The research was conducted at 2 clinical sites: the Dental Polyclinic of Ye.A. Vagner Perm State Medical University (Perm, Perm Krai, Russia) and the Department of Maxillofacial Trauma and Orthognathic Surgery of Dental Hospital of Zunyi Medical University (Zunyi, Guizhou Province, China). A health questionnaire was developed for the project, 2 observation groups of young and middle-aged patients (according to the WHO classification) were formed: group A comprised patients from Russia, and group B comprised patients from China. Results. Significant differences were identified in the structure of concomitant somatic conditions among patients with TMJ dysfunction between the Russian Federation and the People`s Republic of China. A number of modifying factors that influence the development and clinical course of the primary dental disorder were determined. The study also demonstrates that implementation of a unified health questionnaire for patients with TMJ dysfunction combined with somatic pathology enables deeper analysis of individual etiopathogenetic processes, which, consequently, will improve the effectiveness of treatment and lead to stable clinical outcomes, regardless of the patient's country of residence.

The article is dedicated to the 145th anniversary of the birth of Viktor P. Protopopov, Russian- Soviet psychiatrist, pedagogue and academician of the Academy of Sciences of Ukraine. Victor Pavlovich left a rich scientific legacy, publishing more than 160 works, including 5 fundamental monographs. The research of V.P. Protopopov covered a wide range of issues in the field of psychiatry, physiology and pathology of higher nervous activity. He developed a unique method of calling conditional motor reflexes, which has become an important contribution to science. His work on pathophysiology, biochemistry and treatment of schizophrenia and manic-depressive psychosis has made a significant contribution to understanding these diseases. Viktor P. Propopov was one of the first in the Soviet Union who introduced innovative treatment methods such as sleep therapy and detoxification procedures, which significantly improved the quality of life for many mentally ill people.

Aortic stenosis (AS), the prevalence of which increases with age, raises the risk of developing ischaemic stroke (IS), but the risk factors for cerebral ischemic events have not been fully established. Objective: to evaluate IS predictors in patients with moderate or severe AS, which will help identify high-risk groups and optimise stroke prevention. Material and methods . A retrospective review of data from the hospital information system for case-control analysis was conducted at one of the Federal Centers for Cardiovascular Surgery. Inclusion criteria: moderate or severe AS, patient age ≥18 years. Exclusion criteria: moderate or severe mitral stenosis, moderate or severe mitral regurgitation. Logistic regression was used to determine IS predictors. Odds ratio (OR) with 95% confidence intervals (CI) were calculated for each of the significant risk factors. Results . The study included 208 patients with AS (the main group consisted of 51 patients with a history of IS or transient ischemic attack). The median age of patients was 68 [62.0; 72.0] years, the proportion of men was 53.8%. According to the multivariate analysis, the following predictors of cerebral ischemic events were identified: male gender (OR 2.739; 95% CI 1.048–7.156, p=0.040), extra-, intracranial stenosis >50% (OR 2.488; 95% CI 1.089–5.686, p=0.031), aortic arch atheromas (OR 5.947; 95% CI 1.179–29.994, p=0.031), the result of the CHA2DS2VASc scale with an increase of 1 point (OR 4.030; 95% CI 1.912–8.499, p<0.001). Conclusion. Supra-cardiac atherosclerosis (extraand intracranial atherosclerosis, aortic atheromas) is the main predictor of IS in patients with AS, which determines the need for its assessment in order to optimise patient treatment.

Introduction . The safety of local anesthetics in dentistry is directly determined by the quality of drug supply management, including monitoring the movement of medications, taking into account the patient’s allergy history, and reducing the risk of adverse reactions. However, most dental clinics lack automated systems for personalized drug accounting. The purpose of the study was to improve the drug supply system using local anesthetics as an example through the implementation of automated personalized accounting. Materials and methods. The study was conducted at the Regional Dental Polyclinic (Perm Krai) in 2022–2023. The processes of anesthetic movement were analyzed, followed by an audit, implementation of the Unified State Information System in Healthcare (EGISZ PC), economic assessment, and a survey of 87 dentists. Results . The introduction of personalized accounting made it possible to ensure accurate documentation of each ampoule, reduce the risk of errors, improve anesthetic selection, reduce the consumption of local anesthetics by 34%, and decrease expenditures by 28%. Conclusion . The implementation of an automated system and a personalized approach ensured quality control and safety in the use of anesthetics and improved the economic performance of the dental medical organization.

Objective. To analyze the long-term average values of the birch and cereal pollination periods. Relevance. Fluctuations in the concentration of pollen grains from allergenic plants in the air significantly affect allergy symptoms in sensitive patients, that is why aeropalynological monitoring is so important. Materials and methods. An analysis of aeropallinological monitoring data for the city of Perm from 2010 to 2019 and in 2023 was carried out. For the birch and cereals, an assessment of the main pollination period was made based on 98% of the total annual number of pollen grains (MPP 98) and the pollination season (PS) according to the method of the European Academy of Allergy Clinical Immunology (EAACI). Statistical processing of the obtained data was carried out using the following programs: Microsoft Excel® 2016 was applied for the calculation of the median total pollen grains concentration (p. g.) of the birch and cereals, the duration of pollination of these plants, Statistica 6 was used to determine the differences between median values based on the Mann-Whitney U-criterion. Results. The median total pollen grains concentration of the birch per season was 19,478 [3,024; 32,094] p.g./m3, cereals – 522 [238; 916] p.g./m3, the median duration of the pollination period of the birch was 31 [22; 36] days, cereals – 35 [31; 49] days according to the EAACI method. Statistically significant differences were detected between the duration of cereal pollination when calculated using the MPP 98 and PS methods (p = 0.01). Conclusions. High inter-seasonal variability in the total pollen grains concentration of allergenic plants was determined, the intensity of birch pollination per season in 2013 and 2014 differed by 35 times, that of cereals in 2015, 2016 – by 9 times.

The oral microbiota includes more than 700 species of microorganisms, the bulk of which are opportunistic pathogens, and the relationships between them are characterized by wide variability, which is manifested by both antagonism and mutualism. At the same time, it has not been established yet how the symbiotic relationships of microorganisms that are of clinical importance, are reflected in the virulence of certain species. Moreover, the issues of microbial syntrophy are hardly studied in medical microbiology. It is of interest to study the accumulated information on changes in the functional and metabolic activity of oral microorganisms, taking into account their symbiotic relationships. Currently, in the study of the oral microbiome, a rejection of a culture-based approach in favor of nucleic acid analysis methods is observed due to some reasons. However, the widespread use of such technologies has led to a number of new questions, concerning, for example, the interpretation of the obtained results on the composition of microorganisms, since the methods of nucleic acid analysis allow the identification of taxa represented by almost a few cells. The review article shows that when conducting microbiological studies, it is important to take into account the symbiotic relationships between individual microorganisms, since they can change the functional and metabolic activity of associates, and hence the severity of the pathological process. The existing technologies of molecular genetic analysis do not allow one to evaluate either the orientation of symbiotic relationships or the functional activity of microorganisms. On the other hand, the possibilities of the cultural methods are also limited by the exactingness of most clinically significant taxa to the conditions of cultivation, and the data on the functional activity of isolated strains do not allow us to evaluate its manifestations in real conditions of microsymbiocenosis. It seems appropriate to search and/or develop approaches to assessing the functional and metabolic activity of the total microflora, taking into account the clinical picture of the disease. Moreover, the use and creation of new probiotics, which will allow regulating the composition of the microbial community, and hence its functional activity should be recognized as a promising direction for the search for drug treatment.