ФГБОУ ВО «Тверской государственный медицинский университет» Минздрава России, Тверь Актуальность. При обзоре исследований выявлен малый объем данных о возможном влиянии ходунков на формирование паттерна ходьбы на носках. Гипотезы и цели исследований. В работе рассмотрена гипотеза о формировании аномального двигатель ного паттерна в виде предпочтительного перемещения без опоры на пятку при использовании детских хо дунков. Цель исследования -определение ряда эпидемиологических аспектов использования ходунков, выявление аномального паттерна ходьбы на носках, определение достоверности его связи с ходунками, оценка особен-ностей явления. Материалы и методы. Было проведено три ретроспективных когортных исследования. В выборки включено 749 детей; количество детей в «ходунковых» группах составило 363. В качестве методов выбраны анамнести-ческий опрос родителей по специально разработанным анонимным вопросникам и статистический анализ данных. Результаты исследований. Определено снижение использования ходунков в популяции в течение нескольких лет. Установлены причины использования детских ходунков. Рассчитан относительный риск ходьбы без опоры на пятку в «ходунковых» группах: RR 2 = 3,555 (2,535-4,990 95 % ДИ) и RR 3 = 2,766 (1,178-6,494 95 % ДИ) для второго и третьего исследований соответственно. Выявлен более продолжительный период ходьбы на носках в «ходунковой» группе: М ген. = 14,58 ± 3,49; 11,09-18,07 мес. (95 % ДИ). Установлено увеличение корреляции между ходьбой на носках и ходьбой при помощи детских ходунков при большем времени их использования. Был рассчитан популяционный риск ходьбы на носках в «ходунковой» группе: PAR = 19,647 %. В работе не вы-явлены статические деформации, ассоциированные с использованием детских ходунков. Заключение. Детские ходунки определены как фактор, способствующий формированию паттерна ходьбы на носках. Возможно, ходунки являются этиологическим фактором идиопатической ходьбы на носках.Ключевые слова: детские ходунки; ходьба на носках; идиопатическая ходьба на носках (ИХН); икроножно-камбаловидный комплекс. BABY WALKERS AND THE PHENOMENON OF TOE-WALKING © A.V. Krivova, A.N. SharovTver' State Medical University, Tver' , RussiaBackground. There is limited data in the literature regarding the clinical impact of baby walkers (BWs). Aim. In this study, we examined the hypothesis that the formation of abnormal motor pattern in the form of preferred moving without support on the heel, while using a BW. Objectives. We aimed to determine certain epidemiological impact of the use of infant walkers in order to identify the toe-walking pattern to determine the accuracy of its connection with the walker for estimating the volume and characteristics of the phenomenon. Methods. Three retrospective cohort studies were conducted. All the children included in the sample (n = 749) and 363 infants used BWs. Method selected anamnestic survey of parents on a specially designed, anonymous questionnaires and statistical analysis of data. Results. The study population had been using BWs for several years. The r...

Osteoporosis is a persistent social and medical issue taking into account moral and material losses related to bone fractures occurring against its background. The disease is more frequently examined in women than in men; still, according to EVOS (European Spinal Osteoporosis Study) 13.5 % men older than 50 and 26 % men older than 60 run high risks of fractures in case they have osteoporosis. Risk factors that cause both the disease itself and fractures as its complications have not been examined profoundly, even though men run 1.6 times higher risk of death after a fracture than women. There is an assumption that a reason for this higher mortality is lack of knowledge about risk factors that cause the disease and a fracture as one of its complications. Growing morbidity with osteoporosis among men indicates it is necessary to perform activities aimed at persuading them to pursue healthy lifestyle. Given that, it seems important to assess impacts exerted by smoking and alcohol abuse on risks of fractures among patients with primary osteoporosis bearing in mind prevention of the disease and fractures as its complications. We examined a relation between smoking and alcohol abuse and risks of fractures as osteoporosis markers in 231 patients suffering from primary osteoporosis. We revealed that fractures were authentically more frequent among smoking patients, 90.5 % against 68.1 % (р˂0.001). It was primarily true for fractures of the proximal section in the thigh bone and fractures of vertebral bodies: 20.2 % against 8.8 % and 44.1 % against 27.3 % accordingly. Alcohol abuse also resulted in authentically higher risks of fractures, 89.8 % against 66.2 % accordingly (р˂0.001). Authentic discrepancies were detected only for fractures of vertebral bodies, 43.9 % against 23.6 % accordingly among those who didn't abuse alcohol (р˂0.001). Therefore, we have evidence that there is an authentic relation between smoking and alcohol abuse and risks of fractures of the proximal section in the thigh bone and vertebral bodies. Inclusion of our research results into educational programs may lead to a reduction in frequency of fractures that have the gravest outcomes for health and cause the highest economic losses.

Существенный вклад в рост заболеваемости опорно-двигательного аппарата в последние годы вносит системный остеопороз, который является фактором риска переломов различных костей скелета. Значимость этой проблемы подчеркивается и объявленной Всемирной организацией здравоохранения Декадой костей и суставов (2000-2010 гг.), где остеопороз выделяется как одно из приоритетных заболеваний. Самым серьезным осложнением системного остеопороза являются переломы проксимального отдела бедренной кости. В структуре причин первичной инвалидности переломы этой локализации у лиц старше 50 лет занимают одно из лидирующих мест [7,10,11,15]. В этой связи проведение ретроспективных эпидемиологических исследований частоты переломов проксимального отдела бедренной кости приобретает особую значимость, так как своей конечной целью имеет не только активацию исследований по диагностике, но и организацию лечебнопрофилактических мероприятий в группах риска развития переломов на фоне остеопороза. ЦЕЛЬ ИССЛЕДОВАНИЯИзучить в зависимости от пола и возраста динамику частоты переломов проксимального отдела бедренной кости в городе Твери за период с 1994 по 2004 г.

Amid the COVID-19 pandemic, a large number of patients with joint lesions resistant to nonsteroidal anti-inflammatory drugs (NSAIDs) was encountered in our clinical practice. The article summarizes the positive experience of outpatient therapy of 916 patients (mean age 47.1±11.3 years), including 774 women, with arthritis of various localization, which occurred on average 45.0±7.1 days after a previously transmitted infection caused by SARS-CoV-2. 709 (77.4%) patients used NSAIDs before going to the clinic, the effect of which was absent or insufficient. In this regard, intramuscular injections of betamethasone prescribed to 823 patients were used as the initial therapy (considering the comorbid background and allergy history). During the drug intake, most of the patients had relief of inflammation, pain reduction, improvement of the disease segment function already on the 7th day. In 69.3% of cases, a single-dose administration was sufficient. The obtained results allow drawing preliminary conclusions about the feasibility of using this technique in the complex treatment of reactive arthritis after the SARS-CoV-2 infection. KEYWORDS: coronavirus infection, COVID-19, glucocorticosteroids, nonsteroidal anti-inflammatory drugs, reactive arthritis. FOR CITATION: Yershov V.E., Krivova A.V., Zakharov V.P., Bystrov S.V. Experience of using a systemic glucocorticosteroid as an initial therapy for post-COVID-19 arthritis in outpatient practice. Russian Medical Inquiry. 2021;5(5):252–256 (in Russ.). DOI: 10.32364/2587- 6821-2021-5-5-252-256.

As per various research data, from 42 to 90 % families all over the world use baby walkers. There are some data implying that baby walkers prevent motor skills from their natural development and are to a certain extent dangerous for infants' health. Prevalence of damages associated with baby walkers varies from 7 to 50 % according to different estimations. Our research goals were to determine reasons for application of baby walkers in Russia and their prevalence in Russian families; to assess levels and structure of children injuries caused by baby walkers and their influence on motor development and on walking pattern formation. We performed three cohort pieces of research with pseudo-retrospective design. The overall sampling included 749 children; "baby-walker" groups consisted of 363 infants. We also performed an anamnestic questioning of parents with specially designed anonymous questionnaires. The research was accomplished on typical Russian territories (Rzhev and Rzhev district in Tver' region, population amounts to approximately 60.3 thousand people). We detected that frequency with which baby walkers were applied among children on the examined territories was similar to average frequency detected worldwide and amounted to 62.11 ± 18.5 %. Parents think that basic advantages and reasons for application of baby walkers are as follows: they make a child to develop faster; they keep a baby busy and help to keep it safe; they entertain a baby; it is a tradition. The detected level of injuries caused by baby walkers was relatively low (15.4 %). There were no injuries that require medical aid. Our research didn't reveal any statistically authentic influence exerted by baby walkers on formation of acquired static deformations in infancy. There is also no statistically authentic discrepancy between children from "baby walkers" group and "without baby walkers" group in the examined sampling when they reach the following stages in their development: "standing with a support" and "moving with a support". But on average, children who grew with baby walkers started to walk on their own with a 13-day delay. We detected a statistically authentic strong correlation (p<0.01) between application of baby walkers and risk of tiptoe walking (RR=3.56; CI 2.56-4.99 for 95 % provision). A longer period of tiptoe walking in "baby walkers" group confirms that baby walkers exert long-term negative influence on walking pattern structure. We detected the following additional (attributable) population risk (PAR): absence of walking on one's own, PAR=4.45-5.3 %; tiptoe walking, PAR=19.6-23.4 %. Application of baby walkers in families from the examined population decreased from 52.03 to 43.66 % and it means that active informative campaigns aimed at explaining baby walkers dangers to parents and guardians were quite efficient. It is advisable to perform further research on the matter.