ISSN (print): 0136-1449, ISSN (online): 2687-1408 Founder: Perm State Medical University named after. ak. E.A. Wagner Editor-in-Chief: Eugene G. Furman, Corresponding Member of the Russian Academy of Sciences, MD, PhD, professor, Frequency / Access: 6 issues per year / Open Included in: Higher Attestation Commission List, RISC
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READ the details online (tap to see in details) Author’s license agreement (public offer) on the publication of an article in a scholarly journal “Perm Medical Journal” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “Perm Medical Journal” (further-the Journal) in accordance with the conditions stated below. I. 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Other rights not directly transferred to the Publisher under this Agreement, including patent rights to any process, method etc., described by the Author in the Article, as well as trademark rights, are reserved for the Author. The territory where the rights to the Article are allowed to be used is the whole world. The validity of this Agreement commences only if the manuscript of the Article is accepted for publication in the Journal and only from the moment of sending a notification of acceptance of the Article for publication to the Author from the official e-mail of the Journal. The rights are granted by the Author to the Publisher free of charge; the publication of the Article in the Journal does not entail any financial deductions to the Author. If the Publisher decides to reject the Submission or refuse to publish the Article in the Journal (i.e., retraction of the published Article), this Agreement becomes invalid. 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Review of methods and techniques to reduce the impact of residual monomer from polymer dental prostheses on the oral tissues and organs
The objective of this review was to systematize the methods and techniques aimed at reducing the impact of residual monomer from polymer dentures on oral tissues and organs. Residual monomer of polymeric materials contributes to the development of allergic and toxico-chemical reactions in the oral cavity. To achieve this aim, we conducted a meta-analysis of modern literary scientific studies of researchers published in both domestic and foreign publications posted on the electronic resources eLIBRARY and PubMed. To provide summarized data on the stated issues, 207 sources were processed, from which 47 publications were selected that were of the greatest interest according to modern concepts. Based on the results of processing the research data of domestic and foreign authors, the following scientific directions were formed: 1) improvement of hygiene products that help to reduce microbial contamination that exposes the surface of orthopaedic dental structures to destructive changes; 2) development of adhesive creams and gels; 3) creation of soft linings; 4) the use of ultrahigh frequency energy, ultraviolet radiation and ultrasound waves to improve the polymerization of the material; 5) the use of supercritical carbon monoxide media to remove soluble substances, residual monomer in particular; 6) modification of the components of polymeric materials; 7) the development of biological coatings that prevent the release of residual monomer. The combination of methods related to the areas mentioned above helps to minimize the concentration of unreacted monomer, improve adaptation, increase the service life of prostheses, which in turn improves the quality of life of this category of people.
Patient registries in clinical practice: the experience of Russia and foreign countries
Cardiovascular diseases and chronic kidney disease are closely related and often occur simultaneously. According to the WHO and Rosstat data, cardiovascular diseases are the leading cause of death, and concomitant chronic kidney disease worsens the prognosis. In Russia, there are registries for chronic heart failure, coronary heart disease, arterial hypertension, and chronic kidney disease. However, their development is uneven: cardiology registries cover more patients, while chronic kidney disease registries mainly record data on dialysis patients. International experience demonstrates the benefits of centralized systems with electronic medical records and analytical tools. In Russia, there are problems with data fragmentation, lack of standards, and manual data entry. An analysis of Russian and international registries of patients with chronic diseases confirms their importance in healthcare. In the Russian Federation, registries for cardiovascular pathologies and arterial hypertension have been established. However, there are some problems, such as nephrology registries covering only patients with end-stage renal disease. Registries are essential for monitoring disease incidence, evaluating the effectiveness of treatment, and identifying risk factors. The implementation of electronic registries simplifies data collection, streamlines the work of healthcare professionals, and enhances the quality of medical care.
Features of the functional and metabolic activity of microorganisms inhabiting the oral cavity
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.
Comparative analysis of the outcomes of cardioneuroablation and pacemaker implantation in cardioinhibitory vasovagal syncope
The objective of this review is to conduct a literature- based comparative analysis of the outcomes of cardioneuroablation and pacemaker implantation in cardioinhibitory vasovagal syncope.
Effectiveness and safety of combination antiretroviral therapy schemes for acute HIV infection
Objective. To conduct a comparative study of efficacy and safety of treatment with nucleoside reverse transcriptase inhibitors (NRTIs) – phosphazide and tenofovir in patients with acute HIV infection. Materials and methods. A comparative study to evaluate the efficacy and safety of domestic drugs phosphazide and tenofovir in combination antiretroviral therapy regimens for acute HIV infection was conducted for 48 weeks in Perm Regional Center for AIDS and Infectious Diseases in 2017-2019. A total of 28 patients, divided into 2 groups, were included into the study. All patients underwent early diagnosis of HIV infection using enzyme immunoassay, immunoblotting, detection of HIV DNA and RNA by polymerase chain reaction (PCR); indicators of cellular immunity were determined – the level of CD4 + lymphocytes, assessment of clinical status before the start of the prescribed combination antiretroviral treatment and after 2, 4, 12, 24, 36 and 48 weeks. Results. High virological, immunological, clinical efficacy and safety of the use of antiretroviral therapy (ART) regimens containing phosphazide or tenofovir in combination with lamivudine and efavirenz in the treatment of the acute stage of HIV infection have been demonstrated. These drugs can be recommended for use in the first-line therapy. Conclusions. The conducted study allows us to recommend the scheme of using phosphazide in combination with lamivudine and efavirenz for the first-line therapy in HIV-infected patients. Further optimization of antiretroviral therapy of HIV infection based on phosphazide involves creation of a combination of fixed doses with a frequency of use once a day for the treatment of HIV/AIDS as new dosage forms.
Poor prognosis in patients with prolonged post-COVID syndrome and predictors of its development
Objective. To assess the incidence of adverse events in patients with prolonged post-COVID syndrome and to determine the predictors of their development. Materials and methods. A two-stage prospective clinical trial was conducted. The first stage was a cross-sectional screening study that identified, over a 3-year period, 305 patients who had had a new coronavirus infection (NCVI) 3 or more months earlier, based on the inclusion and exclusion criteria: 200 with prolonged post-COVID syndrome, 105 without symptoms of long-term COVID-19. The second phase was a prospective observational study, during which all deaths and hospitalizations of patients included into the study were recorded with retrospective evaluation of the data. At the end of the study, to determine the predictors of poor prognosis in patients with prolonged post-COVID syndrome, the patients in this group were divided into 2 subgroups (n=200) depending on the prognosis: the first subgroup included 85 patients with adverse events, and the second one contained 115 patients without adverse events during the observation period. Results. The follow-up period of patients in the study lasted 24.6 [12.4; 47.7] months. Among 200 patients with prolonged post-COVID syndrome, 89 adverse clinical outcomes were detected in 85 (44.5 %) patients, in the group of patients without long-term symptoms of COVID-19, of 105 examined people, 22 adverse events in 22 (21.0 %) patients were revealed. Survival analysis showed no statistically significant differences in the incidence of fatal events between the groups. The frequency of hospitalizations, as well as the frequency of combined mortality and hospitalizations rate, were statistically significantly higher in the group of patients with post-COVID syndrome. It was determined that the development of prolonged post-COVID syndrome in patients who had NCVI increased the relative risk of the need for hospitalizations by 2.110 times, deaths and hospitalizations by 2.197 times. The predictive value of the development of a poor prognosis in patients with prolonged post-COVID syndrome was demonstrated by indicators reflecting the severe course of NCVI in the acute phase, the polysymptomatic presentation of long-term post-COVID syndrome, symptoms of anxiety, depression, cognitive impairments, the presence of a certain comorbid pathology and risk factors with no significant medical history before the verification of prolonged post-COVID syndrome, remodeling of the heart and arteries with high myocardial stress, non-specific inflammation, fibrosis and apoptosis. Conclusions. In patients with prolonged post-COVID syndrome, a high incidence of adverse clinical outcomes is recorded, amounting to 44.5 %, associated with an increase in the need for hospitalizations and the frequency of deaths. Among the 124 parameters, 20 indicators reflecting various demographic, clinical and pathogenetic determinants demonstrated predictive significance of a poor prognosis in prolonged post-COVID syndrome.
Analysis of long-term average pollination periods of birch and cereal grass
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.
Medical and social profile of patients with hypertensive (hypertension) disease with predominant renal involvement according to the dataset data
Objective. To present, on the basis of the dataset, the medical and social profile of patients with hypertensive disease (hypertension) with predominant renal involvement and to consider the diagnostic significance of some biomarkers of this disease. Materials and methods. The analysis of the medical and social profile of 436 patients diagnosed with hypertensive disease (hypertension) with predominant renal involvement was conducted according to the dataset. In our research, combined features by age (18–76 years), sex (male, female), anthropometric (height, weight status, body mass index) and clinical (heart rate, blood pressure, blood creatinine, urinalysis (glomerular filtration rate, protein, density, pH)) characteristics were evaluated. Results. The medical and social profile of patients with hypertensive disease (hypertension) with predominant renal involvement is presented by age groups and sex, including anthropometric, clinical and social characteristics according to the dataset (male and female, respectively: aged 18–34 (25.9 %; 5.7 %), 35–54 (17.2 %;14.9 %), 55–76 (25.7 %; 10.6 %)). The average duration of treatment was 13.8 ± 5.8 days. In our opinion, biomarkers developed on small samples without taking into account the sex and age of patients with this combined pathology require additional research using datasets and artificial intelligence. Conclusions. Large amounts of datasets form the medical and social profile of a patient with a combined pathology, combining the necessary anthropometric and clinical characteristics for the analysis, which allows to integrate information about the patient into artificial intelligence for machine learning and contributes to improving medical care.
Innovative methodology for the comprehensive assessment of population health: integrating classical and trend-based approaches
Objective. To develop a methodology for the comprehensive assessment of public health that integrates both classical and trend-based approaches. Materials and methods. A retrospective analysis of the levels and dynamics of medico-demographic, medico-social, socio-economic and ecological indicators characterizing public health in the Republic of Kazakhstan for the period 2010–2022 was carried out. The study was performed on the basis of systematized official data of the Committee on Statistics of the Ministry of National Economy of the Republic of Kazakhstan (https://stat.gov.kz), statistical collections of the Ministry of Health of the Republic of Kazakhstan "Public health of the Republic of Kazakhstan and the activities of healthcare organizations", "Regions of Kazakhstan". To confirm the regional features of the studied indicators formation, a cluster analysis of 19 regions of the Republic of Kazakhstan was used. The approbation of the developed methodology for the comprehensive assessment of public health was carried out on the basis of an analysis of the determinant factors of public health over 13 years according to the data from statistical collections of the Republic of Kazakhstan using the developed computer program ROSA-1.0 Results. Cluster analysis showed regional differences in the dynamics of health indicators. The presented data of the cluster analysis, which includes all the indicators taken into the study, did not provide a clear result due to the complex interpretation of the obtained combination scheme and interacting indicators. A comprehensive assessment of the health of the regions conducted using the author`s unique methodology ranged from 45.5 to 100 points. This spread confirmed the multidimensional nature of the information, which allows for assessing the well-being of territories both on the basis of the achieved level of indicators, and taking into account the positive or negative dynamics preceding this result. Conclusions. The results of the application of the proposed analysis method made it possible to identify territories with unsatisfactory indicators. This creates the basis for optimizing management decisions in the healthcare sector at both tactical and strategic levels, allowing for targeted improvements in specific parameters.
Dynamics of the key indicators of the oncology service in Perm Krai over a 35-year period (1990–2024)
Objective. To analyze the changes in the key indicators of oncological care for the population in a big industrial region for a 35-year period from 1990 till 2024. Materials and methods. A total of 309,885 patients with malignant neoplasms were registered in Perm Krai over a 35-year period. Due to the extended timeframe and considerable year-to-year variation in most indicators (range: 6–26 %), median values for five-year intervals were used for the analysis. Results. The analysis shows that the incidence of malignant neoplasms increased by 74 % based on median values (average for each five-year period). According to median figures, mortality increased by 6.8 %. over the same period. Conclusions. A decrease in the rate of advanced-stage disease and one-year case fatality was established, alongside an increase in early and active detection rates and a rise in five-year survival. The cancer patient registry (prevalence) has grown by 92.5 % over the last 20 years, from 1,664.6 per 100,000 population in 2005 to 3,165.5 in 2024, compared to the national indicator of 2,887.6 in Russia in 2023.
Blood donors' satisfaction with medical services
Objective. To assess the level of blood donors` satisfaction with the services provided by the Research and Production Center of Transfusiology in Astana for the period from 2022 to 2024 and to formulate recommendations for improving the quality of these services. Materials and methods. The donors` questionnaire included four questions regarding the availability of donor information, the quality of staff work during the manipulations and procedures, the level of staff communication skills and the conditions of stay in the RPCT. To assess the conditions for providing medical services to donors, a scale with the following points was proposed: excellent – 5 points, good – 4 points, normal – 3 points, bad – 2 points, very bad – 1 point. The processing of the survey results was carried out using the functionality of pivot tables in the Microsoft Excel program and descriptive statistics. Results. The final data on the conducted research demonstrate that most of the donors are satisfied with the quality of services provided by the RPCT on the 4 surveyed items: accessability of donor information, the quality of staff work during the manipulations and procedures, the level of staff communication skills and the conditions of stay in the RPCT. However, isolated negative answers which were recorded, allows us to conclude that there are some aspects in the provision of services to donors that can be improved. Conclusions. For further improvement of the availability of donor information, it is recommended to expand information materials, make more active use of digital and social platforms, introduce visual and interactive content, and study the information needs of donors regularly. This will increase satisfaction and attract more regular participants to the donor movement.
Challenges in organizing integrated care for the population in Belarus
Objective. To assess the readiness of the healthcare and social protection systems, non-governmental institutions to implement an integrated approach to the provision of medical care, including medico-social and palliative care, and social services to people in need. Materials and methods. Sociological (questionnaire) and statistical methods were used while conducting the study. The questionnaire “Scaling integrated care in context, SCIROCCO”, developed within the framework of the project “SCIROCCO Exchange EU Capacity Action for integrated care” was used as a research tool. This questionnaire is used in European countries to assess the readiness of the healthcare and social protection systems and non-governmental organizations to implement integrated care. The study involved 325 (79.1 %) employees of healthcare agencies and organizations, 78 (19.0 %) employees of social service institutions, 8 (1.9 %) employees of the Red Cross Medico-Social Service "Dapamoha" of the Belarus Red Cross. Results. There was a statistically significant difference in the average level of assessment of readiness of the healthcare and social protection systems to implement an integrated approach to providing medico-social and palliative care and social services to the citizens in need, depending on the category of workers (Kruskal-Wallis test: H = 22.3; p3 = 0.0001). The highest assessment of readiness to implement an integrated approach was demonstrated by employees of social service institutions, with the median value (Me) reaching 3.2 points (Q25 = 1.6; Q75 = 4.0), the lowest one was shown by healthcare workers (Me = 1.9 points (Q25 = 1; Q75 = 3)). The assessment done by the employees of the medical and social service of the Red Cross was higher than that of the healthcare workers, but lower than that of the employees of social service institutions, and amounted to Me = 2.7 points (Q25 = 1.7; Q75 = 3). Conclusions. The respondents' assessment of the level of readiness of the healthcare and social protection systems to implement an integrated approach to providing medicо-social and palliative care and social services to citizens in need is low and statistically significantly differs depending on the category of workers, which must be taken into account when organizing these types of assistance.
Diagnosis and treatment of the early gastric leak after sleeve gastrectomy in morbid obesity (clinical case)
Morbid obesity is a significant current medico-social problem, and bariatric surgery is a highly effective method for losing weight in individuals with severe obesity. Laparoscopic sleeve gastrectomy is the most commonly performed bariatric procedure. The most formidable complication of this operation is gastric leak. Our report demonstrates the diagnosis and management of early staple line leakage after laparoscopic sleeve gastrectomy. A 34-year-old female patient (BMI 40 kg/m2) underwent laparoscopic sleeve gastrectomy using a calibration bougie 36 F. The failure was suspected on the 2nd day after the operation, but the X-ray examination of the stomach failed to reveal a water-soluble contrast leak outside the gastric wall. The gastric leak was detected on the 3rd day after the procedure on abdominal CT-scan. The abscess was drained on re-laparoscopy. No closure of the insolvency zone and endoluminal stenting of the stomach were performed. The patient maintained fluid intake. On the 7th day after the re-laparoscopy, she was discharged from the hospital in a satisfactory condition with drainage installed in the abscess. On the follow-up examination in 2 weeks, the general condition was satisfactory, the patients got food following the dietary recommendations; fistulography showed a slight leakage of contrast material into the gastric remnant. After another 2 weeks, no contrast material in the gastric lumen was detected on fistulography. In 1 month, no defect of staple line was revealed on esophagogastroduodenoscopy, including insufflation. The used approach allowed us to eliminate the early staple line leakage after laparoscopic sleeve gastrectomy in a relatively short period.
Maria Yakovlevna Podluzhnaya – the founder of the Perm scientific school of public health and healthcare
The article is dedicated to Maria Yakovlevna Podluzhnaya, an outstanding scientist and healthcare administrator, the founder of a public health scientific school, doctor of medical sciences, professor, and teacher. For more than 30 years, she was heading the Department of Social Hygiene and Healthcare Organization at Ye.A. Vagner Perm State Medical University, having trained multiple generations of leaders for medical institutions in the Perm Region and, throughout Russia. 42 dissertations were defended under Professor Maria Yakovlevna Podluzhnaya’s supervision.