Vol 95, No 6 (2014)
- Year: 2014
- Articles: 31
- URL: https://bakhtiniada.ru/kazanmedj/issue/view/119
Theoretical and clinical medicine
Integral stiffness of arterial system in patients with arterial hypertension of different genesis
Abstract
Aim. To study and comparatively analyze the integral stiffness of arterial system in healthy subjects and in patients with hypertensive heart disease, hypothyroidism associated with arterial hypertension and rheumatoid arthritis associated with arterial hypertension. Methods. The study included 32 healthy volunteers and 178 patients with arterial hypertension, including 63 patients with hypertensive heart disease of 1-3 degree, 82 patients with hypothyroidism associated with arterial hypertension, 33 patients with rheumatoid arthritis associated with arterial hypertension. All patients underwent echocardiography; modulus of volume elasticity (MVE), pulse pressure, mean arterial pressure (MAP), total peripheral vascular resistance (TPVR), and MVE/TPVR ratio were calculated. The stiffness of arterial system was considered the main component if MVE/TPVR ratio exceeded 1; if MVE/TPVR ≤1, TPVR was considered the leading component. Results. Patients with arterial hypertension had higher rates of stiffness of arterial system in comparison with control group by MVE and pulse pressure. In control group, 87.5% persons had prevalence of TPVR, and in 12.5% arterial stiffness prevailed. In 77.8% of patients with hypertensive heart disease prevalence of TPVR was found, and in 22.2% arterial stiffness prevailed. In patients with combination of rheumatoid arthritis and hypertension arterial stiffness prevailed, while patients with combination of hypothyroidism and hypertension had higher TPVR. Conclusion. All patients with combination of rheumatoid arthritis and hypertension had arterial stiffness prevailing over TPVR. In patients with hypothyroidism associated with arterial hypertension TPVR prevailed over arterial stiffness.
Kazan medical journal. 2014;95(6):781-785
781-785
Sexual activity significance for male gender self-identity after surviving myocardial infarction
Abstract
Aim. To study the influence of sexual activity for male gender self-identity in patients after surviving myocardial infarction. Methods. Original Clinical Structured Interview, «Gender Differential», «The Hospital Anxiety and Depression Scale» (HADS), «The Method for Diagnosing the Types of the attitude to an Illness» were used as the research methods. The study included 130 in-patients (mean age 53.5±7.09 years) who were undergoing rehabilitation for survived myocardial infarction in the department of cardiologic rehabilitation of the Municipal clinic №40 of Kurortny administrative district of Saint-Petersburg, Russia. A model of short-term psycho-corrective program for sexual rehabilitation for male patients who survived myocardial infarction was developed. The effectiveness of the program was estimated by a comparison of results in experimental (30 patients) and control (30 patients in whom sexual aspects were not incorporated in rehabilitation) groups. Results. At structured interview, over a half of all subjects (62.2%) highly estimated the importance of sexual relations, considering them as an essential part of life and a delight. The large majority of the questioned patients (76.9%) reported the desire for renewing sexual activity after the disease. Psychosexual characteristics for male patients, who survived myocardial infarction, were: predominance of male identity (75.4%) and particular features of relation to own sexual activity after the disease, manifesting as a decrease of gender self-satisfaction (53.8%). Addition of psycho-correction program of the sexual rehabilitation to the conventional treatment of male patients who survived myocardial infarction contributed to the positive results observed in the experimental group. Conclusion. Rehabilitation of patients after myocardial infarction requires new approaches, including those considering aspects of sexual rehabilitation; classes for better restoring of sexual activity, being added to conventional program of rehabilitation, increased the number of persons with balanced attitude to disease.
Kazan medical journal. 2014;95(6):785-790
785-790
Clinical and metabolic status index as an indicator of complex treatment efficiency in patients with type 2 diabetes mellitus
Abstract
Aim. To study the performance of clinical and metabolic status index for estimating the results of treatment in patients with type 2 diabetes mellitus by monitoring their condition. Methods. Treatment results of 70 patients with type 2 diabetes mellitus (28 females, 42 males) were analyzed. Body height and weight, body mass index, systolic and diastolic pressure (while seated) were measured in all patients. Mean arterial pressure was calculated using systolic and diastolic pressures. Clinical and metabolic status index (CMSI) was defined as following: CMSI=а1х1+а2х2+а3х3+а4х4, where x1 - body mass index; x2 - blood glycated hemoglobin level; x3 - mean arterial pressure; x4 - MM-atherogenic index of plasma; a1-a4 - discriminant factors. Results. Baseline value of clinical and metabolic status index in female patients ranged between 45.8 to 70.2 (mean value 53.8±5.69), at the end of the study it ranged from 41.3 to 56.3 (mean value 47.8±3.86, р <0.001). In male patients, baseline value of clinical and metabolic status index ranged from 58.1 to 82.2 (mean value 68.8±6.08), endpoint value - from 54.0 to 66.8 (mean value 47.8±3.86, р <0.001). Conclusion. Developed clinical and metabolic status index allows to make comprehensive estimation and monitoring of the course of type 2 diabetes mellitus.
Kazan medical journal. 2014;95(6):791-794
791-794
Clinical effectiveness of reamberin in treating outpatients with chronic obstructive pulmonary disease
Abstract
Aim. To investigate the clinical effectiveness of meglumine sodium succinate in treating patients with chronic obstructive pulmonary disease in an outpatient setting. Methods. 93 patients with chronic obstructive pulmonary disease were examined. The influence of 3-month combined treatment with long-acting M-anticholinergic drug (tiotropium bromide), combination of salmeterol and fluticasone (Seretide) and antihypoxant drug - meglumine sodium succinate (Reamberin) in combination with breathing exercises on functional parameters of respiratory, cardiovascular system and quality of life was studied. Results. Signs of deceased pulmonary ventilation due to obstruction were revealed. Pulmonary hypertension and decreased right ventricle diastolic function were diagnosed in 89% of patients. Patients taking meglumine sodium succinate (Reamberin) showed statistically significant improvement of functional indices of respiratory and cardiovascular systems, as well as better quality of life after the treatment. In patients who were not taking meglumine sodium succinate, those changes were less prominent. Conclusion. Adding meglumine sodium succinate (Reamberin) to complex treatment of patients with chronic obstructive pulmonary disease supports the improvement in pulmonary function and macrocirculation, which demonstrates the improvement of pulmonary gas exchange function and improves quality of life.
Kazan medical journal. 2014;95(6):795-800
795-800
Clinical course of neurological disorders in experimental hemorrhagic stroke after treatment with interleukin-2 (ronkoleukinum)
Abstract
Aim. To study the influence of recombinant interleukin-2 (Ronkoleukinum) on indicators of oxidative protein modification and severity of neurologic signs in rats with experimental hemorrhagic stroke. Methods. Oxidative protein modification (by aldehyde and carboxyl products), the survival rate, neurological deficit by McGrow Stroke-index and animal psychophysiological status were studied on the model of intracerebral hemorrhage in rats after treatment with 0.01 mg/kg of interleukin-2 (Ronkoleukinum). Results. The progression of experimental hemorrhagic stroke in rats was accompanied with typical pathophysiological signs - oxidative protein modification with following neurological and cognitive disorders, followed by death of experimental animals. Administration of interleukin-2 (Ronkoleukinum) 0.01 mg/kg hampered the processes of free radical proteins damage, therefore decreasing the mortality rate in animals with intracerebral hemorrhage. Animals that were administered interleukin-2 (Ronkoleukinum) died only during the first 24 hours after the stroke, with mortality rate significantly lower compared to controls starting form the 4th day of the experiment (р <0.05). The use of interleukin-2 (Ronkoleukinum) also statistically significantly decreased the severity of post-ischemic behavioral, neurological and cognitive disorders, improving the movement activity, psychoneurological status assessed by McGrow scale, stabilizing the memory and passive avoidance reflex recovery. Conclusion: interleukin-2 (Ronkoleukinum) can effectively prevent the formation of post-stroke neuronal disorders, so its use as a nosotropic nootropic agent seems to have a good perspective.
Kazan medical journal. 2014;95(6):801-806
801-806
Cardiac masses due to tumors (diagnosis, clinical manifestations and surgical treatment)
Abstract
Aim. To summarize the experience on the diagnosis and surgical treatment of primary benign and malignant cardiac tumors. Methods. The paper describes 37 clinical observations of endocavitary primary benign and malignant cardiac tumors: 26 (70.3%) cases of cardiac myxoma, 5 (13.5%) - rhabdomyosarcoma, 2 (5.4%) - angiosarcoma, 1 (2.7% ) - leiomyosarcoma, 1 (2.7%) - fibrosarcoma, 1 (2.7%) - liposarcoma. Patients were 15 (40.5%) males and 22 (59.5%) females aged 18 to 65 years. Endocavitary cardiac tumors were diagnosed by noninvasive tests: echocardiography, computed tomography, magnetic resonance imaging. Results. Patients with primary benign and malignant cardiac tumors had variable clinical manifestations. Symptoms of astenoneurotic syndrome, auscultatory and cardiophonographic signs simulating acquired or congenital valvular heart diseases, which often have a positional relationship; low-grade fever of unknown origin, weight loss were registered. Paraneoplastic syndrome was characterized by an increase in erythrocyte sedimentation rate, leukocytosis, monocytosis, dysproteinemia, polycythemia, hypochromic anemia, increased levels of C-reactive protein. Surgical excision of 25 cardiac myxomas and 8 malignant tumors of the heart was performed with cardiopulmonary bypass, pharmacological cardioplegia and general hypothermia. In 1 case the tumor resection was combined with coronary artery bypass grafting. In 3 patients suffering from malignant tumors, explorative thoracotomy was performed. Surgical revision, emergency and planned microscopic studies of removed cardiac tumors allowed to establish the final clinical diagnosis. Hospital mortality among patients operated for cardiac myxomas was 4.0%, for cardiac malignant tumors - 27.3%. Conclusion. Timely surgical treatment of patients with primary cardiac benign tumors (myxomas) leads to recovery and is accompanied by a relatively low mortality; better results of patients with cardiac endocavitary tumors treatment depend on the early detection and timely radical surgical excision.
Kazan medical journal. 2014;95(6):806-810
806-810
Experience of surgical treatment of internal postoperative complications after median sternotomy
Abstract
Aim. To assess the results of treatment in patients with deep postoperative complications after median sternotomy. Methods. The study included 33 patients: 25 males and 8 females (mean age 58.63±6.29 and 60.3±12.9 years, respectively). X-ray, helical computed tomography of the chest, sternum and anterior mediastinum ultrasound, echocardiography, pulmonary function test, bacteriology, clinical and laboratory tests were used to assess pre- and post-operative conditions of the patients. Fistulography and sternum scintigraphy with 99mTc-technetril were performed if necessary. Complications included anterior mediastinitis, sternal osteomyelitis, sternal diastasis, chest bones instability and sternal fragmentation. Some patients also developed superficial wound infection together with internal complications. The first stage of treatment included secondary surgical debridement, metal suture osteosynthesis, surgical sternal reconstruction by titanium nickelide plexiform tubulous implant and VRAM flap thoracomyoplasty. Results. Secondary surgical debridement was performed as the first stage of treatment in 51.51% patients (n=17) including 29.4% patients who were operated for the second time. Metal suture osteosynthesis as step 1 surgery was performed in 33.3% of patients (n=11); 54.5% of patients (n=6) were re-operated. Metal suture or clamp osteosynthesis did not lead to the sternal reconstruction in 80% of cases. Chest surgical reconstruction by titanium nickelide implants as step 1 surgery was performed in 12.12% of patients (n=4) resulting in chest stabilization, sternal diastasis elimination, and correction of sterno-mediastinitis. VRAM flap thoracomyoplasty was performed in 1 patient. Conclusions. The step-wise approach surgery was preferable (step 1 - secondary surgical debridement and antibiotics, step 2 - surgical sternal reconstruction). Sternal reconstruction by titanium nickelide implants is indicated for treating patients without severe sternal fragmentation and offers good early results.
Kazan medical journal. 2014;95(6):811-816
811-816
Rationale for effectiveness of a new method of radial sphincterotomy during obstruction of extrahepatic bile ducts
Abstract
Aim. Determination of the effectiveness of the improved method of sphincterotomy in choledocholithiasis, called radial sphincterotomy. Methods. Analyzed were results of 38 operations performed by endoscopic retrograde cholangiopancreatography in patients with a diagnosis of choledocholithiasis. In the first group (23 patients) performed a standard sphincterotomy, in the second group - radial sphincterotomy. 21 patients of the first group had gallstones up to 20 mm, 2 patients - more than 20 mm; in 6 patients (out of 15) of a second group gallstones sizes exceeded 20 mm, the other patients had stones sizes 15-20 mm. Results. The technique developed radial sphincterotomy allows multiple incisions towards 11, 12 and 13 hour clock directions. Thus, the main incision can be made to the transverse folds, and other radial incisions should be carried out below it, not going beyond the proposed location of the intramural common bile duct. Anatomical and mathematical justifications of the method of radial sphincterotomy were presented. Depending on the cut and shape of papillae, the severity of the upper transverse folds defining a safe distance from the hole until it papillae, performed lateral radial incisions, thereby achieving an increase of sphincterotomy cut altogether. Neither group registered death. In 2 (8.7%) patients of the first group bleeding occurred during the procedure, after the operation pancreatitis has developed in 1 (4.3%) patients in first group and in 1 (6.7%) patients in the second group. Conclusion. The proposed technique of radial sphincterotomy is a safe way to increase the area of dissected papillae to provide high efficiency for removal of large gallstones.
Kazan medical journal. 2014;95(6):816-821
816-821
Diagnosis and surgical treatment of heart valve non-mixoma tumors
Abstract
Aim. To study the clinical, diagnostic, surgical and morphological features of non-mixoma primary tumors of the heart valves, the possibilities of their early diagnosis and to develop an optimal surgical approach. Methods. The surgical treatment of 331 patients with tumors of the heart was analysed, of which 45 (13.6%) were radically distant primary tumors of the heart valves including 33 (73.3%) myxoma and 12 (26.7%) non-myxoma tumors. Among considered in this study 12 non-myxoma tumors 9 cases were papillary fibroelastoma, 1 - neurolemmoma, 1 - lipoma, 1 - fibroma. Results. The leading non-invasive preoperative diagnostic procedures for non-myxoma primary tumors of the heart valves were transthoracic and transoesophageal echocardiographic studies, the sensitivity of which were 91.7 and 100% respectively. In unclear cases, a computer and magnetic resonance imaging were used. Additionally, electrocardiography, phonocardiography, radiological methods were performed, clinical and biochemical blood tests were analysed. Intraoperative revision and morphological verification ensures the establishment of tumors final clinical diagnosis. Patients with non-myxoma tumors of the heart valves had polymorphic symptomatic picture which included circulatory failure, false angina, arrhythmias, clinical signs imitating heart defects, embolic syndrome, dizziness and/or syncope, causeless fever. Surgical removal of the 12 non-myxoma tumor was performed by cardiopulmonary bypass and pharmacological cold cardioplegia, in 4 cases, the intervention combined with the replacement of the affected valves by artificial prostheses, in 1 case - coronary artery bypass grafting. Hospital mortality of patients was zero. Quality of life of operated patients was rated as good in 9 (75%) patients, satisfactory - in 2 (16.7%), unsatisfactory - in 1 (8.3%) patients, which was due to the death of the patient 13 months after removal of neurolemmoma in connection with multiple metastasis in the brain and spinal cord. Conclusion. Timely surgical intervention helped to stabilize the functional state of the patients, to create a favorable prognosis to improve the quality of life and increase its length.
Kazan medical journal. 2014;95(6):821-830
821-830
Indices of physical activity, quality of life and psychological characteristics in patients with amputated lower limb
Abstract
Aim. To study the physical activity in disabled patients who underwent an amputation of the lower limb in a late period of rehabilitation and prosthetics. Methods. The study included patients with structural and functional disorders of limbs. 308 patients aged 18 to 66 years were randomly selected to participate in the study as they were referred to Prosthetic and orthopedics center «Reabilitaciya invalidov», Kazan, Russia from 2008 to 2010. Patients were allocated to five age groups: 19 to 29 years, 30 to 39 years, 40 to 49 years, 50 to 59 years old and older than 60 years. Activity level, depending on the motor capacity was investigated in 308 patients who were offered prosthetics according to the classification subdividing locomotor activity on five levels. SF-36 questionnaire (quality of life), Spielberger-Hanin reactive and personal anxiety scales, Beck Depression Inventory, the Mehrabian Achieving Tendency Scale, Smisek-Leonhard characterological test were administered. Quality of lower limbs prostheses were assessed by «TWO LEGS» prosthesis evaluation questionnaire on a 5-point scale. Results. The majority of patients who were at the remote stage of rehabilitation after prosthesis had high level of physical activity - 141 (45.7%) patients, average activity level - 81 (26.2%) patients, reduced level of activity - 63 (20.5%) patients. High level of physical activity, depending on the locomotor activity, was more typical for the second (20-29) and third (30-39 years) age groups - 60 and 54%, respectively. Very high and high levels of physical activity was equally observed in patients with one and both amputated both lower legs: 8.4 and 7%, respectively. Conclusion. Level of amputation, age and psychological characteristics, as well as prosthesis quality and the term of prosthesis use were essential for motor activity, quality of life and functional independence of the disabled with structural and functional of the lower limb disorders.
Kazan medical journal. 2014;95(6):830-835
830-835
Clinical significance of regulatory antibodies content evaluation in pregnant women with fetal growth retardation
Abstract
Aim. To identify the possibility of fetal growth retardation prediction at early stages of pregnancy by revealing changes in the content of some regulatory autoantibodies. Methods. A comprehensive examination of 388 pregnant women at risk of gestational complications was performed. After standardization of groups 185 pregnant women were selected for the analysis. Out of these, 80 patients with fetal growth retardation were included into the main group, 80 matched pairs were selected from the group of pregnant women at risk of fetal growth retardation (comparison group). The control group consisted of 25 healthy pregnant women with physiological pregnancy and childbirth. Patients with fetal growth retardation were divided into three subgroups. The first subgroup consisted of 40 pregnant women with grade I of fetal growth retardation, 24 pregnant women with grade II of fetal growth retardation formed the second subgroup, and 16 pregnant women with grade III of fetal growth retardation were included into the third subgroup. Along with the standard methods of examination the serum levels of regulatory class G antibodies binding with double-stranded deoxyribonucleic acid, β2-glycoprotein, total phospholipids, human chorionic gonadotropin, collagen, pregnancy-associated plasma protein-A, insulin, and the level of anti-neutrophil cytoplasmic antibodies, on the dates of 11-14 and 26-28 weeks of pregnancy. Results. The peculiarities of the regulatory autoantibodies content in pregnant women with fetal growth retardation and in women at risk of this condition were revealed. Pregnant women with grade I and II of fetal growth retardation had higher values of autoantibodies, whereas severe forms of fetal growth retardation were characterized by diverse changes of the examined regulatory autoantibodies with a predominance of low values. In case of pregnant women at risk of fetal growth retardation changes in the content of regulatory autoantibodies were diverse. Conclusion. The revealed changes in the content of regulatory autoantibodies can be used for prediction of fetal growth retardation in pregnant women.
Kazan medical journal. 2014;95(6):836-840
836-840
Treatment of chronic urogenital infection in woman using the methods of extracorporeal blood correction
Abstract
Aim. To study of the effectiveness of treatment of patients with chronic urogenital infection by antibiotic therapy and extracorporeal immunotherapy. Methods. Clinical, microbiological, immunological and statistical methods were used. The main group consisted of 70 women with chronic urogenital infection previously treated with conventional treatment. Women received the extracorporeal antibiotic therapy and immunotherapy using moxifloxacin and metronidazole in combination with local therapy - suppositories with chlorhexidine, metronidazole and miconazole. For antibiotic and extracorporeal immunotherapy selected leukocyte cell suspension was incubated with an antibiotic and was stimulated by leukinferon and then was returned to the patient. In a control group patients received conventional drug treatments, ornidazole administered in conjunction with local therapy. When mixed infection was diagnosed josamycin additionally was administered. The diagnosis was verified by means of the polymerase chain reaction, bacteriological and microscopic methods. Results. The main complaints of the patients were excreta from the genital tract, itching, burning. The results of treatment were evaluated at 2 weeks, 1 and 2 months. After 2 weeks, in the main group more rapid regression of clinical manifestations and the improvement of the general state were registered, in the control group the symptoms persisted in more than 50% of women. After one month there were no complaints in the main group, while in the control group, the symptoms persisted in 30% of patients. After 2 months, patients of the main group had no complaints, but 0.4% had leukocytosis in the smear and marked growth of Trichomonas. In the control group excreta was maintained in 6.7%, positive culture on Trichomonas registered in 3.3% of patients. Conclusion. Our research indicates the clinical efficacy of extracorporeal antibiotic therapy and immunotherapy in the treatment of chronic urogenital infections compared with traditional methods, it promotes more rapid bacterial eradication and relief of the inflammatory process.
Kazan medical journal. 2014;95(6):841-848
841-848
Clinical and epidemiological factors of internal diseases in females of reproductive age
Abstract
Aim. To identify the factors of internal and nutrition-related diseases in females of reproductive age. Methods. A comprehensive general physical examination of 383 pregnant women aged 16 to 46 years old with the following internal diseases at pregnancy: gestational arterial hypertension (n=183), essential arterial hypertension (n=66), obesity (n=134) was conducted. Control group consisted of 153 pregnant women without any signs of internal diseases. Results. Combination of social and demographic, psychosomatic and inherited factors may define the risk of neurohormonal mechanisms deregulation, obesity, and type of arterial hypertension. Females with internal diseases had significantly lower level of physical activity compared to females of the control group. The largest number of long-term and heavy smokers was revealed in groups of female patients with gestational and essential arterial hypertension, patients with obesity and mature nulliparous women. Multivariate analysis showed that income level and physical activity of pregnant women have a significant impact on excessive fat body mass in pregnant women during gestation and before it. No statistically significant relationships between educational level and body mass index before pregnancy and at gestation were found. Conclusion. Factors influencing the risk for internal and nutrition-related diseases in females of reproductive age were: (1) the increased demand for nutrients and energy in developing placenta-fetus system, leading to irrational nourishment; (2) decreased body reserves, caused by repeated pregnancies and childbirth; (3) smoking; (4) social and economic status; (5) living area; (6) hereditary factors and constitutional features.
Kazan medical journal. 2014;95(6):848-852
848-852
Prognostic significance of immunohistochemical expression profiles of some antigens in cervical cancer
Abstract
Aim. To evaluate the prognostic significance of immunohistochemical expression profile of some antigens in patients with cancer of the cervix. Methods. Analysed was the data of primary medical records (medical history and hospital records) and information of the Belarusian Cancer Registry of the 100 women who received special treatment in the Republican Scientific and Practical Centre of Oncology and Medical Radiology named after Alexandrov and in Grodno Regional Clinical Hospital. Histological and immunohistochemical studies of the content of markers Ki-67, Her2/neu, Bcl-2 and p53 in tumors (archival paraffin blocks) were performed. Results. Low level of expression of Ki-67 was detected in 44, moderate - in 19, high - in 37 of patients. Low levels of expression of the mutant p53 protein was detected in 44, moderate - 16, high - 29 of women. Low level of expression of Bcl-2 antigen was found in 92, moderate - in 6, high - in 2 patients. The absence of relationship between the level of the protein HER2/neu and stage cervical cancer was showen. The most prognostic significance had the proliferative activity (the proportion of Ki-67-positive cells), since an increase of this index by 1 unit decreased overall survival observed in 0.9884 times. Multivariate analysis of the cumulative impact of the studied oncogenes on overall survival observed in view of the degree of spread of the tumor process has allowed to develop a formula for calculating the risk of disease progression in a specific clinical observations. Conclusion. The expression of markers Ki-67, p53, Bcl-2, in conjunction with the degree of tumor spread are prognostic criteria of cervical cancer.
Kazan medical journal. 2014;95(6):852-858
852-858
Peculiarities of cerebral blood flow in patients with chronic diffuse liver diseases of viral etiology
Abstract
Aim. To study the features of cerebral blood flow at different structural and functional levels of the brain vascular system in patients with chronic hepatitis and cirrhosis of viral etiology. Methods. A comprehensive ultrasound examination of the brain vascular system using an algorithm of cerebral arterial and venous blood flow examination based on the concept of the brain vascular system construction considering five structural and functional levels was performed in 65 chronic viral hepatitis patients and 61 patients with liver cirrhosis of viral etiology. The examination of the main brain arteries was performed using duplex scanning ultrasound SSD-5500 scanner («Aloka», Japan) with 5-12 MHz linear transducers. Examination of intracranial vessels was performed by transcranial color duplex scanning using ultrasonic SSD-5500 and «Sonoline G60» scanners («Siemens», Germany) with linear and phased 2.1-2.5 MHz transducers. Control group consisted of 50 healthy persons. Results. Remodeling of the cerebral arteries: the expansion of the lumen of the main cerebral vessels, reduction of blood flow in the carotid and middle cerebral arteries, decreased elasticity and increased vascular wall rigidity and, as a consequence, a change in vascular resistance and cerebral blood flow disturbance occurs in patients with chronic viral liver diseases. Identified changes of blood flow parameters at all levels of structural and functional brain perfusion indicate the presence of cerebral microangiopathy and arteriopathy based on the development of arteriosclerosis of main arteries and all penetrating arteries and arterioles in patients with chronic diffuse liver diseases. Conclusion. Adaptive remodeling of the vascular wall of the main cerebral arteries which provides an adequate regulatory response is found in patients with hepatitis B and C-associated liver cirrhosis. The reduction of blood supply to the brain, depletion of functional vascular reserve and development of intracranial venous circulatory distress are seen in patients with liver cirrhosis associated with viral hepatitis.
Kazan medical journal. 2014;95(6):859-865
859-865
Changes in quality of life in adolescents as an indicator of treatment efficiency
Abstract
Aim. The research is targeted for estimating quality of life in adolescents with different types of tuberculosis. Methods. Quality of life in 30 adolescents aged 13-17 years was evaluated using Pediatric Quality of Life Inventory - PedsQL questionnaire. Parents were evaluated separately. An initial level of a quality of life before the treatment initiation and quality of life right after in-patient treatment completion (56 days) were compared. Results. Adolescents had pessimistic and emotionally limited subjective estimations of their clinical condition and its influences on all types of activities. The change in Pediatric Quality of Life Inventory scores (49.4±2.1 before treatment, compared to 51.9±2.0 after treatment) confirmed that recreation and treatment of tuberculosis significantly raised the subjective scores for all aspects of patient’s quality of life. Quality of life indicators by different functional scales were higher if assessed by parents compared to patients themselves (p <0.001). Parents were sure in positive influence of the prolonged course of the specific treatment on «school life» scale parameters. Comparative assessment of quality of life trend showed that improvement after treatment was observed according to assessment both by parents and patients themselves. All quality of life indicators were higher in female patients (score of all types of activities - 55.7±2.7 points) compared to males (48.3±2.8 points). Conclusion. Revealed trends confirm the need for performing recreational, medical, social, rehabilitative actions and psychosocial correction considering the age features of adolescents, their subjective estimations and functioning in a hospital.
Kazan medical journal. 2014;95(6):866-869
866-869
Ultrasound for breast condition monitoring in females using levonorgestrel-containing intrauterine systems for 5 years
Abstract
Aim. To assess the breast condition in females using levonorgestrel-containing intrauterine system (20 μg) for 5-year period, by repeated ultrasound monitoring. Methods. Results of regular clinical examination and breast ultrasound repeated during 5 years of follow up in 118 women aged 30 to 55 years, continuously using levonorgestrel-containing intrauterine system (20 μg) for 5-year period, were analyzed. Results. According to the results of 5-year sonographic monitoring of breast condition in females using levonorgestrel-containing intrauterine system, breast cancer was diagnosed in 2 (1.7%) patients during the first 6 months of the research; no other cases were discovered during the subsequent follow-up. Fibroadenoma of the breast was diagnosed in 3 (2.5%) women, which was lower compared to statistical prevalence in general population (5%). By the end of the follow-up period, no mammary gland adenosis foci were found at ultrasound. The number of patients with breast cysts decreased, as well as the number of breast cysts in single patient, which were found in 41 (34.7%) female patients before the treatment and in 13 (11.0%) patients after a year of treatment with levonorgestrel-containing intrauterine system. No mammary gland dilatation was diagnosed before levonorgestrel-containing intrauterine system was administered, during the first year of treatment it was revealed in 16 (13.5%) patients. According to the results of ultrasonography, maximal size of fibrous glandular complex after 5 years of treatment was 16.2 mm, mean - 10.2 mm (before the treatment - 18.2 and 14.2 mm respectively, after 1 year of treatment - 17.4 and 13.3 mm respectively. Conclusion. The use of levonorgestrel-containing intrauterine system was associated with favorable effects on breast condition. No adenosis foci were further found, the number of patients with mammary gland cysts decreased as well as the number of the cysts, the fibrous glandular complex thickness has decreased, revealing the downward trend for breast focal masses formation.
Kazan medical journal. 2014;95(6):870-874
870-874
Experimental medicine
Experimental rationale for colocolonic anastomosis formation by a compression suturing device
Abstract
Aim. To experimentally compare the durability and biological integrity of compressional and manually made anastomoses, and to find out morphological features of their regeneration. Methods. Experimental studies were performed on 54 non-pedigree dogs of both gender and on autopsied specimens in prosectorium. Colocolonic anastomoses were formed by compression suturing device, Ziganshin-Gunter device, compression anastomosis device, and manually. Results. Compression anastomoses had higher durability compared to manual sutures (р <0.05). A test for microbial penetration showed only minimal signs of bacterial contamination of colocolonic anastomoses made by compression suturing device. Bacterial contamination of colocolonic anastomoses performed by compression anastomosis device and compression suturing device, was significantly less common compared to anastomoses formed by Ziganshin-Gunter device and manually (р <0.05). Examination of compression anastomoses morphogenesis revealed that healing of colocolonic anastomoses is accompanied by homogenous standard morphologic pattern. No scarring occurs due to absence of inflammation and low amount of connective tissue at the anastomosis region. Study of colocolonic anastomoses formation by compression devices on an autopsied specimens confirmed the opportunity for anastomosis formation on any part of colon. Conclusion. Compression colocolonic anastomosis formed by compression suturing device is characterized by low bacterial permeability, provides good durability and does not cause scarring in the anastomosis region. Revealed advantages of compression colonic suture allow recommending it for clinical use.
Kazan medical journal. 2014;95(6):875-881
875-881
Influence of interleukin-1 receptor antagonist on dynamics of the glutathione system, energy metabolism and oxydative protein modification in experimental hyperglycemia
Abstract
Aim. To study the dynamics of glutathione system, energy metabolism and the oxidative protein modification indicators in rat brain tissue in case of experimental diabetes mellitus and use of metabolic action cerebroprotector Piracetam + Thiotriazoline (Tiocetam) and cytokine medication - recombinant interleukin-1 receptor antagonist. Methods. Studies were conducted on 40 white Wistar rats, divided into four groups of 10 animals each. First group - intact animals, second - animals with experimental diabetes mellitus, the third - animals with diabetes mellitus treated with Piracetam + Thiotriazoline (Tiocetam) administered at a dose of 500 mg/kg, the fourth - animals with diabetes mellitus treated with recombinant interleukin-1 receptor antagonist at a dose of 7.5 mg/kg. Experimental diabetes mellitus was induced by injection of an aqueous solution of alloxan monohydrate. Blood glucose concentration was measured on the 11th day after alloxan injection. Brain tissue specimens were used for biochemical studies. Statistical data analysis was performed using the Statistica 6.0 software package, the comparative analysis in the groups was performed using ANOVA. Results. The development of hyperglycemia in experimental animals was accompanied with glutathione system destabilization (increased levels of oxidized glutathione along with a marked decrease in its reduced form, glutathione peroxidase and glutathione reductase activity). Ischemic lesion of the brain tissue of animals with experimental diabetes mellitus was characterized with an increase of markers of oxidative protein modification (aldehyde and carboxyl products) and energy deficit in brain homogenate. Treatment with Piracetam + Thiotriazoline (Tiocetam) and interleukin-1 receptor antagonist contributed to the normalization of the glutathione peroxidase and glutathione reductase activity, stabilization of energy phosphates and indicators of oxidative protein modification. Maximal activity was observed in case of interleukin-1 receptor antagonist. Conclusion. The activity of the interleukin-1 receptor antagonist in terms of glutathione system stabilization and inhibition of oxidative and nitrozilizing stress manifestations exceeds those of Piracetam + Thiotriazoline (Tiocetam).
Kazan medical journal. 2014;95(6):881-887
881-887
DNA repair profile in gastrointestinal stromal tumors (gists) - novel perspectives for therapy
Abstract
Aim. To assess the expression of various types of DNA repair proteins in gastrointestinal stromal tumors (GISTs) to identify the possible defects in DNA repair pathways and therapeutic targets. Methods. The study was performed on the human fibroblasts, imatinib-sensitive vs imatinib-resistant GISTs and leiomyosarcomas (LMS) cell lines, as well. The cell lines indicated above were cultured in the corresponding culture medium supplemented with fetal bovine serum, L-glutamine and antibiotics (37 °C и 5% СО2). Protein expression level and its intracellular localization were assessed by Western blotting. Results. The reduced BRCA1 expression was observed in most of the GIST cell lines, which was associated with an up-regulation of Rad51, thereby indicating about the potential abnormalities of homologous recombination pathway in these cells. This phenomenon was typical for GISTs and was not observed in LMS cells lines. In contrast to LMS cell lines, all GIST cells showed an upregulation of O6-methylguanine DNA methyltransferase (MGMT), the key enzyme involved in alkylated DNA damage repair pathway. Most GIST cells exhibited high level of MSH6 known as a key member of mismatch repair pathway. Most notably, topoisomerases were over-expressed in all of GIST cell lines. Conclusions. We found several striking alterations in expression levels of DDR pathway enzymes in GISTs. For instance, an up-regulation of topoisomerases in all GISTs indicates that these cells might be sensitive to topoisomerase II inhibitors and could be potentially targeted therapeutically.
Kazan medical journal. 2014;95(6):888-891
888-891
Healthcare mangement
Indicators of primary disability due to musculoskeletal and connective tissue diseases in Russian Federation and Volga federal district in 2011-2013
Abstract
Aim. To distinguish the regularities for primary disability occurrence due to musculoskeletal and connective tissue diseases in Russian Federation and Volga Federal District in 2011-2013. Methods. Data copying, comparative analysis of indicators of primary disability due to musculoskeletal and connective tissue diseases in Russian Federation, and federal districts ranking by level of disability due to musculoskeletal and connective tissue diseases in 2011-2013 were performed. Results. Central Federal District of Russian Federation had a high level of primary disability due musculoskeletal and connective tissue diseases registered in 2011-2013. Southern, North-Caucasian and Volga Federal Districts had low levels of disability due to the same diseases. Among the subjects of the Russian Federation included in the Volga Federal District, high levels of primary disability due to musculoskeletal and connective tissue diseases in 2011-2013 were registered in the Kirov region (17.1-15.3-11.1 per 10 000 of the adult population), low levels of primary disability - in the Saratov region (4.1-3.4-3.5 per 10 000 of the adult population). Conclusion. The trend for reducing the primary disability in the Volga Federal District in 2011-2013 (6.6-6.3-5.9 per 10 000 of the adult population) indicates the success of regional rehabilitation programs for persons with disabilities.
Kazan medical journal. 2014;95(6):892-896
892-896
Reviews
Role of connective tissue dysplasia in obstetrics and gynecology
Abstract
A review of literature on the problem of connective tissue dysplasia in obstetric and gynecological practice is presented. The questions of terminology, classification, clinical manifestations and diagnosis are surveyed. Currently, many experts note the change of the classical clinical course of a significant number of internal diseases, increased prevalence of allergic and autoimmune diseases. Since the 90s of the last century, connective tissue dysplasia is considered one of the main reasons of the above mentioned conditions. Connective tissue dysplasia is the malformation, which is the basis of a significant number of internal diseases, with diverse symptoms and no clear diagnostic criteria. Researches on connective tissue dysplasia are mainly focused on cardiologic and pulmonary diseases, musculoskeletal diseases, and autoimmune processes. Researches addressing connective tissue diseases in a number of gynecological diseases and conditions in obstetrics appeared only recently. The presence of connective tissue dysplasia in women is a major problem in obstetrics and gynecology. Most reliable biochemical and molecular genetic studies are currently unavailable to a practicing doctor due to technical difficulties and considerable cost. So clinical-genealogical method of examination of patients and their families, as well as the widespread use of instrumental diagnostic methods are of special importance. Obstetricians and gynecologists while managing such patients should pay close attention to the phenotypic features of connective tissue dysplasia and carefully evaluate the cardiovascular and pulmonary systems, blood coagulation to avoid possible serious, often life-threatening, complications.
Kazan medical journal. 2014;95(6):897-904
897-904
Peculiarities of HIV-positive patients coinfection with hepatitis C virus
Abstract
The review of publications on human immunodeficiency virus (HIV) «satellite» infections - hepatitis B and C was made. 1329 articles published in the last 10 years concerning the problem of HIV and hepatitis B and C co-infection were found in PubMed database. The problem of viral hepatitis in HIV-infected patients remains extremely relevant nowadays. Results of numerous European studies indicate that chronic hepatitis C is ranked fifth in the list of death causes of HIV-infected patients. Most researchers agree on a more severe course of chronic hepatitis C in HIV-infected patients. Viral hepatitis is found in 7 out of 10 HIV-infected patients. The problem of antiretroviral drugs hepatotoxicity is still not resolved. Hepatitis C viral load is generally higher in HIV-infected patients than that of HIV-negative, and the probability of progression to cirrhosis, liver failure and hepatocellular carcinoma in HIV-infected patients is 3 times higher. So the problem of HIV and viral hepatitis co-infection requires a better understanding of co-infection treatment features, the definition of clear criteria for effectiveness and safety of therapy of HIV-infected patients co-infected with viral hepatitis B and C.
Kazan medical journal. 2014;95(6):905-908
905-908
Hot issues of infectious deseases
The clinical significance of acute phase proteins as inflammatory markers in infectious diseases
Abstract
The article reviews the clinical significance of measuring acute phase proteins (procalcitonin, C-reactive protein and neopterin) for differential diagnosis between bacterial and viral infections. The results of researches preformed at 1984 to 2014, which measured the levels of C-reactive protein, procalcitonin and neopterin in body biological fluids in infectious and non-infection diseases, are analyzed. Most frequently the clinician encounters a situation when it is necessary to differentiate the bacterial infection from other possible causes of increased body temperature, in particular, from viral infections. In some cases, the diagnosis of bacterial infection is possible only after the results of bacteriology, therefore, laboratory markers of bacterial infection, which would allow differentiating the causes of fever and minimizing the number of cases of unjustified antibiotic use, are actively sought out. Combined measuring of three acute inflammation markers was performed in patients with both infectious and non- infectious diseases. In was revealed that the levels of those blood markers correlate with the inflammation severity. Higher diagnostic value of simultaneous measurement of C-reactive protein, procalcitonin and neopterin, as well as the predictive value of procalcitonin and neopterin in monitoring the course of a number of diseases, was shown. Comprehensive analysis of the concentrations of the studied biomarkers in relation to clinical and microbiological data may help to identify patients at high risk of an unfavorable course of some diseases, allowing timely administration of all necessary treatments.
Kazan medical journal. 2014;95(6):909-915
909-915
Clinical and epidemiological features of imported malaria in the Republic of Crimea for a twenty-year period (1994-2014)
Abstract
Aim. To identify the main clinical and epidemiological features of imported malaria in the Republic of Crimea for a twenty year period (1994-2014). Methods. Archival case reports, results of thin and thick blood films for malaria, a set of general clinical and biochemical laboratory parameters were assessed. Results. Over the past 20 years, 48 patients (including 47 men) aged 21 to 61 years were treated for imported malaria in the department of infectious diseases of the 7th City Clinical Hospital in Simferopol. 34 patients were diagnosed with Plasmodium falciparum malaria, 7 - with Plasmodium vivax malaria, 1 - with Plasmodium ovale malaria, 2 - with Plasmodium malariae malaria. Mixed infection (Plasmodium falciparum and Plasmodium ovale, Plasmodium falciparum and Plasmodium vivax) was revealed in 2 patients; in 2 cases the diagnosis was based on clinical and epidemiological data. Malaria was imported form Sierra Leone, Angola, Mali, Guinea, India, Yemen, Nigeria, Congo, Ghana, as well as from neighboring countries - Azerbaijan and Tajikistan. The clinical picture of Plasmodium falciparum malaria was characterized with diverse fever, absence of manifest chills and sweats, challenging the diagnosis. Plasmodium vivax malaria cases were typical with repeated fever, but were diagnosed late. Self-intake of antimalarial and antibacterial drugs, as well as inadequate chemoprophylaxis distorts the clinical picture of the disease and worsens the quality of laboratory diagnosis. Difficulties in film examinations were most common in cases of mixed-malaria and Plasmodium ovale malaria, requiring repeated tests performed by experienced professionals. Intravenous quinine should be added to treatment together with pyrimethamine + sulfadoxine (Fansidar) and artemisinin in cases of severe course of Plasmodium falciparum malaria associated with increasing parasitaemia. Conclusion. Imported malaria, mostly Plasmodium falciparum malaria, which is associated with the most severe clinical course, increased risk for complicated forms development and unfavorable outcome, is quite common in the Republic of Crimea. Mandatory testing of non-immunized persons returning from endemic areas with any change in well-being and active detection of malaria carriers among residents of endemic areas, arriving in non-endemic areas, are crucial for the early diagnosis of malaria.
Kazan medical journal. 2014;95(6):916-920
916-920
Trends for incidence of chronic hepatitis B monoinfection and chronic hepatitis B+D co-infection in the Kyrgyz Republic for the period of 2010-2012
Abstract
Aim. To assess the trends for the epidemiological situation of chronic hepatitis B monoinfection and chronic hepatitis B+D co-infection in the Kyrgyz Republic for the period of 2010-2012 for the development of anti-epidemic measures depending on the intensity of the process. Methods. The analysis of a database of national reporting forms on the treated cases of chronic viral hepatitis B monoinfection and chronic hepatitis B+D co-infection in primary health care units, cumulated by Republican Medical Information Center of the Ministry of Healthcare of the Kyrgyz Republic for the period of 2010-2012 was performed. Results. The incidence of chronic viral hepatitis D is identical to that of chronic viral hepatitis B (23 and 21 per 100 000 of population respectively) in the Kyrgyz Republic. Over the period of 2010-2012 the high level of total chronic hepatitis B incidence was reported in the northern part of the country (the Issyk-Kul region, 71 per 100 000, and chronic hepatitis D - in the southern part of the country (Osh, 62 per 100 000 of population). Statistically significant increase in the incidence of chronic hepatitis B in almost all regions of the country was recorded whereas only an upward trend was revealed in chronic hepatitis D incidence. Conclusion. Separate registration of patients with chronic viral hepatitis B and D in the Kyrgyz Republic starting from 2010 allowed evaluating the trends for the epidemiological situation of these diseases in different areas and developing preventive and anti-epidemic measures in regions of Kyrgyz Republic.
Kazan medical journal. 2014;95(6):921-924
921-924
Clinical and pathogenetic aspects of the side effects of chronic viral hepatitis C alpha-interferon antiviral therapy
Abstract
Aim. To investigate the relation of prooxidant and antioxidant systems with adverse effects of antiviral alpha interferon treatment in chronic hepatitis C. Methods. The study included 67 patients with chronic hepatitis C aged 19 to 45 years [males - 28 (41.8%), females - 39 (58.2%)] who were receiving antiviral treatment. Prooxidant (diene ketones and diene conjugates, malon dialdehyde) and antioxidant (catalase, superoxide dismutase, glutathione and glutathione-dependent enzymes) systems indicators were measured. According to the severity of side effects, patients were distributed to two groups. The first group consisted of 19 (28.4%) patients with transient passing adverse effects, usually manifesting as short-term flu-like syndrome after the medication injection, lasting no longer than 2-3 weeks of treatment. The second group consisted of 48 patients (71.6%) with prolonged side effects, registered throughout the whole treatment period. Results: Flu-like syndrome with intense myalgia and asthenic syndrome were the most frequent side effects (89.5 and 83.3% of cases, respectively). Dyspepsia, psychopathy and arthralgia were less common (79.2, 72.9 and 68.7%, respectively). Over than a half of the patients lost weight (7-9 kg compared to baseline weight), and also had alopecia and autoimmune thyroiditis. Most of the patients could not tolerate the treatment, 33 (49.2%) patients aborted the treatment. In patients with long-term side effects, low baseline levels of glutathione reductase, glutathione peroxidase, glutathione transferase were revealed (p <0.05). Patients with long-term side effects of antiviral treatment preserved high levels (p <0.05) of diene ketones and diene conjugates and statistically significant (p <0.05) suppression of antioxidant system at the 10-12 weeks of treatment. Conclusion. Examined patients with chronic hepatitis C had diverse activity of antioxidant system. Long-term side effects were seen in patients with low levels of parameters of antioxidant protection at the baseline.
Kazan medical journal. 2014;95(6):924-928
924-928
Functional and metabolic neutrophils activity in patients with acute intestinal infections and the influence of selimakcid
Abstract
Aim. To explore the functional activity of neutrophils in healthy individuals and patients with acute intestinal infections and the effect of selimakcid on it in vitro. Methods. 48 patients with acute intestinal infections aged 20 to 60 years were examined. The control group consisted of 10 healthy people of the same age. Functional and metabolic activity of neutrophils was studied by a nitro blue tetrazolium chloride test and by «BURSTTEST» (Neutrophil Oxidative Burst Test). Results. Examination of the functional and metabolic activity of neutrophils in patients with acute intestinal infections revealed increased results of spontaneous nitro blue tetrazolium chloride test in acute period of the disease. The same changes were discovered while studying the Serratia marcescens stimulated cell activity in patients with dysentery. However, in patients with salmonellosis neutrophils activity in induced nitro blue tetrazolium chloride test did not differ from that of healthy controls. The number of neutrophils synthesizing reactive oxidants recorded by «BURSTTEST» in patients corresponded to the indicators of the induced nitro blue tetrazolium chloride test and did not differ in patients with different nosologies. Studying the effect of selimakcid on neutrophils functional activity in healthy controls and patients with acute intestinal infections by nitro blue tetrazolium chloride test and «BURSTTEST» showed that pre-incubation of neutrophils with selimakcid intensified the response to Serratia marcescens. The ability of the drug to modulate the neutrophils activity in patients with acute intestinal infections was higher compared to healthy individuals. Conclusion. Increased functional activity of neutrophils associated with reduced reserve capacity was revealed in patients with salmonellosis and shigellosis of moderate severity. Selimakcid showed immunomodulatory effect, increasing the functional and metabolic potential of neutrophils in patients with acute intestinal infections in vitro.
Kazan medical journal. 2014;95(6):929-934
929-934
Pathomorphology of colonic mucosa in patients with chronic post-parasitic colitis
Abstract
Aim. To identify pathologic features of the colonic mucosa in patients with chronic post-parasitic colitis. Methods. Under the observation were 80 patients aged 38-42 years (38 men and 42 women) 1.5-2 years after undergoing parasitic diseases (amebiasis, giardiasis, diphyllobothriasis). In 19 patients due to the presence of dyspeptic phenomena colon mucosa was evaluated by morphometric parameters using grid of Avtandilov. The control group consisted of 6 patients with adaptive norm, in which by complex evaluation (bacteriology, parasitology, endoscopic, histologic) the pathology has not been revealed. Biopsies of colon mucosa were fixed in 10% neutral formalin solution and embedded in paraffin. Histological sections were stained with 1% aqueous solution of Alcian blue, Mayer’s hematoxylin and eosin; for morphometric analysis of 24 objective indicators - azure II-eosin by Romanovsky, with eosin methylene blue and thionine by Nicolas. Results. It was found that the mucosa in chronic post-parasitic colitis in all cases different from the normal colonic mucosa by registered parameters: the amebiasis - in 50% of cases, giardiasis - in 54.1%, with difillobotriosis - in 70.8%. In post-difillobotriosis colitis the number of fibroblasts in the lamina propria was reduced. Post-lyambliotic colitis characterized by hypertrophy of the surface epithelium and a high mitotic activity of the epithelium of intestinal glands. Conclusion. After undergoing parasitic diseases, in the colon mucosa preserved histological changes corresponding to chronic ulcerative colitis; post-amebiasis chronic colitis characterized by catarrhal-haemorrhagic inflammation, chronic post-lyambliotic - catarrhal-follicular, post-difillobotriosis - catarrhal-haemorrhagic inflammation with high activity of the pathological process and moderate atrophy of the intestinal glands.
Kazan medical journal. 2014;95(6):934-938
934-938
Neopterin - a potential diagnostic and prognostic marker in infection diseases
Abstract
Clinical significance of determining the neopterin concentration in body fluids is reviewed. The results of researches on determining the neopterin concentrations in various infectious diseases (vector-borne diseases, herpes, respiratory and intestinal infections, as well as human immunodeficiency virus infection) conducted over the past 2 years are discussed. Neopterin is a biologically stable metabolite, which gives an advantage of its detection to assess the activity of the immune response. Previously neopterin was determined mainly by high-performance liquid chromatography. In recent years, enzyme-linked immunosorbent assay was introduced and frequently used for determining neopterin concentrations. It was shown that neopterin concentrations can vary also in the absence of the pathological process. In particular, some general factors such as race, age, body mass index, smoking and arterial pressure may influence on the concentrations of neopterin in the human body. Increased level of neopterin in body biological fluids and the kynurenine/tryptophan ratio are measured in diseases involving interferon-γ-mediated immune response activation. In this regard, the highest concentrations of neopterin and increased kynurenine/tryptophan ratio are observed in cases of infectious diseases, malignancies, transplant rejection, a number of cardiovascular and autoimmune diseases. It was shown that neopterin can be regarded as a highly specific marker of viral infection, and its blood concentration reflect the prognosis of the disease. Monitoring neopterin level may be useful to assess the severity and activity of an infectious disease, its clinical course, and to control the effectiveness of etiological treatment for many infectious diseases.
Kazan medical journal. 2014;95(6):938-943
938-943
Chronicles
Sovershenstvovanie printsipov obucheniya vrachey (po materialam VIII s\"ezda onkologov i radiologov SNG i Evrazii)
Kazan medical journal. 2014;95(6):944-945
944-945