Vol 98, No 6 (2017)
- Year: 2017
- Articles: 39
- URL: https://bakhtiniada.ru/kazanmedj/issue/view/435
Theoretical and clinical medicine
Features of epilepsy in acute and chronic cerebral ischemia
Abstract
Aim. To study clinical features, functional and neuroimaging characteristics of the brain of patients with ischemic brain disease and epileptic seizures. Methods. 772 patients with acute and chronic cerebral ischemia (265 stroke patients with epileptic seizures and 174 patients with seizures on the background of chronic cerebral ischemia, and 203 patients with stroke and 130 patients with chronic cerebral ischemia without seizures) were comprehensively examined. The clinical neurological examination, electroencephalography, magnetic resonance imaging, ultrasound duplex scanning of extra- and intracranial arteries with the assessment of the level and degree of stenosis and cerebrovascular reactivity were carried out. Results. Focal seizures prevailed in patients with cerebral ischemia. In patients with epileptic seizures on the background of both ischemic stroke and chronic cerebral ischemia cortical localization of ischemic foci prevailed. Early epileptic seizures in patients with ischemic stroke developed with significantly more frequent localization of ischemic focus in the right hemisphere with the orientation vector of neuroimaging formation of the ischemic lesion in the caudal direction. In patients with chronic cerebral ischemia with epileptic seizures, along with frequent lesion of the cortex, more frequent damage of white matter of the brain was observed. In patients with acute and chronic ischemia of the brain with epileptic seizures, a higher incidence of stenosis of major arteries and predominance of impaired cerebrovascular reactivity in posterior cerebral circulation system were established. Conclusion. Multimodal examination of patients with acute and chronic cerebral ischemia allowed forming risk groups for epileptic seizures.
Kazan medical journal. 2017;98(6):877-883
877-883
Сombined radiotherapy for cervical cancer with the use of polyradiosensitization with cisplatin and gemcitabine - immediate trial results of Azerbaijan national center of oncology
Abstract
Aim. Study of immediate results of chemoradiotherapy of locally advanced cervical cancer with the use of polyradiosensitization with cisplatin and gemcitabine. Methods. The article analyzes diagnostic and treatment results of 128 patients with IIA-IIIB stage cervical cancer. The age of patients varied between 31 and 76 years. External beam radiotherapy was performed with 1.8 Gy fraction up to a total dose of 45 Gy, high dose rate brachytherapy consisted of four 7.0 Gy fractions. Patients from group 1 received weekly infusions of cisplatin (40 mg/m2) and from group 2 - polyradiosensitization with cisplatin (40 mg/m2) and gemcitabine (75 mg/m2). Results. Chemoradiotherapy with the use of polyradiosensitization compared to standard chemoradiotherapy allowed significant improving of immediate results of treatment of patients with locally advanced cervical cancer, which was particularly prominent in such unfavorable cases as cervical adenocarcinoma and IIIB stage of the disease. Early toxicity of the treatment was higher in group 2 but effectively resolved with symptomatic supportive treatment and did not lead to interruptions in radiotherapy. Conclusion. Combination of conformal external beam radiotherapy, high dose rate intracavitary brachytherapy and concurrent polychemotherapy with cisplatin and gemcitabine is feasible and reasonably safe; chemoradiotherapy with the use of polyradiosensitization improves immediate results of the treatment of cervical cancer with acceptable level of toxicity.
Kazan medical journal. 2017;98(6):884-889
884-889
Predictors of biochemical recurrence of prostate cancer
Abstract
Aim. To study the role of postoperative parameters in predicting the probability of development of biochemical recurrence in patients with prostate cancer with low pre-operative risk of its progression. Methods. 95 patients who underwent radical prostatectomy, were included in the study, the average age being 59.5±0.7 (44-76) years. The average levels of total and free prostate-specific antigen were 5.8±0.2 (1.71-9.9) and 1.03±0.07 (0.2-3.6) ng/ml respectively. Biochemical recurrence was defined as the level of prostate-specific antigen higher than 0.2 ng/ml after radical prostatectomy. Results. 8 (8.4%) patients during the follow-up period were diagnosed with biochemical recurrence. The average period to biochemical recurrence development was 45.8±6.7 (24-84) months. Pathomorphological examination revealed presence of tumor cells at surgical margin in 18 (18.9%) cases. Biochemical recurrence was diagnosed in 5 out of 77 (6.5%) patients with negative surgical margins and in 3 out of 18 (1.7%) patients with positive surgical margins. In our study, no correlation between the state of surgical margin and biochemical recurrence development was revealed (χ2=1.958; р=0.162). In the study group postoperative Gleason score was not prognostically significant as well (р=0.294). The average tumor volume in resected material was 11.8±1.0% (1-55%) of prostate volume (мм3). Extraprostatic extension was diagnosed in 10 (10.5%) cases. Results of univariate dispersion analysis of postoperative parameters revealed prognostic significance of tumor volume in removed specimen (р=0.007) and extracapsular extension (р=0.027). Conclusion. In our study we determined that tumor volume and extracapsular extention are independent risk factors for biochemical recurrence in prostate cancer patients with low pre-operative risk of disease progression.
Kazan medical journal. 2017;98(6):890-894
890-894
Individual prognosis of urolithiasis, benign hyperplasia and prostate cancer development based on medical and social risk factors
Abstract
Aim. To predict the risk of developing urolithiasis, benign hyperplasia and prostate cancer on the basis of mathematical modeling on individual medical and social factors. Methods. Prognostic evaluation of the risk of studied pathology development based on 30 medical and social factors was performed. Representive samples of patients with verified diagnosis of urolithiasis, benign prostatic hyperplasia and prostate cancer (study groups) as well as individuals without these diseases (comparison group) constituted the material of the study. The study protocol included preparation of primary data, transformation of qualitative data into numerical form, logistic regression modeling of risk, verification of models. Risk prediction itself was performed with the use of reasonably chosen methods of mathematical modeling (a priori ranging, regression analysis and discrete correlation pleiades aimed at minimizing the informative parameter redundancy). The developed models were verified by passive experiment method. Results. Based on long-term empirical observation the scientific hypothesis was proposed that urolithiasis, benign hyperplasia and prostate cancer development is more probable in patients with certain risk factors. To prove or reject the proposed hypothesis, the analysis of prognostic informativeness was performed for 30 factors suspected to cause the studied pathology development. It was performed with the use of logistic regression models. As a result among the studied working and living conditions of urological patients prognostically significant factors were determined. Developed on their basis (and subsequently verified) models allowed mathematically evaluating real risk of the studied urologic diseases development. Conclusion. Development of the models of individual risk of the studied nosologic forms development based on the analysis of medical and social factors is principally possible; verification of the developed models confirms their practical applicability and proves the principal feasibility of the proposed approach.
Kazan medical journal. 2017;98(6):894-900
894-900
Optimization of perioperative management of patients with small intestinal urinary diversion after radical cystectomy
Abstract
Aim. To evaluate the incidence of complications of the developed scheme of management of patients in the perioperative period after radical cystectomy with small intestinal urinary derivation. Methods. The study included 105 (100%) patients treated at the department of urologic oncology of the National center of oncology of the Ministry of Health of the Republic of Azerbaijan during the period from 2008 to 2015. Modified Hautman Ileocystoplasty was performed in 87 (82.9%) patients, urine derivation by Bricker’s method - in 18 (17.1%) patients. Tactics for patient management corresponded to the proposed scheme of patient preparation and algorithm for the management. The main criteria for evaluation of the efficacy of the proposed scheme were the incidence and nature of the most common complications in the early postoperative period (30 days) according to the Clavien-Dindo classification. Results. 131 complications occurred in 71 (67.6%) patients within 30 days after the operation, out of them one complication in 32 (30.5%) patients, two in 23 (22%), three complications in 11 (10.5%), four and more - in 5 (4.8%) patients. The most common complication in the early postoperative period was gastrointestinal atony - 33.4% (n=35). Conclusion. Combined anesthesia and extraperitoneal bladder removal provide significant reduction of the incidence of postoperative gastrointestinal atony; for conclusive evaluation of the effectiveness of the proposed complex controlled studies are necessary.
Kazan medical journal. 2017;98(6):900-906
900-906
Evaluation of the syndrome of functional deficit in elderly with non-oncological pathology
Abstract
Aim. Comparative analysis of the profile of integral functional disorders and the degree of their deficit in elderly patients after stroke and in chronic heart failure functional class III-IV. Methods. Physical exam and interviews were used during comprehensive geriatric assessment with the analysis of the degree of functional disorders according to PULSES Profile scale and the degree of asthenia in the elderly. Results. The analysis of the degree of functional disorders in elderly and senile patients showed the diversity of issues that should be considered when providing medical and social care. In a moderate functional deficit in patients after stroke emotional and intellectual disorders prevailed - 47.2±0.1 cases, as well as upper extremities dysfunction - 29.9±0.2, and lower extremities dysfunction - 27.6±0.2. In severe heart failure inability to control excretory functions is predominant - 14.6±0.2 patients. Severe functional disorders prevailed in patients with consequences of stroke, which manifested as upper extremities dysfunction - 21.3 cases; lower extremities dysfunction - 22 cases; in severe heart failure communication disorders were prevalent - 6.4 cases. Conclusion. The more severe degree of functional deficit correlating with a high need for palliative medical and social care was observed more frequently in patients after stroke with prevailing upper and lower extremities dysfunction, while in chronic heart failure functional class III-IV communication disorders were predominant.
Kazan medical journal. 2017;98(6):906-909
906-909
Anxiety-depressive disorders of patients with external genital endometriosis
Abstract
Aim. To study the prevalence of anxiety and depression in patients with external genital endometriosis and other gynecologic pathology. Methods. The study involved 152 women. The main group consisted of 100 patients with external genital endometriosis diagnosed by laparoscopy and histologically confirmed. The comparison group included 52 women with other gynecologic pathology (infertility, hysteromyoma, ovarian benign tumours). Exclusion criteria were oncology, acute gynecologic and somatic pathology. To determine the prevalence of anxiety and depression in the groups, the hospital anxiety and depression scale was used. Results. In the group pf females with endometriosis 33 (33%) patients had anxiety and 9 (9%) patients - depression. In the comparison group (N2=52), anxiety disorder was revealed in 18 (34.6%) women, and depression - in three patients (5.8%; p >0.05). To study the features of anxiety and depression in patients with different clinical presentation of endometriosis, females with asymptomatic disease (n1=26), infertility (n2=29) and pain syndrome (n3=43) were compared. Analysis of the results demonstrated that significantly more frequently anxiety and depression developed in patients with pain syndrome. The number of women suffering from anxiety in group n3 was 22 (51.2%), in group n2 - 6 (20.7%) and in group n1 - 2 (7.8%). The number of women with depression in group n3 was 8 (18.6%), in group n2 - 1 (3.4%) and in group n1 there were no women with depression. Conclusion. The conducted study showed no significant differences in the prevalence of anxiety and depression among patients with external genital endometriosis and other gynecologic pathology; anxiety and depression develop more frequently in the presence of pain syndrome.
Kazan medical journal. 2017;98(6):910-912
910-912
Assessment of premorbid background in pregnant women with obesity of various degrees
Abstract
Aim. Comparative evaluation of premorbid background in pregnant women with obesity of various degrees. Methods. A comparative evaluation of premorbid background in 82 pregnant women with obesity class 1 (49 patients), class 2 (22) and class 3 (11) and 65 somatically healthy females was performed on the basis of somatic and obstetric and gynecological history. Results. In obese females in 30.5% of cases menstruation disorders were observed, most pronounced in obesity class 3 that exceeds the number in control group by 3.0 times. Out from gynecological diseases, in pregnant women with obesity class 2 and 3 the most common were colpitis - 2.0 and 2.6 times more prevalent, adnexitis - 1.5 and 1.2 times more, cervical erosion - 1.8 and 2.4 times more, endometritis - 2.2 and 1.5 times more, secondary infertility - 3.0 and 6.1 times more prevalent than in the control group. In comparison with the control group, in obesity class 2 and 3, respiratory diseases were diagnosed 1.3 and 2.5 times more often; cardiovascular disease - 2.9 and 5.9 times more, arterial hypertension - 3.0 and 12.1 times more, chronic gastritis - 1.3 and 1.7 times more, chronic cholecystitis - 1.2 and 2.4 times more, and chronic pyelonephritis - 1.8 and 2.4 times more often. Conclusion. In pregnant obese women a high prevalence of gynecological and somatic diseases was detected, that creates unfavorable conditions for pregnancy; the obtained results have a prognostic value in terms of pre-conceptional preparation of obese women.
Kazan medical journal. 2017;98(6):913-917
913-917
Bacteriophage use in the focus of hospital-acquired shigellosis
Abstract
Aim. Evaluation of epidemiologic effectiveness of polyvalent dysentery bacteriophage use for management of infection outbreak caused by Shigella flexneri. Methods. Investigation was performed in Tula psychoneurological hospital where the persistent focus of shigellosis was formed by Sh. flexneri 2a. As part of the study, evaluation of efficacy of antibacterial treatment (ciprofloxacin 250 mg per day for 7 days - group 1) was performed by evaluating duration of bacterial excretion in 18 patients with mild, 21 with moderate and 2 with severe Shigella infection. At the same time efficacy of Shigella bacteriophage (group 2) was assessed during treatment of 19 patients with mild and 17 with moderate form of the infection. Prevention of hospital-acquired shigellosis was provided for all patients in the departments where the infection was diagnosed. In this case bacteriophage was administered as following: first 5 days - 2 pills of bacteriophage 4 times a day, then 2 pills once a day during the whole period of hospitalization. This scheme was administered also to all patients newly admitted to the involved departments from day 1 of hospital stay. Results. Treatment with antibiotics led to fast and full recovery not in all cases. Insufficient clinical effect (persistence of disease signs and bacterial excretion for more than 7 days) in the treatment of mild, moderate and severe forms of Shigella infection was 16.7, 61.9 and 50.0%, respectively. High clinical effectiveness was noted in the treatment of patients with the use of Shigella bacteriophage. Ratio of insufficient clinical recovery from mild and moderate forms of the disease was 5.3 and 17.6%, respectively. In the course of anti-epidemiological measures aimed at localization and elimination of the focus, about 1000 patients were exposed to mentioned regimen of prevention. No patients had manifested infection or bacterial excretion registered. Conclusion. The study confirmed clinical and epidemiological effectiveness of polyvalent dysentery bacteriophage use for management of outbreak caused by Sh. flexneri 2a.
Kazan medical journal. 2017;98(6):917-921
917-921
Prognosis of the development of pneumonia in children at the outbreak of respiratory mycoplasmosis
Abstract
Aim. To identify risk factors for mycoplasma pneumonia at the outbreak of respiratory mycoplasmosis in the children’s collective using a comprehensive statistical analysis. Methods. 120 children aged 12-15 years from the focus of respiratory mycoplasmosis outbreak were observed. They were divided into two groups: study group - 33 children with mycoplasma pneumonia, and control group - 56 children from the focus of infection, 14 of which during the observation period had no disease simptoms, and 42 children had other forms of respiratory mycoplasmosis. Results. 6 factors influencing the development of mycoplasma pneumonia were identified in children from the focus of respiratory mycoplasmosis outbreak. The correlation analysis was performed and one-dimensional models of the chance of developing pneumonia were constructed by calculating odds ratios. Past history of pneumonia increases the risk for pneumonia by 23.46 times, passive smoking in a child - by 2.77 times. At the same time, emergency prevention with immunotropic drugs reduces the risk for pneumonia by 8.93 times, daily walking - by 3.31 times, walking for more than 2 hours - by 3.83 times, increasing fruit in the diet - by 3.09 times and taking multivitamins - by 2.56 times compared to cases when these measures were not taken. The binary logistic regression was calculated to build a multidimensional research model. The sensitivity of this model was 87.88%, specificity - 91.07%. Conclusion. At the outbreak of respiratory mycoplasmosis the risk factors for the development of mycoplasmal pneumonia are pneumonia in past medical history, smoking in a child’s family; preventive measures are long-term daily exposure to fresh air, emergency prevention with immunotropic, complex multivitamin preparations with trace elements and lactic acid bacteria, dietary intake corrected for fruit intake.
Kazan medical journal. 2017;98(6):921-927
921-927
Evaluation of the quality of functioning of artificial neural network with logic outputs in the diagnosis of diseases of hepatopancreatoduodenal zone
Abstract
Aim. To develop a set of information methods to improve the quality of neural network diagnosis of diseases of hepatopancreatoduodenal zone. Methods. The study involved 385 patients with peptic ulcer, cholecystitis and pancreatitis undergoing in-patient treatment in medical organizations of the city of Kursk. For data mining internally developed software «System of Intellectual Analysis and Diagnosis of Diseases» was used which is an environment for the creation, adjustment, training and practical clinical application of an artificial neural network, such as a multilayer perceptron with an activation function - hyperbolic tangent. Results. Hyperbolic tangent (activation function) of the output layer’s neuron takes the value OUT ∈ ℝ ∧ OUT ∈ (-1; 1) which requires an interpretation. For logic network gates, for example, presence/absence of a disease, it can be performed by comparison with an arbitrarily assigned threshold yB ∈ (0; 1). In this approach, the values are interpreted as false (if y ≤-yB), undefined if y ∈ (-yB; yB), or true (if y ≥yB). Network operation control includes calculation of sensitivity, specificity, false positive and false negative results, for which the comparison of arrays of pairs of calculated and empirical values is carried out. In case of artificial neural network use for diagnosing diseases of hepatopancreatoduodenal zone, the optimal mode was achieved assigning yB≈0.3 as a threshold of the output neuron activation function. Conclusion. Assessing the quality of the ability of artificial neural network with logic outputs to diagnose hepatopancreatoduodenal zone diseases, as well as its controlled setting, is most effective by evaluation of sensitivity, specificity, frequency of false positive and false negative results at the threshold value yB≈0.3; the demonstrated sensitivity (83-94.7%) and specificity (83-97.8%) levels are comparable to the traditionally used diagnostic methods.
Kazan medical journal. 2017;98(6):928-932
928-932
Hepato-pancreato-biliary system pathology among children with atopic dermatitis
Abstract
Aim. To determine the structure and character of the damage of hepato-pancreato-biliary system organs by ultrasound in children with atopic dermatitis of varying severity. Methods. 342 children aged 2 months to 17 years with atopic dermatitis in the acute period were examined with the use of standardized complex of clinical and laboratory methods. All children underwent ultrasound examination of the abdominal organs (liver, gall bladder, pancreas, spleen). Results. When analyzing the results of complex clinical, laboratory and instrumental examination of children with atopic dermatitis, in 51% of cases pathology of the pancreas was detected and as a rule was verified by ultrasound and treated as «reactive (responsive) pancreatitis», or «pancreatopathy». According to echography, changes of the gastrointestinal tract prevaled in infants and preschool children, their number amounted to 75% of all the examined children. Hepatomegaly and splenomegaly was detected in 76 (22%) and 80 (23%) children with atopic dermatitis, respectively, more likely in infants and preschool children - 67 (88%) and 72 (90%), respectively. Deformation of the gallbladder was diagnosed in 71 (21%) children. Conclusion. The received data show interaction between atopic dermatitis and high frequency of damage of hepato-pancreato-biliary system organs (especially of the pancreas) among children; gastrointestinal disorders can orchestrate the cascade of neuroimmunological reactions leading to the development of atopic dermatitis, that actualizes development of a strategy of timely neuroimmune correction of this disease.
Kazan medical journal. 2017;98(6):932-937
932-937
The levels of circulating cytokines in the early post-implantation period
Abstract
Aim. Analysis of cytokine levels in the blood and dentogingival fluid in patients before and after dental implantation. Methods. 164 patients with dental implants were examined, the average age was 54.6±4.17 years. Dental implantation was performed in one- and two-step procedures, osteoplastic materials Geistlich Bio-Oss spongiosa granules 0.5 g and Bio-Gide membranes 25×25 mm (Germany) were used. A total of 641 implants were installed. The course of post-implantation period was studied in all patients on days 1-3 and 6-7. Dental fluid was collected from each implant with sterile filter paper strips «F». The level of pro- and anti-inflammatory cytokines were measured in the blood serum and gingival fluid before and 6-7 days after intervention by the solid-phase ELISA method. Results. Immediately after implantation (1-2 days), all patients noted soreness, swelling and hyperemia, which on day 3 regressed in 139 (84.6%) patients, and 25 (15.2%) patients were diagnosed with acute mucositis, manifested by edema and hyperemia of soft tissues in the implant area. After dental implantation, imbalance of pro- and anti-inflammatory cytokines was observed, especially in complicated cases. The most pronounced changes were noted in the concentration of TNFα, IL-1β and IL-6. Predominance of hyperproduction of pro-inflammatory cytokines in acute mucositis was revealed. The ratio of pro- and anti-inflammatory cytokines in acute mucositis was increased by 5.5 times (p <0.001) in the blood and by 5.0 times (p <0.001) in gingival fluid. Conclusion. Time course of cytokine levels in blood serum and gingival fluid before and after dental implantation indicate changes in the balance of pro- and anti-inflammatory cytokines; an increase of the production of anti-inflammatory cytokines is especially pronounced against the background of acute mucositis and changes in the level of anti-inflammatory interleukin-4 and -10 have multidirectional character.
Kazan medical journal. 2017;98(6):938-943
938-943
Proand anti-inflammatory cytokines in children with various clinical forms of chronic glomerulonephritis
Abstract
Aim. Study of the level of pro- and anti-inflammatory cytokines, their relationship and changes, depending on the activity of various variants of chronic glomerulonephritis in children. Methods. 104 children with nephrotic form of chronic glomerulonephritis (group 1), 9 children with hematuric form (group 2) and 88 children with mixed form (group 3) were examined. The average age of children was 10.63±3.88 years. The remission was observed in 130 (45.1%), exacerbation - in 158 (54.9%) patients. The concentration of proinflammatory (interleukin-1β, -8, tumor necrosis factor α, interferon γ) and anti-inflammatory cytokines (interleukin-10 and -4) was determined in the blood by ELISA. Results. A significant increase in the levels of interleukin-1β and -8, tumor necrosis factor α, interferon γ was revealed. The index of cytokines in nephrotic and mixed variant was 2.6 standard units, in hematuric form - 2.5 standard units. More pronounced imbalance of pro- and anti-inflammatory cytokines was revealed in nephrotic and mixed forms of chronic glomerulonephritis. Regardless of the form, an increase was revealed in the ratio of interleukin-1β/interleukin-4 (p <0.05), tumor necrosis factor α/interleukin-4 and tumor necrosis factor α/interleukin-10 (p <0.01). Conclusion. Children with different clinical variants of chronic glomerulonephritis were found to have imbalance of cytokines with the shift towards predominance of proinflammatory cytokines; the most pronounced differences were observed in the content of interleukin-1β and tumor necrosis factor α; both in exacerbation and remission phases cytokine index is higher than 1 which is indicative of active inflammatory process.
Kazan medical journal. 2017;98(6):943-948
943-948
Biochemical aspects of pathological processes
Effect of hypoxia tolerance on the relation between indicators of free radical oxidation of lipides and proteins in murine kidneys during the post-resuscitation period
Abstract
Aim. Study of the relationship between the parameters of free radical oxidation of proteins and lipids in the murine kidneys in the post-resuscitation period after stopping the systemic circulation, depending on their resistance to hypoxia. Methods. The systemic circulation was stopped by intra-thoracic clamping of the neurovascular bundle for 5 minutes, performed under general ether anesthesia in male noninbred white rats, divided after testing into two groups based on resistance to hypoxia. The observation period lasted for 35 days. In the homogenates of kidney tissues, the content of products reactive to tiobarbituric acid, carbonylated proteins, the formation of metal-catalyzed carbonylated proteins and bitirozin were determined. Results. The characteristic manifestation of oxidative stress in the recovery period after stopping blood circulation and resuscitation was found to be reciprocity of the relationship between the levels of lipoperoxidation and oxidative modification of proteins. Highly resistant to hypoxia animals were characterized by high resistance of proteins of kidney tissue to free radical oxidation against the background of high levels of lipid peroxidation. On the contrary, in animals non-resistant to hypoxia, against the background of relatively low values of lipoperoxidation, high levels of oxidative modification of proteins, both initial and induced, were recorded. Conclusion. In post-resuscitation period in highly resistant to hypoxia animals, marked activation of lipoperoxidation occurs accompanied by a transient increase in the carbonylation of proteins in the early observation period; for low-resistant to hypoxia animals high intensity of carbonyl stress against the background of the relative «preservation» of lipid structures of the cell is characteristic, which persists throughout the post-resuscitation period, which can make a significant contribution to kidney damage, increasing the risk of renal failure.
Kazan medical journal. 2017;98(6):949-954
949-954
Study of the influence of medicinal preparations on the indicators of mixed saliva in patients with essential hypertension
Abstract
Aim. To identify the effect of drugs on the functional state of the salivary glands in patients with essential hypertension. Methods. A total of 38 hypertensive patients were examined. Depending on the prescribed drug therapy, all patients were divided into four groups: group 1 received an angiotensin-converting enzyme inhibitor; group 2 received a beta-blocker; group 3 received a slow calcium channel blocker, group 4 received a statin. For the analysis of salivary glands, the salivation rate was calculated, pH of the mixed saliva and activity of lactate dehydrogenase, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase were measured. Results. In the mixed saliva of hypertensive patients, the salivation rate decreased in patients taking statins. The pH values of saliva in all groups were within neutral values, from 6.80 to 7.04. The amount of total protein was increased in patients taking angiotensin-converting enzyme inhibitors and statins, and was reduced in patients taking beta-adrenoblockers and slow calcium channel blockers. High activity of lactate dehydrogenase and aspartate aminotransferase was detected in patients taking statins, which indicates activation of anaerobic bacteria and inflammatory processes in the oral cavity. The increased activity of alkaline phosphatase, noted in patients taking beta-adrenoblockers, suggests possible violation of the processes of enamel mineralization. High activity of alkaline phosphatase and aspartate aminotransferase in the mixed saliva of observed patients coincides with the increase of papillary marginal alveolar index up to 27±4.6%, which indicates the development of pathology in the periodontal tissues. Conclusion. In patients receiving statins salivation function was suppressed; increased activity of lactate dehydrogenase and aspartate aminotransferase in the mixed saliva indicates activation of anaerobic microflora and tissue protein breakdown in the oral cavity.
Kazan medical journal. 2017;98(6):954-957
954-957
Levels of antithrombin III and D-dimers as predictors of pulmonary artery thromboembolism in patients with deep vein thrombosis
Abstract
Aim. Search for predictors of pulmonary artery thromboembolism in patients with deep vein thrombosis among the indicators of hemostasis system. Methods. Retrospective analysis of indicators of hemostasis system was performed in 23 patients with defined pulmonary artery thromboembolism, 30 patients with deep vein thrombosis and 20 healthy volunteers. Values of platelet aggregation by Born method, concentration of circulating thrombocytic aggregates by Kohanna method, values of thromboelastometry, as well as blood levels of D-dimers and antitrombin III in arterial and venous blood were measured. Results. It was established that in patients from both thrombosis groups, haemostasis system changes are similar in nature: (1) a high value of Wu-Hoak is registered - more than 15 times higher in both arterial and venous blood compared to the control group; (2) platelet aggregation rates demonstrate hyperaggregation with all inductors, both in arterial and venous blood; (3) thromboelastography results are characterized by increased activity of thrombocytic hemostasis, prolonged clotting time, heightened clot strength compared to control in both arterial and venous blood flow. However, the difference was revealed between groups with and without pulmonary thromboembolism in venous blood levels of D-dimers and activity of antithrombin III. A function to predict pulmonary thromboembolism was constructed depending on the level of D-dimers and activity of antithrombin III in patients with deep vein thrombosis. Conclusion. The developed function for prediction of pulmonary artery thromboembolism can objectively assess the likelihood of pulmonary thromboembolism, which in turn allows minimizing risk and timely assessing the effectiveness of taken preventive measures.
Kazan medical journal. 2017;98(6):957-962
957-962
Experimental effect of collagen-containing medication on skin morphology
Abstract
Aim. To evaluate morphological skin changes of the experimental animals after intradermal injection of collagenous medication. Methods. The histological and histochemical methods (staining with hematoxylin and eosin, by Van-Gieson, Mallory and Foot method) were used to study the skin of mature female rats in the area of intradermal injection of collagen preparation «Kollost» by using mesotherapy method in 2, 4, 21 and 37 days. Murine skin was compared between experimental and control groups, in which the rats had solution of dextrose (glucose) injected intradermally. Results. On days 2-4 after the injection, inflammatory reaction was weak in the form of cellular infiltration along the needle stick. Numerous macrophages resorbing fibrous elements of the medication were determined in the injection zone. On days 7-14 fibroblasts proliferation, occurrence of argyrophilic thin newly-formed collagenous fibres and significant content of glycosaminoglycanes in the granulation tissue were revealed. By the 21-st day of the experiment following the injection, the dermal plate of the skin had become more dense due to the formation of thicker collagenous bundles in regeneration zones. When impregnated by silver nitrate they became yellow-brown that was indicative of fibre maturity. On day 37, the collagen fibers of the injected preparation in the injection zone were not detected in free unsubstituted form. The skin had a typical structure. The signs of stimulation of regeneration processes were not revealed in the skin of rats from the control group following the glucose solution injection. Conclusion. The collagenous preparation did not cause any pronounced inflammatory processes in the skin following intradermal injection to mature female rats; the fibrous structures of «Kollost» are resorbed by macrophages and substituted by the collagenous fibres integrating into the tissues; the processes are accompanied by stimulation of proliferation of structural elements of the skin connective tissue.
Kazan medical journal. 2017;98(6):962-967
962-967
Measurement of aminotransferases activity and concentration of pro-inflammatory cytokines in vascular wall in varicous veins of lower extremities
Abstract
Aim. To investigate the role of alanine aminotransferase, aspartate aminotransferase, tumor necrosis factor α and interleukin-1β in the pathogenesis of varicose veins in patients of different age groups. Methods. The study included 43 patients. Three groups were identified: patients aged 30-44 years (11 patients, group 1), patients aged 45-59 years (18 individuals, group 2), patients aged 60-74 years (14 individuals, group 3). Alanine aminotransferase and aspartate aminotransferase activity in vascular wall were determined spectrophotometrically in patients after phlebectomy. The content of tumor necrosis factor α and interleukin 1β was measured by enzyme-linked immunosorbent assay. Results. The highest alanine aminotransferase and aspartate aminotransferase activity was detected in tissue samples taken from patients aged 60 to 74 years compared to those obtained from tissue samples from patients of other age groups. Determination of the concentration of IL-1β also showed that the highest concentration of this parameter was found in patients aged 60-74 years, and reaches 13.2±0.54 pg/g of tissue, which is significantly higher than in patients of other study groups. According to enzyme-linked immunosorbent assay for determining the content of tumor necrosis factor α in the test samples, increased concentration of this parameter was observed in age group 2, and decreased one in group 3. Conclusion. Increased concentration of IL-1β and alanine aminotransferase and aspartate aminotransferase activity in the vascular wall of patients with varicose veins of the lower extremities positively correlates with the patient’s age; concentration of tumor necrosis factor α increases in group 2 and decreases in study group 3, which indicates dysregulation of immuno-inflammatory reactions in the elderly.
Kazan medical journal. 2017;98(6):968-970
968-970
Influence of experimental hypothyroidism on bone tissue metabolism and mineral exchange
Abstract
Aim. Characteristics of the changes of bone remodeling markers and mineral metabolism parameters in experimental mercazolilum-induced hypothyroidism in rats. Methods. Development of hypothyroidism in sexually mature male rats caused by 3-week-long intragastric administration of mercazolilum at a dose of 2.5 ml/100 g of animal weight, was monitored by measurement of the total serum triiodothyronine and thyroxine, and thyroid-stimulating hormone. At the end of intoxication, in the serum of experimental and control rat groups the concentration of Ca, P, Mg, C-terminal telopeptides of collagen type I, bone alkaline phosphatase, parathyroid hormone, testosterone, follicle-stimulating and luteinizing hormones, pro-inflammatory cytokines (interleukin-1β and tumor necrosis factor α) was measured. Results. It was found that mercazolilum-induced hypothyroidism leads to a decrease of serum levels of bone tissue metabolism markers, C-terminal telopeptides (β-Cross Laps), and bone alkaline phosphatase, characterizing slowing of remodeling processes. Decrease of Ca and P concentration in the blood was not observed in such cases. In experimental hypothyroidism caused by mercazolilum administration to male rats, shifts in hormones and cytokine balance occur. Decrease of testosterone, increase of levels of gonadotropins, parathyroid hormone, interleukin-1β, interleukin-6 and tumor necrosis factor α was observed. Conclusion. In experimental hypothyroidism developing after mercazolilum administration, disorder of bone and mineral metabolism not only is a consequence of direct influence of thyroid hormones on bone tissue, but is also mediated by changes in hormone and cytokine status.
Kazan medical journal. 2017;98(6):971-975
971-975
Influence of high-protein diet on the functional ability of the liver in rats and correction possibilities
Abstract
Aim. To study the changes of biochemical parameters of blood serum, the qualitative and quantitative composition of the large intestinal microbiota, the feces of prepubertal rats with a high-protein type of nutrition and following correction with the probiotic «Normobakt». Methods. To create a model, Wistar rats were used, who received a high-protein diet (35% of the total diet) for 7 weeks (group 1). The second group of laboratory animals received «Normobakt» preparation for 2 weeks. The control group was on a balanced diet. Biochemical parameters of blood serum were evaluated using an automatic biochemical analyzer СА-400 (Japan) with liquid stable diagnostic kits (Diasys, Germany). For bacteriological study, samples of feces and large intestine tissues of the laboratory animals were obtained. Results. In animals receiving a high protein diet, the biochemical parameters of blood serum were characterized by high levels of aspartate aminotransferase, alanine aminotransferase, total protein, triglycerides compared to the control group, and by contrast, concentration of cholesterol and Apo-A1-protein was decreased. In the microflora of the large intestine and feces, the level of opportunistic microflora remained unchanged, levels of Bifidobacterium spp. and Lactobacillus spp. were significantly lower than those of the control group. Correction with the «Normobakt» preparation led to a significant decrease of the levels of aspartate aminotransferase, total protein and glucose in the blood serum. Moreover, in microbiota of the large intestine and feces, the level of opportunistic microflora reduced to zero, but the concentration of Lactobacillus spp. and Bifidobacterium spp. significantly increased in comparison with the rat group without biotic correction. Conclusion. High-protein diet has a negative effect on the functional ability of the liver, causing an increase of aminotransferase activity, changes in cholesterol and protein metabolism, accompanied by changes of the intestine and feces microbiota; use of the drug «Normobakt» promotes normalization of the parameters; on the background of increasing levels of Lactobacillus spp. and Bifidobacterium spp. quantitative parameters of opportunistic microflora decrease.
Kazan medical journal. 2017;98(6):975-980
975-980
Evaluation of effectiveness of the use of toothpastes in treatment of non-carious teeth diseases
Abstract
Aim. To assess the effectiveness of the use of therapeutic and prophylactic toothpastes containing hydroxyapatite nanoparticles or sodium fluoride in patients with non-carious lesions. Methods. Mixed saliva was studied in 40 individuals. All subjects were divided into three groups. Group 1 (n=15) used toothpaste №1 containing zinc citrate and sodium fluoride for tooth brushing, group 2 (n=15) brushed teeth with a paste №2 with hydroxyapatite nanoparticles which contained materials removing dental plaque due to antioxidant β-glycyrrhetinic acid possessing anti-inflammatory activity. The control group included 10 subjects with healthy oral cavity. Hyperesthesia of teeth was assessed using Shiff air sensitivity scale, indices of prevalence of tooth hyperesthesia and intensity of tooth hyperesthesia in %, periodontal condition (papillary marginal alveolar index) in % and the oral hygiene score were determined. The activity of lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase (U/l) before and after tooth brushing with toothpastes containing hydroxyapatite particles or sodium fluoride, was also measured. Results. After tooth brushing with both pastes for three months, a decrease of tooth hyperesthesia was observed, as evidenced by the values of Shiff test, index of prevalence of hyperesthesia and intensity of tooth hyperesthesia. Oral hygiene and periodontal state improved. The best effect was observed with a paste №2, containing anti-inflammatory and abrasive components and hydroxyapatite nanoparticles. This is confirmed by a decrease of the activity of lactate dehydrogenase present in anaerobic bacteria, as well as activity of aspartate aminotransferase and alanine aminotransferase, reflecting a decrease of inflammation in the periodontal tissues. Conclusion. Use of toothpastes containing hydroxyapatite nanoparticles or sodium fluoride reduces hyperesthesia of the enamel and inflammation in the periodontium and is accompanied by decreased activity of enzymes in mixed saliva.
Kazan medical journal. 2017;98(6):980-984
980-984
Post-hypoxic reaction of astrocytes of the visual cortex in the experiment
Abstract
Aim. To study the nature of reactive changes in astrocytic glia and oxidative metabolic status in the visual cortex of experimental animals after acute circulatory arrest. Methods. A series of experiments was performed on 47 mature males of noninbred white rats weighing 150-180 g. Under general ethereal anesthesia, a 5-minute anoxia was modelled by intrathoracic clamping of the vascular bundle of the heart followed by resuscitation and observation of the general state dynamics of the animals within 5 weeks after revitalization. Morphometric characteristics of reactive astrogliosis were studied with evaluation of a neurospecific protein (glial fibrillary acidic protein) by immunohistochemistry. The processes of free radical oxidation in brain homogenates were evaluated by determination of products reacting with thiobarbituric acid and by chemiluminescence analysis. The state of antioxidant system in the studied tissues was determined by recording the activity of superoxide dismutase and the level of reduced glutathione. Results. Regarding astroglial link, significant expression of glial fibrillar acidic protein was recorded throughout the observation period with maximum intensification on day 21 of the experiment. In the early periods and during the second week after recovery, the increase of the light sum of iron-induced chemiluminescence was noted, followed by a prolonged accumulation of secondary metabolites of lipid peroxidation. The investigated level of superoxide dismutase significantly increased not only on days 1-3, but also during the second week of the postresuscitation period. When assessing the level of reduced glutathione, a significant increase of its content occured during the first three days after recovery. Conclusion. The revealed activation of a neurospecific protein production with preceding shifts in pro- and antioxidative systems is indicative of hyperreactive character of astrogliosis formed in brain structures against the continuous oxidative stress, disrupting the functioning of neural networks in the visual cortex of experimental animals.
Kazan medical journal. 2017;98(6):984-988
984-988
Experimental medicine
Comparative characteristics of the hemostasis system state during hypothermic and early reactive periods of general freeze injury in rats
Abstract
Aim. To study the hemostasis system state in rats during hypothermic and post-hypothermic periods. Methods. Male Wistar rats (53 individuals) were used in the study. The animals from the experimental group underwent single immersion cooling in water at a temperature of 5 °C until profound hypothermia was reached, the control group of the animals was placed in water at a temperature of 30 °C. From the animals of the first group, blood was taken immediately after reaching profound hypothermia and from the second group - 24 hours after cooling was stopped. Results. Comparative analysis of the results showed that immediately after the end of a single cold exposure, significant increase in platelet aggregation activity occured, as well as appearance of thrombinemia markers in the bloodstream and inhibition of fibrinolytic system activity. 24 hours after the experimental exposure, these parameters returned to the initial values. When assessing the activity of external and internal ways of coagulation immediately after the termination of cooling, development of hypocoagulation was established, both with routine tests and from thromboelastography. After 24-hour period, hypocoagulation, recorded immediately after reaching the sought rectal temperature, persisted. Thus, after the end of a 24-hour period after cold exposure termination, most of the parameters of hemostatic system that had deviated immediately after the end of the experiment, returned to the normal level. The delayed effect of hypothermia in such cold exposure regimen manifested only by hypocoagulative shift at the initial stages of coagulation. Conclusion. Signs of abnormal hemostasiological blood properties, recorded immediately after the cooling termination, disappear within 24 hours, and only hypocoagulation persists in the blood.
Kazan medical journal. 2017;98(6):989-993
989-993
Establishment of imatinib-resistant gastrointestinal stromal tumor cell subline and investigation of its sensitivity to the chemomotherapeutic agents
Abstract
Aim. To establish the subline of imatinib-resistant gastrointestinal stromal tumor (GISTs) cells and to evaluate its sensitivity to various types of chemotherapeutic agents. Methods. To establish imatinib-resistant subline, tumor cells of GIST T-1 line were cultured with gradually increasing doses of imatinib for 18 months. Sensitivity of GIST T-1 cells to imatinib was comparably evaluated every 3 months by using MTS-based colorimetric assay. Level of expression of proteins serving as apoptotic markers, was examined by Western blotting with appropriate monoclonal antibodies. After establishment of GIST T-1 cell line with the signs of resistance to target medication imatinib, its sensitivity to various groups of chemotherapy (doxorubicin, etoposide, vinblastine, paclitaxel and cys-platinum) was evaluated. Sensitivity of imatinib-resistant GIST T-1 cells to chemotherapy as well as the level of expression of proteins serving as apoptotic markers, was evaluated by using MTS-based colorimetric assay and Western blotting. Results. After 18 month of culturing GIST T1 cells in the presence of gradually increasing doses of imatinib, the sings of resistance to this drug were observed. The obtained subline of GIST T1 IM-108R cells was sensitive to all used chemotherapeutic agents. Doxorubicin, vinblastine and etoposide were found to be the most potent cytostatic agents against imatinib-resistant GIST T1 IM-108R cells. Conclusion. Imatinib-resistant GIST T1 subline cells are sensitive to various types of chemotherapeutic agents; the established GIST T1 IM-108R cell subline might be further used for screening for the most effective chemotherapeutic agents and novel synthesized compounds.
Kazan medical journal. 2017;98(6):993-997
993-997
Endogenous sodium pump inhibitors: common pathogenetic mechanisms of impaired glucose tolerance and preeclampsia
Abstract
Aim. Study of the influence of sodium chloride overconsumption by pregnant rats with induced diabetes mellitus on the synthesis of marinobufagenin and Na/K-ATPase activity. Methods. The study was performed on 72 female Sprague Dawley rats. Type 2 diabetes mellitus was induced by administration of 65 mg/kg streptozotocin on day 4 after birth. Increased intake of salt was achieved by replacement of drinking water with 1.8% sodium chloride solution on days 12 to 19 of pregnancy. Results. In intact rats, pregnancy was associated with a two-fold increase of marinobufagenin level in the blood and mild impairment of glucose tolerance. Pregnant rats with induced diabetes mellitus apart from fetal macrosomia exhibited greater impairment of glucose tolerance and higher levels of marinobufagenin compared to those in intact pregnant animals. Compared to healthy pregnant rats, salt supplementation for laboratory animals with diabetes was associated with an increase in systolic blood pressure, decreased fetal and placental weight, five-fold elevation of marinobufagenin excretion, and in 42% - with inhibition of Na/K-ATPase activity in erythrocytes. In nonpregnant rats, pre-treatment with anti-marinobufagenin antibodies produced an exaggerated increase of blood levels of glucose and insulin in oral glucose tolerance test. Conclusion. Marinobufagenin is an important factor of pathogenesis of both preeclampsia and diabetes mellitus, and regulation of glucose tolerance may be one of the physiological functions of endogenous cardiotonic steroids.
Kazan medical journal. 2017;98(6):998-1004
998-1004
Influence of L-Nω-nitroarginine methyl ester and sodium nitroprusside in vitro on the oxidative modification of rat lysosome proteins
Abstract
Aim. To investigate in vitro effects of 5 mM L-Nω-nitroarginine methyl ester and 0.1 mM sodium nitroprusside on oxidative modification of lysosomal proteins of liver of intact sexually mature female rats of Wistar line. Methods. In the control groups in vitro incubation of isolated lysosomes in the isolation medium for 1, 2 and 4 hours was carried out. Experimental groups were incubated similarly in solutions of 5 mM L-Nω-nitroarginine methyl ester and 0.1 mM sodium nitroprusside. Protein oxidative modification was measured in sedimentary fraction according to R.L. Levine’s method in E.E. Dubinina’s modification. Reserve-adaptive capacity was calculated as the difference between total area under the curve of carbonyl derived proteins after metal-catalyzed oxidation (taken as 100%) and spontaneous oxidation, expressed as a percentage. Results. After 4-hour in vitro incubation 5 mM L-Nω-nitroarginine methyl ester was found to statically significantly increase the total level of protein oxidative modification compared to the control group by 2.41 times and to reduce reserve-adaptive capacity by 4.96 times, and 0.1 mM sodium nitroprusside increases the total level of protein oxidative modification compared to the control group by 2.05 times and reduces reserve-adaptive capacity by 1.56 times. One of the possible mechanisms of this phenomenon may be the reduced activity of lysosomal proteinases. 2-hour and 4-hour in vitro incubation of lysosomes in 5 mM L-Nω-nitroarginine methyl ester is accompanied by an increase of secondary markers of the ratio of protein oxidative modification relatively to 1-hour exposure by 1.18 times and 1.35 times, respectively. At 1-hour in vitro incubation in 0.1 mM sodium nitroprusside, increase of secondary markers of protein oxidative degradation by 1.64 times occurs. Conclusion. The in vitro effect of 5 mM -Nω-nitroarginine methyl ester and 0.1 mM sodium nitroprusside results in visible changes of oxidative modification of rat liver lysosomal proteins.
Kazan medical journal. 2017;98(6):1005-1011
1005-1011
Reviews
Comorbidity in the clinical presentation of internal diseases: focus on symptomatic gastroduodenal ulcers
Abstract
At present, comorbidity is one of the current interdisciplinary problems of clinical medicine. At the same time, in the modern literature the number of teaching and study guides, monographs and other scientific publications reflecting the essence of comorbidity and its prognostic significance for the patient, is clearly inadequate. Also, no national clinical guidelines exist for managing patients with comorbid diseases. The aim of the review is to draw practical physicians’ attention to the importance of timely detection of comorbid nature of the internal disease necessary for the correct choice of therapeutic measures for patients suffering from multiple diseases, early prevention of possible complications and the formation of a favorable prognosis. Symptomatic gastroduodenal ulcer lesions were chosen as one of the examples of comorbid pathology, late diagnosis and absence of early prevention of which can become the causes of gastrointestinal bleeding and related deaths in patients. The article reflects the definition of comorbidity, existing synonyms, its main types, and methods of evaluation. The causes and factors of the development of comorbid diseases, their prevalence in the population are analyzed. Attention is focused on the rules for formulation of clinical diagnosis for a comorbid patient, the need to take into account comorbidity when choosing an algorithm for integrated diagnosis and rational treatment of the disease. The importance of assessing the risk of drug interactions in the pharmacotherapy of comorbid diseases and possible complications are emphasized. The epidemiology of symptomatic gastroduodenal ulcers, their pathogenesis, common clinical presentation and its features depending on a specific type, complexity of diagnosis are analyzed in detail.
Kazan medical journal. 2017;98(6):1012-1019
1012-1019
Spindle-cell lung carcinoma: classification of types, features of diagnosis and treatment
Abstract
Spindle-cell lung carcinoma is a very rare disease, one of the forms of biphasic squamous-cell carcinoma, which can be detected in isolated cases. Despite different descriptions of this pathology, currently there is no consensus about methods of its exact morphological diagnosis and effective treatment. Therefore, it is very important to study all existing at the moment results of spindle-cell carcinoma research for the purpose of systematization and analysis of available data and development of effective methods of the disease control. The review contains modern understanding of clinical medicine about the tumor and different methods of its classification and identification based on worldwide scientific experience. The results of the research of spindle-cell lung carcinoma development causes are discussed, and statistical measures of its detection and used treatment methods are described. Spindle-cell lung carcinoma, frequently affecting male smokers as a large peripheral focus, has unfavourable prognosis even in those cases when the diagnosis was made at the early stage and radical surgery was performed. Distant metastases occur more frequently and earlier than in other tumors of the same group, and survival after recurrence is very low. One of the most promising methods of treatment in case of such malignancy is targeted immunotherapy such as anti-PD-1/PD-L1 antibodies aimed at inhibiting immune control point.
Kazan medical journal. 2017;98(6):1019-1023
1019-1023
Diode laser in dental practice
Abstract
The review presents the possibilities and experience of using diode lasers for treatment of oral inflammatory diseases. Earlier, low-intensity laser was used in dentistry only as a physiotherapeutic device. The laser applications range has expanded significantly with the advent of new technologies. Diode laser has a high level of safety, so it can be used in periodontics and endodontics without fear of tooth tissue structure damaging. In surgical dentistry, high-intensity laser radiation is used as an alternative to cutting and rotational instruments. Features of diode laser for surgical interventions are sterile conditions during the intervention and avoidance of bleeding during and after surgery, predicted depth of injury, high incision accuracy. Accumulated experience of using a diode laser shows good hemostatic effect, which leads to minimal recession of gingival margin. Many authors emphasize that postoperative scars are absent or are more tender and elastic, not constricting tissues. In comparison with traditional methods, use of laser scalpel can reduce epithelialization time of a wound by half. Also, a number of authors claim that the diode laser stimulates immune system, reduces pathogenicity of microflora, increases its sensitivity to antibiotics, positively regulates the function of dental cement in vitro. Use of laser technology improves the quality and effectiveness of ongoing treatment, reduces repeated paient visits, shortens treatment time, avoids relapses and complications. Due to this, the question of expanding the indications for diode lasers use in dentistry and improving the methods remains of current interest.
Kazan medical journal. 2017;98(6):1023-1028
1023-1028
Social hygiene and healthcare management
Infectious morbidity and resource provision for infectious disease service in municipal districts of the Republic of Tatarstan
Abstract
Aim. To conduct analysis of resource provision for medical care for patients with infectious pathology and to study primary infectious morbidity at the level of municipal districts of the Republic of Tatarstan. Methods. Study of primary infectious morbidity according to official statistics of the Federal Service for Supervision of Consumer Rights Protection and Human Well-Being in the Republic of Tatarstan based on form No. 2 with extracting data in 495 units, annual reports of Infectious Disease Service of the Ministry of Health of the Republic of Tatarstan for 2005-2015 - 66 units. The analysis of resource provision according to the central regional hospitals data, with extracting data in 70 units. Results. During the period of 2005-2015 the highest rates of primary infectious morbidity were observed in municipal districts where the administrative center is a city (13 054.01 per 100 000 population), the lowest - in rural areas (7953.6). The level of infectious morbidity in municipal districts is significantly lower than in average across the Republic of Tatarstan (р ˂0.05). 3 municipal districts having different types of administrative center are studied: Zainsky (urban population 72%), Apastovsky (rural people 73.9%), Drozhzhanovsky (rural people 100%) districts. The highest level of infectious morbidity in Zainsky District (2005 - 10 510; 2015 - 11 800.85 per 100 000 population), Apastovsky (7600.0 and 3612.44) and Drozhzhanovsky district (1629.68 and 4765.84). Differences in resource provision for infectious disease service are established: Zainsky district (there is an infectiologist, infectious beds, infectious disease office, specialized laboratory), Apastovsky district (service in infectious disease office is provided by part-time infectiologist), Drozhzhanovsky district (service in infectious disease office is provided by a nurse). In Drozhzhanovsky and Apastovsky districts there are no infectious beds and specialized laboratories. Conclusion. Level of infectious morbidity in municipal districts of the Republic of Tatarstan is closely related to the type of municipal district and resource provision for infectious disease service.
Kazan medical journal. 2017;98(6):1029-1033
1029-1033
Promising models of the organization of general medical practices in a city
Abstract
Aim. To propose promising organizational and functional models of general medical practices in a city with the expansion of the functions of paramedical personnel. Methods. Analysis of the forms data of federal statistical observation in Russia and its subjects was carried out. The following research methods were used: content analysis, statistical method, direct observation, sociological method (questionnaire), functional organizational modelling. Results. The indicators of availability of general practitioners (family doctors) and nurses of a general practitioner in Russia and its subjects are presented. The main reasons for inhibiting the introduction of the institute of general medical practice in a city are revealed. The actual model of general medical practice in a medical organization is presented, that provides outpatient medical care, as well as prospective models of general medical practices, focused on the rational use of resources, including specialists with secondary-level medical education in accordance with their level of professional competence. Different variants of perspective models are discussed for general medical practice in the conditions of city policlinics serving the adult population and distinguished by the forms of work; (1) an independent appointment for patients with the general practitioner’s nurse is organized; (2) preliminary appointment for patients with general practitioner’s nurse together with a general practitioner; (3) independent, before-doctor appointment for patients with a medical assistant and a nurse of a general practitioner; (4) a complex team of general practice can include a medical register. Conclusion. The proposals on improving the organizational bases for the activities of general medical practices in a city were developed.
Kazan medical journal. 2017;98(6):1034-1039
1034-1039
Medical and social portrait of families raising children with cerebral palsy
Abstract
Aim. To perform medical and social characterization of families raising children with cerebral palsy. Methods. The study was performed among families raising children with cerebral palsy and living in Omsk. It is a cross-sectional epidemiologic study. Survey of parents based on our developed questionnaire was performed. A total of 324 families took part in the study. The following factors were evaluated: family structure, character of relationship between members, social and living conditions, satisfaction with the quality of medical care. Results. Medical and social characterization was performed in families raising children with cerebral palsy. In 77% of cases a child was brought up in a traditional family (but in about half of the families after developing apparent abnormalities in a child and making a diagnosis of cerebral palsy, worsening of family relationships occurs). Due to necessity for taking care of the child with cerebral palsy, most of mothers are forced to quit their job that negatively affects the level of material wealth. Availability of their own accommodation was revealed in 64% of responders. Mother’s age at the time of birth of a child with cerebral palsy was primarily in the range from 25 to 29 years. A number of factors adversely affecting the health of children, both in the period of prenatal development and the newborn period: pregnancy with complications, acute respiratory viral infection during pregnancy, smoking during early pregnancy. Role of these factors in developing cerebral palsy was detected by a number of researchers. A number of difficulties met by the family members after bearing a child with developmental disabilities were identified (deterioration of family relationships, decline in material wealth, dissatisfaction with the quality of medical care). Conclusion. After making a diagnosis, family relationships worsen; most families have houses not adapted for defects of a child with cerebral palsy; some features of medical organizations service are revealed that might negatively affect the quality of medical care for children with cerebral palsy.
Kazan medical journal. 2017;98(6):1040-1043
1040-1043
Clinical observations
Idiopathic generalized dystonia
Abstract
Idiopathic generalized dystonia is a group of neurodegenerative diseases primarily charecterized by dystonic hyperkinetic disorder (irregular slow involuntary movements of different body parts accompanied by specific muscle tone changes and pathological poses). A 54-year-old female was admitted with various complaints. The leading syndrome was extrapyramidal due to which the differential diagnosis included Parkinson’s disease, multiple system atrophy, corticobasal degeneration, etc. The diagnosis of idiopathic generalized dystonia, in the form of lower extremity hyperkinesia with dystonic equinus of the left foot and hallux extension and cheirospasm, was made by a method of exclusion. The clinical case described in the article illustrates variety of clinical manifestations of the disease imitating clinical presentation of various neurological and psychiatric disorders, complexity of diagnostic search and importance of timely diagnosis of this disease.
Kazan medical journal. 2017;98(6):1044-1047
1044-1047
Clinical experiences
On the question of surgical treatment of advanced oral and oropharyngeal cancer
Abstract
Aim. To improve the results of treatment of patients with advanced oral and oropharyngeal cancer. Methods. To achieve the aim, studies were carried out on 30 patients with advanced cancer of the oral cavity and oropharynx. An operation was developed that involved modified mandibulotomy with vertical slanting jaw incision and separation of its fragments, and radical removal of the tumor under visual and manual control, which was performed in 14 patients (study group). Postoperative osteosynthesis was performed by fixing jaw fragments with a titanium miniplate. For comparison, 16 patients were operated in a traditional way (control group), in which the cheek was dissected up to the projection of the mandible branch, the tongue was stitched and stretched, the tumor process was removed. Results. Use of the proposed method provides visibility of the tumor process, its boundaries, topography of the internal carotid artery, facilitates radical removal of the tumor. The event-free 2-year survival in the study group was 43±7.2%, in control group - 25±6.0%. The median event-free survival in the study group was 22 months, in control group - 14 months. Conclusion. The proposed method of surgery provides radical removal of the tumor while monitoring the internal carotid artery, and in the post-operative period - rehabilitation of the resected organs of the oral cavity.
Kazan medical journal. 2017;98(6):1048-1052
1048-1052
Experience of treatment of forefoot pain syndrome of various genesis
Abstract
Aim. Defining the causes of metatarsalgia and methods of its elimination. Methods. With the use of clinical and radiologic methods the results of conventional and surgical treatment were studied in 132 patients treated at Foot surgery center of the international clinic «MEDEM» from September 2014 to September 2016 with initial diagnosis of metatarsalgia of unknown origin. Females comprised 74.2%, males - 25.8%. Results. Physical examination, Х-ray, CT- and MRI-scan, and ultrasound of soft tissues of feet were performed. In all cases, the exact cause of metatarsalgia was established: transverse platypodia - 20.4%, longitudinal platypodia - 11.3%, anterior tibialis tendinitis - 10.6%, plantar fasciitis - 9.1%, tailor’s bunion - 7.6%, peroneal tendinitis - 6.8%, Haglund’s deformity - 6.8%, achilotendinitis - 6.1%, hallucis extensor tendinitis - 6.1%, Morton’s neuroma (neurofibroma) - 5.3%, congenital long second toes - 3%, Keller’s disease II - 2.3%, Ledderhose disease - 2.3%, stress metatarsal fractures - 1.5%, Mueller-Weiss disease - 0.8%. Conservative treatment was conducted in 55.3% of cases, surgical treatment - in 44.7%. Follow-up period was 6 to 30 months. No complications were registered. Evaluation of the results was carried out with the use of visual analogue scale - the average score was 6 (73 before treatment); American Orthopaedic Foot and Ankle Society (AOFAS) scale - the average score was 97 (64 before surgery); scale of Nizhny Novgorod Research Institute of Traumatology and Orthopedics - the average score was 40 (27 before surgery). Conclusion. Metatarsalgia is a manifestation of multiple foot diseases; robust diagnosis, a combination of conventional and surgical methods of treatment, early activation and dynamic follow-up provide an accurate identification of etiology and rapid relief of pain syndrome.
Kazan medical journal. 2017;98(6):1053-1057
1053-1057
Jubilees
Professor Vil’dan Khayrullaevich Fazylov is 70 years old
Kazan medical journal. 2017;98(6):1058-1059
1058-1059
Obituary
Assistant professor Grigoriy Ivanovich Kharitonov
Kazan medical journal. 2017;98(6):1060
1060
Index of authors
Kazan medical journal. 2017;98(6):1061-1064
1061-1064