Vol 103, No 6 (2022)

Background. Cardiometabolic diseases are one of the leading causes of disability and mortality worldwide, which justifies the relevance of studying their early manifestations.

Aim. To analyze the hemodynamic and structural echocardiographic parameters of the heart in relation to cardiometabolic risk factors and its staging according to the Cardiometabolic Disease Staging (CMDS) scale in young patients.

Material and methods. 109 patients were examined: 57 males (52.3%) and 52 females (47.7%) aged with a median of 36.1 [32.6–39.2] years without cardiometabolic diseases. The design of the study was a cross-sectional case-control study. The parameters of cardiometabolic risk were assessed with its calculation and assessment taking into account the stage according to the CMDS scale. Echocardiography was performed in M- and B-modes. The data were processed using the SPSS Statistics 23 program. The Mann–Whitney U test, the Kruskal–Wallis test, and the Pearson and Fisher χ2 tests were used. Correlation analysis according to Spearman was carried out.

Results. The first stage of cardiometabolic risk was established in 17 examined patients (15.6%), the rest had stage 2 (n=57; 52.3%) or stage 3 (n=35; 32.1%) of cardiometabolic risk. Deviations from the normal values of hemodynamic echocardiographic parameters were not revealed. The frequency of increase in the index of relative thickness, the thickness of the posterior wall of the left ventricle, the interventricular septum thickness, the myocardium mass of the left ventricle did not differ (p=0.198–0.983). A direct correlation between the left atrial, end-systolic and diastolic volumes, left ventricle wall thickness, and an inverse relationship between the left ventricular ejection fraction and cardiometabolic risk factors was established. At the 3rd stage of cardiometabolic risk, higher values of the left atrial volume (47 [46–49] ml; p=0.005), end-systolic (30.42 [29.23–32.04] ml; p=0.001) and diastolic (79 [78–81] ml; p=0.003) volumes of the left ventricle and lower left ventricular ejection fraction (61 [60.35–62.65] ml; p=0.004) than on the 1st and 2nd stages were diagnosed.

Conclusion. An increase in the cardiometabolic risk is associated with an increase in preload and afterload on the left heart.

Background. Ischemic heart disease, despite ongoing therapeutic and preventive measures, remains the leading cause of disability and mortality in people of working age.

Aim. Study of cardiovascular risk factors and assessment of the clinical and angiographic picture in patients with stable coronary heart disease and borderline coronary artery stenoses of various clinical phenotypes.

Material and methods. 236 patients with functional class I–III stable angina pectoris aged 49–59 years with borderline (40–70%) coronary artery stenoses were examined. All patients underwent a general clinical examination, cardiac ultrasound and coronary angiography. The nonparametric Mann–Whitney U-test was used to compare indicators between groups. To compare binary and categorical indicators, Fisher's exact two-tailed test was used. Differences in the compared parameters were considered statistically significant at p <0.05.

Results. The predominance of the following clinical phenotypes, which determined the further distribution into groups, was revealed: coronary heart disease without myocardial infarction — the first group; coronary heart disease with myocardial infarction more than 6 months old — the second group; coronary heart disease with a metabolically unhealthy phenotype of obesity without diabetes mellitus — the third group, coronary heart disease with diabetes mellitus — the fourth group. In the third and fourth groups, there was no significant difference in the frequency of myocardial infarction in the past, and patients in the third group with a history of myocardial infarction suffered it at the earliest age (44.3 [41; 50] years, p <0.01). Despite the presence of arterial hypertension in 97.5% of groups of patients with different phenotypes, the fourth group showed the highest values of the left ventricular myocardium mass index (240.6 [146.3; 286.3], p <0.01). In the same group, multivessel coronary artery lesions were more frequently recorded during angiographic examination — in 25 patients (47.2 [33.4; 52.3]%, p <0.01).

Conclusion. Despite the absence of obstructive coronary artery disease, patients with stable coronary heart disease and borderline coronary artery stenoses are at risk of cardiovascular complications due to the presence of arterial hypertension in the vast majority, a significant incidence of obesity, dyslipidemia, and carbohydrate metabolism disorders.

Background. Cytokine homeostasis is an important factor characterizing the general condition and adaptive capabilities of the body of patients with malignant neoplasms. However, the role of various growth factors and their significance in the development and enhancement of malignant growth in breast cancer remain poorly understood.

Aim. To evaluate the levels of cytokines - tumor necrosis factor α, interleukins-4, -6, -8 and -10 — in the blood serum of patients with different stages of breast cancer in comparison with healthy volunteers.

Material and methods. The study was conducted in 65 patients aged 25 to 67 years (mean age 44.5 [40.0–56.5] years). Two groups were distinguished: the first — with stage 1–2, the second — with stage 3–4 of breast cancer. The comparison group consisted of 15 apparently healthy women without cancer, aged 29 to 66 years (mean age 51.0 [39.0–61.0] years). Blood levels of tumor necrosis factor α, interleukins-4, -6, -8 and -10 were studied by enzyme immunoassay. The obtained data were processed using the methods of variation statistics, the Statistica 10.0 software package. The significance of differences was assessed by calculating the median and interquartile interval, analysis of variance was performed using the Kruskal–Wallis H-test, and Dan's Q-test was used for multiple comparisons. The critical significance level p for statistical tests was taken equal to 0.05.

Results. In the group of patients with stage 1–2 breast cancer, an increase in the blood levels of all studied cytokines was revealed in comparison with the group of healthy women: interleukin-6 (p=0.00719), interleukin-8 (p=0.00259), tumor necrosis factor α (p=0.00014), interleukin-4 (p1=0.0133), interleukin-10 (p1 <0.00001). In the group of patients with stage 3–4 breast cancer, an increase in blood levels was characteristic of all studied cytokines: interleukin-8 (p=0.00009), tumor necrosis factor α (p=0.000004), interleukin-4 (p <0.00001), interleukin-10 (p <0.00001), except for interleukin-6 (p=0.15608). The established patterns in changes in the content of cytokines in the blood of patients with breast cancer at different stages of development can serve as the basis for developing approaches to the diagnosis and treatment of the disease.

Conclusion. In patients with breast cancer, the levels of tumor necrosis factor α, interleukins-4, -6, -8, -10 (p <0.05) are higher than in healthy women.

Background. The spread of highly resistant strains of Klebsiella pneumoniae in the departments of purulent orthopedics determines the need for constant monitoring of the sensitivity of bacteria to antibacterial drugs.

Aim. To monitor the resistance of K. pneumoniae bacteria isolated from patients with chronic osteomyelitis to antibacterial drugs.

Material and methods. The resistance profiles of 663 clinical strains of K. pneumoniae isolated from wounds and fistulas of 294 patients with chronic osteomyelitis who were treated in the purulent department of the Federal State Budgetary Institution “National Medical Research Center for Traumatology and Orthopedics named after G.A. Ilizarov” in the period 2016–2021 to eight drugs: cefazolin, cefotaxime, cefepime, imipenem, meropenem, amikacin, gentamicin, piperacillin + tazobactam were analyzed. The analysis of the results was statistically proces¬sed using the software AtteStat, version 13.0. Data are presented as a percentage (%) of the total number of strains isolated during the study period.

Results. K. pneumoniae strains showed the greatest resistance to cephalosporin antibiotics and inhibitor-protected penicillins. The number of strains resistant to aminoglycosides decreased from 2016 to 2021. Imipenem had the highest activity against Klebsiella, the proportion of resistant strains did not exceed 48% over 6 years. Meropenem was active against Klebsiella over a 3-year period from 2016–2018 (the proportion of resistant isolates did not exceed 28.5%). Starting from 2019, the number of resistant strains increased, in 2021 their number was 63.9%. Among all the isolated strains of K. pneumoniae, the largest share fell on polydrug-resistant strains (89.6%).

Conclusion. The monitoring of the resistance of K. pneumoniae strains to eight antibacterial drugs revealed a high incidence of multidrug-resistant strains, low efficacy of cephalosporin antibiotics and inhibitor-protected β-lactam drugs, and an increase in resistance to carbapenems.

Background. The rapid development of abdominal, endovascular surgery and transplantology necessitate a detailed study of the structural features of the abdominal cavity vessels.

Aim. To study the variant anatomy of the colonic branches of the superior mesenteric artery in men and women.

Material and methods. The study was conducted based on the analysis of the results of multislice spiral computed tomography, a total of 2300 computed tomograms of adults aged 25 to 75 years (913 males and 1387 females) were studied. To assess the statistical significance of the aorta branches architectonics variants frequency dependence on gender, the method of analyzing four-field tables (Pearson's chi-square test) was used. The correlation strength was assessed using the normalized value of the Pearson coefficient.

Results. It has been established that the branches of the superior mesenteric artery, which vascularize the large intestine, have a wide range of variant anatomy. According to their number and the presence of aberrant branches, these variants can be classified into mono-, bi-, tri-, quadri- and penta-arterial. The most common variant of the architectonics of these branches of the superior mesenteric artery is biarterial. Mono- and pentaarterial branching variants of the colonic branches of the superior mesenteric artery are extremely rare in both sexes. The iliocolic and middle colic arteries are permanent branches of the superior mesenteric artery, and the right colic artery may be absent (in 7% of cases in males and 19% in females). Among the aberrant branches of the superior mesenteric artery, we noted the arteries involved in the blood supply to the liver: the right accessory, right replacement, and common hepatic arteries. In men in 25% of cases, in women in 16% of cases, a deviation from the superior mesenteric artery of the aberrant hepatic branch was noted.

Conclusion. The architecture of the colonic branches of the superior mesenteric artery is characterized by a wide range of variant anatomy and a high incidence of aberrant hepatic arteries.

One of the mechanisms for the development of autoimmune diseases is changes in epigenetic regulation, the root causes of which have not yet been established. At the same time, data on the role of transposons as sources of long noncoding ribonucleic acids (RNA) and microRNAs involved in the development of immune pathology have been accumulated. In evolution, transposable elements have become the basis for the emergence of V(D)J recombination and regulation of HLA genes. Pathological transposon activation has been revealed in type 1 diabetes mellitus, rheumatoid arthritis, systemic lupus erythematosus, Aicardi–Goutieres and Sjögren’s syndromes. The influence of exogenous viruses on the development of autoimmune diseases may be due to their interactions with transposons. Transposable elements themselves are able to activate the antiviral immune response, stimulating the hyperproduction of interferon. An assumption about changes in the activation of transposons as drivers of autoimmune pathology was made, which is reflected in the expression of non-coding RNAs, which are key epigenetic factors. The analysis of the transposon-derived microRNA database (MDTE DB) made it possible to identify 13 microRNAs associated with autoimmune diseases: systemic scleroderma (miR-31, miR-609, miR-3162), juvenile rheumatoid arthritis (miR-151), systemic lupus erythematosus (miR-198, miR-342), psoriasis (miR-224, miR-378) and myasthenia gravis (miR-421, miR-551a, miR-612, miR-891b), multiple sclerosis (miR-584 ), which serves as a proof of the proposed hypothesis. Since changes in epigenetic factors under the influence of transposons are reversible and are reflected in the expression of certain non-coding RNAs, targeted therapy using microRNAs and their analogues as tools is a promising direction in the development of specific treatment for autoimmune diseases.

Background. Currently, in the Russian Federation, the criteria for establishing disability do not take into account the assessment of the quality of life, while in developed countries this indicator is a mandatory component of examination programs and evaluation of the effectiveness of treatment and rehabilitation. In Russian pediatrics, research on the development of indicators of the quality of life in children with chronic disabling diseases has begun, this work is a continuation of this direction.

Aim. To assess the quality of life of disabled children with various somatic diseases using all the possibilities of the Health Utilities Index questionnaire.

Material and methods. A survey of 213 patients aged 5 to 18 years with chronic diseases with the status of a “disabled child” and their legal representatives was conducted using the Russian version of the international general questionnaire Health Utilities Index. Statistical analysis was performed using the SPSS software package version 26.0. The Kruskal–Wallis test and Dunn's posterior test were used.

Results. During the study, multi-attribute utilitarian indices were developed for each group of children, which ranged from 0.67±0.3 (95% confidence interval 0.55–0.78) in patients with rheumatological diseases to 0.85±0.21 (95% confidence interval 0.79–0.91) in children with heart disease and statistically significantly (p <0.001) were lower than in healthy children (0.9±0.17; 95% confidence interval 0.87–0.92). The features of one-attribute utilitarian indices depending on the class of the disease have been established. An analysis of the level and degree of functioning disorders showed that the most common and frequent for children with disabilities in the studied groups were emotional disorders; problems associated with the presence of pain; disability caused by a sense of cognitive deficit. For the first time, to determine the “categories” of the severity of violations an approach according to a multi-attribute utilitarian index was used.

Conclusion. The quality of life in children with disabilities, reduced compared to healthy peers, has nosological features; the most pronounced decrease in the quality of life was noted in children with skin diseases and rheumatological diseases.

Deep vein thrombosis is one of the most formidable conditions, which can subsequently cause pulmonary embolism and trigger the development of post-thrombophlebitic disease. The aim of our work was to evaluate the result of antegrade venous thrombectomy with stenting for acute iliofemoral phlebothrombosis in a patient with post-thrombophlebitic disease. Patient G., 33 years old, was admitted to the Department of Vascular Surgery of the City Clinical Hospital No. 7 of Kazan on January 1, 2021 on an emergency basis with complaints of severe swelling and pain in the right lower limb. Upon admission, the patient underwent ultrasound Doppler scanning of the veins of both lower extremities and X-ray tomography of the chest and abdominal cavities with contrast, according to which the diagnosis of acute iliofemoral phlebothrombosis on the right with thrombus flotation in the common iliac vein for 7 cm was made. According to vital indications, the surgery — transjugular thrombectomy from the iliofemoral segment using a proximal venous trap and subsequent implantation of a venous stent into the right common iliac vein — was performed. In the postoperative period, the patient received anticoagulant therapy. A day after the operation, a control ultrasound of the veins of the lower extremities and the inferior vena cava, X-ray tomography of the organs of the chest and abdominal cavity were performed. On the 5th day, the patient was discharged in a satisfactory condition under the supervision of a surgeon at the place of residence. Analysis of the results of surgical treatment of a patient with post-thrombophlebitic disease complicated by acute iliofemoral phlebothrombosis using antegrade venous thrombectomy with stenting showed that the patency of the stented iliac-femoral segment was maintained for up to 12 months. Thus, the proposed method of surgical treatment allows us to safely remove floating and occlusive thrombi from the iliocaval and femoral segments, implant stents, and thereby restore the patency of the segment, reducing the risk of possible repeated thrombosis, embolic and post-thrombophlebitic complications.

Background. Description of the pathomorphology of patchy atrophy of the skin is found in rare publications on dermatology. At the same time, we noted a surge in the number of such cases over the past 3 years.

Aim. To study the detectability of patchy skin atrophy based on the materials of histological examination of skin biopsy specimens in the Republican Dermatovenerological Dispensary for 2016–2021, find out the most frequent localization of the process and determine the most characteristic pathomorphological signs of patchy skin atrophy.

Material and methods. The biopsy material of the skin from 816 patients, in which red spots on the skin of the trunk, arms and legs were clinically determined (clinical diagnoses were diverse) was studied. Histological preparations of the skin of patients were stained according to the standard method with hematoxylin and eosin.

Results. For 6 years (2016–2021) of studying and diagnosing 194 cases of patchy skin atrophy, the same frequency of the disease in men and women was noted (ratio 1:1). In men, patchy skin atrophy was more often detected in the young age group (up to 30 years), and in women, in the older age group (after 60 years). The most common localization of patchy skin atrophy is the trunk, extensor surface of the arms and lower leg. Histological examination of the skin in patients with patchy atrophy revealed two variants: with perivasculitis in the papillary dermis and without perivasculitis. We suggested two stages in the development of the disease: the first is the erythematous stage, the second is the sclerotic stage. The most characteristic pathomorphological signs of patchy skin atrophy are described.

Conclusion. An increase in the number of diagnosed cases of patchy skin atrophy was noted, the histological signs of which are a decrease in the number of rows of cells in the Malpighian layer, the disappearance of the basal and granular layers of the epidermis.

Background. The widespread prevalence of diabetes and the progressive deterioration of health against the background of this disease substantiate the need for the use of new methods for the early diagnosis of diabetic microangiopathies. The combined use of digital capillaroscopy and deep learning technologies will significantly improve the quality and speed of microvascular disorders diagnostics.

Aim. Development of a system for assessing capillary images based on artificial neural networks, as well as its testing for the early diagnosis of microangiopathy in patients with diabetes mellitus.

Material and methods. 136 patients (59 females and 77 males) with type 1 diabetes mellitus aged 25.82±6.05 years were examined and divided into two groups: the first group included 65 (47.8%) patients who had no symptoms of diabetic microangiopathies, the second group — 71 (52.2%) patients who were diagnosed with one or more diabetic microangiopathies. The control group consisted of 30 practically healthy volunteers. All patients with diabetes melitus, as well as individuals from the control group, underwent сapillaroscopic examination. The resulting images were analyzed using the developed evaluation system based on artificial neural networks. Statistical data processing was performed using the Student and Mann–Whitney tests (U-test), logistic regression analysis, and ROC analysis.

Results. In patients with diabetes mellitus, there was a decrease in the capillary network density in both groups and the diameter of the arterial sections in the second group. Capillaroscopy using the developed system showed a sufficient level of significance (χ2=21, p=0.000), high sensitivity (71.43%) and specificity (85.71%). This method can be used in the diagnosis of microangiopathy in diabetic patients.

Conclusion. The combined use of capillaroscopy and neural networks allows to increase the speed and quality of the examination, as well as simplify the interpretation of the resulting images.

The reform of dental education began in the RSFSR in 1918, when the People's Commissariat adopted a regulation according to which dental schools (secondary educational institutions that trained dentists in pre-revolutionary Russia) were to be closed, and odontological units and departments for pathology and therapy of dental diseases, prosthetic technology, surgery of the jaws and oral cavity were opened at the medical faculties of universities. The establishment of odontological departments did not allow a significant increase in the ranks of odontologists, since students had to spend as much time on studying dentistry as future doctors, and received only the right to practice dentistry and an incomplete medical education. The proposal to revive dental schools to meet the needs of the population in dental care by specialized professionals met with fierce resistance from the head of the dental subsection of the RSFSR People's Commissariat of Health P.G. Dauge, who considered secondary education unacceptable. The article describes the discussion that unfolded on this issue, as a result of which odontological departments were created at the medical faculties of universities, the number of dentists decreased, and the preventive direction proposed by P.G. Dauge, as a method of reducing the country's need for dental specialists, became one of the main ones in Soviet dentistry.

The Department of Skin and Venereal Diseases is one of the oldest departments of Kazan State Medical University. It originates in the bowels of the medical faculty of the Kazan Imperial University. The founder and first head of the Department of “Skin and Syphilitic Diseases” was Professor A.G. Ge. There are three periods in the development of the scientific school, which differ in research issues and teaching methods. The first period — from the birth of the school of A.G. Ge until the end of the 1920s, it is characterized by the fight against syphilis, which is reflected in the name of the department of “skin and syphilitic diseases”. The starting point of the second period in the history of the Kazan school of Dermatovenereology can be considered 1930, when the medical faculty of the university formed an independent institute — the Kazan State Medical Institute. At this stage, it is difficult to identify the main scientific direction, the research was carried out based on the urgent tasks of the time. The third stage (from the 1970s to the present) is characterized by research into issues of allergy and its skin manifestations. Employees of the Department of Dermatovenerology of the Kazan State Medical University are currently continuing the main traditions of the Kazan dermatovenerological school.

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Liu S-H, Saldanha IJ, Abraham AG, Rittiphairoj T, Hauswirth S, Gregory D, Ifantides C, Li T. Topical corticosteroids for dry eye. Cochrane Database of Systematic Reviews. 2022. Issue 10. Art. No.: CD015070. DOI: 10.1002/14651858.CD015070.pub2.

This publication is a reprint of an article by Assistant I.F. Kozlov “A case of female false hermaphroditism”, published in the Kazan Medical Journal in 1923. Reprinting is carried out in preparation for the celebration of the 150th anniversary of the first issue of the Kazan Doctors’ Society Diaries, the assignee of which is the Kazan Medical Journal. Original publication: Kozlov IF. A case of female false hermaphroditism. Kazan Medical Journal. 1921;17(2):224–232. DOI: 10.17816/kazmj79462.