bluuebunny/crossref_metadata_2025 huggingface dataset:
An estimation of compliance of acute community-acquired pneumonia detection in children with local healthcare protocols
Authors: Gorachuk V V
Published: November 2019

Aim. To study the rationale for the diagnostic tests use and their compliance with the lists recommended by local protocol of healthcare for acute community-acquired pneumonia in children and to develop management measures to improve the diagnosis of the disease. Methods. Methods of comparative and statistical analysis were applied to assess the use of diagnostic tests conducted in 2011 at the prehospital and hospital stages in 240 children admitted to Children’s Regional Hospital, Chernigov, Ukraine depending on patients’ age and severity of the acute community-acquired pneumonia. Results. It was found that the list and the conduction of the diagnostic tests in children with moderately severe pneumonia deviated from the recommended national protocol requirements without reasonable clinical indications. Additionally to the obligatory tests (full blood count, chest X-ray) every second child was administered electrocardiography, and every fifth - liver function test. Chest X-ray was re-done in 14.4% of children aged 1-3 years and 12.0% of children aged 4-16 at admission. Low coverage level with examinations performed on out-patient stage in children regardless of their clinical condition was revealed, leading to a waste of resources of the hospital for the diagnosis of the disease. Conclusion. The results of the study demonstrate the need for adopting and implementing the management decisions to improve the diagnosis of acute community-acquired pneumonia in children based on the obtained evidence.
Comparative study of different models of alloxan-induced diabetes mellitus
Authors: Jafarova R E
Published: November 2019

Aim. To compare the clinical course of diabetes mellitus induced by alloxan using classic and modified technique. Methods. Experiments were carried out on mature white mongrel rats, which were divided into two groups: the first group (25 rats) was administered a 200 mg/kg single dose of alloxan (classic model), the second group (25 rats) was administered 150 mg/kg of alloxan at the first day, 100 mg/kg of alloxan at the second day and 100 mg/kg of alloxan at the fourth day. 25 intact rats were examined as a control group. The animals were withdrawn from the experiment by decapitation on the 10th and 21st day, blood and tissue samples were taken for the laboratory testing. The animals’ status (mortality, grooming behavior, body weight, food and water intake) were measured by visual examination. The levels of glucose and lipids were assessed using enzyme colorimetric detection («Human» laboratory kits, Germany, FP-901 analyzer), insulin and C-peptide levels were examined by enzyme-linked immunosorbent assay («Chemwell» analyzer, «DEMENITECKILL-WELLSEE» laboratory kits, Germany); levels of diene conjugates and malonic dialdehyde - using the photocolorimetry based on the colored thiobarbituric acid products. Results. In the first group, the mortality reached 68%, mean weight loss - 41.2%. Blood glucose level at the 10th and 21st days was higher by 370.7 и 146.2% respectively compared to intact animals. Insulin level decreased by 95.8 and 83.7%, C-peptide level - by 96 and 83.7%. In the second group, mortality was 32%, mean body weight loss - 36.5%, blood glucose level at the 10th and 21st days elevated by 364.5 and 151.5%, insulin level decreased by 96.1 and 82.9%, C-peptide level - by 96.0 and 83.7% respectively. A moderate hyperlipidemia was observed in both groups with increased levels of cholesterol, triglycerides, low and very-low density lipoproteids, free fatty acids and decreased levels of high density lipoproteids. The concentration of diene conjugates and malonic dialdehyde increased rapidly to a variable degree depending on the tissue anti-oxidative activity. Conclusion. When diabetes mellitus is modeled by the use of alloxan, an acute form of alloxan-induced diabetes is observed on the 10th day, a chronic form - on the 21st day in both groups. The modified model of alloxan-induced diabetes showed 36% less mortality rate compared to the classic model.
Hypokalemic myoplegia
Authors: Sakovets T G , Bogdanov E I
Published: November 2019

Acute generalized muscle weakness may have a different underlying cause. Among all urgently admitted patients, hypokalemia is observed in more than 20% of cases. Usually blood potassium concentration decrease is not fatal, but severe hypokalemia can be life-threatening for the patient suffering from cardiovascular diseases and respiratory disorders. Hypokalemia manifests clinically by muscle pain, weakness, the intestinal motility disorders, constipation, marked decrease in serum potassium levels can lead to fatal rhabdomyolysis. The key hormones that regulate the total stock of potassium in the body and its normal redistribution of intra- and extracellular fluid are insulin and catecholamines, interacting with β-adrenergic receptors. Regulation of blood potassium level is provided by insulin and it is a feedback (hyperkalemia stimulates insulin secretion, decreased potassium levels inhibits it). The level of catecholamines is not determined by potassium concentration, however, it influences the serum potassium level. Hypokalemia is usually the result of potassium loss due to abnormal renal (treatment with thiazides, high doses of corticosteroids, antibiotics, primary hyperaldosteronism due to adenoma, adrenal carcinoma, bilateral adrenal hyperplasia, Liddle, Bartter’s, Gitelman’s syndromes, 11β-hydroxysteroid dehydrogenase, 11β-hydroxylase, 17α-hydroxylase deficiency, Cushing’s syndrome) or extrarenal (intense vomiting, diarrhea due to excessive laxative use, salmonellosis, yersiniosis, HIV-infection, bowel tumors, chemotherapy, radiation therapy in cancer patients, celiac disease, jejunoileal bypass, a lack of potassium in food) potassium loss, an also a transmembrane shift of potassium (hypokalemic familial periodic paralysis, β2-agonist, bronchodilators, theophylline intake). Hypokalemic myoplegia may lead to fatal complications, requiring doctors of various specialties’ to know the clinical manifestations of hypokalemia, which may have different underlying cause.
Kazan anatomic scientific school of V.N. Tonkov and its siberian branches
Authors: Kiyasova E V
Published: November 2019

Anatomic scientific school of Tonkov is one of the established scientific and scholar schools in Russian medicine. The school has reached its rise at the period when Vladimir Nikolaevich Tonkov headed the department of anatomy at the Academy of Military Medicine, however, the scientific and life journey of that great anatomist is intimately related to the department of anatomy of the medical faculty at the Emperor’s Kazan University, where V.N. Tonkov was admitted at a hard time for the department. The situation has changed with his arrival. V.N. Tonkov was a talented scientist and scholar. He has founded the basis of a new scientific field in studying vascular system, anthropologic studies, that were traditional for the department, were continued. The certain merit of V.N. Tonkov was the foundation of the study museum at the department. Vladimir Nikolaevich headed the department of anatomy for 10 years (1905-1915). It was in Kazan where the famous anatomic Tonkov’s scientific school, honoured by its followers, alumni of Emperor’s Kazan University, who had grown up within its walls, got an outstanding education and left alma mater as a professor to honor the native university in other cities of Russia. From all of the V.N. Tonkov’s students, only V.A. Popov and K.M. Yakhontov did not leave the Kazan University. Both died in Kazan, being staff members of the department of anatomy. Honored scientific researcher and academician A.D. Speransky, the head of the department of anatomy of Omsk Medical Institute professor B.N. Bazhanov, the head of the department of anatomy of Saratov Medical Institute professor V.I. Bik had started their scientific career as students of V.N. Tonkov. They have always noted that they belong to the Kazan anatomic scientific school headed by Tonkov. K.V. Romodanovsky and I.S. Malinovsky, also students of V.N. Tonkov, have contributed to the development of medical education in the Universities of Siberia. The first head of the department picked out from the Emperor’s Kazan University alumni for its centennial history was the student of V.N. Tonkov, Nikolay Dmitrievich Bushmakin, who later participated in creation of medical faculty in Irkutsk University, and of Khabarovsk Medical Institute.
Association of arterial stiffness and cardiovascular system remodeling in patients with hypertension
Authors: Bastrikov O Yu , Grigoricheva E A , Belov V V , Milegov V V
Published: November 2019

Aim. To study the indices of arterial wall local stiffness and it association with structural and functional parameters of cardiovascular system remodeling in hypertensive patients. Methods. Cross-sectional population study included 213 industrial workers, among them 106 patients with stage I-II hypertension and 107 healthy individuals. The stage of arterial hypertension and additional cardiovascular risk category was performed in accordance with national guidelines. All patients underwent echocardiography, carotid arteries ultrasonography, including arterial stiffness evaluation. Results. In patients with hypertension, significant association of arterial wall stiffness indices and «intima-media» complex thickness (total impact of 91%) and echocardiographic parameters describing the left heart chambers volume were revealed. The fact of identifying the relatively high rate of altered arterial wall stiffness parameters, as well as its association with «intima-media» complex thickness in healthy individuals with normal blood pressure (total impact of 81%) may suggest that vascular wall rigidity change may premise vascular remodeling. Conclusion. Arterial wall stiffness indices may be a marker of effective control of risk factors in individuals with normal blood pressure and effect of drug therapy in patients with hypertension.
Assessing treatment efficiency in patients with hepatic encephalopathy
Authors: Kutepov D E
Published: November 2019

Aim. Comparative analysis of the efficacy of conservative and extracorporeal methods of treatment in patients with hepatic encephalopathy. Methods. The study included 117 patients with chronic liver failure. In all patients hepatic encephalopathy, registered in 100% of cases, was one of the major syndromes, with its severity ranging from stage 2 to 4. All patients were distributed to 4 groups, conservative treatment was continued in all groups. In the 2nd group plasma exchange, in 3rd - plasma exchange + high volume venovenous hemofiltration, in 4th - Molecular Adsorbent Recirculating System (MARS) were added. Treatment effect was assessed by the number of patients with positive changes in mental status (assessed by number connection test) and by the number of patients with varying degrees of hepatic encephalopathy regression (in points). Results. Data analysis showed that both conservative and extracorporeal methods of treatment leaded to the reduction of hepatic encephalopathy severity, as well as better results in number connection test, but the improvement was more significant in patients treated with extracorporeal methods. Among them, better effect was seen in patients treated with Molecular Adsorbent Recirculating System use. At the time of discharge, no signs of deterioration was seen in patients treated by Molecular Adsorbent Recirculating System and plasma exchange + high volume venovenous hemofiltration. Conclusion. Extracorporeal methods of treatment are more effective for hepatic encephalopathy severity reduction compared to conservative therapy, Molecular Adsorbent Recirculating System is the most effective method compared to other extracorporeal methods.
Role of heritable connective tissue diseases phenotypes in assessing the risk for internal diseases
Authors: Tyurin A V , Davletshin R A , Muratova R M
Published: November 2019

Aim. To identify the prevalence of main phenotypes of polygenic heritable connective tissue diseases in patients with internal diseases and to assess the prevalence of different internal diseases in such patients. Methods. The study involved 600 patients (254 males, 346 females) aged 18 to 64 years. Average age of males was 52±3.8 years, females - 47±2.2 years. Patients were examined to reveal the signs of different phenotypes of heritable connective tissue diseases in patients with internal diseases, as well as the severity of connective tissue diseases, and possibilities for it screening using the wrist and thumb hypermobility tests. Results. Signs of heritable connective tissue diseases were revealed in 147 (24.5%) patients with internal diseases. In females, those signs were observed in 104 (30.0%) cases, of which 44 (42.3%) were graded as mild, 35 (33.7%) - moderate, 25 (24.0%) - severe. In males, signs of heritable connective tissue diseases were revealed in 43 cases (16.9%), including mild - 17 (39.5%), moderate - 14 (32.5%) and severe - 12 (28.0%). Ehlers-like phenotype was the most common (52.0%), Marfan-like phenotype was observed in 14.0% of cases, primary mitral valve prolapse was diagnosed in 7.0% of patients, unclassifiable phenotype was observed in 11.0% of cases. Joint hypermobility syndrome was revealed in 31.0% of patients, presenting both as specific phenotypes (Marfan-like, Ehlers-like) and as a self-phenotype (31.9% of all the patients with heritable connective tissue diseases phenotype). Benign joint hypermobility was observed in 6.1% of cases. Symptoms of heritable connective tissue diseases were more frequent in patients with gastrointestinal and musculoskeletal diseases. Conclusion. The most common phenotype of heritable connective tissue diseases is Ehlers-like with skin, bone and systemic manifestations. Presence of heritable connective tissue diseases was most commonly associated with gastrointestinal and musculoskeletal diseases.
FAS-receptor expression in peripheral blood lymphocytes and monocytes in pregnant women with fetal growth restriction
Authors: Kazantseva E V , Dolgushina N V , Tereshkov P P
Published: November 2019

Aim. To study the expression of Fas-receptor on peripheral blood monocytes and lymphocytes in women who have given birth to children with low birth weight. Methods. Population-based study recruited 242 women who have given birth at the gestation term of more than 35 weeks. Group 1 (n=108) included mother-newborn pairs with low birth weight of newborns, group 2 (n=134) - mother-newborn pairs with normal birth weight for the gestational age. Peripheral blood lymphocytes and monocytes total count and subpopulations, CD95 (Fas-receptor) apoptosis receptor expression level (using four- and five-parametric phenotypic test) were determined, using a combination of monoclonal antibodies to differentiation and activation markers. Results. CD3+CD95+ cells levels were significantly higher in women who delivered of low birth weight children. In T-cell subpopulation of group 1 women, there was a statistically significant increase in relative values of Fas-receptor expression on T-helpers and T-cytotoxic lymphocytes - by 1.6 (p 0.001) and 6.3 (p 0.001) times, respectively, and by 2.9 (p 0.001) and 2.6 (p 0.001) times, respectively, in absolute values. There was a reduction in absolute counts of CD3+CD4+ and CD3+CD8+ T-lymphocyte subpopulations in women who delivered of low birth weight children compared to controls. The ratio of CD95+-expressing T-lymphocyte subpopulations in group 1 women was the following: CD4+CD95+/CD8+CD95+ ratio was 4.9 times higher compared to the second group (p 0.001). Increased absolute and relative Fas-receptor expression on B-lymphocytes [by 63.9% (p 0.001) and 33.3% (p=0.002), respectively] was found in women who delivered of low birth weight children compared to women who delivered of children with normal birth weight. CD14+CD95+ expression analysis revealed increased absolute and relative counts of Fas-receptor expressing monocytes. Conclusion. Marked expression of CD95+ in circulating monocytes and raised CD4+CD95+/CD8+CD95+ ratio in women who delivered of low birth weight children may be a laboratory test for detecting higher chance for fetal growth restriction.
Analyzing the reasons for patients’ dissatisfaction with the results of multifocal intraocular lens implantation
Authors: Ivonin K S
Published: November 2019

Aim. To analyze the causes for patients’ dissatisfaction with the results of multifocal intraocular lens implantation. Methods. The research is based on the results of cataract surgeries in 220 patients (50 patients were implanted multifocal refractive intraocular «M-flex» lens, 40 - multifocal intraocular «Gradiol» lens, 64 - multifocal intraocular «Accord» lens, 66 - monofocal intraocular lens). Pre-and post-operative examination included visual acuity test (with and without correction to near, far and moderate distances), determination of the nearest point of clear vision, contrast sensitivity study using the «Zebra» software, stereo vision test, pupil diameter measuring, refractometry, keratometry, binocular vision color tests, patient questioning. Pre-operative evaluation was performed 1 day prior to surgery. Post-operative observation was carried out 1 week, 1, 3, 6 and 12 months after the surgery. Results. No statistically significant difference (p 0.05) in uncorrected visual acuity at different light intensity - 102 lux and 416 lux - was found between the groups with different types of multifocal intraocular lenses. In groups with multifocal intraocular lenses light side effects were observed in 46-52.5% of patients. However, there was no link between the light side effects and patients’ satisfaction with results of the surgery. Reduction of spatial contrast sensitivity parameters was registered in all groups of multifocal intraocular lenses patients compared to patients with monofocal intraocular lenses (p 0.05). According to the survey results, 92.5 to 94% of patients with multifocal intraocular lenses did not report decreased visual acuity on moderate distance. Conclusion. The most important reason for patients’ dissatisfaction with the results of the multifocal intraocular lenses implanting was the reduction of spatial-contrast sensitivity parameters. Bilateral multifocal intraocular lenses implanting improved the contrast ratio.
Eye disorders in patients with chronic alcoholism
Authors: Fazlyeva R R , Saifullina F R
Published: November 2019

Aim. To study the features of ophthalmic disorders in patients with chronic alcoholism. Methods. Sixty patients (120 eyes) with chronic alcoholism (the main group), including 20 people (40 eyes) with the first stage, and 40 people (80 eyes) with the second stage of chronic alcoholism. Control group consisted of 30 healthy volunteers aged 18 to 46 years. All patients underwent ophthalmologic examination, which included visual acuity test, refractometry, biomicroscopy, biomicroophthalmoscopy, visual field test using chromatic and achromatic colors, color vision test using the tables by E.B. Rabkin (1972), tonometry, flicker fusion rate, and bulbar conjunctiva microcirculation examination. Results. In patients of the control group, eye condition complied with a person’s age, a few changes of the conjunctiva microcirculation were revealed, perivascular changes index was assessed as 1.26±0.05 points, vascular changes index - 1.2±0.05 points, capillary changes index - 1.28±0.05 points, intravascular changes index - 2.3±0.05 points, total conjunctival index - 5±0.13 points. Patients with chronic alcoholism showed reduction of central vision in 26% of cases; white color perception visual field decrease - in 80% of cases, red color - in 40%, green - in 13% of cases. Color perception change was an acquired one in 88% of cases, inherited - in 22% of cases; unilateral reduction of visual flicker fusion rate to red light was observed in 35% of cases, bilateral decrease - in 23% of cases. All patients with chronic alcoholism had bulbar conjunctiva microcirculation disorders: perivascular changes index was assessed as 3.48±0.06 points, vascular changes index - 11.25±0.32 points, capillary changes index - 10.51±0.06 points, intravascular changes index - 2.36±0.06 points, total conjunctival index - 27.61±0.48 points. Conclusion. Alcohol intoxication causes profound pathological changes in the eye seen as visual field decrease, color vision disorders, reduced flicker fusion rate, presence of perivascular, intravascular and vascular disorders of bulbar conjunctiva microvasculature, which should be considered at main process monitoring and choosing the appropriate treatment.
Clinical features of bacterial dysentery caused by shigella flexneri and associated with severe neurologic disease
Authors: Khaliullina S V , Anokhin V A , Khaertynov Kh S , Urmancheeva Yu R , Sushnikov K V , Alatyrev E Yu , Valiullina A N , Khasanova E A
Published: November 2019

Aim. To assess clinical and epidemiological features of bacterial dysentery caused by Shigella Flexneri 2а in children with severe neurologic comorbidities. Methods. 27 case histories of children with the clinical picture of shigellosis were analyzed. All patients were admitted to the pediatric ward of the hospital of infectious diseases from specialized neuropsychiatric care home in October-November 2013. Results. Clinical picture of bacterial dysentery in examined children was classic. 22 out of 27 children (81.5%, CI 66.9-96.1) had mild disease, 3 (11.1%, CI -0.7-22.9) - moderate, 2 (7.4%, CI -2.5-17.3) - severe form of the disease. In majority of cases, intestinal involvement was manifesting as enterocolitis - in 20 out of 27 patients (74.1%, CI 57.6-90.6). In 3 patients (11.1%, CI -0.7-22.9), shigellosis was manifesting as gastroenterocolitis. In 4 cases (14.8%, CI 1.4-28.2) clinical signs of hemorrhagic colitis were observed. Severe dehydration (2nd and 3rd degree) was registered in 4 out of 27 patients, (14.8%, CI 1.4-28.2), moderate - in 2 (7.4%, CI -2.5-17.3). In 4 out of those 6 patients (66.7%, CI 29-104.4) dehydration was isotonic, in 2 (33.3%, CI 0.4-75) - hypotonic. Conclusion. The infectious disease did not influence the clinical course of concomitant neurologic disorder and did not lead to development of neurologic complications in the admitted patients. In most of the cases shigellosis was mild, and patient’s condition was mostly determined by a concomitant disease.
Optimizing antibacterial treatment in acute pancreatitis (experimental and clinical research)
Authors: Zainutdinov A M , Malkov I S
Published: November 2019

Aim. To examine the effectiveness of interstitial electrophoresis in antibacterial treatment in animals with experimental pancreatitis and in patients with acute pancreatitis. Methods. Cefotaxime concentration was studied by highly effective chromatography at different routes of administration in 40 rats of both gender with body weight of 150-250 g at the department of surgery of Kazan State Medical Academy and department of pharmacology of Kazan State Medical University. The clinical part of the research compared treatment results in group of patients (n=27) in whom interstitial electroforesis was performed together with antibacterial treatment with group of patients (n=26) who were treated conventionally. Results. Antibiotic introduction using galvanizing in experimental pancreatitis is more effective compared with traditional antibiotic introduction 24 hours after acute pancreatitis modulation. In the clinical part of the research in the main group complications were registered in 14.8% of cases, localized forms of infection (3 effusions, 1 retroperitoneal abscess) were the most common. In control group complications were seen in 34.6% of cases, generalized infections were the most common type (omental and retroperitoneal abscess - in 15.4% of cases, retroperitoneal pyogenic cellulitis - in 19.2% of cases). So, in the basic group less invasive procedures were more common compared with laparotomy, marsupialization, lumbotomy being more common in control group. Mortality rate was 11.1% in the main group and 15.4 in control group (р 0.05). Conclusion. Using interstitial electrophoresis in antibacterial treatment decreases the frequency of purulent complications, with localized forms of the infection being more prevalent, and allows to decrease the mortality rate in patients with acute destructive pancreatitis.
Public awareness of the arterial hypertension preventive measures
Authors: Agaev A A
Published: November 2019

Aim. To explore the public opinion on provided information load about arterial hypertension preventive measures. Methods. Prospective study including adult population of Baku city was performed. Modified international questionnaire SF-36 (the Azerbaijan version) was administered to the study subjects, 2584 completed questionnaires were received. Subject were distributed to 3 groups. All subjects were additionally provided questionnaires studying public need for the medical information on arterial hypertension. Of all study subjects, 374 subjects of the 1st group, 212 of the 2nd group and 632 of the 3rd group responded back. Results. Public awareness of the arterial hypertension was overall assessed as unsatisfactory. Even in subjects with controlled arterial hypertension, despite constant doctor visits and undergoing treatment, only 18.4±2.0% of questioned showed reported knowledge, and 12.6±1.7% were under-informed. Level of knowledge of the majority of questioned subject was assessed as moderate - 37.7±2.5%, and sufficient - 31.3±2.4% of subjects. Situation was even worse in subjects with uncontrolled arterial hypertension and in control group, where 30.7±3.2 and 36.9±1.9% of subjects, respectively, were under-informed, and 18.9±2.7 и 21.4±1.6% were completely not informed about arterial hypertension. Priority sources of medical information were doctors, followed by television and environment. At the same time, information got from doctors was described by the subjects as scarce, matter of common knowledge, non-specific. Meanwhile, the need for the risk factors and ways of their control was high. The main part of the questioned subjects were motivated in terms of the blood pressure, blood glucose level, body weight control, proper nutrition and physical exercise, smoking cessation and low alcohol consumption. Conclusion. Public awareness of the medical care and disease prevention, including arterial hypertension, is insufficient. Active informing targeted to public preventive behavior correction is required.
Arterial stiffness as a cardiovascular events risk marker and possibilities for its downregulation by contemporary antihypertensive medications
Authors: Zagidullin N Sh , Zulkarneev R Kh , Scherbakova E S , Safina Yu F , Zagidullin Sh Z
Published: November 2019

Arterial blood pressure measured by Korotkov’s method is a non-valid predictor for possible cardiovascular events, which requires introduction of new methods of arterial hypertension diagnostics. Recently, the effect on arterial stiffness has become a very important characteristic of antihypertensive drugs overall efficacy. Evaluation of arterial stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to more precise cardiovascular risk stratification and reflects target organ damage and the effectiveness of antihypertensive treatment. In particular, pulse wave velocity exceeding 12 m/s is a significant risk factor of cardiovascular events. Arterial compliance can be determined by applanation tonometry, pulse wave shift at the carotid and femoral arteries, finger photoplethysmography, volume pulsoxymetry, echo-tracking, suprasystolic pulse waves recording method and cardio-ankle vascular index. Different effects of antihypertensive drugs on arterial stiffness at the same blood pressure reduction have been repeatedly shown. The article discusses the impact of the most commonly used antihypertensive drugs, including contemporary antihypertensive drugs combinations, on arterial stiffness. Effect of beta-blockers greatly varies depending on the characteristics of the drug, diuretics have neutral effect, calcium antagonists (especially amlodipine) decrease the pulse wave speed and arterial wall stiffness. Both angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (more data for enalapril, perindopril and valsartan) were effective in decreasing arterial wall stiffness. A significant reduction in arterial wall stiffness was mainly found if antihypertensive drugs combinations were used, especially the combination of calcium antagonists and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.
Staged medical aid in acute myocardial infarction management as a key for successful treatment of elderly patients with severe comorbidities
Authors: Yakupov I F , Galyavich A S , Korchagina K V
Published: November 2019

During the recent years, since the start of coronary artery stent era not only coronary artery bypass graft surgery, but percutaneous transluminal angioplasty became common in patients with left main coronary artery stenosis. Mechanical complications of myocardial infarction, such as ventricular septal rupture, left ventricle free wall rupture and mitral regurgitation due to papillary muscle rupture, are straight indications for cardiac surgery. However, studies show that the age of over 70 years is a high-risk factor for cardiac surgery. In elderly patients, the duration of cardiopulmonary bypass and aortic cross-clamping time have a major impact on the surgery outcome. Therefore, strategies aimed at reducing the volume of cardiac surgery, should be more successful in elderly patients. On the other hand, elderly patients should be well prepared for surgery, and it should be performed when concomitant diseases are compensated. A case of 82-year patient admitted to the intensive care unit with acute myocardial infarction and chord papillary muscles partial rupture associated with severe mitral regurgitation, is presented. Due to the progression of pulmonary edema, mechanical ventilation was started and emergency percutaneous intervention was administered as a life-saving measure. Stents were placed in obtuse marginal branch, circumflex artery and anterior interventricular artery. Because of existing mitral regurgitation of 3-4 grade, after 2 weeks the patient was re-evaluated ex consilio. Considering relatively stable condition, mitral valve replacement with cardiopulmonary bypass was administered, which was successfully done. The successful treatment of this patient was possible because of the proper and timely staging of the patient’s management.
The history of biliary surgery
Authors: Fedorov I V
Published: November 2019

From the ancient times biliary surgery attracted a great attention of the doctors and other specialists all over the world. In medieval times, main efforts of medical workers were targeted to the liver and biliary anatomy research. Until the XV century doctors were not aware of the cholelithiasis, first steps in diagnosing and treating this disease were related to obstructive jaundice and biliary abscesses. Surgical treatment in XVIII-XIX centuries included intra-abdominal abscess drainage, pus and bile drainage, gall bladder lithotomy. If biliary colic was associated with local skin hyperemia in right hypochondrium, a surgeon would make an incision in this area, leading to biliary fistula formation and further recovery in some patients. In the middle of XIX century, surgeons started to perform cholecystostomy, removing the stones out of the gall bladder and performing the cholecystopexy to the laparotomy wound. Only in 1882 27-year old Langhenbuch, who was appointed as a head doctor in a hospital in Berlin, was the first one in the world to perform a cholecystectomy in 43-year old patient, who suffered from biliary colics for 16 years. Langhenbuch started to do surgeries on biliary system after many years of training on dead bodies. The peculiar progress in biliary surgery was observed during the last century. Minimally invasive and endoscopic technologies along with general anesthesia and antiseptics made this specialty safe for most of the patients, with cholecystectomy becoming one of the world’s most common surgeries. During the last decades laparoscopic cholecystectomy became the surgery of choice in treating cholelithiasis, and endoscopic papillosphincterotomy and choledocholithotomy - in treating choledocholithiasis.
Health care in Kazan during the Great patriotic war
Authors: Faskhutdinova E N , Mukharyamova L M
Published: November 2019

The article is devoted to the health care system in Kazan during the Great Patriotic War. The activity of evacuation hospitals, organization of care for the wounded has been shown. The work of Kazan Medical Institute in preparing qualified medical personnel and conducting research in the field of military medicine has been discussed.
Diagnostic program and tactical approaches to treatment of patients with obturative colonic obstruction of tumor genesis
Authors: Malkov I S , Toltoev M M
Published: November 2019

Aim. To determine the value of ultrasound investigations, colonoscopy and laparoscopy in the complex diagnosis of acute obturative colonic obstruction of tumor genesis and in selecting the optimal treatment strategy. Methods. Conducted was an anlysis of results of treatment of 112 patients with obturative colonic obstruction of tumor genesis. A set of diagnostic procedures was carried out for every admitted patient: digital rectal examination, radiography of the abdomen, ultrasound examination, fiber colonoscopy, and laboratory studies. Results. Based on the clinical and radiographic the diagnosis of obturative colonic obstruction was established in 64.3%, ultrasound investigation revealed the presence of bowel obstruction without specifying its location in 92% of the cases. Emergency colonoscopy was informative only in 55.5% of cases due to inadequate prior preparation of the colon. Using the developed methodology of preparing the colon, it was possible to perform colonoscopy up to the level of the tumor in 26 patients (92.9%) out of 28 patients. In the 32 cases minimal surgical intervention were performed by way of formation of an ileotransverse anastomosis by-pass, double-barreled ileostomy or colostomy. 80 patients underwent resection of the bowel with the tumor, including operations with the formation of a primary anastomosis, which were performed in 20 patients when the tumor was located in the right segments of the colon. In 22 patients an intraoperative colonic lavage was performed. Postoperative complications were recorded in 30 (26.8%) patients. Postoperative mortality was 24.1% (27 patients). Conclusion. Based on the radiographic and ultrasound investigations of the abdominal cavity it is possible to establish the presence of bowel obstruction without specifying the localization of the obstruction zone; in order to determine the cause of the obturative colonic obstruction it is necessary to perform an emergency colonoscopy with rigorous preparation of the colon according to the developed technique, while the volume of surgical intervention should be determined in each case individually.
The dependence of the activity of alanine aminotransferase on the gender of the patient in viral hepatitis B
Authors: Enaleeva D Sh , Beshimova D T
Published: November 2019

Aim. To reveal the dependence of alanine aminotransferase on the gender of the patient in the inactive form of chronic viral hepatitis B. Methods. Instrumental determination of the activity of alanine aminotransferase in 64 healthy subjects (32 males and 32 females) and 255 patients with an inactive form of chronic viral hepatitis B. According to the time of infection the patients were divided into three groups: up to 5 years, 5-10 years, and more than 10 years. Results. Normal alanine aminotransferase activity was detected in 18 (21.4%) males and 66 (78.6%) females. Among the 34 patients with constantly high indices of alanine aminotransferase activity were 24 (70.6%) males and 10 (29.4%) females, that is, increased activity is 2.8 times more frequently recorded in males. The higher absolute index of this enzyme’s activity (IU/L) in males was noted with disease duration of 5-10 years (1.25 times average increase in activity) and 10 years or more (1.5 times). Conclusion. The more marked and frequent increase in alanine aminotransferase activity among males with chronic viral hepatitis B, should be considered when interpreting the results of laboratory tests.
Diagnosis of psychovegetative disorders in adolescents with diseases of the upper gastrointestinal tract
Authors: Kokurkin G V , Akimova V P
Published: November 2019

Aim. To develop a method of diagnosing psychovegetative disorders in adolescents with diseases of the upper gastrointestinal tract. Methods. Examined were 120 adolescents. The main group - 90 adolescents with diseases of the upper gastrointestinal tract (mean age 15.9±2.5 years): extroverts (the first group - 31 people), centroverts (the second group - 37 people), introverts (the third group - 22 people). The control group - 30 practically healthy adolescents aged 14 to 18 years: 18 boys and 12 girls. This group included examined individuals, who did not report any complaints to the state of health, without chronic somatic and neuropsychiatric diseases in the anamnesis, with no deviations in the physical status. Conduced were clinical examination, determined was the level of extra-introversion, stomach acid-producing function, the nature of autonomic regulation, assessed was the psycho-emotional state, conducted was fibroesophagogastroduodenoscopy, ultrasound investigation of the liver, biliary tract, pancreas, stomach and duodenum. Results. Introverts had an unfavorable course of the diseases of the upper gastrointestinal tract. All patients of this group were diagnosed was duodenal ulcers; often several parts of the digestive system were involved in the pathological process. The most common and severe symptoms were heartburn, vomiting, nausea, loss of appetite, in 65.7% of patients revealed was an increase in acid production, in 86.4% - Helicobacter pylori infection. Autonomic regulation was characterized by vagotonia. Hypertrophic diffuse gastroduodenitis and duodenal erosions were diagnosed in extroverts. The main clinical syndrome was pain, established were moderate disturbances of the acidity of the gastric juice (in 43.5% of patients of this group), and Helicobacter pylori infection (48.4%). Autonomic regulation was characterized by sympathicotonia. Among centroverts the diseases of the upper gastrointestinal tract had a very mild course, most often superficial gastroduodenitis was present. Among the clinical symptoms flatulence was often reported. Compared with other groups disturbances of the acidity of gastric juice (15.3%) and Helicobacter pylori infection (18.9%) were reported with less frequency. Autonomic regulation was characterized by autonomic dysfunction of both vagotonic and sympathicotonic types. Conclusion. The data on personality characteristics (Eysenck’s questionnaire), psycho-emotional state (I.D. Spielberger test) and autonomic regulation (variation cardiointervalography) can be used in predicting the course of diseases of the upper gastrointestinal tract in adolescents.
Creation of artificial chords during mitral valve replacement in patients with rheumatic heart disease
Authors: Abdul’yanov I V , Mukharyamov M N , Dzhordzhikiya R K , Vagizov I I
Published: November 2019

Aim. To evaluate the effectiveness and safety of the use of artificial chords using polytetrafluoroethylene sutures during mitral valve replacement in patients with rheumatism. Methods. The study included 134 patients operated on for isolated rheumatic mitral valve disease. Immediate (10 days) and long-term (24 months) results were evaluated in the three groups of patients, depending on the method of valve replacement: creation of prosthetic chords using polytetrafluoroethylene sutures (37 patients), preservation of native chords (67 patients), total excision of the subvalvular apparatus (control group, 30 patients). Results. 24 months after surgery in the group of prosthetic chords and the group of preserved native chords recorded was a significant decrease in the pulmonary artery pressure, the left atrial size and a reduction in the end-diastolic left ventricular size. In the control group of patients reported was a reduction in left ventricular ejection fraction in long-term follow up. Conclusion. The use of polytetrafluoroethylene sutures in order to create new chords demonstrated their safety and effectiveness in preserving the physiological left ventricular geometry; artificial chords, as well as the preserved native chords, have a positive effect on the left ventricular contractile function in the remote postoperative period.
Changes in the content of some cytokines during chronic heart failure
Authors: Kuzmin A G , Gorbunov V V , Goryainova E V , Bogatikov E V , Koshevaya O D
Published: November 2019

Aim. To determine the changes in the content of cytokines, systolic intraventricular and interventricular dyssynchrony in patients with chronic heart failure. Methods. The study included 223 patients (174 males, 49 females) who suffered a Q wave myocardial infarction of the left ventricle, with clinical manifestations of chronic heart failure with functional class III according to the classification of the New York Heart Association. Pro- and anti-inflammatory cytokines (tumor necrosis factor alpha, interleukin-6, -4, and -10, interferon-gamma) were studied in blood plasma by enzyme immunoassay. Dyssynchrony was studied by pulsed-wave Doppler investigation, M-mode measurements of the left ventricle and pulsed-wave mode of tissue Doppler investigation of the myocardium. Results. Noted was an elevation of levels of tumor necrosis factor alpha, interleukin-6, interferon gamma, in combination with a reduction in the content of interleukin-4 and -10 in all groups. The maximum increase in the content of tumor necrosis factor alpha and interleukin-6 was found in the group of eccentric hypertrophy and dilatation of the left ventricle. Positive correleation links of medium strength have been established between the levels of interleukin-6 and the degree of interventricular mechanical delay, and between systolic and diastolic myocardial stress. In the group with eccentric hypertrophy and dilation of the left ventricle the content of tumor necrosis factor alpha directly correlated with the time interval from the beginning of the Q wave on the electrocardiogram to the beginning of the oflow in the left ventricular outflow tract, as well as with the concentration of N-terminal fragment of the precursor of the human brain natriuretic peptide. During remodeling according to the type of eccentric hypertrophy without dilatation of the left ventricle observed were positive correlation links of medium strength between the content of the tumor necrosis factor alpha and the intraventricular mechanical delay, end-diastolic pressure in the left ventricle. In the group of concentric hypertrophy the content of the tumor necrosis factor alpha and interleukin-6 is positively associated with electrocardiographic interval from the Q wave to the beginning of the systolic Doppler artifact S. Conclusion. One of the factors, which contributes to the preservation of abnormal levels of tumor necrosis factor alpha and interleukin-6 in blood plasma is the intraventricular and interventricular dyssynchrony; the combination of dilatation, myocardial hypertrophy, systolic and diastolic left ventricular dysfunction, dyssynchrony and the toxic effects of proinflammatory cytokines on the myocardium contributes to progression of chronic heart failure.
Study of the absorptive intestinal function in an experimental model of chronic alcohol intoxication
Authors: Yakovleva L M , Lezhenina S V , Maslova Zh V , Kupriyanov S V
Published: November 2019

Aim. To study the absorptive function of the rat intestine on the background of prolonged alcohol intoxication. Methods. The study was performed on 24 nonlinear white male rats (12 animals in the control and experimental groups) weighing 220-240 g, which had a daily consumption of 20° ethanol solution (ethyl alcohol) for the duration of 180 days. After 6 months perfusion of the isolated segment of jejunum with a dextrose (glucose) solution 35 mmol/L was performed by in the rats the method A.M. Ugolev. The luminescence-histochemical method was used to examine the content of catecholamines and serotonin in the neuroamine containing structures. Results. In the control rats, the rate of absorption in the first 10 min of perfusion reached a maximum value with a further decrease in the intensity of absorption. The content of serotonin and catecholamines in the absorptive epithelial layer of the jejunal villi was lower than in the muscle membrane. In the experimental rats the content of biogenic amines in the wall of the jejunum increased: the amount of serotonin in the absorptive layer of the villi increased up to 122% and in the muscle membrane - up to 126%. The content of catecholamines also increased up to 154% in the muscle membrane and up to 124% in the epithelial layer in the area of the villi compared with controls. In conditions of chronic alcohol intoxication the rate of absorption of dextrose (glucose) during perfusion in the first 30 minutes was reduced by 33% compared with the control. During the next hour, the intensity of absorption reduced by 45% (55% of control). After 1.5 hours the absorption increased slightly, accounting for 64% of the control value and by the end of the 2nd hour the intensity of the absorption reached 91%. Conclusion. An increase in content of catecholamines and serotonin in the mucous and muscular layers of the intestine in chronic alcohol intake and a decrease in the intensity of the absorption of dextrose (glucose) was established; in the setting if modified combined effects of neurotransmitters on smooth muscle cells an increased motor effect is formed, which is accompanied by rapid evacuation of the intestinal chyme with a reduction in the rate of absorption
The effect of new quaternary phosphonium salts with highest alkyl substituents on the permeability of cell membranes for sodium ions in vitro
Authors: Orlova O V , Oslopov V N , Sidullina S A
Published: November 2019

Aim. To assess the effect of newly synthesized quaternary phosphonium salts with highest alkyl substituents (C10, C12, C14, C16, C18) on the permeability of cell membranes for sodium ions in vitro. Methods. In vitro studied was the effect of different concentrations of new quaternary phosphonium salts with highest alkyl substituents on the cell membrane permeability to sodium ions according to the rate of Na+-Li+-countertransport in the erythrocyte membrane. Results. Low concentration (0.001 mM) of substance C10 increased the rate of Na+-Li+-countertransport in the erythrocyte membrane by 11.9%, substance C12 - by 11.8%, substance C14 - by 12.7%, substance C16 - by 13%, substance C18 - by 12.3%. Higher concentrations of substances (0.01-0.05 mM) had no significant effect on the cell membrane permeability to sodium ions. Conclusion. An increase in the rate of Na+-Li+-countertransport in the erythrocyte membrane is influenced by minimal concentrations of a substance, under the influence of other concentrations the rate of Na+-Li+-countertransport doe not change.