bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of endoscopic interventions in patients with bowel stomas
Authors: Timerbulatov M V , Ibatullin A A , Gainutdinov F M , Kulyapin A V , Aitova L R , Kyzylbaeva A I , Abdeev A A
Published: November 2019

Aim. To evaluate potentials and to determine indications for endoscopic interventions in case of bowel stomas surgery. Methods. Case series of 66 patients with bowel stomas who underwent endoscopic interventions at various stages is presented. The causes of stoma formation were: colon cancer (43 patients), colon diverticular disease (10), inflammatory bowel disease (5), colon trauma (4), benign colon tumors (2), dolichosigmo-id (2). Results. Laparoscopic technique was most widely used in cases of acute intestinal obstruction - 39 patients. Laparoscopic subtotal colectomy with Brooke end ileostomy was performed in 3 patients. Laparoscopically assisted reversal was completed in 11 patients after Hartmann’s procedure. Introduction of endoscopic interventions to bowel stoma surgery techniques allowed to reduce the number of post-operative complications. The terms of rehabilitation after radical interventions with complete colon stoma closure in patients with diseases of the colon requiring surgical treatment were decreased to 7-11 days. Conclusion. The use of laparoscopic techniques in bowel stoma surgery is possible at every stage of surgical rehabilitation of patients who underwent colostomy; it is safe and has a number of advantages compared to standard procedures.
Genetic predictors of theophylline efficacy and safety in children with bronchial asthma
Authors: Kantemirova B I , Starodubtsev A K , Sychev D A , Griganov V I
Published: November 2019

Aim. To study the prevalence of С734A polymorphic marker of CYP1А2 genotype in population of children of different ethnical groups, and to estimate the phenotypic activity of CYP3A4 izoenzyme by age and gender for further increasing the theophylline treatment safety in children with bronchial asthma. Methods. 250 healthy children aged from 1 to 10 years from different ethnical groups (Russians, Kalmyks, Ingush, Chechens, Tatars). Each ethnical group consisted of 50 children. CYP1А2 izoenzyme genotype (by С734A polymorphic marker) was detected by polymerase chain reaction. CYP3A4 izoenzyme of liver cytochrome P 450 activity was measured by calculating urine 6-β-hydrocortisone level to urine cortisol level ratio. Urine 6-β-hydrocortisone and cortisol levels were measured by high precision Liquid chromatography-mass spectrometry. Results. It is the first time when high prevalence of CYP1А2 genotype was reported in children of 5 different nationalities living in Astrakhan region, associated both with slow and rapid CYP1А2 substrate drug metabolism, showing the importance of further individual studies on CYP1А2 genotype polymorphism. Age and gender-related features of CYP3A4 izoenzyme phenotype activity, that should be taken into account while choosing the most effective and safe methylxanthines dosing, were revealed. Conclusion. Before the long-term drug therapy of bronchial asthma using theophylline it is rational to investigate CYP1А2 gene polymorphism and CYP3A4 izoenzyme phenotype activity to increase treatment safety.
Fast track surgery - a multimodal strategy for managing surgical patients
Authors: Mazitova M I , Mustafin E R
Published: November 2019

Multiple factors are involved in the recovery of patients without significant complications and in reduction of the duration of their stay in hospital. The search for effective treatment methods for surgical patients with minimal risk led to the emergence and development of a new concept - fast track surgery. This is a package of healthcare services, which provides a modern approach to the preoperative, intraoperative and postoperative phases of patient management, the combined effect of which is in the reduction of complications, postoperative pain, stress responses and organ dysfunction, as well as early rehabilitation. Reducing the cost of treatment, time of in-hospital stay, faster return to normal life and work - are the benefits of a multimodal strategy for management of surgical patients. Promising initial results obtained using the fast track program, raise the issue of the need to change the traditional system of surgical care in order to improve postoperative results and to further study of each component of this program. Further improvement of this technique requires combined use of minimally invasive surgeries, pharmacological suppression of stress and effective multimodal non-opioid analgesia with active rehabilitation techniques.
Evaluation of myocardial viability in patients with coronary heart disease complicated with advanced left ventricular dysfunction
Authors: Saifullina G B , Ibatullin M M , Sadykov A R , Valiullina N M
Published: November 2019

Review of the literature on myocardial viability evaluation at the stage of surgical treatment planning in patients with coronary heart disease complicated with advanced left ventricular dysfunction is presented. In significant number of patients myocardial revascularization may improve regional and global heart function, and lead to further clinical improvement. The underlying pathophysiology involves different types of reversible myocardial dysfunction (hibernation, stunning), which may co-exist within the same patient’s myocardium. Potentially reversible left ventricular dysfunction is characterized by preserved cell membrane integrity and cardiomyocyte metabolism (sufficient to maintain cellular functions and cell membrane integrity in conditions of chronic or repetitive ischemia). Another important objective when assessing myocardial viability - pre-operative evaluation of post-infarction aneurysms in patients with severe left ventricular dysfunction. Results of clinical trials assessing the effectiveness of surgical revascularization in patients with ischemic cardiomyopathy as well as the results of the clinical trial on surgical treatment of ischemic heart failure are presented. A spectrum of non-invasive methods of myocardial viability evaluation, including the most studied nuclear, allows to identify cases of reversible left ventricular dysfunction in patients with congestive heart failure and to make a prognosis on success of the surgical treatment.
The association of the FTO gene polymorphism with overweight in russian population
Authors: Nasibulina E S , Shagimardanova R R , Borisova A V , Ahmetov I I
Published: November 2019

Aim. To investigate the association of the first intron of FTO (fat mass and obesity associated) gene T/A (rs9939609) polymorphism and overweight in Russian population. Methods. 107 (females 48, males 59) overweight (body mass index 25.0-29.9 kg/m2) subjects or subjects with obesity (body mass index ≥30 kg/m2) were included. The control group (body mass index ≤24.9 kg/m2) consisted of 453 subjects (females 323, males 130). Genotyping for the T/A (rs9939609) polymorphism of the FTO gene was performed by polymerase chain reaction (PCR) and restriction enzyme digestion. Results. The frequency of the FTO A allele in subjects with overweight or obesity was significantly higher compared to controls (45.3% vs. 33.4%; p=0.0015). The genotype distribution of the FTO gene T/A polymorphism (TT - 32.7%, TA - 43.9%, AA - 23.4%) in a group of subjects with overweight or obesity was significantly different compared with controls (TT - 44.6%, TA - 43.9%, AA - 11.5%; p=0.0028). The relative risk of being overweight or obese was 2.4 for subjects with the FTO AA genotype. Conclusions. The results of the presented study suggest an association of the FTO gene T/A polymorphism with the risk of obesity, which is consistent with the data of numerous studies.
Prevalence of sustained arterial hypertension, white coat hypertension and masked hypertension among working women
Authors: Kalcheva E Y , Oslopov V N , Zakharova O V
Published: November 2019

Aim. The prevalence of sustained arterial hypertension, white coat hypertension (isolated clinical arterial hypertension) and masked hypertension (isolated ambulatory arterial hypertension) among employed women of Kazan was studied. Cardiovascular risk factors in these conditions were evaluated. Methods. The study cohort included 108 patients. The examination was conducted at the jobsite and included questionnaires, blood pressure measurements, anthropometry, fasting glucose level and lipid profile examination. Assessment of blood pressure in everyday conditions was performed by 24-hour monitoring of blood pressure or home blood pressure measurements over 4 days. Results. The prevalence of sustained hypertension in the study cohort was 31.6%, white-coat hypertension - 4.6%, masked hypertension - 13.9%. Among patients with white coat hypertension and masked hypertension most of the patients had two or more cardiovascular risk factors; the distribution of risk factors number in these groups was similar to a group of patients with sustained hypertension. Conclusion. Among the employed women the prevalence of sustained arterial hypertension was high, the prevalence of masked hypertension was quite high, the prevalence of white coat hypertension was lower than expected.
The role of pharmaco-electroencephalographic monitoring in treatment of patients with resistant forms of epilepsy
Authors: Stolbova E A , Bein B N
Published: November 2019

Continuous electroencephalography monitoring plays an important role in assessing the effect of anticonvulsant treatment. To illustrate this, an own clinical experience of continuous electroencephalography monitoring in a patient with giant subcortical-periventricular heterotopia at the stage of anticonvulsant selection is presented. A clinical case of symptomatic epilepsy as a result a giant subcortical-periventricular brain heterotopia was observed. Seizures were resistant to ongoing treatment. Epileptic seizure and coincident epileptic brain activity were registered for the first time in this patient only at continuous electroencephalography monitoring. On brain magnetic resonance imaging signs of giant subcortical-periventricular heterotopia of right frontal and temporal lobes were found. The combination of anticonvulsants was changed, allowing to achieve clinical remission, which was proved by repetitive electroencephalography after 7 months of treatment. The role of continuous electroencephalography monitoring to determine the effect of administered anticonvulsant treatment is shown. Heterotopias are a group of subcortical displasias - various maturation abnormality of the cerebral cortex, which are often associated with neurological deficits, onset as an epileptic seizure is characteristic. The particular feature of the presented case is minimal neurological deficit observed. The onset of epileptic seizures in the patient was at the age of 12 despite considerable morphologic brain changes.
Mammary gland in vulva (rare clinical case)
Authors: Kozlov L A , Zhuravleva V I
Published: November 2019

A rare clinical case of a patient with fibroadenoma of the vulva’s right labium majus with a typical hystological structure of mammary grand is described. The patient noticed a tumor of the right labium majus approximately 10 years before admission. After the childbirth while breastfeeding patient noticed a whitish discharge form the tumor which looked like breast milk. At the oncologic dispensary biopsy was performed after the tumor punction, atypical basal epithelium was found, and the basal cell carcinoma was suspected. Histological examination revealed fibroadenoma with a typical hystological structure of mammary grand.
Instant and long-term results of surgical treatment in patients with peripheral vascular disease as a complication of diabetes mellitus
Authors: Krepkogorskiy N V , Sharafutdinov M R , Ignatyev I M , Bredikhin R A , Galyautdinov F S
Published: November 2019

Aim. To define the indications and to evaluate the effectiveness of various surgical treatment methods in patients with arterial stenosis and occlusion due to atherosclerotic vascular disease of lower extremities as a complication of diabetes mellitus. Methods. Results of surgical treatment of 52 randomly assigned patients who underwent surgeries due to peripheral vascular disease as a complication of diabetes mellitus (type 2 - 51 patients, type 1 - 1 patient) were analyzed. The following surgeries were performed: arterial reconstructive surgery - 24 (46.2%) patients (group 1), balloon catheter angioplasty and stenting - 12 (23.1%) patients (group 2), indirect revascularization surgery (revascularising osteotrepanation, endovascular prostaglandin E therapy) - 16 (30.7%) patients (group 3). Following parameters were assessed: decrease of ischemic rest pain, arterial insufficiency stage, hospitalization terms, healing of foot ulcers, mortality rate, and amputation rate. The longest foot ulcers healing terms [only in 5 patients (31.2%) at first year] were registered in the third group. 1 death was registered each in the first and in second groups (mortality rate 4.2 and 8.3% respectively), no deaths were registered in group 3. The results of trophic ulcers treatment in the patients from the third group were poor. It is tactically appropriate to prefer endovascular surgeries to open surgeries as far as in this case there is no need for local and general anesthesia allowing to decrease the number of complications and the length of rehabilitation together with comparable results. Primary open arterial reconstructive surgeries are possible in patients with diabetes mellitus as a next step after endovascular surgery or when endovascular surgery can not be done. Conclusion. Similar instant and long-term results were found after direct comparison of bypass and endovascular surgeries, allowing to recommend these surgeries in patients with peripheral vascular disease as a complication of diabetes mellitus.
Prevalence of the eye diseases in children living in ecologically unfavourable environment
Authors: Amirov A N , Saifullina F R , Zainutdinova I I
Published: November 2019

Aim. To study the influence of environmental pollution on eye function in children. Methods. Prevalence of eye diseases was retrospectively studied in 1250 children aged 14-16 years using the 5-year data from medical charts. Children from a region with intensive traffic (threshold limit value exceeded for the following parameters: CO - 3.3 times higher, dust - 1.5-2 times higher, sulfur - 1.3-1.8 times higher, nitrogen dioxide - 1.5-2 times higher), were analyzed as the main cohort. Children from the control cohort lived in region with lower traffic load, with no excess of threshold limit values for basic substances. Results. The prevalence of eye diseases among the children of Kazan city was assessed as 205,4±0,3‰, it has increased over time at the analyzed time gap. Refractive errors, diseases of conjunctiva and eyelid disease were the most common eye diseases. The prevalence of eye diseases among the children from the intensive traffic district was assessed as 223,1±0,3‰, which was higher compared to the district with small traffic load - 97,9±0,4‰ (р 0,01). Refractive errors, diseases of conjunctiva and eyelid disease were the three most common eye diseases among the children from the intensive traffic district. Conclusion. The prevalence of eye diseases among the children living in the intensive traffic district of Kazan city is higher compared to the district with better environment.
The clinical diagnosis of HIV-infection in a specialized hospital
Authors: Fazylov V H , Manapova E R , Goltz M L , Lustikman E M , Beshimov A T
Published: November 2019

Aim. To assess the structure of opportunistic infections and concomitant diseases, including the stage of infection, in patients hospitalized with HIV-infection. Methods. 40 cases of in-patient treatment of patients diagnosed with HIV aged 25 to 42 (mean age 34.26±1.22), male - 26, female - 14, with mean duration of infection 6,7±0,6 years were analyzed. Results. The patients were admitted to the hospital on 17±3.24 day of the disease, including cases of pulmonary diseases (on 23±3.6 day), cases of chronic hepatitis reactivation and liver cirrhosis decompensation (on 30±10.09 day), cases of acute infections (on 7±1.16 day). Previous psychoactive drug use was confirmed in 28 (70.0%) of patients. 13 (32.5%) patients received treatment with antiretroviral drugs, 3 (7.5%) have abandoned it, the rest had never been offered an antiretroviral treatment. According to the classification by V.I. Pokrovsky, the patient were staged as: stage III - 4 (10.0%) patients, stage IVA - 8 (20.0%), IVB - 11 (27.5)%, IVC - 17 (42.5%) patients. Pulmonary diseases were the most prevalent and were diagnosed in 17 (42,5%) patients, including cases of community-acquired pneumonia (focal, multisegmental, interstitial, lobular) in 8 (47.1%) patients, pulmonary tuberculosis (infiltrative, military, intrathoracic lymph nodes tuberculosis) in 9 (52.9)% patients. Liver diseases (chronic hepatitis B, chronic hepatitis B + C, liver cirrhosis) were the most frequent concomitant diseases and were found in 21 (52.5%) patients. Conclusion. Herpes zoster and liver diseases are the most predominant concomitant diseases at the early stages of HIV-infection, whereas ooportunistic infections, tuberculosis, community-acquired pneumonia and sepsis are typical in patients with late stages of HIV-infection.
Influence of wedged cervical lesions and dentine hypersensitivity on quality of life
Authors: Islamova D M , Bulgakova A I , Valeev I V , Dumeev R M
Published: November 2019

Aim. To study the influence of wedged cervical lesions and dentin hypersensitivity on quality of life. Methods. 118 patients with wedged cervical lesions and dentin hypersensitivity were examined. The quality of life was assessed using the Oral Health Impact Profile (OHIP-14) 14-item questionnaire focusing on seven dimensions of impact (functional limitation, pain, psychological discomfort, physical disability, psychological disability, social disability and handicap). Treatment in patients of the first group (57 patients) included dentin hypersensitivity relief using the «Nanoflyuor» fluoride varnish and dental restoration in patients with medium and promoted stages of wedged cervical lesions. Patients of the control group were treated with «Gluftored» fluoride liquid, dental restoration was performed in patients with medium and promoted stages of wedged cervical lesions. Results. Patients with superficial wedged cervical lesions had lower OHIP-14 scores, indicating better quality of life, with promoted wedged cervical lesions - higher OHIP-14 scores. OHIP-14 scores were higher in patients aged 31-40 and 41-50 years, and lower in patients aged 18-30 years and over 51 years. After treatment of promoted wedged cervical lesions OHIP-14 scores were better in the treatment group compared to the control group with statistically significant difference in functional limitation and physical disability dimensions scores, as well as in combined OHIP-14 score. In patients with medium-stage wedged cervical lesions there was a relevant difference in functional limitation, pain and psychological disability scores. There were no significant differences between the groups in patients with superficial wedged cervical lesions. Conclusion. Dentin hypersensitivity and bad dental appearance influence the patients’ comfort decreasing their quality of life, with minimal influence in patients with superficial wedged cervical lesions and maximal influence in patients with promoted wedged cervical lesions.
Neuroendocrine disorders in women with epilepsy depending on anticonvulsants intake
Authors: Mekhtieva S N
Published: November 2019

Aim. To assess the influence of epilepsy and anticonvulsants on central control of hormone release and ovarian function in women of reproductive age. Methods. The reproductive and endocrine functions were assessed in 82 female patients with epilepsy, of whom 37 did not receive anticonvulsants (first group), 45 patients were on anticonvulsant treatment (second group). 17 healthy females (control group) were also assessed. Serum levels of estradiol, progesterone, prolactin, luteinizing hormone, follicle-stimulating hormone and dehydroepiandrosterone were estimated during follicular (n=48) and luteal (n=34) stages of menstrual cycle. Results. Estradiol serum level was below normal ranges, and prolactin serum level - above normal limits at follicular stage of menstrual cycle in female patients not treated with anticonvulsants. In luteal phase serum levels of estradiol, progesterone, dehydroepiandrosterone exceeded the reference ranges, and testosterone levels were lower than normal in both patients treated and not treated with anticonvulsants. Comparison of two groups showed that estradiol serum level was lower in untreated patients in both stages of menstrual cycle compared to patients treated with anticonvulsants. There was a marked difference in endocrine function at all levels of reproductive neuroendocrine regulation in untreated female patients compared to female patients treated with anticonvulsants with major transformations in female patients with epilepsy not treated with anticonvulsants. Conclision. Epilepsy and treatment with anticonvulsants can influence the central regulation of hormone release in females.
Influence of dry extract of gentiana algida on clinical course of experimental pneumonia
Authors: Mondodoev A G , Kokhan S T , Konovalov P V , Shantanova L N , Akhmetyanov L A
Published: November 2019

Aim. To assess the effect of dry extract of Gentiana algida in experimental bronchopneumonia of combined etiology. Methods. The experiments were conducted on 32 white Wistar rats (body weight of 180-200 g). The animals were divided in 4 groups, 8 animals each. Bronchopneumonia was caused by dichlorvos inhalations followed by pharyngeal contamination by Staphylococcus aureus (1 bln/ml). Dry extract of Gentiana algida was given intragastrically at a dose of 200 mg/kg once a day for 7 days to the study group rats. Control group rats received distilled water with the same regimen. Comparison group rats received 40 mg of alantonum known as a mucolytic, anti-inflammatory and antibacterial agent. The fourth group consisted of intact animals. The clinical course of the disease was assessed according to the clinical symptoms, peripheral blood count, O2 and CO2 partial blood pressure, lung tissue histological examination and lipid peroxidation processes intensity and antioxidant enzymes activity. Results. Treatment of experimental bronchopneumonia by dry extract of Gentiana algida at a dose of 200 mg/kg was associated with lower mortality, less severe clinical course, lower respiratory rate. Also, a statistically significant erythrocyte sedimentation rate and white blood cells count decrease was noted, indicating the anti-inflammatory effect of the extract. Partial arterial blood pressure of respiratory gases has normalized, indicating the lung ventilation improvement. The effect of dry extract of Gentiana algida according to the noted parameters was superior to alantonum used as a comparison drug. Anti-inflammatory effect of the tested plant extract might be a result of lipid peroxidation inhibition, confirmed by statistically significant decrease of the peroxidation products (malonic dialdehyde and conjugated dienes) and increase of antioxidant protection enzymes (superoxide dismutase and catalase) activity. Conclusion. Dry extract of Gentiana algida at a dose of 200 mg/kg has a positive effect in treatment of acute experimental bronchopneumonia, promoting the respiratory organs morphologic and functional status normalization in laboratory animals at the earlier stages of the disease.
The problem of concomitant diseases with a focus on the cardiovascular system condition in patients with arterial hypertension and acid-related diseases
Authors: Khlynova O V , Tuev A V , Beresneva L N , Agafonov A V
Published: November 2019

At present, the problem of concomitant diseases still remains very important for medical science as well as for medical practice. Arterial hypertension is one of the most actual global healthcare problems, holding the leading place among cardiovascular diseases. Acid-related diseases, including gastroesophageal reflux disease and duodenal ulcer are also widely-spread with the tendency of prevalence growth, and are having the leading place among gastrointestinal diseases. The combination of arterial hypertension and acid-related diseases is a new state of an organism regulation. Their synchronism is not accidental, as both diseases share links of the general etiology and pathogenesis. The daily arterial pressure profile and heart rhythm variability has a number of distinctive features when the diseases collide. The presence and progression of esophageal and duodenal mucous membranes inflammation in these patients promotes the certain arterial blood pressure profile formation. The data concerning the prevalence, common etiology and pathogenesis, features of hemodynamics and clinical manifestations in patients with arterial hypertension associated with peptic ulcer disease and gastroesophageal reflux disease are reviewed. Data of autonomic regulation features, 24-hour blood pressure profile and central hemodynamics condition in patients the combination with the mentioned diseases are also covered.
Connective tissue features influencing the results of abdominal hernia repair
Authors: Slavin L E , Chugunov A N , Borissova I Y , Shakirova A Z , Aliullova R R
Published: November 2019

Nowadays connective tissue disorders are considered to play a great role in abdominal hernia formation and recurrence. Benign hypermobility syndrome is associated with diffe-rent diseases of locomotive system (flat foot, scoliosis), varices of lower extremities, progressive myopia, mitral valve prolapse, tracheobronchomalacia etc. This predisposing factor favors abdominal wall debilitation, anatomical aperture’s enlargement and hernia formation. As a result, benign hypermobility syndrome hampers the post-operative scar organization even in small-sized hernias and is an important risk factor of abdominal hernia recurrence. That is why the individual choice of abdominal hernioplasty technique is justified. There is no established optimal technique of abdominal hernioplasty allowing no complications and recurrences. Thus, the understanding of morphological manifestations of tissue reaction inside the mesh endoprosthesis particularities may become of great importance to prevent abdominal hernioplasty complications. Abdominal hernioplasty technique choice is based on individual selection of endoprosthesis, depending on individual characteristics of patient’s connective tissue, abdominal hernioplasty method and endoprosthesis tendency to shrinking in late postoperative period.
Diseases of the eye in chronic alcoholism
Authors: Iskhakova R R , Saifullina F R
Published: November 2019

Chronic alcoholism is a disease affecting all the vital organs, including development of functional and organic eye disorders in 2-70% of cases. Alcoholic (ethanol) amblyopia with such features as slow gradient visual acuity decrease in both eyes (although visual acuity can decrease down do a very low grade, the complete blindness is rare) is among the disorders in patients with chronic alcoholism. Fundus of the eye at the beginning of the disease is normal in most of the cases, sometimes an optic nerve congestion and mild features of optic neuritis can be observed. Sometimes optic nerve hyperemia or anemia can be observed. Simple optic nerve atrophy seen as the temporal parts or the entire disc blanching can be seen at the late stages. Alcohol toxicity can also result as peripheral vision decrease, with degree of it increasing depending on the clinical manifestations of the alcoholism. Generally, eye disorders in patients with chronic alcoholism in most of the cases manifest as central retinal area damage and combination of retinal and optic nerve involvement.
Sources and amounts of financial support for medical care in the institutions of the federal penitentiary service
Authors: Tulenkov A M , Ponomarev S B
Published: November 2019

Aim. To evaluate the state financial guarantees for providing medical care to prisoners of penitentiary institutions. Methods. The general assessment of actual state funding of penitentiary healthcare as well as the shares of separate sources in funding of penitentiary healthcare at facilities of Russian Federal Penitentiary Service. Results. The combined funding of penitentiary healthcare increased up to 3 861 568.7 thousands of rubles in 2011 (twofold compared to 2009). Per capita funding was equal to 3844.0 rubles per year per Russian Federal Penitentiary Service facilities prisoner - 2.34 times higher compared to 2009. Hence, despite the total funding increase, the handicap compared to national healthcare funding is still huge. Conclusion. The gained data provides a real-time picture of the penitentiary healthcare funding and is necessary for improvement of medical and sanitary services in the Russian Federal Penitentiary Service institutions.
The contemporary status of the blood donorship in the Mari El Republic
Authors: Zangerova E Y
Published: November 2019

Aim. To detect the weak points of the existing system of blood donors’ draw in, to define the paths of blood donorship development in the Republic of Mari El. Methods. The analysis of the existing system of donorship at the period from 2002 to 2011 was conducted according to the data of combined yearly reports, data of united blood transfusion center of the Republic of Mari El database, data of Russia’s blood transfusion system facilities activity analysis. The changes in the number of blood donors, activity of blood donors, and detection of blood-transmitted diseases markers were evaluated. Results. No need for further significant increase in the number of active donors was detected, since the modern methods of blood and blood components preparation allows to increase the amounts of required blood components by other ways. The decrease in donors’ mean age was registered, the share of donors younger than 30 increased 2.8-fold compared to 2002 and 1.46-fold compared to 2007. The mean age of donors is 33,94±0,14 years, gender distribution (females - 39.2%, males - 60.8%) do not collide with the gender distribution of the general population. The share of plasma donors has significantly increased (4.8-fold in 2011). Since 2009 the share of first-time donors has increased to 42.9%, indicating the instability of the group of people ready to donate blood. Electronic database introduction and active use allows to exclude people with blood-transmitted diseases and other absolute contraindications from donating blood. The share of people willing to donate blood with registered blood-transmitted diseases has relatively dropped from 4.18% in 2007 to 1.42% in 2011. Conclusion. The main goal of blood transfusion services of Mari El Republic is still to increase the number of permanent donors, donating blood regularly, it will allow to increase the safety of blood components produced and provide the blood transfusion services stability.
Features of medical specialist formation in the Republic of Tajikistan
Authors: Bandaev I S , Miraliev S R
Published: November 2019

Aim. To study the features and to define the fundamental principles of rational training of the highly skilled specialist doctor in the Republic of Tajikistan. Methods. Complex analysis of the doctor’s formation and training process was performed. Data from the ambulatory, hospital and highly specialized medical care segments, academic faculties, teaching and clinical centers of family medicine of the Republic of Tajikistan were examined. 256 tutors and student doctors trained in the educational institutions of the Republic of Tajikistan from 2000 to 2012 were questioned. Results. 90 (35.2%) out of 256 doctors have changed their specialty, among them 48 (18.8%) - once, 26 (10.2%) - twice, 12 (4.9%) - 3 times, 3 (1.3%) doctors - 4 times and more. The average share of the current specialty experience from the total medical experience was equal to 84.3%. Over a half of the doctors (137 out of 256, 53.5%) were working for one employer in their career, the rest (119 out of 256, 46.5%) have changed the job, among them: 36 (30.3%) - once, 10 (8.4%) - twice, 9 (7.6%) - three times and more. Specialty changes hindered the aggrandizement. A share of the doctors having the higher qualification grade increased with the overall experience and the experience on the given specialty. 65 out of 256 (25.4%) doctors had the qualification degree, among them: 15 (5.9%) - highest degree, 34 (13.3%) - first degree, 16 (6.2%) - second degree. The number of the doctors with highest qualification degree was higher by 8.0% in doctors with 1-10 years of specialty experience and by 39.4% in doctors with specialty experience over 20 years. Conclusion. Constant regular work for one employer favored the specialist formation, whilst frequent job change halts the doctor’s «anchoring» in one exact specialty and hampers the professional growth.
Effect of isosorbide dinitrate on sinoatrial node pacemaker activity in patients with stable angina pectoris of III and IV functional classes associated with hypertension
Authors: Safronova E A , Mironova T F
Published: November 2019

Aim. To study the effect of isosorbide dinitrate on heart rate variability in patients with III and IV functional classes of stable angina and concomitant essential hypertension. Methods. The study involved 122 patients with III and IV functional classes of stable angina and concomitant essential hypertension, mean age 58.4±5.8 years. All patients underwent electrocardiography, Doppler echocardiography, 24-hour ECG monitoring. Rhythmocardiography was performed in the morning before the drug intake (acetylsalycilic acid, beta-blockers, statins, angiotensin-converting enzyme inhibitors) and 1.5 hours after 10 mg isosorbide dinitrate intake. Results. There was a statistically significant increase in overall heart rate variability at Valsalva’s maneuver and active postural test in patients with III and IV functional classes of stable angina and concomitant essential hypertension, which was most likely due to the amplitude of humoral-metabolic waves. The amplitude of the sympathetic pacing fluctuations increased in all samples, while the parasympathetic pacing fluctuation amplitude decreased at Valsalva’s maneuver, Ashner’s test and while lying flat. There was a vegetative spectrum shift towards the humoral-metabolic effect in sympathetic active postural test, sympathetic shift in all tests except for sympathetic active postural test, and significant decrease in parasympathetic effect at Ashner’s test, sympathetic active postural test and while lying flat. Conclusion. In patients with III and IV functional classes of stable angina and concomitant essential hypertension there was an increase in the overall heart rate variability mainly due to the humoral-metabolic and sympathetic waves amplitude increase and parasympathetic amplitude decrease. Isosorbide dinitrate intake resulted in vegetative spectrum redistribution towards humoral and sympathetic metabolic regulation patterns and decrease of parasympathetic regulation pattern, which normally prevails.
Mediastinitis after cardiac procedures via median sternotomy: comparative analysis of outcomes
Authors: Gorbunov V A , Dzhordzhikiya R K , Vagizov I I , Abdulyanov V A , Abdulyanov I V , Mukharyamov M N , Omelyanenko A S
Published: November 2019

Aim. To compare the effectiveness of poststernotomy mediastinitis treatment in 41 patients who underwent vacuum-assisted closure or closed irrigation treatment. Methods. A retrospective analysis of 41 cases of sternal wound infection identified in patients who underwent cardiac surgery between 2007 and 2012. 18 patients (the first group) were treated using closed irrigation, 23 patients (the second group) - using vacuum-assisted closure. We compared the time interval for wound healing and drainage, serum levels of C-reactive protein and blood leukocyte counts on admission and at different time points until discharge. Results. In patients who were treated using vacuum-assisted closure, wound debridement and healing were achieved at shorter terms, and lower rate of complications were observed. There were 8 (44.4%) relapses requiring repeated surgery and debridement in the first group compared to 3 (13%, p=0.01) in the second group. C-reactive protein level decreased more rapidly in patients who were treated using vacuum-assisted closure (p 0.02). The duration of hospital stay was 67±4.1 days in the first group compared to 29.6±8.4 days in the second group (p=0.019). Moreover, patients who were treated using vacuum-assisted closure did not experience any significant discomfort and stayed active. Histological examination of the soft tissues showed marked lymphoid and plasma-cell reaction and neoangiogenesis by the end of the second week of vacuum-assisted closure. Conclusion. The use of vacuum-assisted closure shortens the term of wound debridement, granulating tissue formation and the duration of hospital stay compared to closed irrigation treatment.
Diagnosis and treatment of chronic colostasis in children with dolichosigmoid
Authors: Akilov Kh A , Saidov F Kh , Hodjimukhamedova N A
Published: November 2019

Aim. To choose the proper tactics of constipation diagnosis and treatment in children with dolichosigmoid. Methods. 75 patents with various colonic diseases featured by constipation, were treated, dolichosigmoid was diagnosed in 36 (48%). All patients with dolichosigmoid were distributed to 3 groups. The first group included 22 (61.1%) patients with compensated stage, the second group - 9 (25%) with subcompensation, the third group included 5 (13.9%) patients with decompensated stage. The diagnosis was performed by anamnesis and results of clinical and laboratory examinations (blood analysis, urinalysis, stool analysis, intestinal microbiota test), fibrocolonoscopy was performed in 13 (36.1%), radiologic examination of colon - in 36 (100%), barium follow-through test - in 36 (100%), multispiral computed tomography with contrast media and virtual colonoscopy with 3D-reconstruction - in 8 (22.2%), sphincterometry - in 13 (36.1%), morphological examination of the biopsy samples obtained at fibrocolonoscopy - in 7 (19.4%), duplex ultrasonography of great intestinal vessels - in 9 (25%) of patients. Results. Out of 36 patients with dolichosigmoid, 29 (80.6%) received non-surgical treatment, remaining 7 (19.4%) children underwent surgery. One-stage sigmoid resection with colocolic end-to-end anastomosis formation was performed in 3 (8.3%) patients, one-stage left-sided hemicolectomy with colocolic end-to-end anastomosis formation - in 2 (5.6%), two-staged surgery - left-sided hemicolectomy with proctoplasty by Svenson-Chiatt-Isakov and colocolic end-to-end anastomosis formation - in 2 (5.6%). The best result was obtained in case of left-sided hemicolectomy, the sigmoid resection does not give a good result itself, with frequent relapses of constipation. Conclusion. The treatment of chronic colostasis should be started with non-surgical treatment, and only after rigorous evaluation; the indications for a surgical treatment are: subcompensated stage not responding to medical treatment and decompensated stage of the disease.
Temporomandibular joint dysfunction due to benign joint hypermobility syndrome
Authors: Umanskaya Yu N
Published: November 2019

Aim. To mark out the main features of temporomandibular joint dysfunction in patients with benign joint hypermobility syndrome. Methods. 90 patients with temporomandibular joint dysfunction were examined. The first group included 53 (58.89%) patients with benign joint hypermobility syndrome, the second group - 37 patients with temporomandibular joint dysfunction without any signs of benign joint hypermobility syndrome. Functional joint examination including clinical examination, examination of jaw diagnostic models in articulators, X-ray and magnetic resonance imaging, was performed. The diagnosis of benign joint hypermobility syndrome was set up by clinical findings according to national recommendations of Russian Society of Cardiology. Results. Two main trends were found in patients with benign joint hypermobility syndrome. Joint hypermobility was present in 27 (50.94%) out of 53 patients aged 30 years and older. Temporomandibular joint dysfunction in those patients was quite severe, associated with pain and limited range of mandibular movement. In 49.06% of cases in patients with benign joint hypermobility syndrome aged younger than 30 years, bone symptoms were present. Those patients were complaining of joint noises. In 38.46% of cases, gothic palate or frontal teeth crowding were observed. According to magnetic resonance imaging, there was a condylar processes asymmetry at occlusion in 41 (77.36%) patients with benign joint hypermobility syndrome. Conclusion. Clinical and morphologic signs of temporomandibular joint dysfunction in patients with benign joint hypermobility syndrome are associated with predisposed changes in temporomandibular joint capsule and ligaments. Temporomandibular joint dysfunction is a typical and regular feature of benign joint hypermobility syndrome.
About the optic disc size
Authors: Ekgardt V F , Dorofeev D A , Shaimov T B , Deev R V
Published: November 2019

Aim. To compare the dependence of retinal nerve fibre layer thickness on the optic disc size in confocal scanning laser ophthalmoscopy and optical coherence tomography. Methods. 201 outpatient’s cards with verified diagnosis of glaucoma or with suspicion of glaucoma were retrospectively analyzed. The mean age of the patients was 64 (56; 72) years [Me, (Q1; Q3)]. A group of patients who underwent confocal scanning laser ophthalmoscopy (181 eyes), and a group who underwent optical coherence tomography (183 eyes), were separated. Besides, all the groups were twice divided into 3 subgroups each, by means of cluster analysis and on the basis of size classification: large, medium and small. Results. According to the data of confocal scanning laser ophthalmoscopy, the bigger is the optic disc, the thinner is retinal nerve fibre layer (Rs=-0.22; р=0.001). In optical coherence tomography, different correlation was observed, the bigger is the optic disc, the thicker is the retinal nerve fibre layer (Rs=0.15; р=0.03). Conclusion. The size of the optic disc was related to the retinal nerve fibre layer thickness in both examination modes: there was an inverse relation found in confocal scanning laser ophthalmoscopy - the bigger the optic disc, the thinner is the retinal nerve fibre layer), and there was a direct dependence found in optical coherence tomography (the bigger is the optic disc, the thicker is retinal nerve fibre layer), thus it is important to consider the size of the optic disc while estimating the retinal nerve fibre layer thickness.
Spiral computed tomography angiography in the evaluation of hepatocellular carcinoma vascularity and malignancy degree
Authors: Zogot S R , Akberov R F , Mikhaylov M K
Published: November 2019

Aim. To study the vascularity and malignancy degrees of hepatocellular carcinoma using spiral computed tomography angiography considering its morphological differentiation and tumor size. Methods. A comprehensive clinical and radiological examination of 300 patients (males - 170 (56.6%), females - 130 (43.4%), mean age 52.0±3.2 years) with hepatocellular carcinoma, who were picked out from 2550 patients with malignancies treated in 2005-2013, was performed. Liver cirrhosis was diagnosed in 70 (23.33%) out of 300 patients with hepatocellular carcinoma. The features of tumor bloodflow were assessed using color Doppler ultrasonography and spiral computed tomography angiography (by 4 phases of examination) considering tumor size and tumor morphological differentiation. Results. According to the morphological study results of samples from 123 patients, high-grade differentiated hepatocellular carcinoma was diagnosed in 40 patients, moderately differentiated - in 53, poorly differentiated - in 30 patients. A correlation of tumor vascularity with histological differentiation degree and tumor size was revealed. The difference in high-grade differentiated hepatocellular carcinoma maximal computed tomography density increment gradients at arterial phase compared to liver parenchyma maximal computed tomography density increment was 17 Hounsfield units in tumors sized up to 5 cm and 12 Hounsfield units in 32 (80%) of 40 patients with tumors sized over 5 cm. Thus, high-grade differentiated hepatocellular carcinoma was associated with increased vascularity in 80.0%, normal vascularity - in 8.0%, low vascularity - in 12.0% of cases. The difference in moderately differentiated hepatocellular carcinoma computed tomography density increment gradients compared to liver parenchyma was assessed as 20 and 25 Hounsfield units in tumors with the corresponding size in 45 (89.4%) out of 53 patients. Moderately differentiated hepatocellular carcinoma was associated with increased vascularity in 89.4%, normal vascularity - in 4.0%, low vascularity - in 6.6% of cases. Poorly differentiated hepatocellular carcinoma was associated with increased vascularity only in 7 out of 30 patients. Conclusion. The correlation of tumor vascularity with histological differentiation degree and tumor size was revealed. Increased vascularity was observed in high-grade differentiated and moderately differentiated hepatocellular carcinoma, low vascularity - mainly in poorly differentiated hepatocellular carcinoma.
Comparison of the effects of rituximab, tumor necrosis factor alpha inhibitors and non-steroidal antiinflammatory drugs on ankylosing spondylitis clinical activity and sacroileitis intensity on magnetic resonance imaging
Authors: Protopopov M S , Erdes Sh F , Lapshina S A , Myasoutova L I , Zakirov R Kh , Afanasyeva M A
Published: November 2019

Aim. To investigate the effect of rituximab in ankylosing spondylitits on disease activity and on intensity of sacroileitis detected by magnetic resonance imagigng compared to tumor necrosis factor alpha inhibitors and non-steroidal anti-inflammatory drugs. Methods. The study included 91 patient [14 (15.4%) females, 77 (84.6%) males, mean age - 34.4±9.13 years, disease duration - 6.6±3.8 years] with established diagnosis of ankylosing spondylitits. The main group included 20 patients (17 males, mean age 36.9±9.9 years) who were treated with rituximab. The comparison group included 36 patients (30 males, mean age 34.3±8.6 years) treated with tumor necrosis factor alpha inhibitors. The control group consisted of 35 patients (30 males, mean age 33.4±9.3 years) treated with non-steroidal anti-inflammatory drugs and sulfasalazine. Disease activity was measured by BASDAI (Bath Ankylosing Spondylitis Disease Activity Index) and ASDASESR (Ankylosing Spondylitis Disease Activity Score) scores before the treatment initiation, at the 2nd, 8th, 16th and 24th weeks of treatment. Magnetic resonance imaging of sacroiliac joints was performed before the treatment initiation and at the 24th week of treatment, T1 and STIR sequences were analyzed. Results were processed using the SPARCC (Spondyloarthritis Research Consortium of Canada) scoring methodology. Results. There was a significant reduction of the disease clinical activity measured by BASDAI score (from 6.19±1.48 to 3.70±0.91, p 0.01) and ASDASESR score (form 3.43±0.72 tо 2.11±0.46, p 0.01) in patients treated with rituximab at the week 24. Mean SPARCC score reduced from 15.9±7.2 to 4.6±8.2 (p 0.01). The influence of rituximab on clinical activity of the disease was superior over the effect of the standard treatment (BASDAI and SPARCC scores 5.22±1.14 and 7.8±7.1 accordingly at the week 24, p 0.05), but inferior over the effect of tumor necrosis factor alpha inhibitors (BASDAI and SPARCC scores 2.03±0.64 и 4.9±7.0 accordingly at the week 24, p 0.01). Conclusion. Anti B-cell therapy is effective in treating active ankylosing spondylitis and leads to the decrease of the clinical symptoms intensity and disease activity measured by BASDAI и ASDASESR scores. The effect of rituximab was superior over the effect of non-steroidal anti-inflammatory drugs and sulfasalazine and inferior over the effect of tumor necrosis factor alpha inhibitors.