bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics of extreme increase of vector-borne infections in the european north
Authors: Burmagina I A , Agafonov V M , Burmagin D V
Published: November 2019

Aim. To describe clinical and epidemiological situation of the massive increase of cases of vector-borne infections and the level of preventive and antiepidemic measures in the Archangelsk region over the last decade. Methods. Retrospective, longitudinal study investigated ten-year incidence of vector-borne infections, vaccination of the population and the amount of disinfection measures in the region over the last decade. Results of a survey of 232 citizens, who were referred for vaccination against tick-borne encephalitis, are listed. The study included 101 patients with tick-borne encephalitis, 19 of which had concomitant a tick-borne Lyme disease, and 21 patients with tularemia treated in infectious hospitals of Archangelsk between 2011 to 2014. Results. Observations performed over the last decade showed marked increase in the incidence of vector-borne infections among the population of the Archangelsk region Levels of immunization against tick-borne encephalitis has also increased, level of vaccination against tularemia was unstable. Amounts of disinsectization measures tends to increase, but the number of people bitten by ticks also progressively increases. None of patients diagnosed with tick-borne encephalitis and tularemia who got the disease in the Archangelsk region had been previously vaccinated. The survey of 232 citizens showed sustainable motivation for vaccination, therefore, regional program for children and adult vaccination should be facilitated, considering the increasing incidence of vector-borne infections in non-vaccinated subjects. Predominant clinical forms were feverish and severe focal for tick-borne encephalitis, erythema for Lyme disease and bubonic for tularemia. Due to climate change, incidence of vector-borne infections over the last decade was on stable upward trend with high share of severe forms and high risk for progredient clinical course. Conclusion. Preventive and antiepidemic measures in the Archangelsk region over the last decade tend to increase, but are still not enough effective, as do not lead to a significant reduction of incidence.
Features and role of lipid peroxidation in patients with chronic hepatitis C (genotype 1b) before and after antiviral therapy
Authors: Konstantinov D Yu , Suzdal’tsev A A
Published: November 2019

Aim. To estimate the levels of lipid peroxidation products in erythrocytes of patients with chronic hepatitis C (genotype 1b) before the initiation of antiviral therapy and after its completion. Methods. The study included 195 patients with chronic hepatitis C (genotype 1b). The levels of conjugated dienes, triene ketones, Schiff bases and oxidation index were measured after extraction of erythrocyte membranes with chloroform/isopropanol (2:1) mixture according to I.D. Stal’naya method modified by I.A. Volchegorskiy. All patients were allocated to four groups depending on the alanine transaminase activity prior to antiviral therapy: the first group (n=52) - with normal levels of the enzyme, the second (n=74) - with elevation not exceeding 3 normal ranges, the third group (n=42) - 3 to 5 normal ranges, the fourth group (n=27) - exceeding 5 normal ranges. Antiviral treatment included pegylated interferon alfa-2b and ribavirin for 48 weeks. Results. Level of conjugated dienes, triene ketones, Schiff bases and oxidation index were ranged from 0.71±0.04 to 1.02±0.03, from 0.45±0.08 to 0.94±0.02, 0.17±0.04 to 0.41±0.04 and from 0.91±0.13 to 1.91±0.03 units respectively, which was significantly higher than normal ranges and was directly dependent on the alanine transaminase activity. In addition, in patients who did not respond to antiviral treatment, these parameters were significantly higher compared to patients with immediate virologic response (p 0.01). Conclusion. Patients with chronic hepatitis C had increased levels of lipid peroxidation products in erythrocytes; their high content in patients who did not respond to antiviral treatment may be a predictive factor for antiviral treatment effectiveness.
Educational process management in HIV medicine in Saint Petersburg
Authors: Rakhmanova A G , Yastrebova E B
Published: November 2019

The stages of the Department of socially significant infections formation, starting from the training course for laboratory diagnosis of acquired immunodeficiency syndrome (AIDS) at the Department of Infectious Diseases, scientific, educational and practical association «AIDS and AIDS-defining illnesses» at the Medical Academy of Postgraduate Education (nowadays - Northwest Medical University), approved by the order of Healthcare ministry of USSR №467 in 1987, which in 1992 came under the jurisdiction of Russia, headed by Professor A.G. Rakhmanova, up to creating the Department of the Pavlov First Saint Petersburg State Medical University. In the late 90s and early this century, Department of Infectious Diseases with the course of the AIDS laboratory diagnosis was virtually the only one in the country for training on human immunodeficiency virus (HIV) infection, its laboratory diagnostics and other related diseases. As a result of scientific, educational and practical association «AIDS and AIDS-defining illness» activity, for over 20 years scientific staff was trained on HIV Medicine and associated socially significant infections. As a part of that effort, more than 25 doctors of science and 60 PhDs who are currently teaching HIV medicine and associated co-infections: chronic viral hepatitides, tuberculosis, herpes and other diseases in Russia and countries of the former post-Soviet space, were trained. The next step was the establishment of «HIV Medicine» course in 2009 in the Pavlov First Saint Petersburg State Medical University, and later in 2013 - creation of an independent Department of socially significant diseases.
Clinical characteristics of chronic hepatitis C in children with natural course of the disease
Authors: Leonova G F
Published: November 2019

Aim. Identification of the clinical features of chronic hepatitis C in children with the natural course of the disease. Methods. Examined were 168 children with chronic hepatitis C in the age of 0-17 years. Features of chronic hepatitis C was determined by the manifestation of infection, duration of disease, route of infection, objective data, the results of clinical and laboratory, instrumental and morphological studies of the dynamics for the period 2000-2013. Results. Depending on the variant of the infection, all children were divided into two groups: those with asymptomatic (121 patients, 72%) and manifest (47 patients, 28%) forms. Asymptomatic chronic hepatitis C in children characterized by the absence of complaints, normal values of alanine aminotransferase (36.4% of cases) and the minimal viral load (38.8% of cases). The clinical picture of chronic hepatitis C in children with manifest course characterized by the presence of clinical symptoms of low intensity as astenovegetatic (55.3%) and dyspeptic (55.3%) syndromes and extrahepatic manifestations (22.3%). According to the elastometry in more than half of the children (58.2%) liver fibrosis was identified. In 3 children in early childhood (up to 3 years) there was the elimination of the virus. Conclusion. Chronic hepatitis C in children in 72% of cases is asymptomatic; manifest form of chronic hepatitis C differs from asymptomatic form by a faster rate of disease progression.
Anemia of chronic disease in patients with HIV infection: clinical and laboratory characteristics
Authors: Hasanova G R , Mustafin I G
Published: November 2019

Aim. To provide clinical and laboratory characteristics of anemia of chronic disease in HIV infection in order to improve its diagnosis. Methods. The study included 63 HIV-infected patients with anemia of chronic disease. Assessed were the frequency of complaints and physical changes, erythrocyte indices, serum iron level, total iron-binding capacity of the blood, soluble transferrin receptor and erythropoietin markers of inflammation (ferritin, interleukin-1β, tumor necrosis factor-α, soluble receptor CD14, C-reactive protein). Comparison group consisted of a group of 35 patients with iron deficiency anemia. Results. The most frequent were complaints of weakness, fatigue and diarrhea. Hemoglobin level of the majority of patients corresponded to mild anemia. It often had a micro- or normocytic character (48.1±6.8 and 46.3±6.8% of patients, respectively), was normochromic (53.7±6.8% of patients) and hyporegenerative; in 94% of patients relative level of reticulocytes in the blood level was 0.2-1.2%; 87.3% had a reduced number of red blood cells. A negative relationship between levels of hemoglobin with erythropoietin (r=-0.5, p=0.0003) was established. Low levels of serum iron was typical for anemia of a chronic disease, as well as for iron-deficiency anemia. In patients with anemia of chronic disease revealed were significantly higher levels of soluble receptor CD14, C-reactive protein and ferritin and the relatively low level of total iron binding capacity of serum. Conclusion. Anemia of chronic disease in HIV infection is characterized by a predominance of light forms, the frequent lack of «typical for anemia» complaints; mainly micro or normocytic, normochromic types of process with low serum iron; hyporegeneration character against the backdrop of an adequate response to erythropoietin-synthesizing cells decrease in hemoglobin concentration; high levels of markers of inflammation (sCD14, C-reactive protein and ferritin) and relatively low total iron binding capacity of serum.
Modern aspects of the natural course of chronic viral hepatitis B
Authors: Enaleeva D Sh
Published: November 2019

Currently there are about 400 million people infected with the hepatitis B virus, including five million people - in Russia. A serious problem is the development of complications of chronic viral hepatitis’ - liver cirrhosis and hepatocellular carcinoma, from which eventually 20-35% of patients die. Undoubtedly, the outstanding science achievement of the XX century was the creation of a genetically engineered vaccine against hepatitis B. The pursued immunizations on a global scale has led to significant results - reduction of the number of cases of acute forms of viral hepatitis B, the frequency of formation of the chronic variant of the disease. Despite these successes, there remains the problem of prevention of the perinatal transmission path. Identified were the risk factors for neonatal infection, amongst which the most significant are the presence of the antigen of the hepatitis B virus, which is not a part of the Dane particles (HBEAg), and the level of viremia prior to delivery. The basis of prevention is an active-passive immunization, which helps prevent infection in infants in 90-95% of cases. Encouraging results (reduction in the risk of infant infection) were obtained in studies of antiviral therapy in the III trimester of pregnancy. The introduction of new molecular biological diagnostic methods (polymerase chain reaction) made it possible to determine the genetic material of the virus in serum and tissues, the presence of mutations and genetic variability of the virus. At present, identified are the factors that determine the progression of the disease, the efficacy of antiviral therapy. Identified are the new variants of the clinical course of viral hepatitis B, depending on the profile of the serological (antigen-antibody) markers. The latent course of viral hepatitis B deserves special attention. The serological feature of this variant is the presence of «isolated» antibodies and/or deoxyribonucleic acid of the virus, or the absence of all markers of hepatitis B. It is obvious that patients with a latent course of infection pose a real threat in spreading viral hepatitis B.
Long-term prognosis of the course of sarcoidosis: analysis of the literature and own experience
Authors: Vizel I Yu
Published: November 2019

Aim. To evaluate the prognosis of the course of sarcoidosis in patients with a follow-up term of 10 years or more. Methods. Analysis of the literature, comparison with the data from own research. Analyzed was the data on 15 patients with sarcoidosis with the follow-up term of 10 years or more. Compared were the parameters of spirometry, blood tests, blood oxygen saturation, of the conducted treatment in the patients with remission and with a chronic course. Results. In 8 patients (53.3%) during the last follow-up visit (10 years or more after detection) noted was a stable remission (in 7 after the initial detection and in 1 after a single exacerbation). Among all the 15 patients after 10 years or more the frequency of dyspnea on exertion increased from 33.3 to 46.9%, chest pain - from 6.7 to 20%, complaints of weakness decreased from 66.7 to 53.3%, of fever - from 26.7 to 13.3%, and of cough - from 53.3 to 20%, of erythema nodosum - from 40 to 6.7%, of articular syndrome - from 60 to 20%, of splenomegaly - from 13.3 to 6.7%. When comparing the dynamics of the indicators in the subgroup with persistent remission noted was a significant decrease in the instantaneous volume rate after the exhalation of 50% of the forced vital lung capacity; blood oxygen saturation and diastolic blood pressure significantly increased, the proportion of monocytes in the leukocyte formula decreased. Registered was a significant increase in erythrocyte sedimentation rate within the physiological range. In patients with a chronic course of sarcoidosis occurred a significantly reduction of the forced vital lung capacity, of the forced expiratory volume in 1 s, of the instantaneous volume rate after exhalation of 25% of the forced vital lung capacity. Conclusion. The best prognosis had the patients, who were young adults with an acute onset, and who did not receive glucocorticoids. Pentoxifylline may improve the course and outcome of sarcoidosis.
The status of element homeostasis in children and adolescents with essential arterial hypertension
Authors: Makarova T P , Khabibrakhmanova Z R , Sadykova D I , Chilikina Yu M
Published: November 2019

Aim. To study the features of element homeostasis in children and adolescents with different variants of essential arterial hypertension. Methods. The clinical and functional variant of arterial hypertension was established based on the data of 24-hour monitoring of the arterial blood pressure. Investigation of the element content in the blood serum and daily urine was performed using the method of atomic absorption spectrophotometry. The clearance and the excreted fraction of the investigated elements were measured. Results. Revealed was an increase of the content of lead in the blood serum, an increase in lead excretion with urine, an increase in its clearance and excreted fraction in patients with stable arterial hypertension. It has been shown that for children and adolescents with a variety of clinical and functional variants of arterial hypertension characteristic is an excess of the serum content of a toxic element (lead) over the content of an essential element (zinc), and these changes are most pronounced in the group with stable arterial hypertension. In children and adolescents with the increase in arterial blood pressure registered was a decrease in the content of zinc and magnesium in the blood serum, whereas the disturbances of element homeostasis relate to the metabolic type. The increase in the content of copper and calcium in blood serum of patients with high blood pressure is also a manifestation of the metabolic type of element homeostasis disturbances. Conclusion. The increased level of lead in blood serum in combination with its enhanced excretion may be a cofactor in the development of essential arterial hypertension in childhood and adolescence.
New opportunities for local therapy of pustular skin diseases
Authors: Nurullin R M , Abdrakhmanov R M , Khaliullin R R
Published: November 2019

Aim. To study the effectiveness of a universal antiseptic Betadine (international nonproprietary name - povidone-iodine) in the treatment of pustular skin diseases. Methods. The study had the form of an open, non-comparative one, which involved 25 patients aged from 2.5 to 40 years (mean age 16.1±1.2 years) with disease duration from 1 to 7 days (mean 4.2±0.8) with various forms of pyoderma: 21 patients with streptococcal impetigo and 4 patients with folliculitis. Assessment of safety of the study was carried out on the basis of clinical and laboratory data, patient tolerability of the substance, the expert-opinion of the physician-researcher. Changes in the quality of life as a result of treatment of patients with pyoderma using Betadine solution was evaluated by a questionnaire SKINDEKS-29. Results. All patients willing used the proposed betadine solution. No reasons for discontinuation of treatment during the study (including side effects, allergic reactions or exacerbation of the cutaneous process) were identified. Deterioration of the quality of life on the «Emotions» scale of SKINDEKS-29 questionnaire at the beginning of treatment was 49.8±1.3 points («sometimes»), during the second visit - 26.8±0.9 points («rarely»), by the end of treatment (third visit) - 10.2±0.3 points («no»); on a scale of «Function» at the beginning of treatment - 77.8±1.8 («often»), during the second visit - 53.2±1.6 («sometimes»), by the end of treatment - 16.2±0.8 points («no»); on a scale of «Symptoms» at the beginning of treatment - 51.2±1.3 («sometimes»), during the second visit - 27.6±2.8 («rarely»), by the end of treatment - 12.3±0.3 points («no»). Conclusion. Betadine is characterized by high clinical efficacy in pustular skin diseases, good tolerance, absence of adverse reactions, a positive impact on the quality of life and can be recommended as a therapeutic and prophylactic agent.
Lymphocyte-platelet adhesion and aggregation of platelets in patients with erysipelas
Authors: Emel’yanova A N , Vitkovskiy Yu A
Published: November 2019

Aim. To study the lymphocyte-platelet adhesion in patients with various forms of erysipelas in the dynamics of treatment. Methods. 90 patients with erysipelas participated in the study: 20 with the erythematous-bullous form and 20 with the erythematous form. According to the recurrence of the disease the patients were divided into two groups: the main group (40 patients with the primary form of erysipelas) and the comparison group (50 people with recurrent erysipelas). The control group, which was comparable by sex and age, was comprised of 55 healthy people. The index of lymphocyte-platelet adhesion and hemostasis were studied in all patients. Results. The index of lymphocyte-platelet adhesion sharply declined already during the onset of the disease, despite the fact that no significant changes in the content of the absolute number of lymphocytes compared to healthy individuals during this period were identified. Severe course (erythematous-bullous form) was accompanied by significant shifts in the parameters of lymphocyte-platelet adhesion, and their dynamics made it possible to evaluate the effectiveness of treatment. Conclusion. The ability of lymphocytes to adhere to the surface of platelets is reduced during erysipelas; platelet hyperaggregation develops during the first days of onset of clinical manifestations, the nature and duration of which depends on the form of the disease.
Monitoring of the activity of antibodies against hantavirus in patients with hemorrhagic fever with renal syndrome
Authors: Shakirova V G , Khaertynova I M , Khaertynov K S
Published: November 2019

Aim. To determine the diagnostic significance of antibodies to Hantavirus in patients with hemorrhagic fever with renal syndrome, depending on the period and the severity of the course of disease. Methods. Studied was the content of specific antibodies (immunoglobulins G) to hantaviruses in blood serum in the rapidly precipitating and slowly precipitating circulating immune complexes by enzyme immunoassay using a test system «Hantagnost» in modification. Studied were 226 patients with hemorrhagic fever with renal syndrome (24 patients with mild form, 105 with moderate and 97 patients with severe form of the disease) in the febrile, oliguric and polyuric periods. Results. Specific antibodies (immunoglobulins G) were present already in the febrile period of the disease in all (100%) patients in the serum and in the rapidly precipitating circulating immune complexes. Antibodies in the slowly precipitating complexes in the febrile period were found only in patients with severe and moderate forms of hemorrhagic fever with renal syndrome, in subsequent periods they were found significantly more frequently in patients with a severe course of disease. Severe forms of hemorrhagic fever with renal syndrome caused the most pronounced serologic response with a maximal content of immunoglobulins G to Hantaviruses in the oliguric period. During the period of polyuria the severe forms of hemorrhagic fever with renal syndrome were accompanied by significantly lower levels of free circulating antibodies and a high level of bound antibodies compared with moderate and mild forms of the disease. Conclusion. In patients with hemorrhagic fever with renal syndrome anti-Hantavirus antibodies (immunoglobulins G) in serum and in the rapidly precipitating immune complexes are detected already at the early stages of the disease in 100% of the cases; the frequency of detection of antibodies in the slowly precipitating circulating immune complexes in the early stages depends on the severity of disease: they are present in 100% of patients with a severe form of the disease, in 50% - with the moderate form, and with the mild form - can not be detected.
Analysis of the effectiveness of rehabilitation measures for dental caries
Authors: Shaikhutdinova A I , Gilyazeva V V
Published: November 2019

Aim. To evaluate the effectiveness of rehabilitation measures for dental caries. Methods. Studied were 246 patients aged 18-50 years (146 women and 100 men) who received dental treatment for dental caries and its complications, the duration of follow-up was 18 months. Conducted was an expert evaluation of 246 medical records of dental patients and patients’ management. The hygienic status of the oral cavity was assessed by the criteria of OHI-S (Oral Hygiene Index Simplified) and PHP (Patient Hygiene Performance), for values of OHI-S (PHP) 0.6±0.1 (0.4±0.03) the status was considered good, for values 1.3±0.1 (0.7±0.02) - satisfactory, for values 2.6±0.1 (1.8±0.04) - unsatisfactory. Results. Good oral hygiene status was noted in 64 patients (first group), satisfactory - in 88 (second group), unsatisfactory - in 94 patients (third group). In the third group, the share of fully intact restorations and fillings during middle and deep caries after 6 months was 89 and 81%, at 12 months - 80 and 78.2%, after 18 months - 79.7 and 71.8%, respectively; in the second group after 6 months - 94 and 92.8%, after 12 months - 89 and 85.3%, after 18 months - 87.5 and 81.2%, respectively; in the first group at 6 months - 96 and 96%, after 12 months - 96 and 91.3%, after 18 months - 94.5 and 90.5%, respectively. Only 152 of the 246 patients fulfilled all the recommendations and prescriptions, 34 (13.8%) did not complete the rehabilitation of the oral cavity. Prevention and rehabilitation activities were performed in 30% of cases: in 15% - in full, in the remaining 15% primarily professional oral cleaning and remineralization therapy was conducted. Conclusion. The program of rehabilitation of dental patients should include regular inspections, monitoring of the oral hygiene, professional cleaning of the oral cavity, grinding and polishing of the restorations and fillings, pathogenetic therapy.
The state of the eyes in patients with end-stage chronic renal failure depending on the method of renal replacement therapy
Authors: Moshetova L K , Shmarina O V , Storozhev R V , Anisimov Yu A , Dmitriev I V , Shmarina N V , Pinchuk A V
Published: November 2019

Aim. To assess the state of the organ of vision in patients with end-stage chronic renal failure, who are on renal replacement therapy with hemodialysis and peritoneal dialysis. Methods. Examined were 35 patients with end-stage chronic renal failure. The first group consisted of 20 patients receiving renal replacement therapy with hemodialysis, the second group consisted of 15 patients treated with continuous ambulatory peritoneal dialysis. In addition to the standard ophthalmologic techniques (visual acuity, tonography, perimetry, biomicroscopy and ophthalmoscopy) conducted were optical coherence tomography and photographic imaging of the retina. The following data were also taken into account: arterial blood pressure, blood hemoglobin, creatinine and urea levels and indicators of phosphorus-calcium metabolism. Results. Regardless of the method of blood dialysis of all patients had decreased corrected visual acuity. In the patients of the first group it was 0.88±0.13, in the second group - 0.71±0.19. Also in both groups revealed was a concentric narrowing of the visual fields by 5-10%. Conclusion. In patients on hemodialysis, revealed was more severe course of retinopathy; in patients on continuous peritoneal dialysis, the most frequently encountered was swelling of the retina, metastatic calcification manifested to a lesser extent.
Combination of autoplasty with autodermoplasty in the treatment of lateral abdominal hernias
Authors: Botezatu A A , Nurmeev I N
Published: November 2019

Aim. To improve the outcomes of treatment in patients with lateral abdominal hernias by combining autoplastic methods with autodermoplasty. Methods. 42 case histories of patients with lateral abdominal wall hernias, operated in the first surgical department of the State Institution «Republican Clinical Hospital», Tiraspol city, from 2001 to 2011 were subjected to retrospective analysis. In all of the cases surgical treatment was performed. Combined methods of hernioplasty, which combine autoplasty with autodermoplasty, were applied. The authors’ personal patented method of hernioplasty was also used among others. Results. According to the classification of Chevrel-Rath (2000) 23 (54.7%) of the patients had inferolateral hernias, 5 (11.9%) patients - supra-lateral hernias, 8 (19%) patients - lumbar hernias, there were also 2 (4.8%) patients each with transrectal, pararectal and paracolostomy hernias. Despite their small number in the total amount of postoperative hernias (17.5%), 26 (65%) patients had large and giant lateral hernias, while recurrences were present in 7 (16.7%) cases. Treatment results were satisfactory. Complications and recurrence occurred in 1 (2.9%) patient each. Conclusion. The combination of autoplasty with autodermoplasty is an effective method of treatment for inferolateral, supra-lateral, pararectal, transrectal, paracolostomy and lateral hernias; during lumbar hernias autodermoplasty even with two autodermal grafts was not as effective, and therefore justified is the search for new methods of hernioplasty.
The results of dismembered flap pyeloplasty for hydronephrosis in children
Authors: Sizonov V V , Kogan M I
Published: November 2019

Aim. To evaluate the effectiveness of dismembered flap pyeloplasty for extensive obstruction of the pyeloureteral segment in children. Methods. Dismembered flap pyeloplasty throughout the period 2001-2010 was performed in 9 children (first group), mean age 69 months, 7 (77.8%) boys and 2 (22.2%) girls. Left-sided hydronephrosis was diagnosed in 8 (88.9%) cases, right-sided hydronephrosis - in 1 (11.1%) case. Dismembered flap pyeloplasty was performed in those cases, when after the resection of the ureter and during an attempt to form a direct uretero-pyelo-anastomosis excessive tension of the tissues occurred. In order to replace the resected part of the ureter used was a tubularized U-shaped flap of the renal pelvis, which was anastomosed in an «end to end» fashion with the proximal section of the ureter. The comparison group (second group, 58 patients) included patients who had undergone dismembered pyeloplasty with the formation of uretero-pyelo-anastomosis in the horizontal plane after standard resection of the dysplastic area of the proximal ureter. Results. In the early postoperative period, clinical manifestations of urinary tract infections were recorded in 1 (11.1%) of 9 patients, treated medically. The degree and rate of reduction of the increased anteroposterior size of the renal pelvis after dismembered flap pyeloplasty significantly lagged behind the comparable parameters of patients undergoing standard dismembered pyeloplasty, and at the same time, one year after the operation noted was a marked decrease in the anteroposterior size of the renal pelvis by almost 3 times as compared to the preoperative values. Conclusion. Implementation of dismembered flap pyeloplasty for extensive ureter obstruction makes it possible to achieve good short- and long-term results in the treatment of hydronephrosis in children.
The choice of surgical treatment method of patients with bacterial liver abscesses
Authors: Tolstikov A P
Published: November 2019

Aim. To improve the results of surgical treatment of patients with bacterial abscesses of the liver. Methods. During the period from 2000 to 2010 treated were 118 patients with bacterial liver abscesses, 75 men and 43 women aged from 18 to 80 years (mean age 52.1 years). Management of the patients was based on the developed algorithm of diagnosis and treatment of liver abscesses. Two groups of patients were formed: the main group (treatment consisted of percutaneous puncture and drainage of the abscesses under ultrasound guidance) - 94 patients, the comparison group - 24 patients. In the comparison group surgical interventions were performed using the transabdominal access: laparotomy, opening and drainage of the abscess (18 patients), hepatic resection (3 patients), left-sided hemihepatectomy (2 patients), right-sided hemihepatectomy (1 patient). Results. In the patients of the comparison group the following early postoperative complications developed: wound infection - 4, intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 2, exudative pleuritis - 2, pneumonia - 3 cases. The average duration of patient hospitalization was 19.5±1.6 bed-days. In the main group the average duration of patient hospitalization was 9.2±±0.6 bed-days. Early postoperative complications in patients of the main group included: intra-abdominal hemorrhage - 1, bile leakage - 1, abscesses of the abdominal cavity - 1, exudative pleuritis - 2, pneumonia - 2 cases. There were no deaths in either of the groups. Conclusion. Puncture and drainage of bacterial liver abscesses under ultrasound guidance is an effective method of treatment that makes it possible to reduce the number of abdominal operations, reduce the number of postoperative complications and shorten the hospital stay.
Diagnosis and treatment of snoring and sleep apnea syndrome
Authors: Batyrshin R G , Shagiakhmetova L Ya , Batyrshin T R , Gaysina T A
Published: November 2019

Aim. To assess the effectiveness of modern methods of diagnosis and surgical treatment of night snoring. Methods. Conducted was polysomnography in 117 patients suffering from snoring at night. In the case of evident signs of obstruction, patients were offered surgical treatment. Results. Out of 117 people with snoring polysomnography revealed obstructive sleep apnea syndrome: in 35 - mild form, 11 - moderate severity, 1 - severe. In 69 patients benign snoring was revealed, which does not lead to a decrease in blood oxygen saturation. Simultaneous complex surgical treatment was performed in 38 patients who according to polysomnography revealed upper airway obstruction. The obstruction was eliminated by endoscopic surgical correction of the intranasal structures and the nasopharynx, and minimally invasive uvuloplasty using the method of radiofrequency coagulation. Postoperatively the patients received local medications biclotymol (hexaspray), fusafungine (bioparox), rinsing of the pharynx with antiseptics. Positive effect (disappearance of snoring) was achieved in 29 patients after an average of 1.5-2 months after surgery, in 6 patients with obstructive sleep apnea syndrome of the II and III degree of severity and co-morbidities the episodes of apnea and hypopnea decreased significantly. In 3 patients with recurrent polypous rhinosinusitis secondary to bronchial asthma (2 patients) and encephalopathy (1 patient), surgical intervention (endoscopic polysinusotomy, radiofrequency uvuloplasty) did not achieve the desired effect and the patients were referred for conservative treatment. Conclusion. The method of polysomnography and surgical treatment strategy of night snoring meet the modern requirements and in most cases have shown to be effective.
The effectiveness of clopidogrel in the prevention of thrombotic complications in patients with acute coronary syndrome and genetic factors
Authors: Galyavich A S , Valeeva D D
Published: November 2019

This review article presents the current views on genotyping during administration of clopidogrel - an antiplatelet drug from the class of thienopyridines, for patients with acute coronary syndrome. Highlighted were the data on genetic disorders affecting the absorption and metabolism of clopidogrel. The gene ABCB1 (MDR1) encodes the intestinal transporter P-glycoprotein. The variability of this gene may affect the bioavailability of clopidogrel. However, data on the relationship between C3435T polymorphism of ABCB1 gene and the expression of P-glycoprotein still remain controversial. Differences in the effects of C3435T may reflect the differences in the frequency of ABCB1 polymorphism among ethnic groups and the complex of effects of different polymorphisms in the same gene within a haplotype, or confounding factors of the environment. The most important role in the metabolism of clopidogrel is played by cytochrome P-450 (iso-enzyme CYP2C19). Several large studies have confirmed the prognostic significance of CYP2C19 polymorphism in patients receiving clopidogrel. In a recent meta-analysis of nine pharmacogenetic studies of clopidogrel, which included 9685 patients with acute coronary syndrome, revealed was a significant association between the homozygous and heterozygous alleles with reduced CYP2C19 function and an increased risk of death due to cardiovascular disease, myocardial infarction or stroke. Two large randomized studies of CYP2C19 genotyping did not reveal any relationship between its variants and the occurrence of cardiovascular events in patients with acute coronary syndrome or atrial fibrillation. Thus, in genetic studies of the antiplatelet effectiveness of clopidogrel, there are many uncertainties; domestic data on this subject is extremely scarce.
Intervertebral disc homeostasis at normal conditions and during pathology
Authors: Kobyzev A E
Published: November 2019

Intervertebral discs are rather complex structural units of the spine. It is believed that a disturbance of the factors of their homeostasis immediately leads to changes in the bone tissue of the vertebral bodies and, consequently, to pathological changes at the level of the vertebral-motor segment. It follows that the maintenance of normal metabolism within the discs is one of the key directions in the prevention of many clinically important lesions involving the entire vertebral complex. The causes of metabolic processes disorders in the intervertebral disc can be divided into several levels: chronic diseases that directly affect the blood supply to the spinal column as a whole; diseases that affect the permeability of the capillary zone of the subchondral zone of the vertebral bodies; disturbances in the delivery of nutrients into the disc through its matrix, which serves an important selective barrier. However, regardless of the level of the causes of metabolic disorders, all of which eventually lead to anatomical and functional changes in the intervertebral discs and to their subsequent incapacity to provide the daily life cycle of the vertebral complex, consisting of periods of stress and relaxation. Thus, based on the known literature data we can conclude that: the intervertebral discs to date, remain poorly understood elements, however even from a narrow range of studies on this subject it is evident that their functionality is largely dependent on the properties of the disc matrix and the interstitial nature of metabolic processes.
Modelling the health condition of medical workers using a multivariate statistical analysis
Authors: Ermolina T A , Shilovskaya N A , Martynova N A , Kalinin A G , Krasilnikov S V
Published: November 2019

Aim. To identify the most important differential diagnostic criteria of the immunological parameters with the help of discriminant analysis in order to assess the level of health of medical personnel of an oncology dispensary. Methods. With the aim to model the generalized indicators of the health level, evaluated was the health of physicians and nurses, and a cross-sectional study of the immune status of health workers of the oncology dispensary was conducted. Firstly the content of T- and B-lymphocytes with different phenotypes was studied. The model «level of health of medical workers» was built on the basis of a sample of 96 observations (the group of medical personnel, the work of whom is associated with emitting apparatuses). The control group consisted of 98 people of the same medical institution, who are mainly office staff. Results. The health status can be described using macro parameters. At the same time under the state of health in the most general sense a specific value of the hierarchically interrelated parameters of the additive model of health is understood. Carrying out a differential diagnosis based on the assessment of clinical and laboratory data, functional parameters and their significance makes it possible to predict the level of health of medical workers. Conclusion. Informative features for differential diagnosis are the work at the department of radiology, working in surgical departments, working with the emitting apparatuses, secondary professional or higher professional education of the worker, the age of the employee, gender of the employee and the employee’s length of service for the department; the most informative features - work at the department of radiology (F=22.292), at the surgical departments (F=7.890), as well as work with the emitting apparatuses (F=3.985).
Personal mobile medical pharmaceutical electronic card of a customer (patient) as a tool for optimizing medical and pharmaceutical service for the population
Authors: Kirschina I A , Soloninina A V , Katkova A D , Spiridonov M L
Published: November 2019

Aim. To create a united informational space for members of the health care system and to optimize the pharmaceutical and medical services by improving the use of digital technologies. Methods. Theoretical and empirical modelling. Results. Proposed was the project entitled «Personal mobile medical and pharmaceutical electronic patient card» that makes it possible to combine all the aspects of pharmaceutical patient’s history and some medical information into a united informational database with the aim of rational organization of the personalized choice of drugs for each individual patients at any stage of delivering medical or pharmaceutical care. On the example of patients with diabetes, especially those in need of constant medical and pharmaceutical supervision, it was shown that the proposed project is an important component of optimizing the pharmaceutical activity, which makes it possible to enhance the quality, speed and efficiency of medical and/or pharmaceutical care. Conclusion. Practical application of the proposed project will make it possible to unify the system of delivering pharmaceutical care, provide access to patient information, and improve the quality of individual health care services for people affected by socially significant diseases.
Planning dental services using the methods of marketing
Authors: Kireev M Yu , Akhmetzyanova G Z , Saleev R A
Published: November 2019

Aim. To justify the use of marketing methods in the activities of dental institutions. Methods. During the period 2008-2011 conducted was a sociological survey of 857 patients with detailed clinical examination; eight predictive models were developed. Used were variational statistics, regression analysis, mathematical modeling, expert method. Results. 171 (27.0%) men and 460 (73.0%) women went to seek care in commercial dental institutions. 267 (33.0%) men and 459 (67.0%) women went to seek care in state dental institutions. The referability of women to dentists was higher in both cases (p 0.05). Women aged 20-29 years preferred to go to commercial dental institutions (32.0±2.3%), than to the state ones (17.0±1.8%, p 0.001), while men, on the contrary, went to the state (37.0±2.4%) rather than commercial dental institutions (20.0±2.0%, p 0.001). At the age of 30-39 years the women went to state dental institutions (33%) more frequently than to commercial dental institutions (29%), while men - mostly to commercial dental institutions (26%) compared with the state (17%). Among the reasons for seeking dental treatment in a commercial organization the first one is the lack of queues at the reception: to surgeons 46.1±1.7%, therapists 58.3±1.7% and orthopedists 60.0±1.85%; the second place is held by a convenient patient schedule: for the profile of surgery 34.2±1.6%, therapy - 26.7±1.5%, orthopedics - 22.0±1.4%, and the contribution of other causes did not exceed 10.0±1.0%. Proposed were eight prognostic models in the form of regression analysis equations for complex evaluation of the influence of factors, which determine the choice of a health care institution, and the referral to the therapist-dentist, surgeon-dentist, orthopedist-dentist, and orthodontist both in public and private health care organizations. Conclusion. Prognostic matrices, calculated using the formulas of mathematical analysis, can be used when planning outpatient dental care, justifying the required number of dentists’ positions in the state and commercial dental organizations.
The physiological significance of body weight at birth for subsequent age periods of life
Authors: Karpenko Yu D
Published: November 2019

Aim. To study the significance of the features of early development of a child’s body, estimated on the basis of the anthropometric data at birth for subsequent age periods. Methods. The study involved practically healthy 1-5 year students with normal birth weight, 439 males and 112 females, mean age was 21.13±±0.08 years. Measurements of systolic and diastolic arterial blood pressure were performed using an automated tonometer, heart rate variability was studied on a computer electrocardiography device in accordance with the generally accepted guidelines. Conducted was a multiple regression analysis, in which as an independent random variable were the age and height of the mother, the sex of the newborn, the serial number of delivery, and as a dependent variable - the birth body weight. Results. Established was a significant correlation between birth body weight and body length (β=0.163; p=0.000), maternal age (β=0.137; p=0.001), month (season) of birth (β=-0.2012; p=0.003) and sex (β=-0.1009; p=0.003) of the child. Noted was a correlation of the respiration rate with the body weight at birth both during the semester period (r=-0.2; p=0.05) and during the examination period (r=0.26; p=0.03). Conclusion. During the examination period the correlation between birth weight and the values of functional parameters (respiratory rate, tidal volume, arterial blood pressure) of the students increases, therefore, birth body weight among the surveyed students was a predictor of the functional state of the respiratory system, cardio-vascular and autonomic nervous systems.
Cases of alloimmunization with rh-antigen D in patients with uncomplicated transfusion history
Authors: Gadilshina R S , Bel’skaya E E
Published: November 2019

Aim. To attract the attention of practicing physicians to the problem of transfusion safety of erythrocyte-containing preparations to patients at risk for the emergence of post-transfusion complications. Methods. Gel technique, diagnostic panel of erythrocytes for screening and identification of alloimmune antibodies. Results. During the study of blood samples of patients identified were alloantibodies to the D antigen of the Rh-system and provided were recommendations for blood transfusions with individual selection. Conclusion. Antibodies to erythrocyte antigens of the Rh-system can be synthesized as a result of immunization due to an incompatible blood transfusion or incompatible pregnancies, as well as in cases of intravenous drug use, in the antigen D immunized donors.
On the prevention of occupational infection of health care workers with bloodborne pathogens
Authors: Glotov Yu P
Published: November 2019

Medical personnel of health care institutions are a group of occupational risk for infectious diseases. The aim of the present study was to draw attention of the medical personnel to the relevance of preventing nosocomial infection by bloodborne pathogens while performing professional duties. According to the blood service of the Central Military District among the donor-servicemen for the past 5 years the proportion of carriers of hepatitis B viral markers reached 7.9%, of hepatitis C - 8.0%, HIV - 1.7%. Presented in detail were the precautions while conducting invasive procedures and other manipulations with medical products, which are contaminated with biological fluids, discussed were the requirements of the sanitary legislation on this issue. The basic principle of prevention of occupational infection is compliance with the rules of sanitation and anti-epidemic regimen while providing service to any patient.
Ozonized erythrocyte mass in the treatment of patients with ulcerative gastroduodenal bleedings
Authors: Dobrokvashin S V , Rakhimov R R , Volkov D E , Yakupov R R , Izmaylov A G
Published: November 2019

Aim. To determine the effect of ozone on blood coagulation system and to develop the tactics of treatment of patients with acute gastroduodenal ulcerative bleedings in order to prevent postoperative complications. Methods. Analyzed were the results of treatment of 328 patients (males) with acute gastroduodenal ulcerative bleedings who were treated at the department of emergent surgery of the Veterans Hospital of Kazan during the period of 2005-2009. Ozone therapy was used in the complex treatment in 66 patients of the main group with acute gastroduodenal ulcerative bleedings. The comparison group included 262 patients who underwent complex treatment according to the traditional scheme. Electronic coagulography machine was used to assess the effects of ozone on blood coagulation. Results. Tissue oxygenation improved after transfusion of the erythrocyte mass treated with ozone, which significantly reduced the progression of necrotic ulcer. The use of ozone therapy in patients with this pathology has led to a decrease in postoperative mortality from 24.7 to 16.7%. Conclusion. The use of ozone following this technique in the complex treatment of patients with acute gastroduodenal ulcerative bleedings is an important component of prevention of a myocardial infarction, acute ischemic attacks and thrombotic disorders.