Kazan medical journal

Medical peer-review journal for physicians and researchers.

Editor-in-Chief: Ayrat U. Ziganshin, MD, PhD, Professor.


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Published bimonthly since 1901, distributed by subscription.

About: the Kazan Medical Journal is a peer-reviewed journal for clinicians and medical scientists, practicing physicians, researchers, teachers and students of medical schools, interns, residents and PhD students interested in perspective trends in international medicine.

Missions of the Journal are to spread the achievements of Russian and international biomedical sciences, to present up-to-date clinical recommendations, to provide a platform for a scientific discussion, experience sharing and publication of original researches in clinical and fundamental medicine.







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Vol 102, No 6 (2021)

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Theoretical and clinical medicine

Gene polymorphisms associated with lipid metabolism disorders in young adults with risk of ­sudden cardiac death
Kachnov V.A., Kryukov E.V., Kolyubaeva S.N., Kutelev G.G., Tyrenko V.V.

Aim. To study the frequency of polymorphisms in genes associated with lipid metabolism disorders in young people with risk of sudden cardiac death, to identify the relationships between gene polymorphisms and risk factors of sudden cardiac death, and to develop mathematical models to identify the probability of carrying mutations in these genes.

Methods. The study included 436 young people (mean age 19.8±1.6 years). A standard examination and survey by questionnaire specially developed by us were conducted to identify an increased risk of sudden cardiac death. 59 individuals with a risk of sudden cardiac death were selected. The control group was 65 people, which was comparable to the study group. A blood test was performed to determine lipid profile and polymorphisms: Leu28Pro (rs 429358) in gene APOE, C3238G (rs 5128) in gene APOC3, Gln192Arg (rs 662) in gene PON1, Ser447Ter (rs 328) in gene LPL, G250A (rs 1800588) in gene LIPC. Statistical analysis was performed using the statistical package SPSS 17.0 and Statistica 6.0. The parametric Kruskal–Wallis test, the Mann–Whitney U-test, the Pearson’s chi-squared test, the Spearman rank correlation coefficient, and logistic regression analysis were used.

Results. We revealed a high frequency of Gln192Arg (rs 662) polymorphism in the PON1 gene in the group of individuals at risk of sudden cardiac death and its correlation with the deaths in relatives under age 50 years. Mathematical models for predicting the presence of polymorphisms in genes associated with lipid metabolism disorders have been developed. Among the developed mathematical models, the models for identifying carriers of the minor allele of Gln192Arg polymorphism in the PON1 gene, Ser447Ter in the LPL gene, and 250 G>A in the LIPC gene had the highest sensitivity, specificity, and accuracy.

Conclusion. In persons at risk for sudden cardiac death, it is advisable to conduct a screening for mutations in genes associated with lipid metabolism disorders, especially in Gln192Arg polymorphism in gene PON1.

Kazan medical journal. 2021;102(6):805-814
pages 805-814 views
Some indicators of left ventricular dysfunction in hypertensive patients, depending on the level of matrix metalloproteinases and tissue inhibitors of metalloproteinase-1
Kalinkina T.V., Lareva N.V., Chistyakova M.V.

Aim. To study the level of matrix metalloproteinases-1 and -2, and tissue inhibitor of metalloproteinases-1, the indicator of left ventricular myocardial deformation in patients with stage 1–2 hypertension.

Methods. 114 patients (40 women and 74 men) with hypertension of 1–2 stages observed in the cardiology “Department of the Road clinical hospital Chita II” were examined. The median age was 42±8.3 years. Left ventriclular diastolic function was studied by using tissue Doppler imaging in apical four-chamber views. Serum matrix metalloproteinase-1, matrix metalloproteinase-2, and tissue inhibitor of metalloproteinases-1 levels were measured in all patients on automated immunoassay analyzers using ready-to-use ELISA kits.

Results. An increase in serum levels of matrix metalloproteinases-1 and -2 in the group of patients with hypertension and diastolic dysfunction by 46 and 47%, respectively, was found against increased levels of serum tissue inhibitor of metalloproteinase-1 (р=0.049). In patients with diastole dysfunction, myocardial global longitudinal strain was decreased in was observed by 22.8% compared with patients without diastole dysfunction (p <0.05). The analysis revealed a moderate negative relationship between left ventricular global longitudinal strain and the serum levels of metalloproteinases-2 (r=0.64, p <0.05).

Conclusion. In patients with hypertension and left ventricular diastolic dysfunction, a decrease in left ventricular global longitudinal strain is associated with the serum level of matrix metalloproteinase-2; a tissue inhibitor of metalloproteinases-1 is unrelated to left ventricular global myocardial strain.

Kazan medical journal. 2021;102(6):815-820
pages 815-820 views
Study of indicators of the immune status in HIV-infected patients with concurrent allergic pathology
Nora S.A., Arkhipova G.S., Arkhipova E.I., Nikitina N.E., Buikin S.V.

Aim. To study the indicators of the immune status and manifestations of allergic diseases in HIV-infected patients in the Novgorod region.

Methods. We studied the data of HIV-infected patients living in the Novgorod region for the years 2000–2021. A total of 1020 cases of HIV infection were studied, in which 121 (12%) patients were diagnosed with allergic reactions. In patients with allergic manifestations, the human immunodeficiency virus type 1 ribonucleic acid content was measured by the polymerase chain reaction method, and the indicators of the immune status (the content of lymphocytes, eosinophils, basophils, the levels of CD3+, CD3+CD4+, CD3+CD8+ cells, immunoregulatory index) were assessed. For statistical analysis, the Student's test (t) was used to assess the statistical significance of diffe¬rences in immune status indicators, and the Pearson χ2 test to assess the statistical significance of differences in allergic manifestations in patients with HIV.

Results. The subjects of the study were divided into 2 groups based on the levels of HIV viral load. Analysis of these groups using the Pearson χ2 test showed a statistically significant (p <0.012) correlation between high viral load and the development of drug hypersensitivity reaction in HIV-infected patients. The following etiology of allergic reactions was determined among the subjects: drug (59%), food (19%), pollen (5.7%), household (5.7%), che¬mical (1.9%), unspecified (6.7%). The study of the immune status in two groups did not reveal statistically significant differences (p >0.05). The study of the immune status indicators in HIV-infected patients with drug hypersensitivity reactions and different levels of viral load revealed a significantly higher level of CD3+ cells (p <0.003) in patients with drug hypersensitivity reactions and detectable viral load.

Conclusion. The study revealed statistically significant differences in the immune status of HIV-infected patients with drug hypersensitivity reactions living in the Novgorod region compared with HIV-infected patients without drug allergies.

Kazan medical journal. 2021;102(6):821-826
pages 821-826 views
Results of osteopathic treatment of infants with psychomotor developmental disorders
Veber V.R., Egorova I.A., Zinkevich E.R., Chervotok A.E.

Aim. To compare the effectiveness of osteopathic treatment of infants with psychomotor development disorders with standard treatment in terms of functional status.

Methods. The study was conducted at the Yaroslav-the-Wise Novgorod State University and the Institute of Osteopathic Medicine named after V.L. Andrianov, between 2020 and 2021. The study included 49 children with delayed psychomotor development, of which: the main group consisted of 26 children receiving osteopathic treatment; the control group consisted of 23 children treated with standard therapies. Data gathered included the indicators of the functional health state, complaints of parents, assessed neurological, vegetative, and osteopathic statuses, the psychomotor development in the children according to the Zhurba–Mastyukova scale, performed neurosonography. The results were processed using descriptive statistics followed by checking for the significance of the difference by using the Student's t-criterion for related samples.

Results. A comparison of the effectiveness of osteopathic and standard treatment of infants with a delay in psychomotor development by indicators of the functional status was carried out. The need for an integrated approach to therapeutic and diagnostic procedures was substantiated. The number of subjective complaints about the health of children from parents in the main group decreased, while in the control group, it remained the same. Neurological status in children of both groups improved, but the changes are more pronounced in the main group (p <0.05). The outcomes of the treatments indicate for improving psychomotor development of the children in the main group, in the control group, such an increase was only 13.0% (p <0.001).

Conclusion. The results of the study showed that osteopathic treatment of infants with psychomotor development disorders is more effective than standard complex treatment, which is reflected in the improvement of functional health indicators.

Kazan medical journal. 2021;102(6):827-834
pages 827-834 views
The relationship between impaired uteroplacental blood flow and blood pressure level in pregnant women with chronic and gestational hypertension
Medubayeva M.D., Kerimkulova A.S., Latypova N.A., Veber V.R., Idrisov A.S., Nurpeissova R.G., Mar­kabayeva M.A.

Aim. To assess the relationship between impaired uteroplacental blood flow and different levels of blood pressure in pregnant women with chronic and gestational hypertension at different stages of pregnancy with the determination of the optimal systolic blood pressure.

Methods. We conducted a prospective cohort study between 2018 and 2019. The study enrolled pregnant women aged 18 to 45 years: 55 women with chronic and gestational hypertension each, as well as 80 healthy pregnant women as control. The groups were formed by the continuous method, in which all pregnant women with arterial hypertension were included in the study until the required number of subjects was obtained. Follow-up was conducted at different gestation periods (14–16, 20–22, 28–30, 34–36 weeks) until delivery. Independent groups were compared by using the Student's t-test, the Pearson’s χ2 test, the Mann–Whitney U test, the Kruskal–Wallis H test.

Results. Comparison of the groups revealed differences in blood pressure levels at different gestation periods. In chronic hypertension compared with gestational hypertension, there was an increase in the impairment of the uteroplacental blood flow in pregnant women, indicating an unfavorable prognosis. The study of impaired uteroplacental blood flow among pregnant women with various forms of arterial hypertension revealed an increase in pregnant women with chronic arterial hypertension compared with gestational (p=0.04), indicating an unfavorable prognosis. In chronic arterial hypertension, the impairment of uteroplacental blood flow was the least for systolic pressures up to 120 mm Hg (up to 0.9%) at 14–16 and 20–22 weeks of gestation, and for 130–139 mm Hg (from 1.8 to 2.7%) in later pregnancy. In gestational hypertension, the least or no impairment rate of uteroplacental blood flow was determined for blood pressures up to 129 mm Hg at all stages of pregnancy compared with chronic hypertension.

Conclusion. The optimal systolic blood pressure in chronic hypertension reducing the risk of impaired uteroplacental blood flow in pregnant women is <129 mm Hg before 20th week of pregnancy and 130–139 mm Hg in later (20–30 weeks); in gestational hypertension, blood pressure reduction to 129 mm Hg is recommended at all stage of gestation.

Kazan medical journal. 2021;102(6):835-842
pages 835-842 views
Concomitant diseases in COVID-19 and their impact on the risks of adverse outcomes
Ivanova N.V., Belov V.S., Samarkin A.I., Tretyakevich Z.N., Mikushev V.M., Bruttan Y.V.

Aim. To analyze COVID-19 comorbidities and their impact on disease course and the risk for unfavorable outcomes.

Methods. This study examined a group of 110 patients aged 32 to 97 who were admitted to the intensive care unit of the Pskov Regional Infectious Diseases Hospital in the period from October 7, 2020 to March 23, 2021. The mean age of patients was 65 years, 51% (56 people) were male. The study recorded age, comorbidities on a binary scale (yes — no), course of the disease, the degree of lung injury, hospital length of stay, treatment outcome. The impact of comorbidities on the disease severity and outcomes was assessed by using logistic regression analysis.

Results. It was shown that a regional sample of patients showed an increased hospital mortality rate compared with the data of the ACTIV registry (33.5 versus 7.6%). Chronic respiratory diseases in patients with COVID-19 regional cohorts affected the fatal outcome 2.7 times less than those registered in the Russian register. The presence of endocrine and thrombotic circulatory system diseases was generally close to the register. Concomitant cardiovascular diseases in patients of the regional cohort affected the mortality of COVID-19 outcomes two times less (in patients of the region, the risk of mortality increased by 2.066 times) than in the registry. The reliability of the conclusions is confirmed by testing statistical hypotheses and reliability coefficients below 5%.

Conclusion. The study shows the statistically significant effect of comorbidities on the COVID-19 outcomes; the specificity of the results related to the sampling characteristics and the regional component.

Kazan medical journal. 2021;102(6):843-854
pages 843-854 views
The effect of the geometry of the proximal anastomosis, markers of apoptosis and cell proliferation on the long-term patency following reconstructive interventions on the femoropopliteal arterial segment
Kalinin R.Y., Suсhkov I.A., Klimentova E.A., Shanaev I.N.

Aim. To study changes in the topography of the orifice of the deep femoral artery (DFA), markers of proliferation, and apoptosis in patients after open interventions on the femoropopliteal arterial segment.

Methods. The study included 35 patients with atherosclerotic peripheral arterial disease (PAD), femoral-popliteal occlusion, stage IIB–III of the disease according to the classification of A.V. Pokrovsky–Fontaine, who underwent open surgery. The average age of the patients was 69±4.6 years. These patients included 26 men. Patients were divided into two groups: group A included 18 patients who underwent femoral-popliteal prosthetics (distal End-To-End bypass anastomoses), group B included 17 patients with femoral-popliteal bypass surgery (distal End-To-Side bypass anastomoses). The groups were comparable in terms of age and disease severity (p >0.05). Determination of serum platelet-derived growth factor BB (PDGF BB) and soluble form Fas (sFas) levels was carried out immediately before the intervention, on the 1st, 7th days, and 1 month after the operation. Duplex scanning (DS) was performed on day 7, after 1 and 18 months. Statistica 10.0 software was used for statistical data processing. The significance of differences between unrelated samples was assessed using the Student's t-test. The correlations between variables were analyzed by using Pearson's method.

Results. On 1st day, there was a decrease in soluble Fas in patients of group A compared with group B (0.41 ng/ml vs 0.78 ng/ml, p=0.01). On the 7th day, the levels of serum platelet-derived growth factor BB were increased in patients of group A compared with group B (35.2 ng/ml vs 23.2 ng/ml, p=0.00001). After 1 month, the level of serum platelet-derived growth factor BB in patients of group A remained elevated compared with those in patients of group B (22.8 ng/ml vs 14.4 ng/ml, p=0.0003).

Conclusion. Femoropopliteal prosthetics leads to a change in branching angle of the deep femoral artery up to 70–80%, accompanied by changing dynamics of apoptotic markers and cell proliferation, leading to an increase in the thickness of neointimal hyperplasia and the progression of atherosclerosis.

Kazan medical journal. 2021;102(6):855-861
pages 855-861 views


Health risks of air pollution with fine particulate matter
Fatkhutdinova L.M., Tafeeva E.A., Timerbulatova G.A., Zalyalov R.R.

The review presents up-to-date information on the health effects of ambient fine particulate matter, obtained in large cohort epidemiological studies, as well as in meta-analysis of pooled data. In addition, it summarizes the current data on the potential pathological mechanisms and existing monitoring systems. The literature search used the Scopus, PubMed, Russian Science Citation Index databases for 1990–2020. The results of epidemiological studies carried out in different countries indicate that fine particles in ambient air pose a serious threat to health. Scientific publications assessing the health impact of particulate matter show a wide range of adverse effects — from the increasing incidence of upper and lower respiratory tract diseases, including exacerbations of bronchial asthma, pneumonia, chronic obstructive pulmonary disease, to a high incidence of myocardial infarction, strokes, diabetes mellitus type 2, as well as an increase in overall mortality from natural causes, mainly mortality from respiratory diseases, cardiovascular and cerebrovascular diseases, lung cancer. The effects of short-term exposures are described in more detail, while the effects of long-term exposure to fine particles are not well understood. Potential mechanisms of the harmful effects of fine particulate matter include oxidative stress, inflammatory reactions, disorders of autonomic regulation and heart rhythm, fine particles translocation through the alveolar barrier into the vascular bed with endothelial damage and thrombus formation, and genotoxicity. Ambient fine particulate matter is a manageable risk factor, and reductions in air pollution will have a significant impact on public health outcomes.

Kazan medical journal. 2021;102(6):862-876
pages 862-876 views
Neurological aspects of COVID-19
Aliyeva M.B., Saparbayev S.S., Ayaganov D.N., Kurmangazin M.S., Tuychibaeva N.M.

The coronavirus disease COVID-19 began to spread worldwide in December 2019 from the city of Wuhan (China). COVID-19 is often accompanied by fever, hypoxemic respiratory failure and systemic complications (for example, gastrointestinal, renal, cardiac, neurological, and hepatic lesions), thrombotic phenomena. Central nervous system damage is caused by the primary effect on it, direct neuroinvasion of the virus, and more often by secondary effect due to systemic hyperinflammation. Neurological manifestations include fatigue, headache, insomnia, and olfactory/taste disorders. Neurological manifestations and complications of COVID-19 are diverse: (1) cerebral circulatory disorders, including ischemic stroke and macro/microhemorrhages; (2) encephalopathy; (3) para/postinfectious autoimmune complications, such as Guillain–Barre syndrome; (4) meningoencephalitis; (5) neuropsychiatric complications (psychosis and mood disorders). In terms of pathogenesis, neurological disorders in COVID-19 can be caused by neurotropicity and neurovirulence of SARS-CoV-2, cytokine storm, hypoxemia, homeostasis disorders, as well as their combined effects. COVID-19 adversely affects the course and prognosis of chronic neurological disorders in comorbid patients. The review highlights the need for vigilance to early neurological complications in patients infected with SARS-CoV-2 and other coronaviruses, especially since some neurological complications may precede respiratory manifestations.

Kazan medical journal. 2021;102(6):877-886
pages 877-886 views
Immunogenetic features of HIV-infection and allergy comorbidity
Nora S.A., Arkhipov G.S., Arkhipova E.I., Nikitina N.N.

Today, the comorbidity of infection caused by the human immunodeficiency virus (HIV) is an important problem due to the complexity of the selection of the optimal antiretroviral therapy and the diagnosing of associated pathological conditions. The study of the comorbidity of HIV-infection and allergy is an important area of research. This article presents a literature review on different types of comorbidity. Special attention is paid to the development of allergic reactions to antiretroviral drugs. The presence of an allergic reaction in a patient can cause low adherence to therapy and subsequent development of HIV resistance to the treatment. The review provides information on the possible causes of the development of hypersensitivity in HIV-infected patients. The data on the development of hypersensitivity reactions in response to treatment with the main classes of antiretroviral drugs (nucleoside and non-nucleoside reverse transcriptase inhibitors, synthesis inhibitors, protease inhibitors, integrase inhibitors, cysteine-cysteine chemokine receptor 5 inhibitors) are presented. The most common allergic reactions to these drug classes are itching and rash, as well as increasing hepatic transaminase levels and cough. The existing scientific data on allergic reactions to drugs prescribed for other concurrent conditions (tuberculosis, fungal diseases) is also considered. The examples of studies reflecting the relevance of using immunogenetic and molecular genetic approaches in the study of comorbidity of HIV-infection and allergy are given. The identification of immunogenetic markers of the development of the hypersensitivity to therapy will optimize the diagnostic and treatment algorithms, especially in complex comorbid conditions.

Kazan medical journal. 2021;102(6):887-892
pages 887-892 views
The role of classical risk factors for knee osteoarthritis in unilateral transtibial amputation
Khokhlova O.I., Vasilchenko E.M., Berman A.M.

The study aimed to review the literature on the classical risk factors for knee osteoarthritis and their possible role in the development of this pathology in patients with unilateral transtibial amputation in terms of potential rehabilitation prospects. A search of publications was carried out using PubMed databases of the US National Center for Biotechnology Information and the website of the Elsevier publishing house. Well-established increased risk factors for knee osteoarthritis are old age, female gender, lower limb muscle weakness, low or excessive physical activity, overweight, a history of knee joint injury or surgery, chronic knee pain. These factors are common for disabled persons with unilateral transtibial amputation, which, combined with specific mechanical factors, makes these persons more vulnerable to the development and progression of osteoarthritis. Programs aimed at eliminating modifiable risk factors for the development of knee osteoarthritis can contribute to the preservation of knee joint function in the long term and improve the quality of life of persons with unilateral transtibial amputation. This requires the well-coordinated efforts of a multidisciplinary team, as well as the participation of the disabled persons themselves. Identification and management of the potentially modifiable classical risk factors for the development of knee osteoarthritis are one of the promising pathways of rehabilitation of persons with unilateral transtibial amputation.

Kazan medical journal. 2021;102(6):893-901
pages 893-901 views
Pelvic drain after low anterior resection of the rectum: pros and cons
Akhmetzyanov F.S., Egorov V.I., Abdulganieva G.R.

Low anterior resection, unlike other large bowel resections with anastomosis, is characterized by a high incidence of postoperative complications, repeated surgical interventions, accompanied by high mortality. To reduce these indicators, the creation of a protective stoma and drainage of the pelvis has become widespread. However, the efficiency of pelvic drainage after low anterior resection remains unclear and controversial. This literature review is devoted to the relevance of the problem of efficiency and analysis of studies on this issue. Most randomized trials have not proven the effectiveness of drainage in colorectal surgery, but in these studies, as a rule, little or no attention was paid to draining the small pelvis after total mesorectal excision. This work analyzes the studies of supporters and opponents of pelvic drainage after low anterior resection of the rectum and provides arguments for and against drainage of the pelvic cavity. Although there are randomized trials showing no benefit of pelvic drainage, many clinics use pelvic drain after low anterior resection. The personal experience of the surgeon and the occurrence of intraoperative complications such as bleeding, contamination, technical difficulties in colorectal anastomosis formation has an important role to play in this. A lower rate of repeated operation in the use of pelvic drainage suggests the possibility of conservative treatment.

Kazan medical journal. 2021;102(6):902-907
pages 902-907 views
Chronic obstructive pulmonary disease: an urgent problem of health saving of modern medicine
Raikova S.V., Komleva N.E., Mikerov A.N., Potapova M.V., Zavyalov A.I., Potapova A.S.

Chronic obstructive pulmonary disease is one of the most urgent problems of the modern medical community. Despite the introduction of constantly updated schemes of early diagnosis and treatment into practical medicine, there is still an upward trend in the number of cases, under-examined persons, and prognostically unfavorable outcomes. The review highlights the findings of epidemiological studies confirming the widespread prevalence of the disease, accompanied by rapid disability progression, high mortality, and significant economic damage. The review lists the main exogenous and endogenous risk factors for the development of chronic obstructive pulmonary disease, including occupational etiology. Attention is drawn to the possibility of disease prevention in a professional environment with the proper motivation of the patient and the application of economic efforts. The article discusses the main causes of underdiagnosis and late diagnosis of the disease. Lifestyle modification makes an undeniable contribution to the prevention of chronic obstructive pulmonary disease and improving prognosis in the developed disease. Certain psychological characteristics that reduce adherence to treatment of such patients should be considered in organizing the management of this category of persons and creating special schools. It is important to create a classification of “endotypes” of chronic obstructive pulmonary disease, as well as sufficient public awareness about this disease with the aim of the earliest possible diagnosis.

Kazan medical journal. 2021;102(6):908-915
pages 908-915 views
Next-generation pacemakers: from electrical devices to biological pacemakers
Oslopov V.N., Mamedova A.K., Nafeeva D.N., Khazova E.V., Oslopova Y.V.

The invention of an electric pacemaker in the middle of the 20th century led to a revolution in the treatment of cardiac conduction system diseases. The improvement of pacemakers continued. In 1962, the first small series of external pacemakers for percutaneous and direct stimulation was produced in Kaunas. After a while, electric pacemakers became more reliable, smaller and lighter in weight, but the problem of foreign body associated infection and limited service life remained unresolved. Modern high-tech medicine strives to create less invasive electric pacemakers, but nevertheless, biological pacemakers can expand the therapeutic arsenal for the treatment of cardiac patients, being the most physiological for humans. The concept of an artificial biological pacemaker consists of the creation of an organic structure that generates a spontaneous rhythm from the implantation site in the myocardium. Various gene and cellular approaches were used to create biological pacemakers: a functional reorganization approach (use of adenovirus vectors for hyperexpression of genes encoding ion channels in cardiomyocytes); hybrid approach (use of fibroblasts to deliver genes of ion channels that provide heart automation); somatic reprogramming approach (overexpression of the transcription factor TBX18 using adenoviral vectors, which reprograms cardiomyocytes into induced sinoatrial node cells, creating cardiac stimulatory activity); cellular approach (transplantation of stem cells to a specific place in the heart, thereby creating biological stimulation). Modern methods of electrical cardiac stimulation and the developed concepts of the biological pacemaker clearly show the possibility of eliminating current problems associated with the use of an artificial pacemaker by replacing it with a biological one. Each of the approaches (gene, cellular, hybrid-cellular, somatic reprogramming) has its own advantages and disadvantages, which predisposes to further study and improvement in order to introduce a biological pacemaker into clinical practice.

Kazan medical journal. 2021;102(6):916-922
pages 916-922 views

Social hygiene and healthcare management

Standardization in regulating artificial intelligence systems in Russian healthcare
Zinchenko V.V., Khoruzhaya A.N., Sharova D.E., Akhmad E.S., Mokienko O.A., Vladzymyrskyy A.V., Morozov S.P.

Artificial intelligence technologies in medical practice are a promising direction in the world. Artificial intelligence medical decision support systems, diagnostic and screening programs can help medical personnel in routine and complex tasks and improve the level of medical care provided to patients. At the same time, the development, production and distribution of artificial intelligence systems must be regulated without fail. Registration and subsequent control (post-registration monitoring) of artificial intelligence systems in medicine require the creation, adjustment of the legal framework and technological regulation. The Russian Federation has developed a promising development strategy in this area. Seven national standards have been developed by experts in the field of Artificial intelligence in healthcare. These standards establish the procedures for conducting clinical and technical trials, performance requirements and the concept of life cycle, a quality management system and risk management. A separate standards is devoted to dataset creation for training and testing the developed algorithms, requirements for them and a metadata format. There are plans to bring the developed national standards to the international level, which will allow Russian manufacturers of artificial intelligence systems implemented these national standards to comply with foreign counterparts and become more competitive at the international level. The international community has already supported the development of an ISO standard based on the national standard for clinical trials. The development will be performed based on the technical committee ISO/TC 215 (Health informatics) in conjunction with ISO/IEC JTC 1/SC 42 (Artificial intelligence), this will allow bringing the national requirements for the Artificial intelligence to the international level. The cycle of these standards will summarize recognized methodologies, helping both manufacturers and medical organizations, doctors and patients to produce and use a quality, safe and effective product.

Kazan medical journal. 2021;102(6):923-933
pages 923-933 views

Clinical observations

Justification of treatment and possible outcomes of severe COVID-19
Khamitov R.F., Andreicheva E.N., Hairullina A.R., Mingaleeva G.F.

The role of hyaluronic acid in the pathogenesis of acute respiratory distress syndrome, including those associated with severe COVID-19, is known. Pro-inflammatory cytokines (interleukin-1, tumor necrosis factor) are strong inducers of hyaluronic acid synthase (HAS2) in CD31+ endothelial cells, EpCAM+ cells of the alveolar epithelium of the lungs and fibroblasts. Hyaluronic acid can absorb water in quantities significantly exceeding its own molecular weight. Reducing the presence or inhibiting of hyaluronic acid synthesis is of great importance for facilitating the breathing of COVID-19 patients. Hyaluronidase-based preparations can reduce the accumulation of hyaluronic acid and promote pulmonary alveoli cleansing. Respiratory viral infections, including pandemic strains of coronaviruses, especially in severe cases with acute respiratory distress syndrome, can be complicated by the development of pulmonary fibrosis. It has been shown that changes in X-ray Computed Tomography findings characteristic of fibrosis in the first year after COVID-19 can significantly regress. A clinical case from the practice of treating a patient with a severe course of COVID-19, significant cardiovascular comorbidity, grade 2 obesity, which was regarded as significant risk factors for an unfavorable outcome, is presented. The patient with signs of progressive respiratory failure was admitted to the intensive care unit. Pulse therapy with glucocorticosteroids and anticoagulants was started. Deterioration of the condition is regarded as the beginning of acute respiratory distress syndrome, which complicated the cytokine storm induced by the coronavirus. The patient was taken for high-flow oxygenation. An anti-cytokine therapy was prescribed. Reduction of inflammatory markers was obtained, but severe respiratory failure persisted. The bovgialuronidase azoximer was included in the treatment. The patient's condition began to stabilize then she was discharged in stable condition without oxygen support. The available data on the negative role of hyaluronic acid in the pathogenesis of acute respiratory distress syndrome in patients with COVID-19, as well as the need to reduce the likelihood of developing residual fibrous changes in the lungs in patients who have undergone acute respiratory distress syndrome, suggest the need for further studies of domestic azoximer bovgialuronidase properties in the treatment of severe forms of COVID-19.

Kazan medical journal. 2021;102(6):934-939
pages 934-939 views

Clinical experiences

Preventive esophagomyobronchoplasty as a method to prevent the failure of the bronchial stump in pneumonectomy for lung cancer
Sulimanov R.A., Sulimanov R.R., Spassky E.S., Fedorova T.V., Kholodova M.A.

Aim. Comparative analysis of insufficiency rate of bronchial stump sutures in pneumonectomy for lung cancer, depending on suturing techniques.

Methods. A patented technique for bronchial stump suturing has been introduced into the practice of the GOBUZ clinic “Novgorod Regional Clinical Hospital” based on the Department of thoracic surgery since 2015 for pneumonectomy for lung cancer. Before the introduction of the developed technique, various generally accepted methods of bronchial stump forming were used (mechanical suture, manual suture, their combination, bronchial stump coverage with mediastinal pleura, pericardial flap). A retrospective analysis of 173 case histories and operational protocols of patients with lung cancer who underwent pneumonectomy was carried out for the failure of bronchial stump sutures when using conventional suturing techniques between 2010 and 2014 (the first group of patients). We also performed a retrospective and prospective analysis of 204 case histories and operational protocols of patients in a similar clinical group when using a patented suturing technique between 2015 and 2020 (the second group of patients). Statistical analysis was carried out by using Statistica 10.0 software (StatSoft, Inc. 2011). The qualitative and quantitative indicators were analyzed by using the Pearson’s χ2-test with Yates’s correction.

Results. A retrospective analysis shows that the failure rate in the use of generally accepted bronchial stump suturing techniques for 2010–2014 was 10.4%. After the implementation of the method of preventive esophagobronchomyoplasty, complications as bronchial stump suture failure were not detected in any case between 2015 and 2020.

Conclusion. The study shows high efficiency, a decrease in the incidence of complications as the failure of bronchial stump sutures in the use of the developed method of preventive esophagomyobronchoplasty in pneumonectomy for lung cancer.

Kazan medical journal. 2021;102(6):940-945
pages 940-945 views
The use of digital technologies in the diagnosis of tumor diseases at the pre-medical stage
Cherenkov V.G., Weber V.R., Pasevich K.G., Arendatelev I.G.

Aim. To improve the effectiveness of tumors and risk factors detection in reducing time costs at the pre-medical stage using a robotic complex.

Methods. To achieve this goal, the previously created robotic complex with a program for self-questioning, taking into account gender, has been improved. A portable USB microscope was built into the complex’s housing to transmit images of pathological changes of visible localizations to the touch screen. The survey and examinations were conducted by clinical residents and students of the “case-control” type in 1638 patients at the Novgorod Regional Clinical Oncological Dispensary (in 2019–2021) as part of the Doors Open Days. The average age of patients was 54.6±8.9 years, including 703 men and 935 women. Descriptive statistics methods of Statistica 6.0 software were used. Qualitative characteristics showed as absolute number and the relative value in percentage (%). The differences were considered statistically significant at p ≤0.05.

Results. The use of the complex allowed us to suspect cancer risk factors in 9.03±1.3% patients, of which 31.08±1.8%, or 2.8±2.1% (p=0.017) of the total patients with the further examination was able to confirm oncology-related findings. Patients complained of discomfort in the stomach (59 people) underwent a breath test built into the program of the complex, according to the results of which helicobacteriosis was detected in 29 patients. In 17 patients with fibrogastroscopy, intestinal metaplasia was subsequently established, in 4 — gastric ulcers, 3 of which had malignancy.

Conclusion. The use of a robotic complex-2 saves the time of a doctor of a “lean” polyclinic and improves the effectiveness of identifying cancer risk factors and early-stage cancer.

Kazan medical journal. 2021;102(6):946-950
pages 946-950 views
Improvement of surgical methods for the treatment of spontaneous rupture of the esophagus ­complicated by purulent mediastinitis
Senichev D.V., Sulimanov R.A., Sulimanov R.R., Spassky E.S., Salekhov S.A.

Aim. To improve surgical treatment outcomes of patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis.

Methods. Over the past 30 years, we have experience in the surgical treatment of 31 patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis. Depending on the tactics and techniques of surgical treatment, we identified two groups of patients. The first group (n=8) consisted of patients operated with conventional techniques: thoracotomy, transpleural mediastinotomy according to Dobromyslov, suturing of the esophagus with drainage of the mediastinum and pleural cavities, “blind” mediastinal drainage. The second group (n=23) consisted of patients treated with “programmed re-thoracotomy”. Re-thoracotomy was performed along with the postoperative thoracotomy wounds. The delimited foci of purulent mediastinitis were opened and sanitized (necrotic tissues were excised and removed). Preventive hemostatic methods were used in the area of pressure ulcers from drainage tubes. Replacing and changing the position of the drainage tubes in the mediastinum was a strictly compulsory technique. Pus and necrotic soft tissue that appeared in the thoracotomy wound were subsequently eliminated by a device consisting of two titanium brackets connected by a lock embodied in the form of an oval ring during the wound suturing at the stage of programmed re-thoracotomy. The groups were comparable in age and comorbidities. The average diagnosis of spontaneous esophageal rupture took 3.5 days; the maximum time is 10 days. The statistical significance of differences in immune status indicators was assessed by using the Student's t-test and Pearson's χ2 test.

Results. A systematic approach using the tactical and technical surgical techniques developed by us (such as suturing esophageal wall defects regardless of the rupture time, multifunctional nasoesophagogastric tube installation; the imposition of a purse string suture to prevent reflux from the stomach into the esophagus; programmed re-thoracotomy using the method of temporary fixation of the ribs) allowed to reduce the number of complications, such as haemorrhage from the mediastinal vessels, by 3 times, sepsis — 1.5 times, mortality — almost 2 times.

Conclusion. The introduction of patented techniques allowed to reduce the number of life-threatening complications and mortality in patients with spontaneous rupture of the esophagus complicated by purulent mediastinitis.

Kazan medical journal. 2021;102(6):951-959
pages 951-959 views

History of medicine

Medicines and life (to the 100th anniversary of Professor Irina Vitalievna Zaikonnikova)
Garaev R.S., Ziganshin A.U.

Irina Vitalevna Zaikonnikova is a well-known Soviet pharmacologist, headed the Department of Pharmacology of the Kazan State Medical Institute between 1968 and 1989. The topic of I.V. Zaikonnikova’s Ph.D. thesis was “The influence of dikain on blood vessels and its relationship with adrenaline”. In her dissertation, Irina Vitalievna found that dicaine dilates blood vessels in low concentrations and causes their constriction in high concentrations. The thesis was successfully defended in 1947. In the 50s of the last century in Kazan, for the first time in the Soviet Union, the study of the biological activity of organophosphorus compounds was begun. A large experimental material concerning the correlation between the biological activity and chemical structure of compounds was summarized in his doctoral dissertation “Pharmacological characteristics of a number of dialkylphosphinic acid esters”, which I.V. Zaikonnikova defended in 1968. At the Department of Pharmacology, which she headed since 1968, a close-knit team was formed, united by a common interest — the search and development of new potential drugs. This major work resulted in the creation of cidiphos, glycifon, phosphabenzide, and dimephosphon — organophosphorus compounds of a new type, which mechanism of action is not associated with inhibition of the activity of acetylcholinesterase. In addition, drugs that did not belong to organophosphates were created — the daytime tranquilizer mebikar, a regeneration stimulator with the immunomodulatory effect of xymedon. At present, the Department of Pharmacology of Kazan State Medical University continues the scientific traditions of our outstanding predecessors.

Kazan medical journal. 2021;102(6):960-963
pages 960-963 views
Viktor Vasilievich Trusov — organizer of endocrinology service of Izhevsk
Khalimov E.V., Mikhailov A.Y., Styazhkina S.N., Zavalina M.A., Likhovskikh S.I.

The article is devoted to the 85th anniversary of Professor Viktor Vasilyevich Trusov (1936–2012), one of the prominent representatives of the therapeutic, scientific school of the Izhevsk State Medical Academy. In the range of diverse scientific interests and developments of Viktor Vasilyevich, a significant part was the issues of practical support to patients with endocrinological pathology, including patients with diabetes mellitus. Professor V.V. Trusov was a member of the Board of Russian Association of Endocrinologists, a member of the European Association for the Study of Diabetes, a member of the American Diabetes Association, worked on the problems of optimizing care for patients with diabetes. The article highlights the diabetology segment of the endocrinology service in Izhevsk on the materials of the endocrinological department of the State Clinical Hospital No. 6. The role of Professor Viktor Vasilyevich Trusov in the organization of the endocrinological center of Izhevsk, the viability of the methodological guidelines and recommendations laid down by him in the organization of care for patients with diabetes mellitus was noted. The organization of the work of the endocrinology center are considered. The analysis of the main indicators of the prevalence of diabetes mellitus was carried out according to the data of the endocrinology department (2017–2020). The special place of the diabetic foot clinic in the work of the center is highlighted. Modern and original methods of management of such complications of diabetes mellitus as diabetic foot syndrome are presented.

Kazan medical journal. 2021;102(6):964-968
pages 964-968 views


Professor Charles H.V.Hoyle

Dr. Charles H.V. Hoyle was a world-renowned neurophysiologist, neuropharmacologist, neuroanatomist. He received his bachelor’s degree from Queen Elizabeth College in London in 1982, and already in 1986 he defended his PhD thesis at King's College London (University College London) under the supervision of Professor Geoffrey Burnstock — the founder of the theory and a re­cognised leader in purine research.

Kazan medical journal. 2021;102(6):969-971
pages 969-971 views

Cochrane Review Summaries

Healthcare workers’ perceptions and experiences of communicating with people over 50 years of age about vaccination: a qualitative evidence synthesis

Общение с медицинскими работниками может сыграть важную роль в принятии пожилыми людьми решения о вакцинации. Чтобы помочь принять обоснованное решение о вакцинации, медицинские работники должны уметь определить пробелы в знаниях, потребности и проблемы пожилого человека. Они также должны иметь возможность поделиться и обсудить информацию о риске заболевания человека и тяжести заболевания, об эффективности и безопасности вакцины, а также практическую информацию о том, как человек может получить доступ к вакцинам. Поэтому медицинским работникам необходимы хорошие навыки общения (коммуникаций), и они должны активно держаться в курсе последних доказательств. Понимание их восприятия и опыта общения по вопросам вакцинации может помочь нам в обучении и поддержке медицинских работников и разработке хороших стратегий общения (коммуникаций).

Kazan medical journal. 2021;102(6):972-973
pages 972-973 views
Factors that influence parents' and informal caregivers' views and practices regarding routine childhood vaccination: a qualitative evidence synthesis

Вакцинация детей (детские прививки) — один из самых эффективных способов предотвращения серьёзных заболеваний и смертей детей. Однако во всём мире многие дети не получают все рекомендованные прививки. Существует несколько возможных причин этого. Вакцины могут быть недоступны, или родители могут испытывать трудности с доступом к службам вакцинации. Некоторые родители могут не принимать имеющиеся вакцины и службы вакцинации.

Kazan medical journal. 2021;102(6):973-974
pages 973-974 views
Authors Index
Kazan medical journal. 2021;102(6):975-976
pages 975-976 views

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