Kazan medical journal

Medical peer-review journal for practitioners and researchers.

Editor-in-Chief: Professor Ayrat U. Ziganshin

Indexing:

• Russian Science Citation Index,
• BIOSIS Previews,
• Biological Abstracts,
• EBSCO,
• DOAJ,
• Google Scholar,
• Ulrich's Periodical directory.

Published bimonthly since 1901 in Open Access (Creative Commons BY-NC-ND 4.0 International).

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.


 

 

 

 

 

Current Issue

Vol 101, No 2 (2020)

Theoretical and clinical medicine
The effectiveness of the method of external counterpulsation in patients with chronic stable angina
Alakbarov R.H.

Abstract

Aim. To assess the effectiveness of the complex treatment of patients with stable angina pectoris using the method of external counterpulsation (ECP).

Methods. 92 patients with chronic stable angina were included in the comparative analysis, which divided into 2 groups: 57 patients received one course of treatment using the ECP method (main group), 35 patients received only drug treatment (control group). Before and after the therapy, a general clinical examination (including determining the functional class of angina pectoris and the need to use nitroglycerin preparations), coronary angiography, echocardiography, exercise stress test (stress ECG), and quality assessment using the Seattle Angina Questionnaire (SAQ) was performed.

Results. The decrease in the average functional class of angina was more significant in the main group compare to the control group — from 2.28±0.73 to 0.93±0.80 (p <0.05) versus from 2.34±0.73 to 1.83±0.71 (p <0.05). A decrease of at least 1 functional class more often occurred in the main group — 78.9% of patients versus 57.1% (p=0.0258). The use of nitroglycerin sharply decreased after treatment in the group, that use the ECP method (by 51.6%; p=0.002), whereas in the control group, despite a slight decrease (by 22.7%), the changes did not reach statistical significance (p=0.0736). Both groups showed similar dynamics of changes in echocardiography. The diffe­rences were obtained only for the dynamics of the ejection fraction of the left ventricle (LVEF), which was greater in the main group — an increase of 4.69±5.56% versus 1.75±5.15% (p=0.0448). The dynamics of all indicators of exercise stress test significantly differ between groups, and if for the main group it is positive, in the control group it is negative. Some indicators of quality of life change insignificant and similar for both groups (for example, on the scale for limiting physical exertion), and on some scales (stability scales for attacks and the frequency of angina attacks), the improvement in the main group is much more significant in comparing with the control group: 30–37 points versus 12–13 points, respectively (p <0.0001). The overall quality of life assessment score improved more in the group, that use the ECP method: +96.10±40.73 versus +45.31±35.06 the control group (p <0.0001).

Conclusion. The method of external counterpulsation (ECP) can be used in clinical practice as part of a comprehensive treatment of patients with stable angina pectoris; it can significantly reduce the class of angina pectoris and the need to use nitroglycerin preparations, improve a number of indicators of echocardiography, electrocardiography with exercise and quality of life indicators.

Kazan medical journal. 2020;101(2):165-174
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Analysis of the effect of immunosuppressive therapy on the progression of chronic kidney disease with mesangioproliferative nephritis
Sigitova O.N., Kim T.Y., Sineglazova A.V., Kamasheva G.R., Nadeeva R.A.

Abstract

Aim. To assess the effect of immunosuppressive cyclophosphamide therapy and its regimens on the rate of progression of chronic kidney disease in mesangioproliferative glomerulonephritis.

Methods. 72 patients with mesangioproliferative glomerulonephritis and indications for immunosuppressive therapy with disease activation were included in the comparative analysis: 56 patients received cyclophosphan in conventional doses (26 patients with daily or every other day, 30 patients with in pulse mode 1 time per month), and 16 patients did not receive cyclophosphan. Duration of the disease before observation ranged from 0 to 33.58 years, a median follow-up was 6.00 (interquartile range 1.63–13.17) years, and after observation from 0 to 5 years with the median follow-up was 2.00 (1.00–3.50) years. The examination included nephrobiopsia with a morphological diagnosis, activity index/sclerosis, and glomerulonephritis progression rate for decreased glomerular filtration rate (ml/min/1.73 m² per year).

Results. The progression rate of chronic kidney disease was higher in the group of patients not receiving immunosuppressive therapy, 5.57 (3.27–7.95) ml/min/1.73 m2 per year compared with of the treated patients group, 3.05 (2.04–6.78) ml/min/1.73 m2 per year (p=0.040). There were no differences in the rate of decrease in glomerular filtration rate between groups depending on the treatment regimen: 4.86 (2.12–6.77) ml/min/1.73 m2 per year with regular and 3.67 (2.04– 6.91) ml/min/1.73 m2 per year with a pulse mode (p=0.720). The rate of glomerulonephritis also did not differ significantly: 1.0 (1.0–2.0) and 2.0 (1.0–2.0) relapses over 5 years, respectively (p=0.691) in both treatment regimens.

Conclusion. The treatment of patients with mesangioproliferative glomerulonephritis with cyclophosphane, in combination with prednisone or without it, regardless of the treatment regimen induces a slowdown in the progression of chronic kidney disease, improving the long-term prognosis and without affecting the frequency of relapses of the disease.

Kazan medical journal. 2020;101(2):175-181
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Frequency and specificity of alloantibodies to HNA system antigens in donors of blood and blood components
Krobinets I.I., Mineeva N.V., Bogdanova I.O., Kudryavtsev I.V., Chechetkin A.V.

Abstract

Aim. To study the rate of human neutrophil antigens (HNA) alloimmunization in donors of blood and blood components.

Methods. The study included blood samples of 1,127 donors who donated blood and its components in the Russian Scientific and Research Institute of Hematology and Transfusiology, Saint Petersburg, 635 male and 492 female. 36.18% of female donors were aged between 18 and 30 (n=178) and 63.82% were aged between 30 and 60 (n=314). The medical histories of all donors did not contain the records about the transfusion of blood components. Screening and identification of HNA alloantibodies were performed using the flow cytometric granulocyte immunofluorescence test with monoclonal antibodies CD16-PE, CD45-PC7, CD19-APC, Goat F(ab')2 Anti-Human IgG-FITC and the panel of donor neutrophils with detected HNA genotypes.

Results. The frequency of HNA alloantibodies in blood donors was 0.35% (n=4). No HNA alloantibodies were found in the male donors. Alloantibodies were detected only in female blood donors aged between 30 and 60. HNA antibody frequency in female donors was 0.81%. It were detected anti-HNA-1a, anti-HNA-3b and anti-HNA-4b antibodies of the IgG immunoglobulin class. In one donor, the specificity of antibodies could not be established. To establish whether detected antibodies in immunized donors were alloantibodies, HNA genotypes were determined.

Сonclusion. HNA alloantibodies occur with low frequency and are determined in 0.35% of blood donors. Alloantibodies were detected only in female donors and were directed against HNA-1a, HNA-3b and HNA-4b. The frequency of HNA antibodies in female donors was 0.81%. HNA genotyping confirmed that detected antibodies were alloantibodies.

Kazan medical journal. 2020;101(2):182-187
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Hemostatic system parameters and level of magnesium in patients with beta-thalassemiа
Aliyeva N.R.

Abstract

Aim. To study the hemostatic system parameters and magnesium levels in patients with beta-thalassemia.

Methods. The object of the study was the blood serum of 96 women with beta-thalassemia: 46 patients with intermediate beta-thalassemia and 50 patients with beta-thalassemia minor, without clinical manifestations of hypercoagulation. The blood serum of 30 healthy donors was used as the control group. It was studied hemostasis system parameters: platelet count activated partial thromboplastin time (aPTT), prothrombin time, plasma fibrinogen level, D-dimer level, euglobulin clot lysis time, antithrombin III activity. The serum magnesium level and risk of deficiency were determined using the MDQ questionnaire.

Results. In patients with intermediate beta-thalassemia, an increase in the level of thrombinemia marker D-dimer (>500 ng/ml) was revealed. Patients with intermediate beta-thalassemia were divided into two groups according to the revealed level of D-dimer: 14 (30.4±6.8%) patients with latent hypercoagulation in group 1 and 32 (69.6±6.8%) patients without latent hypercoagulation in group 2. It was found that in the group with a high levels D-dimer, fibrinogen level was increased (p <0.05), fibrinolysis time was prolonged (p <0.05), activated partial thromboplastin time was shortened (p <0.05), and antithrombin III activity was slightly reduced (p >0.05). The serum magnesium level in patients of the first group was lower (t=7.3; p <0.001), and the risk of deficiency in the questionnaire was higher than in patients of the second group (r=–0.785, p <0.05). Hemostasis and magnesium levels in patients with beta-thalassemia minor did not differ from the control group (p >0.05).

Conclusion. One-third of patients with intermediate beta-thalassemia have a pre-thrombotic state for hemostasis — latent hypercoagulation and magnesium deficiency which can be predictors of clinical signs of thrombosis.

Kazan medical journal. 2020;101(2):188-192
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Clinical, gender and age aspects of the internet addiction
Shaidukova L.K., Rashitova E.L.

Abstract

Aim. To study clinical, gender, and age-related aspects of Internet addiction.

Methods. The study includes 400 people related to computer technology, which was divided into 4 study groups by age and gender: 100 adolescents aged 14.1±0.6 years was in the first group, 100 professional computer engineers aged 30.6±4.2 years in the second group, 100 male students at the age of 22.3±3.6 years in the third group and 100 women students aged 22.1±3.1 years. Clinical-psychopathological and experimental psychological methods were used: interviewing, using a modified Internet Addiction Test (IAT) divided into three categories of questions by conditions. In the work, we used the data of a previous study with increasing of the sample and numbers of objectives.

Results. A study of the clinical features of Internet addiction revealed the presence of “Internet-related paranoiac reactions”, which was most in the second group (52.2±9.8), most rare in the first group (8.3±1.7), and equally in the third and the fourth groups (24.4±4.3 and 32.1±6.4). For the study of gender differences in Internet addiction, were included in the third and fourth groups. 48.7±3.6% of all included respondents preferred virtual communication to real, 46.3±3.1% had signs of Internet dependence on being in cyberspace, 30.8±2.4% there were deviations in the psycho-emotional sphere. Male was more likely to experience severe impairment of working capacity and a decrease in energy potential (45.6±3.8). Communication in social networks turned out to be more relevant for women (60.3±8.7). The study of the age-related aspect of Internet addiction was performed in the first group. It was revealed the presence of computer games addiction in 16.3±2.4% adolescents, addiction to the virtual communication in 48.2±3.9% adolescents, web surfing addiction in 10.4±1.7% adolescents, mixed forms of Internet addiction in 26.7±2.9% respondents and also correlation of Internet addiction with the level of intelligence of the adolescents.

Conclusion. A retrospective analysis of Internet addiction developmental dynamics showed alternation various forms of this addiction and the presence of age stages.

Kazan medical journal. 2020;101(2):193-199
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The dental status of patients with neuropsychiatric disorders who underwent dental debridement under general anaesthesia
Abdrashitova A.B., Gainullina D.K.

Abstract

Aim. To study the dental status of patients with neuropsychiatric disorders in dental debridement under general anaesthesia.

Methods. A comparison of the prevalence of oral pathology among patients depending on gender, age, and nosological group was performed. It was studied the dependence of the prevalence of both acute and chronic forms of dental pathology on the type of background disease and compared the frequency of dental pathology depending on the background disease.

Results. 50.8% of patients were male and 63.82% were female. All patients had poor oral hygiene and lack of knowledge about personal hygiene practices. Dentin caries (K01.2) was in 39 (30.5%) patients, irreversible pulpitis (K04.0) — in 31 (24.2%) patients, and chronic forms of periodontitis and their exacerbation (K04.5) — in 99 (77.3%) patients. In our study, most patients with neuropsychiatric disorders (35.9%) had Cerebral palsy (G80), 28.1% had mental retardation (F70–F73), and 10.2% had schizophrenia (F20). Irreversible pulpitis (K04.0) was statistically significantly more common in patients diagnosed with cerebral palsy (G80) — 21.7%, while in patients with mental retardation (F70–F73) only in 5.6% (p=0.007). The prevalence of periodontitis was highest in patients with mental retardation (F70–F73) — 86.1%, medium in patients with schizophrenia (F20) — 46.2% and lowest in other diseases (39.4%); the differences were statistically significant (p=0.001).

Conclusion. We identified characteristics of the dental status, intensity and prevalence of dental diseases in patients with neuropsychiatric disorders in dental debridement under general anaesthesia.

Kazan medical journal. 2020;101(2):200-205
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Causes of hypocalcemia after thyroid surgery
Hummatov A.F., Abbasov A.H., Ismayilov A.K., Gasymov E.M.

Abstract

Aim. To identify the causes affecting hypocalcemia and its frequency of causing after thyroidectomy.

Methods. The study included 402 patients after thyroidectomy, 361 (89.8%) women and 41 (10.2%) men, for the period 2015–2019. The patients were between the ages of 14 and 77 years (average 45±27.2 years). Patients were tested for the presence of hyperthyroidism, the volume of tissue removed and type of thyroidectomy, presence of repeated thyroid operations and accidental parathyroidectomy, the results of parathyroid autotransplantation and pathohistological reports. To determine the effect of these factors on hypocalcemia, patients were divided into three groups. The first group included patients (n=51, 12.7%) were underwent surgery for Graves’ disease, the second (n=335, 83.3%) — for nodular goiter, and the third (n=16, 4%) — for recurrent goiter. Statistical data analysis was performed with IBM SPSS 16.0. The results were analyzed by one-way analysis of variance or Kruskal–Wallis test and the median test. Results were considered statistically significant at p <0.05 (two-sided criterion).

Results. In the early postoperative period, 20 (5%) of 402 patients had hypocalcemia, of which 12 (3%) had transient hypocalcemia, and 8 (2%) had permanent hypocalcemia. Postoperative hypocalcemia was detected in 9 (17.6%) patients the first group, 8 (2.4%) patients — in the second group, and 3 (18.8%) patients of the third group. Patients’ hypocalcemia was characterized based on the types of underwent operations as follows: in 14 (5.3%; p <0.05) patients after total thyroidectomy, in 1 (3.2%) patient after close to total thyroidectomy, in 1 (16.7%) patient after total thyroidectomy with central lymphatic dissection, in 1 (20%) patient after total thyroidectomy with central and lateral lymphatic dissection, in 3 (18.8%) patients after repeated surgery. Postoperative hypocalcemia was identified in 5 of 44 patients of the second group with thyroid carcinoma, as well as in 1 patient of the third group with the same pathology (p=0.246).

Conclusion. Incidence of hypocalcemia was more frequent after surgery for hyperthyroidism, especially after total thyroidectomy; in 40% of cases, transient hypocalcemia was identified in patients with autotransplantation of the parathyroid gland after an accidental parathyroidectomy.

Kazan medical journal. 2020;101(2):206-211
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Reviews
Features of mental disorders and their correction in patients with cardiac pathology
Zhidyaevskj A.G., Mendelevich V.D., Galyautdinov G.S., Ibragimova K.R., Zakirova E.B.

Abstract

In everyday practice, the doctor rarely encounters only one specific disease, more often a patient with comorbid pathology comes to him. Such a group of concomitant diseases are mental disorders. Their prevalence in cardiology practice reaches 80%. Mood affective, anxiety and somatization disorders, as well as cognitive impairment are observed most often. The review looked at mental disorders that occur in cardiac diseases with the highest number of deaths, such as coronary heart disease, including myocardial infarction and cardiac arrhythmias, arterial hypertension and cerebrovascular diseases. Including attention is paid to the senile asthenia syndrome, which is accompanied by cognitive impairment, loss of previous vital interests and depression. The review highlights the questions of re­gular and adequate psychopharmacotherapy of cardiovascular diseases, which leads to a statistically significant decrease in the frequency of their exacerbations, which reduces the number of doctors who come to see for somatoge­nic symptoms, and also allows to improve the prognosis of the underlying disease and significantly reduce mortality. It was observed that the doctor should take into account the fact that modern cardiological preparations have effects that can cause side effects in the form of mental disorders when choosing a therapy. Understanding the processes of formation and occurrence of mental diseases in a patient with cardiovascular pathology, as well as methods for their correction, can increase the effectiveness of the therapy and improve the prognosis of the underlying disease.

Kazan medical journal. 2020;101(2):212-225
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Bisphosphonate-related osteonecrosis of the jaw (BRONJ) in cancer patients
Ebzeev A.K.

Abstract

This literature review focuses on the latest advances in the study of osteonecrosis of the jaw in cancer patients taking bisphosphonates. Prescribing bisphosphonates for the treatment of metastatic bone disease is justifiable and unavoidable measure. The action of bisphosphonates leads to increase in bone tissue strength, but significantly suppressing normal bone remodelling, essential for repair, and becomes vulnerable to mechanical trauma and bacterial invasion. The unique anatomical and physiological features of the jaw bones determine their selective damage. The disease is characterized by progressive jaw necrosis, chronic inflammation of the surrounding tissues complicated by a pathological fracture and persistent oroantral fistula, which aggravates chronic pain and leads to a deterioration in the quality of life of patients. The occurrence of bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a multifactorial process. Most often, it occurs in patients with long term treatment with zoledronic acid preparations against after tooth extraction. The fact of an increase in the incidence of osteonecrosis is undeniable for objective reasons, the main of which are an increase in cancer, an increase in the life expectancy of cancer patients and their need for bisphosphonate therapy. In the article, it was analyzed the latest scientific reports on the causes of the disease, risk factors and the pathogenesis of the disease. Data on the frequency of jaw osteonecrosis in different countries are presented. It was shown promising developments and summarizes information on existing methods for diagnosing jaw bisphosphonate osteonecrosis. Questions about the key approaches in the treatment of the disease, as well as about new experimental techniques, are examined. The main problems of the prevention of bisphosphonate-related osteonecrosis of the jaws are formulated.

Kazan medical journal. 2020;101(2):226-231
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Approaches to antithrombotic modification of vascular implants
Sevostyanova V.V., Krivkina E.O., Antonova L.V.

Abstract

Vascular implants in contact with blood must have high thrombotic resistance. However, in some cases, their implantation is associated with thrombosis and subsequent impaired patency of the blood vessel. Most often, this problem affects implants intended for reconstruction of small diameter vessels, which is associated with hemodynamic features in this part of the bloodstream. These include blood vessel prostheses, tissue-engineered vascular grafts, and endovascular stents. The features of the implant material are of great importance when choosing a method for its modification in order to improve biocompatibility and thromboresistance. The review analyzes current experience in using various methods of immobilizing drugs to the surface of vascular prostheses and endovascular stents made from stable and biodegradable polymers. The prospects of creating thromboresistant vascular grafts and stents by joint immobilization on the surface of the polymer material of drugs with antithrombogenic activity and biologically active molecules that regulate the reaction to a foreign body and implant remodeling were evaluated. Numerous studies in the review demonstrating a wide range of ways to modify blood vessel prostheses, tissue-engineered vascular grafts, and endovascular stents with antithrombotic drugs to increase their thrombosis resistance. The main approaches of antithrombotic modification include conjugation of drugs and biologically active molecules on the implant surface. At the same time, new technologies are aimed not only at inhibiting the process of thrombus formation, but also at reducing the intensity of the inflammation process and stimulating the reparation of vascular tissue.

Kazan medical journal. 2020;101(2):232-242
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Methods of local antimicrobic prophylaxis of surgical site infection
Sergeev A.N., Morozov A.M., Askerov E.M., Sergeev N.A., Armasov A.R., Isaev Y.A.

Abstract

Recently, to prevent of surgical site infection, new methods of local antimicrobic prophylaxis have been developed and successfully introduced, which allow to creating high concentrations of antimicrobial drugs in operated tissues and preventing the migration of bacterial flora into the wound. The review describes the main methods used for local impact on microflora and aimed at prophylaxis of surgical site infection. The latter include pre-, intra- and postoperative measures. Optimizing of preoperational methods could be achieved by improving the methods of processing of operating field. Review’s considerable attention is paid to intraoperative measures: the use of surgical gloves with antimicrobial properties, reticulated to implants with antimicrobial properties for tension-free hernioplasty, stage-by-stage surgical wound irrigation with antibacterial drugs during suturing as well as the prospects for the use of bacteriophages in abdominal surgery. To increase the biological tightness of the intestinal suture, some authors propose the use of a biodegradable antibiotic-impregnated implant. The review reflects the possibilities of using biologically active (antimicrobial) sutures, the use of which was very effective at all stages of the operation: from the application of intestinal anastomosis to the skin suture. A wide range of antimicrobial surgical sutures containing antibacterial preparations and made by threads with different biodegradation abilities make, allow us to recommend a differentiated approach to the choice of suture material depending on the stage of surgery and regenerative properties of the sutured tissues. The main measures recommended in the early postoperative period are to cover the wound with special wound coatings preventing the possible contamination and to improve irrigation-aspiration drainage techniques of postoperative wounds.

Kazan medical journal. 2020;101(2):243-248
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Social hygiene and healthcare management
Analysis of disability of the children due to the ear diseases and mastoid process in St. Petersburg
Goryainov I.V., Vladimirova O.N., Goryainova M.V.

Abstract

Aim. To analyze the characteristics of primary childhood disability due to diseases of the ear and mastoid process in St. Petersburg from 2001 to 2018.

Methods. It was analyzed the indicators of primary childhood disability due to diseases of the ear and mastoid process in St. Petersburg over 18 years (2001–2018) since the beginning of the pediatric medical and social examination service appeared in the city: number, rate and structure. For the calculation we used the statistical data of the St. Petersburg Health Committee (reporting forms No. 12 and No. 30), the Federal Treasury Institution “The Main Bureau of Medical and Social Expertise across St. Petersburg” — form 7-D (social security), and data of a single automated vertically integrated information and analytical system for conducting. Statistical methods for studying disability were used: continuous observation (indicators of the number and rate of primary disability), nesting (serial) sampling to study the structure of disability (910 children recognized as disabled by the city’s Bureau of Medico-social Examination from the moment of their occurrence).

Results. The rate of primary disability of children due to pathology of the ear and mastoid process for 18 years ranged from 0.34 to 1.4 per 10 thousand children , the average over the entire period of 0.77 per 10 thousand. In the structure of primary disability due to diseases of the ear and mastoid process in children, was 54.8% boys and 45.2% girls. It was recorded, that increase of the number of children recognized as disabled for the first time due to this pathology was related with an increase in the share of coverage of newborns with hearing screening, as well as an increase in the average annual number of children in St. Petersburg. Also, indicators of primary childhood disability depend on indicators of the primary incidence of ear diseases and mastoid process.

Conclusion. Indicators of the number and rate of disability of the children who were first recognized as disabled due to ear and mastoid diseases in St. Petersburg increased from 2001 to 2018, which is associated with an increase in birth rates, primary morbidity and primary detection of ear and mastoid diseases in children.

Kazan medical journal. 2020;101(2):249-255
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Medicine prices in 2017 and 2018 as a reflection of the effectiveness of government measures to ­ensure access to medicines
Razzakova C.M., Ziganshina L.E.

Abstract

Aim. To conduct a comparative analysis of medicine prices in 2017 and 2018 years in Kazan (The Republic of Tatarstan, The Russian Federation) to assess the effectiveness of government measures to ensure the accessibility of medicines.

Methods. We conducted a comparative analysis of medicine prices according to methodology developed by Health Action International and World Health Organization (WHO/HAI). The analysis included 30 medicines at a preselected dosage form. We studied the accessibility and prices of original brands and lowest priced generic of each medicine in the public and private pharmacies of Kazan in 2017 and 2018, and analyzed the procurement prices of the same medicines in inpatient hospitals. Medicine prices were compared with international reference prices (The Management Sciences for Health (MSH) reference prices) and expressed as median price ratio (MPR).

Results. Prices for originator and generic medicines in the public and private sectors tended to decrease in 2018 compared to 2017, but statistically significant price reduction occurred only for generic medicines in the private sector. For example, the median price ratio for originator products changed from 6.86 to 2.97 in the public sector and from 11.1 to 5.36 in the private sector in 2018 compared to 2017, but the changes were not statistically significant (p >0.05). Prices for generics medicines in the public sector did not change in the studied years and remained at the level of international reference prices (the median price ratio were 1.3 in 2017 and 1.27 in 2018). In the private sector, we found a twofold decrease in the prices of generics medicines in 2018 compared to 2017 [the median price ratio decreased from 3.25 to 1.44 (p <0.05)]. Procurement prices for generics medicines in public hospitals in 2017 and 2018 years did not show statistically significant changes with the median price ratio equal to 1.34 and 0.8, respectively.

Conclusion. Government price control measures of medicines contributed to maintaining the price of generic medicines at the reference prices level in the public sector and to halving the price of generic medicines in the private sector in 2018 compared to 2017.

Kazan medical journal. 2020;101(2):256-263
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Indicators of potentially preventable hospitalizations as a tool for improving the quality of care in cardiovascular diseases
Khafisianova R.K., Burykin I.M., Aleeva G.N.

Abstract

Aim. To assess the possibility of using indicators of potentially preventable hospitalizations of cardiovascular diseases to assess the quality of medical care.

Methods. Indicators of quality of cardiovascular disease treatment were formed based on the analysis of literature, current clinical recommendations and the structure of potentially preventable hospitalizations in the districts and cities of the Republic of Tatarstan. The proposed indicators were studied in the districts of the Republic of Tatarstan in 2011–2015.

Results. It is revealed that the distribution of indicator values in the regions of the Republic of Tatarstan differs from normal and is characterized by high variation. Median, minimum and maximum of hospitalization levels for hypertension in 2015 were 8.4, 1.3 and 26.8‰ respectively; unstable angina, myocardial infarction — 2.2, 0.02 and 8.6‰. Indicators for hospitalization due to stable angina, chronic ischemic heart disease also had a high level of variation (6.3, 0.2 and 17.4‰). As criteria for quality and optimal use of resources, it is proposed to use nonparametric estimates, one of which is the upper quartile. According to this study, in 2015, upper quartile for hypertension was 11.2‰; for unstable stenocardia, myocardial infarction — 3.4‰; for stable angina, chronic ischemic heart disease — 8.6‰.

Conclusion. The results of this study prove that indicators of potentially preventable hospitalizations may be part of a comprehensive assessment of the quality of care.

Kazan medical journal. 2020;101(2):264-270
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Clinical observations
Clinical case of using of implantable spinal access port system
Bondarenko S.Y., Gureev A.D., Trukhanov I.G.

Abstract

This paper presents our experience of implantation and operation of the spinal access port system on the example of patient P, 78 years old. The admission diagnosis: malignant neoplasm of pancreas. Surgical treatment is contraindicated due to multiple metastases to the abdominal organs and lymph nodes. On admission to the hospital, the patient complained of persistent abdominal pain [6–8 points on Visual Analog Scale for Pain (VAS Pain)] was not relieved by the injection of NSAIDs and narcotic analgesics (morphine hydrochloride). We have decided to implant the spinal access port system to the patient aimed at neuraxial analgesia techniques. According to the World Health Organization (WHO), about 3.5 million people every day around the world suffer from cancer-related pain every day. The difficulties associated with the ineffectiveness of traditional pharmacological interventions for pain management lead to search alternative pain management. One of the aims of the paper is to attract the attention of treating doctors, surgeons, anesthesiologists to this technique because since it allows to reduce or relief of pain in this group of patients and improve their quality of life.

Kazan medical journal. 2020;101(2):271-274
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Percutaneous puncture nephrostomy on the back of a patient with an external fixation apparatus on the bones of the pelvis following a road traffic accident
Abdurakhmanov R.A.

Abstract

The article presents a rare clinical case of renal colic with a stone in the lower third of the ureter in the patient after a traffic accident with an external fixation device on the pelvic bones. A 41-year-old patient was hospitalized to the emergency urology department of the City Hospital No. 5 of Naberezhnye Chelny in 2019 with renal colic on the right. An ultrasound revealed right pelvocaliectasis of kidney. Pelvic survey (urogram) shows the shadow (9 mm in diameter) suspicious for renal calculus in the projection of the lower third of the right ureter. The pain was not relieved by analgesics. It was unsuccessfully attempted to stent the right ureter due to insurmountable obstacle at a distance of 4 cm from the ureteral orifice. Due to technical complexity (laying the patient in a lithotomy position and on the stomach or side was impossible due to a possible breakdown of the external fixation apparatus on the pelvic bones) percutaneous puncture nephrostomy was performed under ultrasound control in the supine position according to emergency indications. The pain was relieved. The patient was discharged home. After one month, the external fixation device for the pelvic bones was removed. The patient was hospitalized again. Ureteroscopy and contact ureterolithotripsy on the right ureter were performed routinely. Nephrostomy was removed. The patient recovered. The described case is of clinical interest as a rare combination of renal colic and the presence of an external fixation apparatus on the bones of the pelvis, which causes additional difficulties for the drainage of the urinary tract. Percutaneous puncture nephrostomy on the back with a roller in the ipsilateral kidney is a good alternative for urologists when to lay the patient on the stomach or side is impossible.

Kazan medical journal. 2020;101(2):275-278
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Clinical experiences
Effect of minimally invasive extracorporeal circulation on endothelial dysfunction in cardiac ­surgery patients
Kornev V.I., Kalinina N.M., Startseva O.N.

Abstract

Aim. To assess the changes in endothelial dysfunction in patients undergoing cardiac surgery with minimally invasive extracorporeal circulation (MiECC).

Methods. The study included 50 patients who were undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). The patients were divided assigned to either a minimally invasive cardiopulmonary bypass system (group 1, n=15) or standard extracorporeal circuit (group 2, n=35). Changes in the laboratory parameters were assessed 5 times: before the operation, 5 minutes after protamine sulfate administration, 12 hours after the operation, 7 days after the patient's discharged from the hospital and one month after the operation. The activity of von Willebrand factor, factor VIII, and the number of activated platelets were examined in all patients in venous blood.

Results. After protamine sulfate administration, the activity of von Willebrand factor was increased to 164% in the group 1, and up to 193% in the group 2, with a tendency to increase the indicator after 12 hours. The peak of endothelial dysfunction, with the growth of von Willebrand factor and factor VIII, occurs on the 7th day after the operation. In patients of the group with MiECC, von Willebrand factor activity was decreased at the hospital discharge and returned to normal in 1 month. The number of activated platelets increases mainly in group 2 (6% versus 4% in group 1, p=0.29). The expression of P-selectin was significantly higher in group 2 at the hospital discharge (5.5% versus 3.1% in group 1, p <0.001), and in 1 month (4.5% versus 2.3% in group 1, p <0.001).

Conclusion. In patients with minimally invasive cardiopulmonary bypass, platelet activation decreases, endothelial dysfunction, accompanied by an increase in the von Willebrand factor and factor VIII activity, is less pronounced; the seventh day after surgery is a period of the high risk of thrombogenic complications.

Kazan medical journal. 2020;101(2):279-283
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The effect of predilation on the incidence of the no/slow-reflow phenomenon in patients with acute coronary syndrome with ST segment elevation
Sazanov G.V., Belokon' O.S.

Abstract

Aim. To assess the effect of balloon predilation on the incidence of no/slow-reflow complication during percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI).

Methods. We analyzed the experience of the department of endovascular diagnostic and treatment methods of the Stavropol Regional Clinical Hospital for endovascular surgical treatment of patients with STEMI, including after thrombolytic therapy (TLT). The study included 721 patients admitted to the hospital within the first 12 hours from the moment of the first contact with a medical staff. For the study, patients were divided into 2 comparable groups according to the gradation scale TIMI (Thrombolysis in myocardial infarction), comparable the patients' gender, age and other characteristics. Each of the groups also was divided into 2 subgroups according to performing predilation. The study also analyzed the correlation between patients' mortality and existence of the no/slow-reflow phenomenon.

Results. The lowest incidence of the no/slow-reflow phenomenon was in groups in which predilation before stent implantation was not performed. In the group where the blood flow was higher than TIMI 0, the occurrence rate of the no/slow-reflow phenomenon was 7.2 times higher in group with predilation. In the group where the artery was occluded, the risk of the phenomenon during predilation was 3.6 times higher than in group with the “tracking” method. The risk of mortality in patients with no/slow-reflow phenomenon was 3.9 times higher.

Conclusion. In carrying out the percutaneous coronary intervention, the most preferable is the refusal to perform predilation if there is an appropriate technical feasibility; it is recommended for patients with a blood flow level TIMI 0 to draw a balloon catheter for an occlusion site, which may allow antegrade blood flow to be achieved.

Kazan medical journal. 2020;101(2):284-288
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Laser technologies in the management of patients with complicated forms of sexually transmitted infections
Misbakhova A.G., Abdrakhmanov A.R., Belyaev A.R.

Abstract

Aim. To study and assess the clinical effectiveness of medical laser technologies in the complex treatment of complicated forms of sexually transmitted infections (STIs).

Methods. Modern technologies of molecular biological laboratory diagnostics in real time with Real-time amplifier CFX96 Bio-Rad Laboratorias (USA), were used for etiological diagnostics of pathogens. Determination of infectious and inflammatory lesions of tissues of the genital system was carried out using ultrasound on ALOKA CCL-680 device (Japan) using cavity sensors with an operating frequency of 5 MHz. Drug therapy was carried out in accordance with the Federal clinical recommendations of the Russian society of dermatovenerologists and cosmetologists “Dermatovenerology” (Moscow, 2015). To assess the effectiveness of laser technologies in complex treatment, patients with complicated forms of STIs were randomly divided into 2 groups: the control group (32 patients), where only traditional therapy was used, and the main group (108 patients), in which, in addition to traditional therapy, treatment was supplemented with laser therapy.

Results. The effectiveness of antibiotic therapy in the main group was 14.0%, and treatment using laser technology was 33.1% higher than the effectiveness of treatment in the control group. This shows the effectiveness of laser technologies in the treatment of infectious and inflammatory structural changes in the tissues of the organs of the reproductive system.

Conclusion. The use of medical laser technologies in the treatment of complicated forms of STIs with a change in exposure parameters depending on the revealed inflammatory-structural changes in the tissues of the affected organs showed high efficiency (79.6%); this technology can be recommended for use in practical health care for the treatment of complicated forms of STIs.

Kazan medical journal. 2020;101(2):289-295
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The dynamics of liver tests in pregnant women with non-infectious hepatitis in the case of ­prescription of ademetionine
Garayeva K.G.

Abstract

Aim. To study the effect of ademetionine on the dynamics of biochemical markers of liver disease in pregnant women with non-infectious hepatitis.

Methods. The study included 19 pregnant with non-infectious hepatitis (5 — alcoholic, 7 — drug, 7 — alimentary) etiologies. For groups comparison it was used the history of previous pregnancies in these same women. To monitor the functional state of the liver in the blood of women, the content of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin was determined using HUMAN reagent kits on a BIOSKREM MS 2000 microanalyzer (USA). Examination of pregnant women was carried out immediately after registration, at the end of the first and second trimesters of pregnancy.

Results. In pregnant women with a high content of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin in the blood, cases of pathological development of the fetus were recorded more often. The use of drugs based on ademetionine contributed to the positive dynamics of liver tests in drug and alimentary (caused by nutrition) hepatitis; no evidence of the positive dynamics in alcoholic hepatitis was obtained.

Conclusion. Prescribing of ademetionine to pregnant women with liver damage by non-infectious etiology can positively affect both the biochemical parameters of the liver and, possibly, the formation of the fetus.

Kazan medical journal. 2020;101(2):296–303
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History of medicine
About therapeutic elite of the beginning of XX century: kazan therapist Alexey Nikolaevich ­Kazem-Bek
Borodulin V.I., Albitskiy V.Y., Topolyanskiy A.V.

Abstract

The article highlights the life path, pedagogical and social activities of an outstanding therapist, pupil of V.N. Vinogradov, Alexei Nikolaevich Kazem-Bek. An analysis of his scientific heritage, as well as his scientific and social activities in those areas of the clinic of internal diseases that later took shape as cardiology and phthisiology, suggests that at the turn of the 19–20th centuries he was among the most prominent research therapists. So, his works on the problems of physiology and pathology of the cardiovascular system indicate that he can be attributed to the pioneers of the emerging domestic cardiology. Activities A.N. Kazem-Bek as the chairman of the Society of Physicians at Kazan University (1903–1907) and editor of the Kazan Medical Journal also allows him to be considered one of the representatives of the therapeutic elite in Russia at the beginning of the 20th century. The article also presents materials that are not well known to the medical reader, revealing the exceptionally attractive appearance of this person-a citizen-doctor. Along with the “Holy doctor” F.G. Yanovsky in Kiev and N.Ya. Chistovich in St. Petersburg, the death of A.N. Kazem-Bek summed up the gaazov (coming from the Moscow doctor F.P. Gaase) tradition of medical asceticism in domestic medicine.

Kazan medical journal. 2020;101(2):304-308
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Jubilees
90 years to Professor Dilyara Sh. Enaleeva
 
Kazan medical journal. 2020;101(2):309-310
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Cochrane Review Summaries
Physical interventions to interrupt or reduce the spread of respiratory viruses
 

Abstract

Хотя респираторные вирусы обычно вызывают только незначительные заболевания, они могут вызывать эпидемии. Приблизительно от 10 до 15% людей во всём мире заболевают гриппом ежегодно, а во время крупных эпидемий уровень заболеваемости достигает 50%. Глобальные пандемические вирусные инфекции были разрушительными. В 2003 г. эпидемия тяжёлого острого респираторного синдрома (ТОРС) затронула около 8000 человек, убила 780 человек и вызвала огромный социальный и экономический кризис. В 2006 г. глобальную тревогу вызвал новый птичий грипп H5N1, а в 2009 г. — новая угроза пандемии свиного гриппа H1N1. Единичных и потенциально дорогостоящих мер (особенно использования вакцин или противовирусных препаратов) может быть недостаточно для прекращения распространения. Поэтому мы провели поиск доказательств эффективности простых физических барьеров (таких, как мытьё рук или ношение масок) в снижении распространения респираторных вирусов, включая вирусы гриппа.

Kazan medical journal. 2020;101(2):311-312
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Interventions to improve hand hygiene compliance in patient care
 

Abstract

Какова цель этого обзора? Выяснить, какие стратегии могут помочь медицинским работникам соблюдать рекомендации по гигиене рук [мытьё рук с мылом и водой или с использованием дезинфицирующего состава для рук на спиртовой основе (ДСРСО), или же оба способа].

Kazan medical journal. 2020;101(2):312-313
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Improving adherence to Standard Precautions for the control of health care-associated infections
 

Abstract

Какова цель этого обзора? Выяснить, какие стратегии могут быть использованы для улучшения соблюдения медицинскими работниками системы действий, известных как «стандартные меры предосторожности», для снижения инфекций в учреждениях здравоохранения.

Kazan medical journal. 2020;101(2):313-314
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Personal protective equipment for preventing highly infectious diseases due to exposure to contaminated body fluids in healthcare staff
 

Abstract

Медицинский персонал подвергается риску инфекций, таких как вирус Эбола или тяжёлый острый респираторный синдром (ТОРС). Одним из способов профилактики инфекций является использование средств индивидуальной защиты для предотвращения загрязнения работника, например защитная одежда, перчатки, маски и очки. Остаётся неясным, какой тип оборудования защищает лучше и как лучше всего его удалить (снять) после использования. Также неясно, каким способом лучше всего обучать работников следовать руководству по эксплуатации этого оборудования.

Kazan medical journal. 2020;101(2):314-315
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Author Guidelines
 
Kazan medical journal. 2020;101(2):316-320
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