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 101, No 6 (2020)

Theoretical and clinical medicine
Clinical efficacy of a screening approach to the differentiated prescription of antibiotic therapy in children with acute tonsilopharyngitis
Pikuza O.I., Zakirova A.M., Moroz T.B.

Aim. To assess the effectiveness of the screening approach by prescribing a streptotest to verify the etiological cause of tonsillopharyngitis in children.

Methods. We observed 67 patients aged 7 to 11 with a history of recurrent respiratory infections. The incidence of acute respiratory infections varied from 8 to 12 times during the year preceding the examination. The main group consisted of 36 children who had tonsillopharyngitis with severe inflammation of the tonsils and plaque on the tonsils. The control group included 31 patients with acute tonsillopharyngitis with inflammatory changes in the tonsils and the absence of plaque. The observation and control groups were comparable and did not have statistically significant differences in gender and age. All patients underwent a common clinical, laboratory, and instrumental exa­mination. Along with microbial culture, the special examinations included an express test (Dectra Pharm, France) for the presence of group A β-hemolytic streptococcus.

Results. All children underwent an etiological examination. The presence of a viral antigen was confirmed in 71.64% of children. 27.49% of patients in the control group and 30.72% of patients in the main group had positive results of the express test for group A β-hemolytic streptococcus, taking into account the requirements for asses­sing this reaction. It was revealed a reliable direct relationship between the detected viral infection and the negative results of the streptatest test (r=0.86; p=0.03) for the control group, and a positive correlation of the confirmed pre­sence of group A β-hemolytic streptococcus in the main group as with both C-reactive protein (r=0.78; p=0.04) and with inflammatory markers in the general blood test. A combination of positive fluorescence of viral antigens based on the results of immunofluorescence and a positive enzyme-linked immunosorbent assay (ELISA) for group A β-hemolytic streptococcus was recorded in 7.46% of all patients. Clinical examples are given the justification of practical implementation of the express test for the quick diagnostic information.

Conclusion. Differentiated etiological diagnosis of acute tonsillopharyngitis based on clinical symptoms and the levels of markers of bacterial inflammation is extremely difficult therefore laboratory criteria should be the justification for prescribing antibiotic therapy; currently, the most accessible is the streptatest for the detection of group A β-hemolytic streptococcus, which allows confirming or denying the presence of group A β-hemolytic streptococcus within a few minutes, which means that it is correct to prescribe antibacterial drugs to patients.

Kazan medical journal. 2020;101(6):805-811
Molecular genetic characteristics of hemostasis in hemorrhagic fever with renal syndrome
Manakhov K.M., Sarksyan D.S., Dudarev M.V., Tolstoluckaya T.O., Ponomarenko N.S., Maleev V.V.

Aim. To assess the predictive value of single-nucleotide polymorphisms of hemostasis and folate cycle genes in hemorrhagic fever with renal syndrome (HFRS).

Methods. 43 patients undergoing HFRS were examined based on the Republican clinical infectious diseases hospital in Izhevsk. Toxic shock syndrome (TSS) in the decompensated phase, pulmonary edema in the alveolar phase, and acute kidney injury (AKI) at stage F [RIFLE criteria (risk, injury, failure, loss, end-stage renal disease)] were registered as complications. Molecular analysis of patients’ genomic DNA was performed after its isolation from peripheral blood cells. Genotyping was performed by using multiplex real-time PCR with conformationally restricted probes. Statistical analysis was performed by the licensed program SPSS 22.0; the significance level of difference between groups was determined using the nonparametric Mann–Whitney test (for quantitative variables) and the Fisher’s exact test (for qualitative variables).

Results. The C/C genotype of the ITGB3:1565T/C gene (p=0.0278), and the C/C genotype of the MTHFR1298 A/C gene (p=0.0407) was less common in severe cases, while the G allele of FGB:–455G/A gene (p=0.046) and the T allele of the ITGB3:1565T/C gene (p=0.0166) was more frequent. More frequent detection of the 5G/4G genotype of the PAI-1:675 5G/4G gene was found in the case of TSS (p=0.0433). Genotype C/C of the ITGB3:1565T/C gene (p=0.0145) and a combination of pathological genotypes A/C and C/C of the MTHFR1298A/C gene (p=0.0004) are less common in the development of AKI at stage F.

Conclusion. The molecular genetic analysis makes it possible to identify patients with genotypes predisposing to a severe and complicated course of hemorrhagic fever with renal syndrome.

Kazan medical journal. 2020;101(6):812-819
Experimental medicine
Anatomical aspects of the use of the thoracodorsal nerve as a donor in musculocutaneous nerve ­injury
Gorbunov N.S., Kober K.V., Kasparov E.V.

Aim. To assess the anatomical possibility of the use of the thoracodorsal nerve as a donor for nerve transfer to the musculocutaneous nerve.

Methods. Anatomical dissection of the brachial plexus with layer-by-layer dissection of secondary bundles, short and long branches was performed in 121 male and female corpses. The localization of the origin of thoracodorsal and musculocutaneous nerves relative to the clavicle, the takeoff angle (degrees) from the secondary bundle, the length (in centimeters) of the nerves from the site of origin to the latissimus dorsi muscle entry point and the perforation of the coracobrachialis muscle, respectively, were investigated. The length of the thoracodorsal nerve with and without extramuscular branches was studied separately.

Results. It was revealed that, in 58.7% of cases, the thoracodorsal nerve has the optimal length required for transposition to the musculocutaneous nerve. The excess length of the thoracodorsal nerve was between 0.1 and 9.1 cm. In 41.3% of cases, the length of the thoracodorsal nerve is not enough for transposition. Of these, in 17.4% of cases, the shortage of the length of the thoracodorsal nerve was –2 cm or less, which categorically does not allow its transfer to the musculocutaneous nerve. Only in 5% of cases, the length of the nerve was not enough for transposition in the use of the thoracodorsal nerve with extramuscular branches.

Conclusion. Due to tension in many cases, the thoracodorsal nerve transfer to the musculocutaneous nerve can be performed with difficulty, and in some cases it is impossible, solving the problem in this category of people dictates the deve­lopment of new surgical techniques with the thoracodorsal nerve or the use of another nerve as a donor.

Kazan medical journal. 2020;101(6):820-824
Stroke risk factors in patients with end-stage kidney disease: current status of the problem
Murkamilov I.T., Aitbaev K.A., Fomin V.V., Murkamilova Z.A., Yusupov F.A., Rayimzhanov Z.R., Schastlivenko A.I.

Chronic kidney disease and its complications are one of the leading causes of morbidity, disability and mortality in the world population, due to both the widespread prevalence of arterial hypertension, diabetes mellitus and co¬ronary heart disease, and the increase in life expectancy. In the terminal stage of chronic kidney disease, mortality from cardiovascular events increases significantly. This review examines the most common risk factors for stroke in end-stage kidney disease. The role of arterial hypertension, diabetes mellitus, chronic heart failure is discussed, taking into account common risk factors, hyperactivation of the renin-angiotensin-aldosterone system, the deve¬lopment of oxidative stress, volume overload with an increase in the size of the left atrium and a subsequent increase in the risk of thrombosis and stroke in patients with end-stage kidney disease on programmed hemodialysis. In addition, data are presented in the study of the contribution of bone mineral disorders to the occurrence of cerebral complications in this category of patients. Timely diagnosis of cardiovascular diseases and secondary prevention of stroke, including adequate antihypertensive, hypoglycemic therapy and correction of heart failure with blockers of the renin-angiotensin-aldosterone system, as well as the elimination of bone mineral disorders are currently a very popular approach to improving the quality of life and increased survival in the discussed category of patients. Understanding the pathogenetic mechanism of stroke in patients with end-stage kidney disease on programmed hemodialysis, with the study of risk factors in the development of an acute cerebrovascular accident, will help to develop a strategy for their management.

Kazan medical journal. 2020;101(6):825-833
Disorders of the gastrointestinal tract and possible mechanisms of their development in autism spectrum disorders
Ivanova D.V., Ziganshin A.U.

The article presents an analysis of current literature covering general information, as well as clinical and experimental research on autism spectrum disorder. Autism is a complex mental disorder. A growing body of literature suggests the association of autism spectrum disorder with dysfunction of the autonomic nervous system, especially those affecting the gastrointestinal tract and bladder. In addition, there are problems with nutrition, meta­bolism, immune and endocrine systems, and microbiota. Prevalence of autism has increased significantly over the past 40 years. As more and more children with autism become adults, understanding this condition throughout life is of paramount importance. Although many research has focused on understanding how diagnosis and treatment can help little children, few are focused on adults with autism and how primary care groups can better help these ­people. Despite significant progress toward identifying the factors influencing the development of autism spectrum disorder, the etiology of the disease remains uncertain. In this regard, scientists are trying to obtain models of autism in rodents to continue further research. Based on the data obtained during clinical and experimental ­researches, a hypothesis about the possible role of the purinergic system in the pathogenesis of autism spectrum disorder is consi­dered. The results are encouraging, but further research is required. Thus, somatic disorders can worsen the main symptoms of autism, which affect communication and behavior functioning. In this regard, further research is ne­cessary, including in a rodent model of autism spectrum disorder to contribute to identifying the possible causes of the disorder.

Kazan medical journal. 2020;101(6):834-840
Medical, social and ethical issues related to COVID-19
Nezhmetdinova F.T., Guryleva M.E.

The recent pandemic caused by the novel coronavirus strain (COVID-19) has suddenly and radically shattered all ideas about the norm, not only in medical practice but also in society. This has particularly affected the healthcare system, physicians, and the distribution of life-sustaining therapy in the context of limited resources and the absence of a known treatment protocol. One of the main ethical dilemmas of the coronavirus epidemic has been the confrontation between public health ethics, reflected in the fair distribution of limited resources and a focus on public safety, and patient-centred clinical ethics. Ultimately, the COVID-19 pandemic is putting medical staff in tragic situations that they have never faced. And in the case of a shortage of medical staff — doctors and nurses, ventilators and other life-supporting devices for patients or even just beds in hospitals, it frequently becomes necessary to classify patients and decide an order to determine who, where and what kind of help will receive (or not receive) and in what queue to provide it. Another important problem was the problem of digital control of citizens, who must limit their freedoms for preserving the health of other citizens. The fear is widely shared that the situation will allow manipulation citizens in the future when there is no epidemiological need. Also, the problem of the responsibi-lity of politicians and authorized organizations for the health not only its people but all over the world arises. These and other questions today require bioethical expertise.

Kazan medical journal. 2020;101(6):841-851
Prophylaxis of surgical site infection
Izmaylov A.G., Dobrokvashin S.V., Volkov D.E., Nikitina L.E., Tereshenkov D.I., Kodochigov A.A.

The article provides a literature review of the methods for the prevention of local infectious complications — preoperative, intraoperative and postoperative. The analysis of the literature is devoted to the methods of prevention of postoperative purulent inflammatory wound complications. The review of scientific medical literature is based on the analysis of this problem. The article presents risk factors that contribute to the development of postoperative wound complications. Classification of surgical wounds was adopted to determine the risk of developing a surgical site infection (SSI), which distinguishes 4 classes: clean, conditionally clean, contaminated and dirty. The presented classification is based on the postoperative assessment of the wound bacterial contamination rate. The Clavien–Dindo classification of postoperative complications is the most relevant. This classification presents the tactics of the surgeon, depending on the class. The results of various studies indicate that antibiotic prophylaxis in the preoperative period reduces the development of local complications. The description of prevention methods focuses on intraoperative methods (devices for bringing together the edges of the wound, devices for treating wounds, surgical needles, suture material) and various types of antiseptics, which can reduce tissue damage during surgical interventions, reduce microbial contamination and the number of wound postoperative complications. Intraoperative instrumental methods allow less pronounced trauma to the wound during its processing and suturing. The postoperative method for diagnosing wound complications is an ultrasound method, which determines various formations in a postoperative wound.

Kazan medical journal. 2020;101(6):852-858
Social hygiene and healthcare management
Current state of the labor system in healthcare
Khabriev R.U., Shipova V.M., Berseneva E.A., Mikhaylov D.Y.

The publication presents an analysis of the modern regulatory framework for labor, shows controversial positions on each component of the labor rationing system in healthcare. The amount of normative time spent on visits to outpatient doctors, established by orders of the Ministry of Health of Russia, in the main medical specialties: doctors-the¬rapists district, pediatricians district and general practitioners (family doctors), does not coincide with the data of the territorial program. Approved more than 20 years ago and currently in force standards for laboratory and instrumental examinations do not correspond to the modern equipment of medical organizations. The numbers of health workers providing primary health care to the population, established by the orders on Procedures and Regulations, for the majority of medical personnel have different meanings in the simultaneously valid regulatory documents for the provision of medical care to both adults and children. The planned and normative volume of work on outpatient care has not been reported since 2013, either in visits or in appeals about diseases. The planned and normative indicators for the amount of hospital care are characterized by sharp annual changes that are not justified ¬either by the morbidity of the population or by the technologies of the medical process, do not correspond to the actual development of the bed stock and are not reflected by healthcare practice. Based on the analysis of time standards, norms of number and planned volume of work, the authors make a reasonable conclusion about serious problems in the system of labor rationing in healthcare. The authors identified the necessary measures for its restoration and revision of the entire labor regulatory framework, which are the need to include labor rationing issues in the program of diploma and postgraduate training of doctors in a healthcare organization; advanced training of developers of staff standards and specialists approving these documents; mandatory expert assessment of documents on labor standards prior to their approval by qualified specialists on labor standardization in health care.

Kazan medical journal. 2020;101(6):859-868
Persons disabled since childhood with severe functional impairments: medical-social portrait
Ishutina I.S., Vladimirova O.A., Afonina K.P., Khodakovskii M.D., Gerashchenko L.I., Kantemirov A.S.

Aim. To study of medical and social characteristics of persons disabled since childhood of the first group, their needs for various types of rehabilitation and care for the development of a medical-social model of personal assistance.

Methods. A sample study of 194 persons disabled since childhood of the first group in eight regions of the Russian Federation was conducted using a specially developed methodology. The calculations were performed by using the IBM SPSS Statistics Viewer 23.

Results. The state of health of persons disabled since childhood of the first group is characterized by polymorphism and polymorbidity. 64.3% of people with disabilities have multiple dysfunctions of organs and systems. In this regard, there are pronounced restrictions on the main categories of life activity. Half of the caregivers (47.4%) spend more than 8 hours a day on organizing care for persons disabled since childhood of the first group; between 4 and 8 hours — 29.8%; between 2 and 3 hours — 12.9%; less than 2 hours — 4.1%. It was found that 32.7% of families spend more than half of their family budget on care (organization of medical and household care, transportation and relocation, organization of training, communication in accordance with age). At the same time, only 30.0% of caregivers work, the remaining 70.0% do not work (do not receive seniority) and will not be able to claim a labor pension. Persons disabled since childhood of the first group are characterized by pronounced restrictions on the main categories of life, the need for constant and regular care of all types, however, 28.4% of this group of people can self-service themselves or with little help from other people. With the presented medical-social portrait, state support for this category of citizens should be carried out in a differentiated manner. The “personal assistance” model allows parents/guardians of persons disabled since childhood of the first group not only to care for a family member but also to find employment as a personal assistant.

Conclusion. Families with persons disabled since childhood of the first group need differentiated support that will allow parents/guardians to care for their family members and work; the “personal assistance” model could solve these problems.

Kazan medical journal. 2020;101(6):869-875
Distance learning opportunities during the COVID-19 epidemic
Ziganshin A.M., Mudrov V.A., Nasyrova S.F., Galimzyanov V.Z., Salimonenko D.A., Alekseeva A.Y., Nasibulin I.M., Yaschuk A.G.

Aim. To compare the results of using traditional and distance education technologies in the training of obstetricians and gynecologists in the continuing medical education cycles.

Methods. The effectiveness of the use of traditional and distance learning technologies in the training of obstetrician-gynecologists on the continuing medical education cycles was assessed based on Bashkir State Medical University. The study included an assessment of the knowledge of obstetricians and gynaecologists trained in the 36-hour program. Two study groups were selected. The group I included 28 doctors, whose training and knowledge assessment was carried out mainly using traditional education technologies. The group II consisted of 30 doctors, whose training and knowledge assessment was carried out using distance education technologies. The final effectiveness of the use of the studied technologies was evaluated based on the analysis of the final test results and the solution of situational clinical tasks as a General interview. The research results processing was performed by IBM SPSS Statistics Version 25.0.

Results. The study revealed that the use of distance learning technologies does not lead to a decrease in the physician's level of training: 70.0% in group I, 60.7% in group II (χ2=0.11, df=1, p=0.74). Meanwhile, the distance lear­ning format causes difficulties for doctors of the older age group: in group I, there is a direct moderate correlation between age and performance (r=0.497, p=0.007), in group II — a noticeable inverse correlation (r=–0.689, p <0.001).

Conclusion. Based on the results of the study, it is necessary to take a differentiated approach to the formation of groups for distance learning in the future.

Kazan medical journal. 2020;101(6):876-882
Risk assessment the potential occurrence of anthrax outbreaks in the Republic of Tatarstan
Makaev K.N., Ivanova S.V., Melnikova L.A., Murtazina G.K., Garaev A.N., Rodionov A.P.

Aim. To assess the risks of potential anthrax outbreaks based on a retrospective analysis of the epizootic situation for this infection and inventory data on the number of stationary anthrax-unfavorable sites in the Russian Federation using the case of the Republic of Tatarstan.

Methods. A retrospective analysis of data on animals with anthrax in the Republic of Tatarstan and the inventory of permanently unfavorable sites for this infection in the Russian Federation was carried out by using veterinary reporting documents for the period between 1914 and 2018. The epizooticity index of anthrax-unfavorable sites was determined by the formula: EI=(n×t)/(N×T), and the effectiveness of specific prevention of the infection was determined according to the guidelines. Analyzes were carried out using statistical methods.

Results. The analysis of the results of the conducted studies showed that between 1914 and 2018, 2037 group and single animals infected with anthrax on the territory of the Republic of Tatarstan, 1208 stationary unfavorable sites for this infection were registered. When assessing the risks of the potential occurrence of anthrax among animals of the Republic of Tatarstan, it was found that 69.8% of the territory of the republic (every third settlement) is permanently unfavorable for anthrax and has serious risks of a possible re-infection of animals with this infection, therefore all livestock of animals once a year vaccinated against anthrax. A study of more than 11,000 blood serum samples of animals vaccinated against anthrax according to this scheme revealed that the titer of anti-anthrax antibodies decreases 1:2 and 1:4 below the level that protecting the animal from infection with the causative agent of this infection in 20% of animals after 6 months, and in 60% after 12 months after vaccination. This creates high risks of anthrax in animals and people in disadvantaged areas since the anthrax pathogen is transmitted from an infected ¬animal to a person by mistaken autopsy of dead animals or the processing of carcasses of animals, hidden carriers of the anthrax pathogen. With this in mind, in regions with high risks of anthrax, it was confirmed the need for introducing two vaccinations per year into the prevention scheme of this infection in animals and monitor the post-vaccination immunological status, which will allow them to maintain high immunity throughout the year and promptly eliminate the focus of infection.

Conclusion. It was found that 69.8% of the territory of the Republic of Tatarstan (every third settlement) is permanently unfavorable for anthrax and has high risks of anthrax outbreaks in animals; it was shown the need for complex anti-anthrax measures, including two-time vaccination of animals during the year, to reduce the risks of infection of animals and the population with the causative agent of this infection.

Kazan medical journal. 2020;101(6):883-889
Scientific substantiation of the assessment of the territorial availability of primary medical health care to the rural population
Kalininskaya A.A., Bayanovа N.A.

Aim. To assess the territorial accessibility of primary health care (PHC) to the rural population in the Orenburg ¬region.

Methods. Statistical, monographic, organizational experiment research methods were applied. Statistical proces¬sing was carried out by using the Statistica 10.0 software. Basic statistics were calculated (arithmetic mean, weighted arithmetic mean). All parameters were checked by using Shapiro–Wilk, Kolmogorov–Smirnov and Lilliefors tests for normal distribution. The parametric method of statistics (Student's t-test) was used.

Results. The assessment of the territorial accessibility of primary medical health care to the population of the Orenburg region was carried out using the methodology developed by us for calculating the criteria for the accessibility of primary medical health care to the rural population “Rating of medical organizations according to the criterion of territorial accessibility of primary medical care to the rural population”. The use the methodology allows ¬making management decisions regarding the territorial planning of primary health care for the rural population in the selection of problem areas with low accessibility of primary medical care. In the Orenburg region, there are the following problems: different levels of accessibility of primary health care with a variety of distance up to 30 km and different population sizes in settlements create difficulties in organizing the provision of primary health care; remoteness from the regional center up to 300 km forms a personnel deficit.

Conclusion. Application of the methodology “Rating of medical organizations according to the criterion of territorial accessibility of primary medical care to the rural population” in the Orenburg region has allowed the development of the following recommendations for making management decisions at the regional level: (1) prioritization of territories for priority measures to ensure the availability help; (2) selection of the form of primary health care organization for the timely medical care provision to the population; (3) the formation of competition among medical organizations in the ranking of the availability of primary health care.

Kazan medical journal. 2020;101(6):890-896
Formation and development of public health teaching in the system of higher medical education (From social hygiene to public health and health care)
Reshetnikov V.A., Manerova O.A., Sozinov A.S., Ismayil-zada N.T.

The article deals with the historical ways of formation and development of the educational and scientific discipline “Public Health and Healthcare”, underlines the role of N.A. Semashko in the formation and development of the edu¬cational and scientific discipline, in the foundation and holding the first Department of Social Hygiene in Russia. The features of teaching the discipline at the stage of formation, the content of the first Russian manual on Social Hygiene are highlighted in this article. The stages of the formation and development of the discipline in Russia since the 20s of the last century until the present, the peculiarities of teaching the discipline at each of the stages, the reasons for changing the name of the discipline are considered. The special role of the Department of Public Health and Health Care Organization, among other departments dealing with the study of health, is highlighted. The article substantiates the leading, methodological role of the Department in teaching the issues of preserving, strengthe¬ning and restoring public health, presents the modern requirements for the departments of Public Health and Health Care Organization, as well as for teachers, shows special aspects of teaching the discipline, the content of the national education program and differences from foreign programs. The ways of development of the academic discipline and the Departments teaching it are also presented.

Kazan medical journal. 2020;101(6):897-907
Clinical observations
Clinical case of intracardiac pacemaker lead fracture
Kalinin R.E., Suchkov I.A., Povarov V.O., Shitov I.I., Potehinskiy S.S., Solovov D.V., Peshkov S.A.

Lead fracture is a serious complication of a pacemaker; its prevalence is 0.1–4.2%. The common site of lead fracture is at the space between the clavicle and the first rib. The causes are intense physical activity, which approximates the clavicle to the rib and compression of the lead, chest trauma, anatomical features, twiddler’s syndrome. Diagnosis of lead fracture is can be made by electrocardiography — there is a transient or permanent stimulation/sensitivity disturbance. When the programmer interrogates the pacemaker, a significant sign is an abrupt rise in the lead impedance, although cases of fracture with normal impedance values have been reported. The article presents an extremely rare clinical case of an intracardiac lead fracture in a 28-year-old patient. At the initial implantation, leads were passed through the accessory left superior vena cava, resulting in a loop in the right ventricle. The patient himself was subjected to increased physical activity. The question of the need to remove such leads remains open. Some authors note that the distal end is firmly fixed to the heart wall, and therefore does not expose the patient to a vital risk. Others consider that the lead can become a source of thrombus formation, or fragmentation with embolism in the pulmonary circulation can occur. In our case, the causes of the fracture were probably an intense physical activity and bending of the lead inside the right ventricle. The clinical situation was discussed with cardiac surgeons of the federal centers of cardiovascular surgery. Given the high risks of open-heart surgery, it was deci¬ded to refrain from removing the broken lead, and the patient was provided with atrial pacing.

Kazan medical journal. 2020;101(6):908-912
Dermatomyositis syndrome in small cell lung cancer
Musin S.T., Berezhnoy S.G., Khrapova I.A., Romanovskaya E.V., Ovsyannikov N.V., Drokina O.V.

Dermatomyositis is a progressive systemic disease clinically manifested by a muscle lesion with impaired motor function as well as skin rashes, often in the form of erythema. In some cases, dermatomyositis can be the onset of cancer. In this regard, the doctor is required to be highly alert and focused on detecting the tumor process in patients with progressive muscle weakness and characteristic skin manifestations of dermatomyositis. The article presents a clinical case of paraneoplastic dermatomyositis co‐existing with small cell lung cancer. The malignancy was dia¬gnosed during cancer screening in a patient with classic manifestations of dermatomyositis. Improvement of clinical manifestations of dermatomyositis appeared with glucocorticosteroid therapy and surgical treatment, but the patient died, since small cell lung cancer has an aggressive clinical course with an unfavorable prognosis.

Kazan medical journal. 2020;101(6):913-918
Clinical experiences
Method for predicting the development of tuberculosis in persons infected with HIV and held in penitentiary institutions
Vostroknutov M.E., Ponomarev S.B., Dyuzheva E.V., Averyanova E.L.

Aim. To create a new prognostic index that allows screening and predicting the development of tuberculosis in persons infected with human immunodeficiency virus (HIV), from among the suspects, accused, convicts, and assessment of how an additional diagnostic criterion can become a justification for additional preventive and anti-¬epidemic measures.

Methods. A mathematical model was developed by using expert opinions and applying the logical-mathematical approach of hierarchical analysis. It includes characteristics and criteria described in the modern scientific literature that does not exclude the presence of active tuberculosis or cause its unfavorable course in HIV-infected patients. The research was carried out in two stages. At the first stage, the weighting coefficients of the predictors used were calculated, and a prognostic index was created. At the second stage, the technique was applied in practice. As a result of the study in the observation group, which consisted of 157 clinical cases, the probability of tuberculosis was calculated by using the statistical grouping method.

Results. A model for calculating the prognostic index of the development of tuberculosis in patients with HIV infection has been developed. Based on the example of patients held in prisons, a graphical method is proposed for assessing the possibility of development/absence of tuberculosis in HIV-infected individuals, depending on the value of the prognostic index. In the practical application of the developed prognostic index, tuberculosis was diagnosed in 37 patients, and plans of preventive measures were developed in 120 patients.

Conclusion. The developed method of screening and predicting the development of tuberculosis in patients with HIV infection makes it possible to improve the timeliness of diagnosis of tuberculosis in the early stages and to determine the need for additional preventive or anti-epidemic measures during the work to counter the spread of this disease in the institutions of the Federal Penitentiary Service.

Kazan medical journal. 2020;101(6):919-925
Comparative characteristics of computed tomography and radiography in the diagnosis of blunt chest trauma
Gasimzade G.S.

Aim. To conduct a comparative analysis of the effectiveness of X-ray diagnostics and computed tomography in detecting injuries in patients with blunt chest trauma.

Methods. We examined 68 patients with chest injuries (men and women) and an average age of 34.6±7 years (between 18 and 65 years). The causes of injury were: road accidents — 37 (54.4%), falls from a height — 21 (30.8%), blunt blow to the chest — 10 (14.8%). The results of X-ray and computed tomography examination of patients were compared.

Results. X-ray examination revealed a chest bone fracture in 24 (35.3%) patients, while computed tomography revealed a bone fracture in 32 (47.1%) cases (χ2=1.943; p=0.163). This allows us to state that the results of compu¬ted tomography scans are more accurate in the diagnosis of chest fractures. computed tomography scan revealed chest injuries — pneumothorax and hemothorax, in 56 (82.4%) cases, while X-ray examination in 37 (54.4%) ¬cases (χ2=12.277; p <0.001). Thus, the results of the study showed that computed tomography is a more informative ¬method of diagnosis compared to radiography, since computed tomography revealed 11.8% more cases of chest bones fractures, and 28.0% more cases of chest cavity damage with blunt trauma.

Conclusion. Our study allows us to recommend computed tomography of the chest in blunt trauma as the initial preferred diagnostic radiology.

Kazan medical journal. 2020;101(6):926-929
History of medicine
Organizational activity of S.V. Kurashov in establishing and developing of national medicine and health care (to the 110th anniversary of the birth of S.V. Kurashov)
Galiullin A.N., Shulaev A.V., Burykin I.M.

The article provides information about the organizational activities and role of S.V. Kurashov in establishing and developing of national medicine and health care in the USSR and his contribution to the organization of health resorts, medical industry, pharmacy. The data on the improvement of outpatient specialized medical care for the population, the dynamics of health care in the USSR in 1950–1965, and the implementation of national programs to eliminate especially dangerous infections in the country are detailed. The paper shows the role of S.V. Kurashov in the training of medical personnel, the construction of multi-specialty hospitals in rural areas, allowing to provide specialized outpatient and inpatient medical care, in the country's accession to the World Health Organization in Geneva, which increased the importance of the USSR health care in the international arena.

Kazan medical journal. 2020;101(6):930-936
Outstanding organizer of post-graduate education of physicians, the representative of the Soviet therapeutic elite Roman Albertovich Luria
Borodulin V.I., Podolskaya M.A., Al'bickiy V.J., Topolyanskiy A.V.

The work aimed to introduce new scientific data and use well-known data about the professor, doctor of medicine, a well-known therapist, director of the Kazan Clinical Institute (Kazan Institute for Advanced Medical Studies) in 1920–1930 Roman Albertovich Luria. The multifaceted activity of R.A. Luria as a health care organizer, teacher, scientist, practitioner, author of unique monographs on internal medicine is shown. In 1920–1941, R.A. Luria was a member of the Soviet scientific and medical elite of healthcare organizers and therapists. In the history of domestic medicine R.A. Luria is the organizer of the Soviet system of postgraduate education of doctors, a prominent ­scientist who made a significant contribution to the development of the national clinic of internal diseases in the first half of the twentieth century, and the pride of Kazan medicine, who remained in the memory of Kazan citizens as a doctor “capable of creating a miracle”.

Kazan medical journal. 2020;101(6):937-943
Kazan Scientific Research Institute of Epidemiology and Microbiology — the stages of a long journey
Reshetnikova I.D., Isaeva G.S., Savitskaya T.A., Bajazitova L.T., Tyurin Y.A., Khaldeeva E.V., Agafonova E.V., Kulikov S.N.

This article was prepared for the 120th anniversary of the Kazan Scientific Research Institute of Epidemiology and Microbiology. The paper describes the main stages of the institute’s development since its founding as the Kazan Bacteriological Institute at Kazan University in 1900. Until 2005, the institute belonged to the system of the Mi¬nistry of Health, and later, among 28 Federal State Institutions of Science, it entered the Rospotrebnadzor system. The information on priority research and the contribution of the institute to the achievements of domestic health care and the federal service for supervision in the field of consumer protection over the 120-year history of its activity are presented. The data on ongoing research and development, development prospects also are presented. The article was prepared using documents from the archives of Kazan Scientific Research Institute of Epidemiology and Microbiology, Kazan Medical University and Kazan Federal University, the National Archives of the Republic of Tatarstan, and the memoirs of employees of the Kazan Research Institute of Epidemiology and Microbiology.

Kazan medical journal. 2020;101(6):944-954
75 years to Professor Vladimir Nikolaevich Oslopov

20 октября 2020 г. исполнилось 75 лет профессору кафедры пропедевтики внутренних болезней имени профессора С.С. Зимницкого Казанского государственного медицинского университета (КГМУ), известному врачу, педагогу, учёному Владимиру Николаевичу ­Ослопову.

Kazan medical journal. 2020;101(6):955-956
Cochrane Review Summaries
Prophylactic anticoagulants for people hospitalised with COVID-19

Что мы хотели узнать? Мы хотели узнать, уменьшает ли профилактическое применение «разжижителей» крови у людей, госпитализированных с COVID-19, число смертельных случаев по сравнению с людьми, которые их не получали или получали плацебо. Мы также хотели узнать, нуждаются ли эти люди в меньшей поддержке дыхания, образовались ли у них всё-таки тромбы, были ли у них кровотечения и были ли у них другие нежелательные явления (например, тошнота, рвота, проблемы с почками и ампутации).

Kazan medical journal. 2020;101(6):957-958
Thoracic imaging tests for the diagnosis of COVID-19

COVID-19 — это респираторная инфекция: у людей с COVID-19 может быть кашель, затруднено дыхание, а в тяжёлых случаях — пневмония COVID-19. Врачи используют визуализирующие исследования (тесты) органов грудной клетки для диагностики болезни COVID-19, при ожидании результатов RT-PCR теста или при отрицательных результатах RT-PCR, а также при наличии у человека симптомов COVID-19.

Мы хотели узнать, насколько точна визуализация органов грудной клетки в диагностике болезни COVID-19 у людей с известной или предполагаемой инфекцией.

Kazan medical journal. 2020;101(6):958-959
Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review

Плазма выздоровевших и гипериммунный иммуноглобулин успешно применялись для лечения других респираторных вирусных инфекций. Эти методы лечения (при капельном или инъекционном введении), как правило, хорошо переносятся, но могут иметь нежелательные эффекты. Мы хотели узнать, является ли плазма от людей, перенёсших COVID-19, эффективным лечением для людей с COVID-19, и не вызывает ли это лечение какие-либо нежелательные эффекты.

Kazan medical journal. 2020;101(6):960-961
Travel-related control measures to contain the COVID-19 pandemic: a rapid review

Мы хотели узнать, насколько эффективны меры контроля, связанные с поездками, в сдерживании пандемии COVID-19. Мы также хотели выяснить стоимость этих мер и узнать о том, какое влияние они оказывают на здравоохранение и использование других ресурсов, а также о потенциальных негативных последствиях, таких как чувство изолированности.

Kazan medical journal. 2020;101(6):961-962
Authors index
Kazan medical journal. 2020;101(6):963-968

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