Kazan medical journal

Aim. To study the effect of nitroglycerin on the heart rate and its variability in patients with stable angina pectoris class 1 and 2.

Methods. 85 men with stable angina pectoris class 1 and 2 pathologies were examined between 2007 and 2012 in the City Clinical Hospital No. 8 of Chelyabinsk (mean age 53.1±5.66 years). In addition to common methods, a rhythmocardiographic study was performed, which allows you to calculate heart rate variability. An electrocardiogram was recorded simultaneously with the rhythmocardiogram.

Results. After sublingual nitroglycerin, the number of ventricular extrasystoles decreased in the background test and during Valsalva maneuver, increased in the Ashner's test and an exercise stress tests and did not change in the orthostatic test. An increase in supraventricular extrasystoles after nitroglycerin administration occurred in 10.6% of patients. Nitroglycerin administration resulted in a decrease in the inter-systolic intervals, an increased in the proportion of slow low-frequency waves— statistically significant in the background and an exercise stress test. Spectral indicators of cardiac sympathetic modulation significantly increased in the Ashner’s test and decreased in the background test, while spectral indicators of cardiac parasympathetic modulation decreased in all samples except in exercise stress tests.

Conclusion. Under the influence of nitroglycerin, supraventricular arrhythmias increased in all vegetative tests except for orthostatic, the number/severity of ventricular extrasystoles ambiguously changed: decreased in Valsalva manoeuvre the background test, did not change in orthostatic and increased in Aschner's and an exercise stress tests; after nitroglycerin, the proportions of sympathetic influence (in Ashner's test) and slow low-frequency waves in the spectrum of the vegetative modulation increased with a decrease in parasympathetic.

Aim. To study the prevalence of gastroesophageal reflux disease (GERD) symptoms and lesions of the esophageal mucosa in residents of Zabaikalsky krai, taking into account ethnicity.

Methods. The first stage: 371 residents of Zabaikalsky krai over 18 years old, were door-to-door interviewed by using the GERD questionnaire (GerdQ). The respondents with 8 or more points were classified as having GERD symptoms. Additionally, we collected passport data, smoking status, alcohol and coffee consumption, anthropometric data and social status. The second stage: we analyzed 2130 upper gastrointestinal (GI) endoscopy reports from Regional Clinical Hospital in Chita.

Results. 48 (12.9%) of 371 respondents had GERD symptoms. 135 (36.4%) respondents were Buryats, and 236 (63.6%) were non-Buryats, with the latter more often had GerdQ total score of 8 or more [38 (16.1%) non-­Buryats and 10 (7.4%) Buryats, p=0.009]. The average age of non-Buryats respondents with GERD symptoms was 53.4±17.47 years and exceeded that in the group without symptoms (46.2±19.2 years), p=0.035. The age of Buryats with and without GERD symptoms did not differ (42.67±11.52 and 37.89±15.54 years, respectively, р=0.087). The prevalence of obesity, smoking, alcohol and coffee consumption of respondents with and without GERD symptoms, both among Buryats and non-Buryats was the same. Of the 2130 patients who underwent endoscopy, 164 (7.8%) had morphological changes in the esophagus, 105 (4.9%) had erosive esophagitis (EE). Catarrhal and erosive chan­ges in the esophagus were detected in 156 non-Buryats (91 men and 66 women) (7.7%), while EE was diagnosed in 97 (4.8%) patients. 6.5% (5 women and 3 men) Buryats had the esophagus pathology, which caused by erosion. It was found that in non-Buryats group EE develop more often in male respondents (p=0.0019). Only non-Buryats had catarrhal changes in the esophagus (37.8%, 59 people), p=0.0312. At the same time, the incidence of complica­ted disease course in groups with EE was the same (p=0.8934).

Conclusion. About 13% of residents of Zabaikalsky krai have weekly symptoms of GERD, male of a non-Buryat ethnic group are more likely to develop erosive esophagitis than women; the incidence of complications of esophagitis is the same in Buryats and non-Buryats respondents groups.

Aim. To study the features of the pathogenesis of anemia in patients with colorectal cancer and metastatic liver damage, as well as to evaluate the effectiveness of etiological correction of anemia in the preoperative period.

Methods. 90 patients with colorectal liver metastases and anemia (hemoglobin content 75–95 g/L), who were observed at the City Clinical Oncological Center of St. Petersburg between 2014 and 2020, were included. The patients were divided into two groups. The first group consisted of prospectively assessed patients with the preoperative correction of anemia by iron supplements (intravenously 7 mg/kg once a week) and recombinant erythropoietin (subcutaneously 150 IU/kg 3 times a week). The second group included retrospectively assessed patients with the correction of anemia only by red blood cell (RBC) transfusion (1–3 doses). The groups were comparable for gender [sex ratio (male/female) was 17:31 and 16:26 for the first and the second groups, respectively; p >0.5], age (63.3±1.4 and 60.2±1.2 years, respectively; p >0.1) and hemoglobin content (87.4±1.0 and 86.7±0.9 g/l, respectively; p >0.2).

Results. In studying the causes of anemia, a decrease in the mean serum endogenous erythropoietin level was revealed in most patients (36.7±1.9 mIU/ml with the required 70 mIU/ml). A decrease in the concentration of serum iron (6.6±0.3 versus 15.1±0.8 μmol/l) and ferritin (15.5±1.9 versus 102.4±8.4 μg/ml) levels were revealed. At the same time, there was no difference in the concentration of pro-inflammatory cytokines in patients with anemia and healthy controls (tumor necrosis factor α, interleukin-1β, interleukin-6; p >0.2), which indicates a low activity of the immune system in response to a tumor, due to conducted chemotherapy. In the preoperative correction of anemia, a positive effect was achieved with both iron supplementation with erythropoietin preparation (the hemoglobin level increased from 87.6±1.0 to 108.1±0.9 g/l; p <0.01) and RBC transfusion (from 86.7±0.9 to 114.6±0.6 g/l; p <0.01).

Conclusion. In patients with colorectal liver metastases, the most common causes of anemia were low levels of erythropoietin and iron deficiency; also for this group of patients, the prescription of erythropoietin and intravenous iron preparations are effective for the preoperative correction of anemia.

Aim. To assess the spectrum and frequency of mutations in patients with hereditary breast cancer from the Republic of Bashkortostan.

Methods. The material for the study was sections of fresh frozen, formalin-fixed and paraffin-embedded tumor tissue from 100 unrelated patients with a histologically confirmed diagnosis of breast cancer. The study was carried out using two methods: real-time polymerase chain reaction and next-generation sequencing-NGS.

Results. By using real-time polymerase chain reaction (PCR), the 5382insC mutation in the BRCA1 gene was detected in 12 cases. By using a next-generation sequencing method (NGS), highly penetrant mutations in BRCA1, BRCA2, CHEK2, PALB2 and RAD50 were revealed in 16 patients. In total, these methods detected mutations in 28 patients. Out of a total of probands in the BRCA1 gene, mutations were detected in 13 patients, that included 12 patients with the 5382insC mutation, and 1 patient with c.3143delG. In the BRCA2 gene, mutations were revealed in 3 patients, of which c.6621_6622del in 2 patients and c.-39-1_-39delGA in 1 patient. Mutations in CHEK2 were detected in 5 patients: c.470T>C in 3 patients, c.444+1G>A in 2 patients. The 1592delT mutation in PALB2 was found in 4 patients. The c.2157delA mutation in RAD50 was detected in 3 patients.

Conclusion. Pathogenic mutations in BRCA1/2, CHEK2, PALB2 and RAD50 were found in 28 patients with a hereditary feature of the disease; the identification of highly penetrant mutations in probands allowed us to determine their relatives, probable carriers of mutations, which were referred for genetic counselling.

Aim. To determine the level of gene expression of the serotonergic neurotransmission system (Slc6a4, Tph2, Htr1b, Htr2a) in the cervical and lumbar enlargement of the spinal cord for mice after 30-day microgravity exposure simulation by using the antiorthostatic unloading model by Morey-Holton et al. and a subsequent 7-dayrecovery period.

Methods. The experimental animals were divided into three groups: “Unloading” group with mice undergoes hindlimb-unloading procedure for 30 days (n=5); “Recovery” group with mice undergoes hindlimb-unloading procedure for 30 days, followed by readaptation within 7 days (n=5); “Control” group with mice kept at standard vivarium conditions (n=5). The expression level of genes encoding synaptic proteins in the central nervous system was estimated by a real-time polymerase chain reaction.

Results. There were no statistically significant differences between the studied groups regarding the Tph2, Htr1b, and Htr2a expressions in the cervical and lumbar enlargement of the spinal cord. Compared to the “Control” group, a statistically significant increase (6.3 times) in the level of Slc6a4 expression in the lumbar spinal cord was revealed after microgravity exposure simulation (“Unloading” group), followed by a 3-fold decrease during the readaptation period (“Recovery” group ).

Conclusion. The expression level of the Slc6a4 gene, which encodes carrier protein involved in the function of serotonergic synapses, may indicate the potential involvement of this neurotransmitter system in the pathogenesis of movement disorders after microgravity exposure simulation on earth.

At present, the most common dental diseases in most regions of Russia are caries, periodontal diseases, and dentofacial anomalies. A literature review was carried out on the prevalence of major dental diseases in Russian adult. The study aimed to analyze the literature on dental morbidity in Russia in the following areas: assessment of the prevalence, intensity, and treatment need of major dental diseases, depending on regional particularities, age, and sex differences. Caries and periodontal diseases are a major medical and social problem. The results of recent epidemiological studies have shown that almost the entire Russian adult has signs of these diseases. There is also a high rate of dental anomalies in children. The high prevalence of dental diseases indicates the need to strengthen the role of preventive work in the doctor's work. In conducting prevention program, it is important to consider the prevalence and intensity of major dental diseases which have pronounced regional particularities. Dental practice in recent years has shown that as a result of a targeted and effective preventive program, you can significantly reduce the level of dental morbidity.

Aim. To analyze the dynamic changes in medical and social indicators of the reproductive potential of the female popu­lation, markers of trends in the formation of the medical and demographic process in the region.

Methods. The study was conducted on the basis of an analysis of literary sources that determine the general trend in the demographic situation in the country, as well as information from statistical collections of the Federal State Statistics Service and the Ministry of Health of Russia and Tatarstan. The analytical and statistical methods (descriptive statistics, student criterion, trend analysis) were used in the study.

Results. It was revealed that the fertility rate of women living in rural areas decreased by dynamics (between 1991 and 2017, from 79.9 to 42.3 per 1000 women aged 15–49; p <0.05). Before 2014, the indicator for rural residents was higher than that for urban women. Since 2015, the trend has been reversed: among urban women it has become higher than among those living in rural areas, which correlates with the birth rate in urban and rural areas. Percentage of live births from 1991 to 2017 in women of early reproductive age (up to 20 years) decreased among urban women from 11.3 to 3.7% (p <0.05), among rural women from 10.0 to 5.8% (p <0.05); among urban women in the age group 20–24 years from 35.4 to 27.1% (p <0.05), among rural women of the same age from 40.9 to 34.2% (p <0.05). In the observed period, percentage of live births among women of the older reproductive age increased both among residents of cities and in rural areas. Percentage of births by birth order was changed: in urban areas accounted for 55.9% of the first child, in rural areas — 44.3%; for the second child — 35.1% and 34.2%, respectively; for third and more children — 9 and 21.5%.

Conclusion. The analysis of medical and social indicators of the reproductive potential of the female population and markers of trends in the formation of the medical and demographic process in the region suggests a decrease in ferti­lity rate (fertility) with an increase in the mean age of women at childbirth.

Aim. To develop a prognostic model of incidence of temporary (short-term) disability due to cardiovascular diseases in a housing and communal services employees using the example of the State Unitary Enterprise (SUE) “Vodokanal of St. Petersburg”.

Methods. The study included 4634 people, observed in the departmental outpatient clinic of SUE “Vodokanal of St. Petersburg”, between 2015 and 2017 years. We calculated extensive indicators determining the disease patterns and intensive indicators characterizing the prevalence of the pathological process in the study of morbidity by the findings of periodic health examinations and incidence of short-term disability. The incidence of short-term disability was predicted by using the method of sequential analysis A. Wald modified by E.V. Gubler and the neural network.

Results. We found that based on the operational and statistical data of the medical and sanitary unit, using a neural network, relying on linear and nonlinear dependence of comorbidity, in particular, respiratory diseases, it is possible to predict (in 92.4% of cases) the incidence of temporary disability due to cardiovascular diseases in employees of the housing and communal services SUE “Vodokanal of St. Petersburg”. The high sensitivity (97.7%) and specificity (90.7%) of the method allows it to predict the need for treatment and prophylaxis measures in the contingent attached to the medical and sanitary unit.

Conclusion. The developed model allows to determine the main directions of preventive work to reduce the incidence of circulatory system diseases with temporary disability: prevention of high blood pressure and respiratory diseases.

Aim. To study the number of neutrophils in the oral cavity, their bactericidal potential, to assess as an indicator for predicting the course of recurrent bronchitis (J40) and community-acquired focal pneumonia in children.

Methods. 87 children between 5 and 10 years old, including 52 children with recurrent bronchitis and 35 with focal community-acquired pneumonia were observed. The control group consisted of 37 conditionally healthy children of a similar age. Viral antigens were studied by chemiluminescence immunoassay. Oral neutrophil counts and functional activity were determined. Antibacterial antibodies were measured by an enzyme-linked immunosorbent assay (ELISA).

Results. 70.11% of patients had a viral antigen, and 57.47% had immunoglobulins M and G against bacterial pathogens. Oral neutrophil counts increased in the main group compared to the control group: up to 163.8±26.5 cells (p <0.001) in recurrent bronchitis, to 110.9±25.5 (p <0.05) in community-acquired pneumonia. By the recovery period, the number of oral neutrophils counts decreased in recurrent bronchitis (1.7 times higher compared to the control group, p <0.01) and remained practically unchanged in community-acquired pneumonia (115.0±26.9, p <0.05). Myeloperoxidase level had opposite changes for the groups compared to the control group: with recurrent bronchitis, it was 1.61±0.09 to the level in the control group (p <0.05), with community-acquired pneumonia — 0.73±0.09 to the level in the control group (p <0.001). The level of lysosomal cationic proteins decreased to 0.77±0.09 to the level in the control group (p <0.05) in recurrent bronchitis, and to 0.80±0.09 (p <0.05) in pneumonia.

Conclusion. In inflammation of the respiratory tract, neutrophil migration to the oral cavity, as well as myelope­roxidase level, increases, indicators of spontaneous luminol-dependent chemiluminescence are activated, and a deficiency of lysosomal cationic proteins occurs; this prevents the penetration of the pathogen into the lower respiratory tract.

Aim. To determine the possibility of predicting the course and outcomes of aneurysmal subarachnoid hemorrhage (aSAH) by using the detection of autoantibody level to neurospecific proteins.

Methods. The autoantibody level to neurospecific proteins was detected in 65 people: 30 healthy volunteers and 35 with a confirmed diagnosis of aneurysmal subarachnoid hemorrhage. Autoantibodies to myelin basic protein (MBP), peripheral myelin, dopamine receptors, myosin, N-methyl-D-aspartate (NMDA) receptors and S100 protein detected by using an enzyme immunoassay. The severity of illness in dynamics was defined in all patients by using the following scales: Rivermead mobility index, Hunt–Hess, Graeb and others. Statistical analysis was performed using Statistica 10.0, with the consistent use of descriptive statistics methods, the Mann–Whitney, Kruskal–Wallis and Pearson tests, Spearman coefficient.

Results. At the first stage, neurospecific proteins characterized by a large increase in autoantibody titers were identified. Further, based on the data obtained, a statistically significant correlation between autoantibody ­titers to S100 protein (360.43±40.35 µg/ml, p <0.05), MBP (145.91±12.43 µg/ml, p <0.05), NMDA receptors (66.17±6.42 µg/ml, p <0.05) and aSAH outcome was established.

Conclusion. The study revealed an increase in autoantibody level to neurospecific proteins in the blood plasma of patients, depending on the severity of subarachnoid hemorrhage and the development of delayed cerebral ischemia due to cerebral vasospasm; high antibodies titers to S100 protein in subarachnoid hemorrhage are associated with cerebral vasospasm and the development of secondary (delayed) ischemic changes in the brain.

The article was prepared for the 75th anniversary of Victory in the Great Patriotic War and the 120th anniversary of the Kazan Scientific Research Institute of Epidemiology and Microbiology. The paper presents the contributions of the Kazan Institute of Epidemiology and Microbiology staff in the sacred cause of victory over fascism to protect the health of soldiers and civilians of our homeland during the Great Patriotic War. The scientific research data and production activities of the institute are presented. The institute turned out to be practically the closest microbiological institution to the front, having the necessary laboratory equipment and a production base. The institute launched the production of medications, including 4 types of anti-gangrenous serums, anti-dysenteric tablets, te­tanus toxoid, anti-typhoid tablets, dysenteric dry bacteriophage, dysenteric subcutaneous vaccine, pentavacine, typhoid vaccine, antibiotic gramicidin and others.

In 1860, the Department of hospital surgery was organized at Imperial Kazan university. The reform of medical education to Western standards supposed the training of students in faculty and hospital clinics. The main task of the faculty Department is to teach the classical clinical picture of the most common diseases, while the task of the hospital Department is focusing to variants of clinical manifestations of the disease and improvement of practical skills. The first head of the Department of hospital surgery at Imperial Kazan University was Professor Andrey Beketov. Professor A.N. Beketov is one of the pioneers of the use of inhalation anesthesia, which he recommended for widespread use in the clinic. Besides, Beketov is the author of priority works in the field of traumatology and orthopedics. In a short time, the hospital surgical clinic in Kazan became one of the leading clinics in the East of Russia, the Urals and Siberia.

2 октября 2020 г. исполнилось 70 лет академику Российской академии наук, заслуженному деятелю науки Российской Федерации (РФ) и Республики Татарстан (РТ), вице-президенту Всероссийского физиологического общества им. И.П. Павлова, декану лечебного факультета, заведующему кафедрой нормальной физиологии, директору Института нейронаук Казанского государственного медицинского университета, доктору медицинских наук, профессору Андрею Львович

2 сентября 2020 г. не стало Анатолия Павловича Цибулькина — доктора медицинских наук, профессора, заслуженного деятеля науки Республики Татарстан и Российской Фе­дерации.

Не существует эффективного лечения или вакцины (лекарства, которое предотвращает заражение конкретным заболеванием) от COVID‐19, поэтому необходимы другие способы замедления (контроля) его распространения. Один из способов контролировать болезнь — карантин. Это означает отделение здоровых людей от других здоровых людей, которые могут иметь вирус после того, как они находились в близком контакте с заражённой персоной, или потому что они вернулись из области с высокими показателями инфекции. Аналогичные рекомендации включают изоляцию (как карантин, но для людей с положительным результатом теста на COVID‐19) и физическое дистанцирование (когда люди без симптомов физически держатся на расстоянии друг от друга).

Что мы хотели узнать? Мы хотели выяснить, останавливает ли и насколько эффективно останавливает карантин распространение COVID‐19 и предотвращает ли он смерть. Мы хотели узнать, было ли это более эффективным в сочетании с другими мерами, сколько это стоит.