Kazan medical journal

Aim. To study of the antibiotic resistance of S. aureus strains isolated from nosocomial infections (pneumonia, surgical site infections and sepsis) in a multidisciplinary surgical clinic.

Methods. Microbiological testing of sputum in 41 patients with pneumonia, of samples (wound, abscess, drainage) obtained from 40 patients with surgical site infections (SSI) and of blood from 46 patients with signs of sepsis was performed. The obtaining cultures were identified by conventional methods (including morphological, cultural, biochemical features, etc.). Disc diffusion method was used to detect methicillin-resistant S. aureus (MRSA) strains. Inducible clindamycin resistance (ICR) of S. aureus strains was determined by double disk approximation test (D-test).

Results. Methicillin-resistant S. aureus was found in 14.3% (2 of 14) of the patients with surgical site infections, in the sputum 27.3% (3 of 11) of the patients with pneumonia, and in the blood 50.0% (7 of 14) of the patients with sepsis (p >0.05). The rate of inducible clindamycin resistance of isolated S. aureus strains in patients with surgical site infections (2 of 14 cases, 14.3%) and with pneumonia (2 of 11 cases, 18.2%) did not statistically significant difference with the rate of methicillin resistance (p >0.05). However the rate was significantly lower septic infections — 7.1% and 50.0% respectively (p=0.0328).

Conclusion. Among S. aureus strains isolated from nosocomial infections, the rate of methicillin-resistant S. aureus had not depended on the type of nosocomial infection; the rate of inducible clindamycin resistance in septic infections was lower than resistance to methicillin.

Aim. To assess the ability to form biofilms by clinical strains of the yeast Candida albicans isolated from patients with atopic dermatitis in exacerbation and remission stages under the effect of Fusarium solani micromycete and its absence.

Methods. The study included 70 strains of C. albicans and one strain of F. solani. Fungal biofilms formed accor­ding to the method of Ramage. The optical density of the biofilms measured using a micro plate reader at 620 nm. The effect of associated fungi on the biofilm-forming properties of C. albicans strains was studied by an extract from opportunistic F. solani fungi.

Results. The greatest biofilm formation was observed in strains isolated at the remission stage. The strains isolated in the acute period were inferior to them in the ability to form biofilms (average values of film formation were 0.143 and 0.087, respectively). Co-cultivation of C. albicans strains with F. solani fungus extract stimulated biofilm formation of C. albicans strains at a concentration of 1:10.

Conclusion. This study showed a possible synergism between C. albicans and F. solani in polymicrobial skin infections, because the products of the fungus F. solani increase one of the virulence factors of the fungus C. albicans; the possibility to assess of a stimulating effect of associated fungi on the virulence one of an agent of infectious disease process will allow predicting the disease severity.

Aim. To analyze the expression of key apoptosis (Bcl-2, caspase-3) and autophagy (Beclin 1, Vps34, p62 and LC3) proteins regulators in peripheral blood T-lymphocytes of patients with systemic lupus erythematosus.

Methods. The object of the study was peripheral blood T-lymphocytes of healthy donors and patients with systemic lupus erythematosus. To obtain T cells, we used the immunomagnetic separation method. Protein expression was analyzed using the Western blot method. Statistically analyzing the results was performed using the R software environment. The data was represented using boxplots. Groups were compared using the Mann–Whitney test.

Results. According to the results of the study of the apoptotic proteins, we found an increased content of caspase-3 and the absence of significant changes in the content of the anti-apoptotic protein Bcl-2 in patients with lupus, which indicates active apoptotic activity. A comparative analysis of Beclin 1 and Vps34 showed their increased content in the cells of patients, which indicates the activation of autophagy. The analysis of two isoforms of LC3 protein revealed their low content in the group of patients. Since the scatter of indicators was very different from the average value, we analyzed these indicators depending on the severity of the disease. In the acute course group, high content of protein LC3-I was detected, the content of form II was lower. In the group with the subacute course, the number of both isoforms is lower than in the other groups. In the group with a chronic course, significant increases of protein LC3-II and a decrease in the ratio of LC3-I/LC3-II were found.

Conclusion. The study showed that depending on the severity of systemic lupus erythematosus, the content of protein LC3 isoforms changes, which can be used for differential diagnosis of disease forms.

Aim. To reveal the rate and severity of clinical manifestations of common dental diseases and dentofacial anomalies in professional athletes

Methods. The effect of intense physical exertion and “overtraining syndrome” on the state of the organs and tissues of the dental system were examined in 200 professional athletes aged 18–25 years between 2014 and 2016. Five groups where each has the same number of athletes (n=40) included: team sport athletes (volleyball, handball), martial arts athletes (wrestling, boxing), gymnasts, swimmers, athletes. The control group consisted of 40 individuals who were not professionally involved in sports. The state of the oral cavity, in particular periodontal tissues, was judged by changes in the following indicators: prevalence of dentofacial anomalies, the incidence of dental caries, state of the oral cavity hygienic using by simplified oral hygiene index (OHI-S) ( Green J.С., Vermillion J.R., 1963), degree of gums bleeding by using the Muhlemann–Cowell bleeding index, degrees of severity of periodontopathy by using the papillary-marginal alveolar index (RMA) [Massler, Schour (1949) in Parma modification (1960)].

Results. According to the values of the simplified oral hygiene index the worst state of the oral cavity hygienic was in wrestlers (2.12±0.022 points) and boxers (2.03±0.029) compared to the control group (1.62±0.026, p=0.049 and p=0.001, respectively). Catarrhal gingivitis and generalized chronic periodontitis are most often diagnosed in the groups of wrestling (82.5±6.01%), gymnastics (77.5±6.60%), boxing (70.0±7.25%) and swimming (70.0±7.25%). Dentoalveolar anomalies were more often detected in boxers (77.5% of cases, p=0.001) and in gymnasts (34.0%, p=0.365) compared to the control group. In these groups, diastema was also more often diagnosed.

Conclusion. Periodontal inflammation indicators were higher in wrestlers and gymnasts groups compared to the dental status of all other groups of athletes; caries and maximum level of dental anomalies are more common for boxers.

This article presents a review of the ocular manifestations of coronavirus disease 2019 (COVID-19) by using materials of Russian and international researchers. After the outbreak of COVID-19 began in China in December 2019, isolated works on ocular manifestations of coronavirus infection began to appear in the literature. The review article summarizes data on the origin and species of viruses that infect humans, the structure of coronaviruses, and intermediate hosts of the virus. A separate chapter is devoted to the mode of transmission for infectious. It is shown that the main route of COVID-19 transmission from person to person is airborne. Of great interest to the ophthalmologists is the review of works devoted to the virus detection in the conjunctival sac. In particular, some studies have shown that in patients with COVID-19, the virus is present in the lacrimal fluid. According to the authors, it indicates that coronavirus might be transmitted through the conjunctiva. These statements are confirmed by clinical and experimental researches. The presence of coronavirus in tears indicates the possibility to cause disease by the ocular route. That is a potential infection source for different types of physicians during routine examinations of patients, and especially by ophthalmologists. Therefore healthcare workers should wear eye protection when dealing with patients who may have COVID-19. Ophthalmologists must take necessary safety precautions, even in conducting a routine physical examination. It is also worth noting that conjunctivitis can be the first symptom of COVID-19. It is proved that the virus in the conjunctiva was detected even in patients without symptoms of eye inflammation. Also interesting for researchers is the manifestations of coronavirus infection in animals, which, according to the authors, is essential for understanding the possible mechanisms of disease development and manifestations in humans.

Inflammation of the prostate gland occupies a significant proportion of inflammatory diseases of the genitourinary system. According to J. Potts et al. (2007), prostatitis is detected in 5–10% of the general male population. Today, one of the main problems associated with prostatitis is the narrowly targeted, often unwarranted treatment with its antibacterial drugs without taking into account the multifactorial nature of the pathogenesis and androgen dependence of the prostate gland. As a result, this leads to ineffective treatment of prostatitis amid growing antibiotic resistance. In turn, recent studies demonstrate key issues of testosterone and prostate gland relationship. These researches show that prostate metabolism is dependent on testosterone levels. The level of the hormone affects the course of chronic inflammation in the prostatic tissues. And also, that the number of bacterial agents that provoke pathological processes in the prostatic parenchyma directly depends on the degree of decrease in testosterone levels. This point of view is also supported by other studies. It was found that most patients with inflammation of the prostate gland had androgen deficiency, and correction of testosterone levels of these patients was highly effective in the treatment of chronic prostatitis. Thus, the androgen dependence of the prostate gland and the effect of hypogonadism on the incidence of prostatic parenchymal inflammatory changes allow us to radically revise the approach to the diagnosis and treatment of chronic bacterial prostatitis. The development and implementation of new algorithms in which the diagnosis and subsequent correction of concomitant androgenic are becoming a promising direction for this group of patients.

Aim. To develop an algorithm for primary specialized cardiovascular care with a priority of endovascular strategy.

Methods. The study was conducted in 2018–2019 based on the Central Clinical Hospital “Russian Railways-Medicine” and 14 polyclinics in the regions of the Russian Federation. The subject of the study is cardiovascular surgeons (n=2), possessing the skills of endovascular care. The object of the study was patients (n=1018) attended regional polyclinics of the Russian Federation. Patients were divided into two groups: group A consisting of 673 patients with clinically significant atherosclerosis of the coronary, brachiocephalic and peripheral arteries and abdominal aortic aneurysm; group B consisting of 345 patients with chronic lower limb ischemia that does not require surgical treatment. The average age of patients in group A was 69±6.1 years, in group B — 63±7.2 years. There were 467 men in group A (69.4%), and 339 in group B (98.3%). An organizational and technological algorithm was developed to improve the primary specialized cardiovascular care. The results were assessed by the presence of outcomes (heart attack, stroke, bleeding, death), the availability of endovascular care and patient survival follow up 12 and 24 months. A content analysis of scientific publications on the issue under study has been performed.

Results. An organizational and technological algorithm of primary specialized cardiovascular care has been deve­loped, including the activities of the cardiovascular surgeon, who has the skills of endovascular care and a nurse in an outpatient clinic. The implementation of the algorithm ensured continuity, 100% availability, safety and quality of cardiovascular care using endovascular technology. Outcomes are not registered in both groups. Both patient groups showed 100% one and two-year survival.

Conclusion. The developed algorithm of primary specialized cardiovascular care has provided high quality ­healthcare.

Aim. To study the opinion of mothers of newborns and neonatologists about the organization of inpatient care for newborns in St. Petersburg.

Methods. An anonymous survey of 2123 mothers of newborns and 172 neonatologists of St. Petersburg was conducted. The representativeness of the sample was checked by using the method of Professor A.M. Merkov, with the errors do not exceed 4 and 3%, respectively. Mathematical processing and data analysis were carried out by using the statistical software package PASW STATISTICS.

Results. 28.9% of mothers were partially or completely unsatisfied with the organization of inpatient care for newborns, in most cases due to the unfriendly and inattentive attitude by the medical staff (22.4%), the unsatisfactory provision by child care products (12.8%) and poor material and technical equipment of a medical organization (12.5%). On average, the human qualities of neonatologists were rated quite high by mothers at 4.63±0.09 (out of 5) points, and in mid-level practitioners were significantly lower — 3.91±0.08 points (p <0.05). In general, ­staying a newborn in a medical organization required financial costs for 37.3% of women, and 13.9% of respondents who received help through compulsory medical insurance paid for individual laboratory and other tests on their own. Mothers rated the organization of inpatient care for newborns on average 4.01±0.09 points. Compared to ­mothers, neonatologists rated it higher in the medical organization they work for and lower overall in St. Petersburg (M=4.11±0.10 points and M=3.78±0.12 points; p <0.05). According to the doctors, the main disadvantages of organizing inpatient care for newborns are poor material and technical equipment and problems associated with the staffing and qualifications of medical personnel.

Conclusion. There is a need to improve the process of providing inpatient care to newborns.

This article describes up-to-date information about aetiology and pathogenesis of course of herpetic eczema. The authors highlighted new approaches to diagnosis and therapy of Kaposi varicelliform eruption in children of early age. It was described the results of own observations of the child in the first year of life with Kaposi varicelliform eruption and experience of application-sorption therapy in the treatment of this disease. The high efficiency of application-sorption therapy in skin lesions caused by combination of infection and allergy in children was noted. The clinical case examined allowed to assess the full complexity of differential diagnostic approaches in verification of eczema herpeticum. For a wide range of paediatricians and surgeons, algorithms for diagnosis and therapeutic tactics were described in the case of Kaposi varicelliform eruption.

Aim. To analyze the results of treatment of patients with ulcerative bleeding, to identify the main risk factors for rebleeding in patients with peptic ulcer bleeding.

Methods. A retrospective analysis of the treatment results of 240 patients with acute peptic ulcer bleeding who were hospitalized in the Beloretsk Central District Hospital from 2008 to 2018 was carried out. Patients were divided into two groups: group 1 — 52 patients with rebleeding, group 2 — 188 patients in whom rebleeding did not occur.

Results. Rebleeding in patients with peptic ulcer was observed in 21.7% of cases. The surgical rate was 22.9% and mortality 6.3%. Based on the obtained data, rebleeding should recognize as a risk factor for death [odds ratio (OR) 68.9; 95% confidence interval (CI) 8.8 to 539.7; p <0.001]. Surgical treatment for rebleeding had unsatisfactory results (postoperative mortality in group 1 — 26.8%, in group 2 — 0). Risk factors for rebleeding in peptic ulcer bleeding include localization of the ulcer on the lesser curvature of the stomach (OR=2.37; 95% CI=1.18 to 4.74) and the posterior wall of the duodenum (OR=3.84; 95% CI=1.69 to 8.73), as well as Forrest type IIA ulcer (OR=2.67; 95% CI=1.55 to 6.48). Forrest IIc and III ulcers reduce the risk of rebleeding (OR=0.24; 95% CI=0.10 to 0.56). It was found that a shock index, a decreased level of total protein and red blood cells, and an increasing level of urea have a statistically significant relationship with rebleeding in peptic ulcer bleeding.

Conclusion. Rebleeding in patients with peptic ulcer is a serious complication of the disease that significantly increases mortality, and predicting the risk of rebleeding is one of the possible tools that can improve treatment outcomes and reduce mortality.

Aim. To analyze the results of one and two-step endoscopic submucosal dissection in the treatment of colorectal neoplasms.

Methods. Between 2018 and 2019, 17 patients (6 men and 11 women) aged 33 to 79 years underwent 21 endosco­pic submucosal dissections of colorectal neoplasms ranging in size from 1.0 to 6.0 cm. Submucosal fibrosis was identified in 2 (11.8%) patients, epithelial neoplasms in 15 (88.2%) patients including laterally spreading tumors in 9 (60%), and large sessile colorectal polyps in 6 (40%) patients. Histological examination revealed a carcinoid tumor (11.8%), adenoma with low-grade (64.7%) and high-grade (23.5%) intraepithelial neoplasia. 13 patients were subjected to the one-step operation, and 4 patients required the two-step operation with a 1-day interval. Follow-up examinations after the operation were performed, on average, between 2 and 6 months.

Results. En bloc endoscopic submucosal dissection was performed in 11 (64.7%) patients, 4 of them in combination with mucosal resection. Endoscopic piecemeal resection of the neoplasia was performed in 6 (35.3%) patients. The average operative time was 155±73 minutes (range 40–320 min). Intraoperative complications, which were eliminated endoscopically, occurred during 8 (38.1%) of 21 operations: intensive bleeding in 6 (75%) patients, diastasis of muscle fibers in 1 (12.5%) patient, perforation of the intestinal wall in 1 (12.5%) patient. At the follow-up at 6 months, all patients formed the scar at the surgical area, while 3 patients required endoscopic removal of residual adenoma 2 months after the operation.

Conclusion. Endoscopic submucosal dissection is an effective method for removing colorectal neoplasms, while two-step dissection is a promising approach to the development of the technique.Keywords: one and two-step dissection, endoscopic submucosal dissection (ESD), colorectal neoplasms.

This article presents the results of a historical and medical research reflecting infectious morbidity among children during the Second World War (the Great Patriotic War 1941–1945). The research, based on archival and lite­rary sources, aims to highlight the situation with infectious morbidity of children in the USSR during the war. The study is relevant because the majority of historical and medical research devoted to the war had been carried out in the Soviet epoch and did not always depict an objective image due to the ideological concepts of that time, which often prohibited the publication of certain information. Inconsiderable in number studies have been conducted on this topic in post-Soviet Russia, yet are selective or localized. A review of a wide range of sources provides an independent perspective on the dramatic situation concerning the significant increase of childhood infections during the war both in the occupied territory and in the regions of children’s evacuation. As a result of systemic control measures carried out by central and regional public health services, childhood infections had not become endemic. Despite the rising number of tuberculosis cases, sexually transmitted diseases, and malaria in the early years of the war, further spread of the socially significant pathologies was prevented.

The article was prepared for the 130th anniversary of the Head of the Department of Microbiology of Kazan State Medical University, Professor Rudolf Robertovich Geltzer. The milestones of R.R. Geltzer’s biography, and highlights the historical aspects of the formation of the Kazan school of microbiologists, which he represented are shown. The paper was prepared using primary sources — scientific articles and monographs published in the period of his activity, memories of colleagues from the Stavropol State Medical University, archival materials of the Department of Microbiology named after V.M. Aristovsky of Kazan State Medical University, as well as the ­National Archives of the Republic of Tatarstan. The main scientific achievements of R.R. Geltzer and his scientific contribution to the development of microbiology as one of the founders of the teaching of spirochetosis are described. The description of experimental studies on the development of culture medium for the isolation of Treponema pallidum, the search methods for diagnosing syphilis and other aspects of the scientific activity of R.R. Geltzer and his students is presented.

Эта Специальная коллекция создана в ответ на пандемию COVID-19 и регулярно обновляется. Она направлена на обеспечение немедленного доступа к систематическим обзорам, самым непосредственным образом относящимся к тактике ведения и лечения людей, госпитализированных с тяжёлыми острыми респираторными инфекциями. Эта коллекция включает обзоры, имеющие отношение к этапному руководству ВОЗ, которые были собраны Группой Кокрейновских обзоров по экстренной и неотложной помощи, а также опирается на знания Групп Кокрейн в поражённых регионах.

Взрослые, находящиеся в критическом состоянии, часто нуждаются в аппаратах, которые помогают им поддерживать дыхание. Одним из побочных эффектов использования этих аппаратов является повышенный риск развития пневмонии. Эта проблема известна как вентилятор‐ассоциированная пневмония (ВАП). Она становится основной причиной смерти у больных, находящихся в критическом состоянии, а также может увеличивать продолжительность пребывания пациентов в стационаре и увеличивать расходы здравоохранения. Положение, в котором находятся пациенты во время вентиляции (угол наклона тела или головного конца кровати), может играть важную роль в предотвращении развития инфекционного процесса в лёгких.

Экстракорпоральная мембранная оксигенация — это форма жизнеобеспечения, направленная на обеспечение работы сердца и лёгких. Для пациентов с тяжёлой дыхательной недостаточностью ЭКМО обеспечивает экстракорпоральный газовый обмен. Для людей с тяжёлой сердечной недостаточностью или остановкой сердца ЭКМО (EСMO) [экстракорпоральная сердечно‐легочная реанимация (ЭКСЛР, ECPR)] обеспечивает газообмен и системное кровообращение. Применение ЭКМО связано с некоторыми рисками (например, кровотечения, образование тромбов).

Острое повреждение лёгких (ALI) и острый респираторный дистресс‐синдром (ARDS) являются острыми и тяжёлыми состояниями, влияющими на структуру и функцию лёгких, которые вызваны повышенной проницаемостью альвеолярно‐капиллярного барьера, приводящей к воспалительному повреждению. Смертность от ALI и ARDS снизилась с течением времени и в настоящее время составляет 43%. Пациентам с ALI и ARDS требуется искусственная вентиляция лёгких (ИВЛ), но это вмешательство может вызвать повреждение лёгких, вызванное ИВЛ-аппаратом (вентилятором). По этой причине терапевтическая цель для таких пациентов основана на защитной вентиляции лёгких.

Исправление к статье Сазанов Г.В., Белоконь О.С. Казанский медицинский журнал. 2020; 101 (2): 284-288. DOI: 10.17816/KMJ2020-284.

На странице 284 в названии статьи вместо «Влияние предилатации на частоту возникновения нарушений коронарного кровообращения у пациентов с острым коронарным синдромом с подъёмом сегмента ST» следует читать «Влияние предилатации на частоту возникновения феномена no/slow-reflow у пациентов с острым коронарным синдромом с подъёмом сегмента ST».