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 103, No 5 (2022)

Theoretical and clinical medicine

From bioinformatic screening of genetic markers to low invasive lymph node metastases diagnosis in patients with cervical cancer
Kutilin D.S., Kecheryukova M.M.
Abstract

Background. The problem of lymph nodes metastases diagnosing in cervical cancer remains relevant and not fully resolved. The last decade studies results have shown the great potential of molecular markers in lymph nodes metastasis prediction, however, additional studies for their implementation in clinical practice are required.

Aim. Bioinformatic and laboratory screening of molecular markers of cervical tumors regional metastasis for its low invasive diagnosis.

Material and methods. The study was performed on 400 patients with cervical cancer and 40 donors without oncological pathology. To identify potential molecular markers of lymph node metastatic lesions, the Cancer Genome Atlas database was initially analyzed. The identified markers were validated by the Real-Time-polymerase chain reaction in tumor cell samples (extracted using laser microdissection) and extracellular deoxyribonucleic acid (DNA). The Mann–Whitney test was used to assess the differences; the Bonferroni correction was used to account for multiple comparisons.

Results. At the bioinformation stage, the change in the copy number of 5493 genes was analyzed, of which 79 genes were selected that most often change their copy number. During the data validation, it was found that primary tumor cells and tumor cells of metastases from the lymph nodes differ from normal cervix cells in the level of gene copies. The copy number of the CCND1 and PPARGC1A genes has the highest potential for regional lymph nodes metastases diagnosing in patients with cervical cancer; the PIK3CA, SPEN, ERBB3, APC, MUC4, CASP8, HLA-A, IGSF1 and TMTC1 loci have a lower potential. The EP300, TTN, DMD, DST, LAMP3, TORC2, TP53 and FOXO3 genes can be used to diagnose cervical cancer, whether metastatic or not. Additional validation of markers was carried out on extracellular DNA of blood plasma of cervical cancer patients and conditionally healthy donors. The presence of a differential copy number of PIK3CA, SPEN, ERBB3, APC, CCND1, HLA-A, TTN, MUC4, DST, PPARGC1A genes was found in two groups of patients with cervical cancer with and without metastatic lesions of the lymph nodes.

Conclusion. The study made it possible to form a list of potential molecular markers for low invasive diagnostics of cervical cancer in general (EP300, LAMP3, TORC2, FOXO3, TP53) and cervical cancer with metastatic lesions of regional lymph nodes (PIK3CA/DST, APC/PPARGC1A, ERBB3/HLA-A and LAMP3/MUC4).

Kazan medical journal. 2022;103(5):725-736
pages 725-736 views
The effect of polymorphic alleles carriage of the VKORC1 gene on clinical and laboratory ­parameters in patients with acute coronary syndrome
Kantemirova B.I., Chernysheva E.N., Orlova E.A., Abdullaev M.A., Petrova O.V., Rostoshvili G.A.
Abstract

Background. The role of the VKORC1 (1639G>A, rs9923231) gene polymorphism in hypersensitivity to warfarin and hypocoagulation is known. It has been proven that polymorphisms in the VKORC1 gene can lead to the progression of atherosclerosis and hypercoagulability, and, therefore, can be factors contributing to the development of acute coronary syndrome.

Aim. To study the effect of polymorphic genotypes carriage of the VKORC1 gene on the clinical and laboratory parameters of patients with acute coronary syndrome.

Material and methods. The pilot observational cross-sectional study involved 77 patients who were under observation in the conditions of the Federal Center for Cardiovascular Surgery in Astrakhan and the vascular center of Kirov City Hospital No. 3 (Astrakhan), from October 2020 to May 2021. Genotyping for CYP2C9, VKORC1, CYP4F2 on a PCR analyzer was performed. For statistical processing, the Hardy–Weinberg and Student criteria; 95% confidence interval were determined using Statistica Trial 13 and IBM SPSS Statistics 26.0. Differences were considered statistically significant at p <0.05.

Results. Significant differences related to the frequency of hemodynamically significant stenosis in homozygous carriers of the GG gene for VKORC1 compared with the group of carriers of the GA genotype — 3 (8.8%) versus 7 (22.5%); p=0.0058. Carriers of the GA and GG genotypes were most often diagnosed with myocardial infarction (Q- and non-Q-forming). Carriers of the AA genotype were more likely to have new or progressive angina pectoris. The level of hyperglycemia and triglyceridemia was the highest in the group of patients with the AA genotype, VKORC1 gene.

Conclusion. Statistically significant differences were established in the clinical and laboratory parameters of patients with acute coronary syndrome, carriers of different genotypes of the VKORC1 gene.

Kazan medical journal. 2022;103(5):737-743
pages 737-743 views
Candida albicans adhesion on buccal epitheliocytes as an indicator of microbiota homeostatic balance in children with chronic gastroduodenitis
Pikuza O.I., Fayzullina R.A., Zakirova A.M., Samorodnova E.A.
Abstract

Background. Recently, the incidence of mycoses in patients with a gastroenterological profile has grown due to an increase in the intensity of the impact on the human body of external factors that cause disturbances in the antimycotic defense system.

Aim. To study the adhesion of Candida albicans on buccal epitheliocytes in children with chronic gastroduodenitis.

Material and methods. 96 children (mean age 12.43±1.24 years) with recurrent respiratory diseases with morphologically proven chronic gastroduodenitis associated with Helicobacter pylori were examined. The adhesion of Candida, contamination of buccal epithelial cells with bacteria were studied. All children underwent paraclinical studies, instrumental methods of research, consultations of specialists were also prescribed. In the study of the adhesive reaction of C. albicans on buccal epitheliocytes, a Candida strain from the collection of the Federal Budgetary Institution of Science “Nizhny Novgorod Research Institute of Hygiene and Occupational Pathology” was used. 100 epitheliocytes were studied, the result was evaluated by the number of Candida in terms of 1 epitheliocyte. Registration of artificial colonization of buccal epithelial cells was carried out according to the method of D. Goldman and E. Goetzl (2003) modified by A.N. Mayansky. The children were divided into 2 groups: the main one — the detected growth of C. albicans over 1000 CFU/g, and the comparative one — the absence of excess growth of C. albicans. Statistical processing included the determination of the correlation coefficient, the arithmetic mean (M) and its standard error (m), differences in indicators according to Student's criteria (the level at p <0.05 was considered statistically significant).

Results. Harmonious proportional development was observed in 55.21% of children, microbiota imbalance was noted: bloating and rumbling along the colon, (p=0.0087), unstable stool (p=0.0241) and constipation (p=0.6092). The spectrum of comorbid pathology revealed the presence of allergic diseases (p=0.0048), up to 10 episodes of acute respiratory viral infection (p=0.1702), more than 10 episodes of acute respiratory viral infection (p=0.0105), adenoid vegetations (p=0.531), chronic pyelonephritis in the stage of clinical and laboratory remission (p=0.0216). Assessment of the intestinal microbial landscape showed a significant decrease in the content of bifidobacteria in the main group (p=0.0482), and lactobacilli were comparable in both groups (p=0.0839). In the comparison group, in 88.63% of cases, the indices of adhesion of C. albicans on buccal epitheliocytes were 6.37±0.46, in the main group — 11.86±0.74 (p=0.0362). A direct relationship between the parameters of artificial colonization of buccal epitheliocytes and the degree of microbiological changes in the intestine was found (r=0.58, p=0.0097).

Conclusion. The study of adhesion of Candida albicans on buccal epitheliocytes in children with chronic gastroduodenitis revealed a unidirectional shift in the quantitative content of the obligate oral and intestinal microbiota, which can be used as a screening for the homeostatic balance of the microbiota.

Kazan medical journal. 2022;103(5):744-750
pages 744-750 views
The structure of intestinal infections in the infectious department
Nikonorova M.A., Karbysheva N.V., Kotovshchikova E.F., Shevtsova E., Beskhlebova O.V.
Abstract

Background. Every year in Russia, the number of patients with acute intestinal infections of unknown etiology remains at a significant level.

Aim. To determine the current etiological structure and features of the clinical course of acute intestinal infections in the infectious diseases department of a city hospital.

Material and methods. For the period from 2017 to 2019, 181 patients with manifestations of acute intestinal infections, who were in the infectious departments of the “City Hospital No. 5, Barnaul”, were examined. The age of the patients ranged from 18 to 76 years (mean age 35.4±14.8 years), including 55.6% females and 44.4% males. The study of biological material from patients (feces) was performed using polymerase chain reaction with hybridization-fluorescence detection, bacteriological examination and serological method (indirect hemagglutination reaction) for the presence of antibodies to pathogens of acute intestinal infections (in blood serum). The statistical significance of differences was assessed by the χ2 test.

Results. Out of 181 patients with acute intestinal infections, 108 (59.7%) had the etiology of the disease, of which 54 (50%) patients had an infection of viral etiology, including in the form of monoinfection — in 45 cases, and caused by a combination of two viruses — in 9 cases. In 41 (38%) patients, acute intestinal infections of bacterial etiology were diagnosed, including a combination of two pathogens in 4 cases, and three pathogens in 1 case. 13 patients had viral-bacterial intestinal infections. As a result of the survey, on the existing list of laboratory tests, the etiology of intestinal infection was not established in 73 (40.3%) patients. In patients with acute intestinal infection of bacterial etiology, the disease proceeded more severely, with higher body temperature and colitis, in patients with intestinal infection of viral etiology — with gastroenteritis.

Conclusion. A high proportion of intestinal infections of viral etiology (up to 50%) with etiological dominance of noroviruses has been established. Among the causative agents of bacterial acute intestinal infections, Campylobacter and Salmonella prevailed.

Kazan medical journal. 2022;103(5):751-760
pages 751-760 views
Ovarian hyperstimulation syndrome in assisted reproductive technology programs in the ­Republic of Bashkortostan
Sugurova A.T., Minniakhmetov I.R., Tyurina A.A., Khusainova R.I., Yashchuk A.G.
Abstract

Background. Ovarian hyperstimulation syndrome is a fatal complication of unknown etiology. In connection with the increase in the frequency of this complication, it is necessary to identify prognostically significant markers to discover the risk of its development.

Aim. To analyze the frequency of ovarian hyperstimulation syndrome and search for the association of genes for differential growth factor 9, luteinizing hormone/horiogonadotropin receptor, and follicle-stimulating hormone receptor with different responses to ovulation stimulation.

Material and methods. A retrospective single-center cohort study of the frequency and clinical parameters of early ovarian hyperstimulation syndrome was carried out in 147 patients, the average age was 36.5 [33–38] years, who underwent an in vitro fertilization program in the period 2006–2021 in the Department of Assisted Reproductive Technologies of the Republican Medical Genetic Center in Ufa. The study of polymorphic loci of the genes for differential growth factor 9, luteinizing hormone/choriogonadotropin receptor, and follicle-stimulating hormone receptor was performed using TaqMan technology and real-time polymerase chain reaction. Deoxyribonucleic acid was isolated from peripheral blood samples. Statistical analysis was performed using the Kruskal–Wallis criteria, median test, Pearson's χ2 test, using the Statistica 12 software package.

Results. 7577 procedures of assisted reproductive technologies were performed. 147 (2.3%) cases of ovarian hyperstimulation syndrome were registered, 53 (0.8%) cases of moderate and severe degree, 84 (1.3%) cases of mild degree. The *CT genotype of the rs254286 polymorphic locus of the differential growth factor 9 gene was associated with a poor ovarian response 15 (0.75); (χ2=4.00; p=0.02; odds ratio 3.4; 95% confidence interval 1.13–10.27). The distribution of allele and genotype frequencies of the other studied genes did not differ statistically significantly in all the studied groups.

Conclusion. The frequency of ovarian hyperstimulation syndrome in the Republic of Bashkortostan was 2.3%; the *CT genotype of the rs254286 polymorphic locus of the differential growth factor 9 gene, as well as the level of anti-Müllerian hormone, can serve as markers of a poor response and ovarian hyperstimulation to ovulation stimulation.

Kazan medical journal. 2022;103(5):761-772
pages 761-772 views

Experimental medicine

Variety of thoracodorsal nerve branching variants
Gorbunov N.S., Kober K.V., Kasparov E.V., Rostovtsev S.I.
Abstract

Background. Accurate knowledge of the anatomy of all branches of peripheral nerves is necessary for successful neurotization and muscle plasty.

Aim. Anatomical substantiation of the use of branches of the thoracodorsal nerve in neurotization and muscle plasty.

Material and methods. The study was carried out on 121 preparations of the thoracodorsal nerve and the latissimus dorsi muscle from 105 cadavers of men and women aged 36–100 years. Variants of extra- and intramuscular branching of the thoracodorsal nerve were studied, a classification was developed and the possibilities of using it in reconstructive surgery were shown. A database was formed from the obtained indicators in the MS Excel 2012 program, and their processing was carried out using Statistica for Windows 12. The article presents only those indicators that do not follow the normal distribution according to the single-sample Shapiro–Wilk test. When describing the studied indicators, the median (Me) and quartile values (Q1, Q3) were determined.

Results. Anatomical layering and macro–microscopic dissection revealed 13 variants of extramuscular branching of the thoracodorsal nerve, which were combined into three groups. In the first group, which is 6.6%, the thoracodorsal nerve penetrates the latissimus dorsi muscle in one trunk and is divided into intramuscular branches of the first and second orders. In the second group (40.5%), the thoracodorsal nerve is divided into extramuscular branches of the first order, which penetrate into the latissimus dorsi muscle and branch into intramuscular branches of the first and second orders. In the third group (52.9%), the thoracodorsal nerve branches into extramuscular branches of the first and second orders, which are divided in the latissimus dorsi muscle into intramuscular branches of the first and second orders.

Conclusion. The thoracodorsal nerve is characterized by 13 variants of extramuscular and a wide variety of intramuscular branching, which is a factor that determines the tactics of nerve transposition and muscle plasty.

Kazan medical journal. 2022;103(5):773-779
pages 773-779 views
Inhibitory effect of DL-butionine sulfoximine on P-glycoprotein activity in vitro
Abalenikhina Y.V., Mylnikov P.Y., Shchulkin A.V., Yakusheva E.N.
Abstract

Background. P-glycoprotein (Pgp) is a multidrug resistance protein 1 with broad substrate specificity. Its functioning can change under the influence of various substances, so the search for endogenous and exogenous compounds that modulate the activity of the transporter protein is an important area of research.

Aim. To evaluate the effect of DL-butionine sulfoximine on the activity and amount of the Pgp transporter protein in Caco-2 cells.

Material and methods. The study was performed on a human colon adenocarcinoma cell line (Caco-2). Cells were incubated with DL-butionine sulfoximine and quinidine (a classical Pgp inhibitor) at concentrations of 1, 5, 10, 50, 100, and 500 µM for 3 hours. Pgp activity was evaluated by the transport of its substrate, fexofenadine, which concentration was determined by high performance liquid chromatography with ultraviolet detection (Stayer, Russia). The results were analyzed using StatSoft Statistica 13.0 (ANOVA), IC50 was calculated using GraphPad Prism 8 software. Differences were considered statistically significant at p <0.05.

Results. Incubation with DL-butionine sulfoximine and quinidine at concentrations of 1–500 µM for 3 hours did not affect the amount of Pgp in Caco-2 cells. Pgp activity decreased when using DL-butionine sulfoximine at concentrations of 50–500 µM by a maximum of 47.7% (p=0.040). Quinidine at concentrations of 5–500 µM reduced Pgp activity by a maximum of 79.1% (p=0.0002) at a concentration of 500 µM. Quinidine inhibited Pgp activity at lower concentrations compared to DL-butionine sulfoximine: the IC50 of fexofenadine with quinidine was 5.16±0.59 µmol/l, for DL-butionine sulfoximine it was 17.21±2.46 µmol/l (p= 0.001).

Conclusion. DL-butionine sulfoximine has a direct inhibitory effect on the activity of the Pgp transporter protein on the Caco-2 cell line.

Kazan medical journal. 2022;103(5):780-787
pages 780-787 views
The effect of the photoperiod on the serotonergic system of the thymus and its role in the ­implementation of the effects of exogenous melatonin
Luzikova E.M., Sergeeva V.E., Moskovsky A.V., Sergeev P.V., Lukachev I.A., Moskovskaya O.I.
Abstract

Background. It was believed that the functioning of the immune organs is photoindependent, but there are a number of works that testify to the effect of the photoperiod shift on the functioning of the immune organs. We hypothesized that the absence of a photoperiod under constant light or constant dark would affect the serotonergic system of the thymus gland, as well as the direction and intensity of melatonin exposure.

Aim. Study of serotonin-containing thymus cells under conditions of experimental desynchronosis and the role of the photoperiod in the realization of the effects of exogenous melatonin.

Material and methods. A comparative study of serotonin-containing thymus cells of 8-week-old Wistar rats, which were divided into 6 groups, was carried out. The first and second groups were kept under conditions of natural photoperiod, the third and fourth — in conditions of constant darkening, the fifth and sixth groups — in conditions of constant illumination within 4 weeks. Melatonin ad libitum at a concentration of 4 mg/l with water was received by animals of the second, fourth and sixth groups for 4 weeks. To determine the level of serotonin in cells, monoclonal antibodies to 5-HT were used. Conclusions about the serotonin content in the cells were made by measuring the optical density of the substance in 100 cells for each animal using the SigmaScan Pro5 program. Descriptive statistical processing was performed using the Statistica 17 program. The data obtained for each group of animals were averaged, the standard error and standard deviation were calculated.

Results. Artificial darkening reduced the serotonin content in 5-HT-immunoreactive cells of the cortical substance by 2.4 times (p=0.001), and constant illumination increased this indicator by 1.9 times (p=0.001). When melatonin was administered to animals kept in dark conditions for 4 weeks, the optical density of serotonin increased by 3.6 times (p <0.0001). Administration of melatonin to animals under constant illumination led to an increase in the optical density of serotonin in the cells of the diffuse endocrine system at the border of the cortex and medulla of the lobules by 1.5 times (p=0.002).

Conclusion. The cells of the diffuse endocrine system of the thymus are sensitive to changes in the photoperiod, and the introduction of melatonin has a multidirectional effect on the amount and optical density of serotonin under different light conditions.

Kazan medical journal. 2022;103(5):788-796
pages 788-796 views

Reviews

Acute kidney injury in acute coronary syndrome
Menzorov M.V., Shutov A.M., Sakharov V.S., Kabanova V.N.
Abstract

Acute kidney injury is a common complication of acute coronary syndrome that aggravates its prognosis. The article presents the current criteria and stratification of the acute kidney injury severity, its place in the structure of cardiorenal syndromes, renal and cardiorenal continuums. The data on the frequency, severity and clinical variants of complications in acute coronary syndrome, myocardial infarction, unstable angina pectoris are presented. The risk factors for the development of acute kidney injury and its contrast-induced variant are described. The data on the significance of acute renal dysfunction in changing the trajectory of cardiovascular disease, worsening the immediate and long-term prognosis, the development and progression of chronic kidney disease, ischemic complications are presented. The effect of mechanical and pharmacological reperfusion on the incidence of acute kidney injury is described. Promising approaches to the diagnostics of acute kidney injury, including the significance of biomarkers and the problems associated with their use, are outlined. The article presents data on the role of radiopaque agents in the development of acute kidney injury, describes the difference between contrast-induced nephropathy, its contrast-associated, post-contrast and contrast-induced variants. The current approaches to the prevention and treatment of acute kidney injury from the point of view of various professional communities are outlined. Approaches to risk stratification and the possibility of using risk scales are described. The main measures for the prevention and treatment of acute kidney injury, depending on its severity, the place of renal replacement therapy are presented. The paper presents the current hydration regimens and describes the principles of their modification depending on the clinical characteristics of patients, proposed by experts from the Scientific Society of Nephrology of Russia and the consensus of the American College of Radiology, the US National Kidney Foundation.

Kazan medical journal. 2022;103(5):797-806
pages 797-806 views

Social hygiene and healthcare management

Economic assessment of the high-tech and primary health care technologies for coronary heart disease according to personalized accounting of medical care for compulsory health insurance
Nazarov A.M., Saifutdinov R.I., Sayfutdinov F.R.
Abstract

Background. The assessment of medical technologies based on digital information is prompt and accurate, but it is currently not widely used, and analysis methods for this have not been developed, which became the basis for this study.

Aim. To economically evaluate the technologies of reperfusion therapy and dispensary observation in coronary heart disease using electronic data on medical care.

Material and methods. 586 patients with myocardial infarction treated in 2016 in two vascular centers of the Orenburg region were identified according to the registers-accounts of the compulsory health insurance fund. Among them were 349 patients with reperfusion therapy (main group) and 237 without it (control group). In the groups, the cost-effectiveness indicator, the cost of inpatient treatment of myocardial infarction and treatment in the postinfarction period were determined. Also, according to the registers-accounts for 2016, 17 225 patients with angina pectoris were identified. Among them, 13 208 patients, who applied to polyclinics for dispensary purposes during 2016–2017, and 4017 patients who did not apply, were registered — the main and control groups. Between groups, the total cost of outpatient, emergency, emergency hospital care and the cost-effectiveness ratio were compared. When processing the data, linear statistics methods and parametric comparison methods (Student's t-test and z-test) were used.

Results. The cost-effectiveness indicator in the group with reperfusion therapy was 425 879, without it — 643 069 rubles/unit, 1.5 times more in the control group. In the postinfarction period, the cost of treatment in the main group was lower than in the control group, 1223.66±19.04 and 1321.11±21.15 rubles, respectively, for outpatient care (p=0.001), 35 138.9±1299.85 and 51 189.6±4903.15 rubles for inpatient care (p=0.002), 4093.0±58.98 and 5428.6±52.95 rubles for an ambulance (p=0.001). The cost of angina treatment in the main group was 2.1 times less than in the control group, 6541.3±85.58 and 13 671.4±92.12 rubles (p=0.001). The cost-effectiveness indicator in the main group was 6867, in the control group it was 15 293 rubles/unit, 2.2 times more in the control group.

Conclusion. The use of reperfusion therapy and dispensary observation in coronary heart disease is economically feasible.

Kazan medical journal. 2022;103(5):807-814
pages 807-814 views
Public awareness of evidence-based medicine, the Cochrane collaboration and drug selection ­approaches in pharmacies
Sharafutdinova G.N., Mullanurova A.F., Korableva A.A., Talipova L.I., Ziganshina L.E., Khairullin R.N.
Abstract

Background. The importance of the appropriate use of medicines by the population (consumers of health services) based on the principles and achievements of evidence-based medicine is widely recognized. However, little attention is paid to this issue all over the world, and the knowledge of the population about evidence-based medicine and sources of reliable information in Russia is practically not studied.

Aim. To study public awareness of evidence-based medicine and the practice of choosing medicines.

Material and methods. A descriptive study among the inhabitants of Russia was carried out. Information was collected using a questionnaire that respondents filled out on their own. A total of 238 people (representing the general population) participated in the study, and the responses of 134 people (individuals working in health care, patients and caregivers) to questions about information were additionally used.

Results. The study showed that the majority of the population has no knowledge about evidence-based medicine (58%) and the Cochrane Collaboration (84%). Compared with the general population, a higher proportion of people working in health care were aware of both evidence-based medicine in general (41% vs. 26%; p=0.04) and the Cochrane Collaboration (37% vs. 5%; p=0.000002). 137/372 (37%) respondents experienced difficulties in choosing drugs in pharmacies, without significant differences between men and women. The most frequent difficulties in choosing medicines were ignorance of the comparative efficacy and safety of medicines, lack of understanding of the reasons for the variation in prices for the same medicine, the offer of predominantly expensive medicines by pharmacy workers, and the choice of the right medicine in a particular situation. When choosing medicines, the respondents most often relied on the recommendations of a doctor and a pharmacy worker. At the same time, half of the respondents also used other sources of information, the most popular of which was the Internet. The vast majority of respondents are interested in obtaining independent, evidence-based information about medicines.

Conclusion. A low level of public awareness of evidence-based medicine and difficulties in choosing medicines in a pharmacy were revealed.

Kazan medical journal. 2022;103(5):815-823
pages 815-823 views
Estimating the indirect costs associated with psoriasis
Novoderezhkina E.A., Zyryanov S.K.
Abstract

Background. The assessment of indirect economic costs associated with psoriasis is relevant due to the poor knowledge of the impact of the disease on key performance indicators, as well as the question of how the expansion of the pool of patients receiving genetically engineered biological drugs affects the indirect costs associated with the disease.

Aim. Evaluation of the indirect economic burden of psoriasis associated with missed work time and reduced performance in the actual presence at the workplace, as well as an assessment of the impact of changing the structure of therapy on indirect costs.

Material and methods. To calculate the indirect economic burden of psoriasis using the human capital method, two approaches were used: through an assessment of the impact on gross domestic product and through the use of the market value of working hours. A Bayesian network meta-analysis was performed to assess the impact of genetically engineered biologics on the indirect economic costs associated with psoriasis. Systematic search and selection of studies for network meta-analysis was performed using several databases (clinicaltrials.gov, Eu Clinical Trials, Pubmed, WHO ICTRP, medRxiv). Studies in patients with moderate to severe psoriasis treated with any genetically engineered biological drug were included.

Results. Indirect economic losses calculated through the assessment of the impact on the gross domestic product amounted to 10.2 billion rubles per year, and through the application of the market value of working time — 17.9 billion rubles per year per 100,000 patients with psoriasis in 2018 in Russian Federation. The genetically engineered biological drugs prescription can lead to a reduction in the annual indirect economic burden by 4.9 billion rubles and 8.6 billion rubles per 100,000 economically active patients with moderate and severe psoriasis, calculated through the assessment of the impact on the gross domestic product and through the application of the market value of working hours, respectively.

Conclusion. A decrease in the work productivity of patients with psoriasis leads to significant indirect costs, while an increase in the proportion of patients receiving genetically engineered biological drugs leads to a decrease in the indirect economic burden on the state and society as a whole.

Kazan medical journal. 2022;103(5):824-831
pages 824-831 views
Study of natural foci of infections transmitted by ticks in the Republic of Tatarstan
Boyko V.A., Savitskaya T.A., Trifonov V.A., Serova I.V., Petrova D.N., Isaeva G.S.
Abstract

The paper presents the history of tick-borne infections’ study, which was carried out at the Kazan Research Institute of Epidemiology and Microbiology, and an analysis of the current epidemiological situation of tick-borne infections in the Republic of Tatarstan. Tick-borne encephalitis was previously quite fully studied in the natural foci of the taiga zone of the USSR, but there was practically no information regarding the features of its distribution in the forest-steppe zone. The occurrence of a number of outbreaks of this disease in the territory of the Tatar ASSR and neighboring republics made research in this direction particularly relevant. Since 1955, the Kazan Research Institute of Epidemiology and Microbiology has begun work to identify and study natural foci of tick-borne encephalitis in the Middle Volga region. These studies have acquired the character of constant monitoring and are being systematically continued up to the present time. It was found that the main carriers of ixodid tick-borne borreliosis pathogens in Tatarstan are two types of ixodid ticks, the same as in viral tick-borne encephalitis. The similarity of the areas and basic patterns of the epidemiology of viral tick-borne encephalitis and borreliosis, as well as the possibility of the simultaneous circulation of the causative agents of these diseases (virus and borrelia) in the same ecosystem, has been revealed. Studies of the Kazan Research Institute of Epidemiology and Microbiology on the etiology, epidemiology and prevention of infections transmitted by ticks were carried out as part of long-term observations of the state of populations of various types of ixodid ticks in the physical and geographical regions of the Republic of Tatarstan, starting from the 50s of the XX century. This made it possible to trace changes in their spatial structure and assess their current epizootological significance. Landscape and epidemiological zoning of the republic's territories according to “tick-borne infections” has been carried out. Starting from 2012, new infections have been studied: monocytic ehrlichiosis and human granulocytic anaplasmosis.

Kazan medical journal. 2022;103(5):832-840
pages 832-840 views
Theoretical foundations and practical implementation of monitoring the accessibility state of ­facilities and services in the field of health care
Ishutina I.S., Shabanova O.A., Khodakovskii M.D., Vladimirova O.N., Kantemirova R.K.
Abstract

Background. By decision of the Commission under the President of the Russian Federation for the Disabled, the Ministry of Labor of Russia was entrusted with monitoring the implementation of federal and regional action plans “road maps” to increase the accessibility of facilities to people with disabilities.

Aim. Monitoring the implementation by state authorities of the constituent entities of the Russian Federation of action plans (“road maps”) to increase the values of accessibility indicators for disabled people in healthcare facilities.

Material and methods. The indicators of accessibility for disabled people of facilities in the healthcare system based on the results of implementation of action plans by executive authorities of 85 constituent entities of the Russian Federation in the field of healthcare, obtained as a result of monitoring the achieved values in the indicators of accessibility for disabled people of facilities in 2019 and 2020, were analyzed. The availability of facilities was calculated on the basis of information from the state authorities of the constituent entities of the Russian Federation, prepared in accordance with the recommendations of the Ministry of Labor of Russia, using the analysis and generalization of the received materials, using the method of comparing absolute and relative indicators.

Results. The accessibility of medical organizations for the disabled is created in two ways — from the standpoint of “universal design” (inclusion of measures to organize the accessibility of facilities and services for the disabled when designing and building new facilities, as well as during reconstruction and major repairs) and using the principle of “reasonable accommodation” for existing facilities (before their overhaul and reconstruction). Ranking the indicators of the e150 domain (design, nature of design, construction and arrangement of buildings for public use) on the basis of a unified assessment scale of the International Classification of the Functioning of Disabilities and Health made it possible to identify regions of the Russian Federation with varying degrees of accessibility of healthcare facilities: absolutely accessible — in 10 (11.8%) regions of the country; with a significant level of accessibility — in 53 (62.4%) regions; with a moderate level of accessibility — in 8 (9.4%) regions; with a low or insignificant level of accessibility — in 9 (10.6%) regions of the Russian Federation; with a very low level of accessibility of healthcare facilities — in 5 (5.8%) regions of the Russian Federation, respectively.

Conclusion. According to the monitoring of the state of accessibility of facilities for the disabled in the healthcare sector in the constituent entities of the Russian Federation, the level of accessibility varied from 100% to 0.5%. The planned indicators of increasing the availability of facilities in the healthcare sector have reached 100% in 52 constituent entities of the Russian Federation.

Kazan medical journal. 2022;103(5):841-850
pages 841-850 views

Clinical experiences

Clinical case of visual axis opacification after primary posterior capsulorhexis
Bantsykina I.V., Malov I.V., Shteyner I.I.
Abstract

The formation of posterior continuous capsulorhexis during cataract removal has traditionally been used to prevent visual axis opacification. According to the current literature, closure of the posterior capsulorhexis opening in our patient's case should not have developed in a period of 1 year, but it did in only one of the two eyes, despite the presence of equal conditions — the same surgeon, the same IOL (sharp-edged hydrophilic acrylic with hydrophobic coating), no concomitant eye diseases and somatic pathology. We conducted a literature search to find the cause of the unilateral development of this complication, as well as the optimal treatment method. The difference between two surgeries was in the diameter of the anterior and posterior capsulorhexis — on the right eye they were 0.5–1.0 mm larger than on the left eye, and the left eye has developed opacity, which required surgery. An effective and safe way of treating this problem is the capsulotomy using a 25 gauge-vitreotome. The clinical case shows the need for further research on this topic, as formation of posterior continuous capsulorhexis has a risk of intra- and postoperative complications, and more data should be considered to ensure that there is no such recurrence of opacity.

Kazan medical journal. 2022;103(5):851-855
pages 851-855 views
Comprehensive treatment of patients with autoimmune thyroiditis using laser technologies
Sadikhov F.G.
Abstract

Background. The frequency of autoimmune thyroiditis reaches up to 40% among all thyroid gland diseases and ranks second among endocrinological diseases.

Aim. Carrying out a comparative evaluation of the effectiveness of laser photodynamic therapy and traditional conservative treatment in diffuse form of autoimmune thyroiditis.

Material and methods. The work is based on the examination and treatment data of 235 patients hospitalized in the Scientific Center of Surgery named after M.A. Topchubashov for the period from 2008 to 2021. Patients were divided into two groups based on the applied methods of treatment. Patients of the main group (106 people, 45.1%) received sessions of laser photodynamic therapy in combination with intravenous laser blood irradiation with low-intensity laser radiation. Patients in the control group (129 people, 54.9%) received a course of conservative therapy in combination with sessions of intravenous laser blood irradiation with low-intensity laser radiation. To test the statistical significance of differences in the concentrations of thyroid hormones, pituitary gland and antibodies to thyroid tissues in the blood serum of patients before and on the 15th day after treatment, Pearson's χ2 test was used. In each group, the mean values of the analyzed clinical parameters, their mean error (±m), 95% confidence interval, and the significance of intergroup differences were calculated according to Pearson's χ2, Mann–Whitney U, and Student's t criteria. Differences were considered statistically significant at p <0.050.

Results. In the main group on the 5th day of treatment, normalization of the main indicators of the inflammatory response occurred in 26 (24.5%) patients, in the control group — in 16 (12.4%) patients (χ2=5.9, p=0.010). In patients of the main group, the levels of antibodies to thyroperoxidase on the 15th day after treatment, compared with their values before treatment, decreased by 5.65 times (t=8.4, p ≤0.001), the content of thyroid-stimulating hormone decreased by 2.18 times (t=6.9, p ≤0.001), free thyroxine increased 2 times (t=3.4, p ≤0.01), free triiodothyronine increased 1.71 times (t=1.4, p ≥0.05). The average values of antibodies to thyroperoxidase in the main group after treatment were within the normal range (31.57±5.75 IU/ml).

Conclusion. The use of laser photodynamic therapy provides the best results in the treatment of patients with diffuse autoimmune thyroiditis.

Kazan medical journal. 2022;103(5):856-863
pages 856-863 views
Effect of controlled dynamic sialometry on the secretory function of the parotid glands
Shchipskiy A.V., Kalimatova M.M., Mukhin P.N.
Abstract

Background. It is noted that patients with xerostomia after sialometry may notice a decrease in xerostomia.

Aim. To study the effect of stimulated sialometry on the quantitative parameters of salivation, to explain the mechanism and reason for such an effect.

Material and methods. Controlled dynamic parotid sialometry was performed in 22 patients with xerostomia. Saliva was taken with a Lashley capsule (n=44) and a catheter (n=44), stimulated with 1% pilocarpine solution. At the 1st stage, the capsule was on the right, the catheter was on the left, a week later (2nd stage) the catheter was on the right, the capsule was on the left. The amount of saliva (ml) obtained with a capsule was taken as a control indicator, with a catheter — as a test indicator, the difference between them determined the rheological state of saliva. The study was approved by the ethical committee. The analysis of indicators in dynamics was carried out separately in the group with a capsule, separately in the group with a catheter. Significance of differences was assessed using Student's t-test. The results were considered significant at p ≤0.05.

Results. By the 2nd stage of the study, the sialometry values (ml) obtained using the capsule increased in 13 (69.1%) cases, did not change (n=2; 9.1%) or decreased (n=7; 31.8%) in 9 (40.9%) cases. By the 2nd stage of the study, sialometry values (ml) obtained using a catheter increased in 16 (72.7%) cases, did not change (n=2; 9.1%) or decreased (n=4; 18.2%) in 6 (27.3%) cases. The number of cases with increased secretion was significantly higher than other cases (t=3.385; p <0.001). The dynamics of the rheological state was as follows. A week later, in 7 (31.8%) cases, the indicators of the rheological state of saliva (the difference between the control and test sialometry values of 0.5 ml or more) returned to normal (the difference between the control and test sialometry values of 0.5 ml or less), in 2 (9.1%) cases, the norm was not achieved (t=1.947; p <0.05). Thus, sialometry in the short term can positively influence the secretory function of the salivary glands. However, parasympathetic stimulation of secretory function depletes the number of secretory granules in glandulocytes, which limits the effect of pilocarpine in reducing xerostomia.

Conclusion. Simultaneous sampling of saliva from the parotid glands with a Lashley capsule (control) and a catheter as a capillary viscometer makes it possible to determine the rheological properties of saliva; the improvement in the rheological properties of saliva after stimulated sialometry is associated with the use of the m-cholinomimetic pilocarpine.

Kazan medical journal. 2022;103(5):864-869
pages 864-869 views
Influence of hemoperitoneum in spleen injury on the formation of peritoneal adhesions in intact peritoneum
Pikalo I.A., Podkamenev V.V., Titov E.A.
Abstract

Background. It is assumed that the outflow of blood during a spleen injury can cause an adhesive process, which justifies the need for sanitation of the abdominal cavity.

Aim. Determine the effect of hemoperitoneum on the formation of adhesions in an intact peritoneum.

Material and methods. The clinical part of the study included 82 patients with closed splenic injury observed from 2002 to 2019. The mean age was 11.1±3.5 years. There were 62 boys and 20 girls. The volume of hemoperitoneum was determined by ultrasound scanning. 74 (90%) children underwent non-surgical treatment. Surgical treatment was performed in 6 children with continued bleeding and in 2 patients with delayed bleeding. Experimentally, blood from a peripheral vein of animals was taken and injected into the peritoneal cavity. Posthumously, 12 sections of the parietal peritoneum from rabbits for histological examination were taken. Statistical processing of the obtained data was carried out by the method of descriptive statistics. Statistical significance of mean differences was assessed using the Mann–Whitney test, and qualitative data — using Fisher's exact F-test. Differences were considered significant at p ≤0.05.

Results. The volume of hemoperitoneum in children with non-surgical treatment of spleen injury did not exceed 15% of the circulating blood volume. In 97.3% of cases, blood resorption from the peritoneal cavity occurred within 14 days. With non-surgical treatment, chronic abdominal pain was registered in 1.35% of cases, with surgical treatment — in 62.5% (p=0.000011). None of the patients after non-surgical treatment of splenic injury had adhesive intestinal obstruction, while after laparotomy it occurred in 25% of cases (p=0.0084). It has been experimentally established on animals that hemoperitoneum without damage to the peritoneal mesothelium was accompanied by the development of aseptic inflammation. On the 3rd day, neutrophilic leukocytes accumulated in the peritoneum. Under aseptic conditions, no damage to the mesothelium occurred. By the 10th day, the inflammation stopped. On the 20th and 30th days, there were no additional fibrin deposits.

Conclusion. The presence of blood in the peritoneal cavity without damage to the mesothelium is not a risk factor for the formation of adhesions.

Kazan medical journal. 2022;103(5):870-878
pages 870-878 views

History of medicine

Development of local infiltration anesthesia by Kazan obstetricians and gynecologists (dedicated to the 125th anniversary of the birth of professor P.V. Manenkov)
Kozlov L.A.
Abstract

The purpose of the article is to highlight the achievements of Kazan obstetricians and gynecologists in replacing general anesthesia with local infiltration anesthesia during obstetric and gynecological surgeries. In the period before the formation of anesthesiology and resuscitation into a separate branch of medicine with its equipment and medicines, local infiltration anesthesia with a tight creeping infiltrate, according to A.V. Vishnevsky, occupied a dominant position in surgery in the first half of the 20th century. In 1925 in Kazan, a student of Professor V.S. Gruzdev, Professor A.I. Timofeev, began to introduce it into the obstetric clinic and developed the technique of this type of anesthesia for gynecological abdominal surgeries. His work was continued by his colleagues, among whom was Professor P.V. Manenkov. He and the staff of the Department and Clinic of Obstetrics and Gynecology of the Kazan State Medical Institute performed more than 5,000 operations in obstetrics and gynecology, refined the technique of local anesthesia, improved technical equipment, expanded the range of indications for surgery under this type of anesthesia. Many years of clinical and laboratory developments, widely covered in the press, made it possible to perform up to 97% of operations in obstetrics and gynecology clinics in Kazan under local infiltration anesthesia.

Kazan medical journal. 2022;103(5):879-887
pages 879-887 views
The contribution of Eduard Shperk to the study of the social causes of syphilis and leprosy in Eastern Siberia in the 19th century
Gaidarov G.M., Alekseevskaya T.I., Demidova T.V., Sofronov O.Y.
Abstract

The article reveals the role of Eduard Shperk in the study of social causes, hygienic living conditions of the indigenous population and the prevalence of syphilis and leprosy in the northeastern districts of the Russian Empire. The personality of a doctor performing his professional duty in the socio-economic, climatographic, epidemiological situation of the north-east of Siberia in the 19th century is not widely reflected in Russian literature. The scientific interests of the doctor were concentrated mainly in the field of syphilidology and dermatology. The purpose of the work was to study the facts of the initial stage of the formation of medical topographic research in the study of the syphilis and leprosy spread among the population, as well as the contribution of the syphilidologist and dermatologist Eduard Shperk. A structural-diachronic analysis of archival and literary sources of the 19th century, characterizing the problem of the syphilis and leprosy prevalence in the northeastern districts of Eastern Siberia, was carried out. The work is based on the study of materials from the Russian State Historical Archive of the Far East. In the conducted historical and medical research, the contribution of Eduard Shperk to the study of syphilis and leprosy that spread in the Yakutsk, Primorsky, Amur regions and in Transbaikalia was analyzed. For the first time, statistical values of the territorial prevalence of various forms of syphilis, the number of deaths among men and women, the clinical picture and the results of medical and police measures taken to limit the epidemic are summarized and shown. Eduard Shperk’s substantiation of the ways of treating syphilis depending on the form of its manifestation is demonstrated. The role of hygienic living conditions in the spread of the disease among the indigenous population is noted. The results and effectiveness of the itinerant nature of the work of Eduard Shperk in the northeastern districts of Siberia are reflected.

Kazan medical journal. 2022;103(5):888-896
pages 888-896 views

Cochrane Review Summaries

Anticoagulants for people hospitalized with COVID-19 (Russian Translation of Cochrane Plain Language Summary)
Abstract

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Flumignan RLG, Civile VT, Tinôco JD, Pascoal PIF, Areias LL, Matar CF, Tendal B, Trevisani VFM, Atallah ÁN, Nakano LCU. Anticoagulants for people hospitalized with COVID-19. Cochrane Database of Systematic Reviews. 2022. Issue 3. Art. No.: CD013739. DOI: 10.1002/14651858.CD013739.pub2.

Kazan medical journal. 2022;103(5):897-898
pages 897-898 views

Book review

pages 899-900 views

Through the pages of the “Kazan Medical Journal”

A case of situs viscerum inversus
Abstract

This publication is a reprint of an article by Assoc. Prof. K.M. Yakhontov “A case of situs viscerum inversus”, published in the Kazan Medical Journal in 1915. Reprinting is carried out in preparation for the celebration of the 150th anniversary of the first issue of the Kazan Doctors’ Society Diaries, the assignee of which is the Kazan Medical Journal. Original publication: Yakhontov KM. A case of situs viscerum inversus. Kazan Medical Journal. 1915;15(4–6):208–210. DOI: 10.17816/kazmj48934.

Kazan medical journal. 2022;103(5):901-904
pages 901-904 views


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