Kazan medical journal

The new coronavirus infection caused by the SARS-CoV-2 virus (COVID-19) is characterized by a high frequency of thrombotic complications varying from venous or, more rarely, arterial thrombosis to the development of disseminated intravascular coagulation (DIC) and/or diffuse pulmonary vascular microthrombosis, which aggravates the disease and becomes one of the leading causes of deaths. Timely and personalized anticoagulant thromboprophylaxis with low-molecular-weight heparins may prevent a severe course of the disease and improve outcomes. This applies to outpatients, hospitalized patients and patients in the early post hospital period. In the future, to develop comprehensive and evidence-based guidelines on the management of patients with COVID-19, it is necessary to conduct comprehensive systematic studies and comparative clinical trials of prophylaxis and treatment of hemostatic disorders in patients with COVID-19.

Aim. To assess the relationship between isolated and combined expression of pSTAT3, pACT1 in tumor cells with the survival of patients with diffuse large B-cell lymphoma (DLBCL).

Methods. The study included 100 patients with the first diagnosed diffuse large B-cell lymphoma, observed in the institute's clinic between 2010 and 2018 who received standard first-line R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy. The relative number of expressing pSTAT3 and pAKT1 ­tumor cells was determined by using immunohistochemical and morphometric methods. The optimal cut-off level of expression on tumor cells estimated by using receiver operating characteristic (ROC) curve analysis for pSTAT3 was 68% and for pACT1 — 70%. Given these values, all patients with DLBCL were divided into groups with a high and low degree of expression of the biomarkers. As a result, 53 patients were enrolled in the pSTAT3 high expression group (≥68% tumor cells) and 47 patients to the pSTAT3 low expression group (<68% tumor cells). Spearman’s correlation coefficient was used to examine relationships. Overall survival and event-free survival were estimated by Kaplan–Meier curves. The log-rank test was used for groups comparison.

Results. The five-year overall survival rate in the pSTAT3 high expression group was 55% versus 87% in the low expression group, p=0.015. A significant difference was found in the assessment of event-free survival: 43% for the group of pSTAT3 high expression, 66% for the group of low expression, p=0.011. A statistically significant value of a high level of pACT1 expression was revealed for 5-year overall and event-free survival (p <0.001 and p=0.003). Overall survival rate was 81% for the pACT1 low expression group and 43% for the high expression group while event-free survival rate was 64 and 41%, respectively. Also, patients with рАКТ1+/рSTAT3+ (high level) co-expression had extremely low rates of overall and event-free survival rates compared with the рАКТ1–/рSTAT3– (low ­level) group (p=0.001; p <0.001).

Conclusion. The pSTAT3 and pAKT1 biomarkers can be used as additional prognosis criteria for diffuse large B-cell lymphoma.

Aim. To assess the degree of fungal contamination and the species composition of the fungal microbiota of residential apartments in Kazan

Methods. A mycological study of 90 air samples and 60 samples from sites of fungal biodeterioration from the re­sidential buildings of Kazan was carried out using cultural and microscopic methods.

Results. The presence of micromycetes fungi were detected in 90% of air samples and 100% of samples from sites of biodeterioration. Higher fungal species diversity was noted in the sites, compared with air samples. Fungal concentrations in indoor air varied between 8 and 360 CFU/m³. Fungal community composition analysis of the sites of biodeterioration showed that the surfaces were more frequently contaminated by undemanding and capable of growth at different moisture levels fungal species (Penicillium spp., Aspergillus spp., Rhizopus stolonifer). The resulting fungal plaque can create conditions favorable for aggressive fungal species that actively damage materials (Chaetomium spp., Acremonium spp., Aureubasidium spp). Allergenic fungi, as well as potentially pathogenic and toxin-forming species, were widespread in the air that can be a health risk factor. A quantitative assessment of air mycobiota indicated the moderate level of fungal contamination.

Conclusion. The presence of potentially pathogenic, allergenic and biodegradable fungal species in the sites of biodeterioration has been confirmed, as well as the relationship between airborne fungal contamination and the spread of fungi in indoors, confirming the need to prevent fungal biodeterioration and control indoor air quality.

Aim. To assess the histomorphological state of lung, gastrointestinal and kidney tissues following exposure to ­copper-zinc-pyrite ore in the long-term model experiment.

Methods. The study was performed on 60 outbred albino male rats, aged 3–4 months, weighting 200±30 g. The ­toxic effect of heavy metal salts of copper-zinc-pyrite ore on the animal's body was analyzed by the model of dosed oral injection of water with ore in a dose 600 mg/kg body weight for 120 days. Pieces of the stomach, small and colon, liver, lungs and kidneys were taken from control and experimental rats for histomorphological study on the 30th, 60th, 90th and 120th day of the experiment.

Results. The structural disorders of the stomach lining were observed on the 30th day of the experiment: desquamated and dilapidated epithelial cells appeared in the preparations. On the 120th day, along with signs of epithe­lial desquamation and diffuse lymphocytic infiltration, the preparations contained large lymphoid follicles that occupy the full thickness of the gastric mucosa. The epithelial layer of the small intestine mucosa was disrupted on the 60th day. At day 120 diffuse infiltration and necrotic changes in the lining of the small intestine were recorded. Lymphomacrophagia infiltrations were observed during portal triad and inside the liver wedges of experimental ani­mals on the 30th day of the experiment. By the end of the experiment, toxic hepatocyte dystrophy developed. On the 60th day, signs of bronchopneumonia appeared in the lung tissue. After 3 months, tubulopathy and tubulointerstitial nephritis were observed in the experimental animals.

Conclusion. Prolonged administration of ore has led to pronounced inflammation and degenerative changes in the gastrointestinal tract, liver, kidney and lung tissues, accompanied by lymphocytic tissue reaction.

Duchenne muscular dystrophy (DMD) is an X-linked progressive disease from the group of primary myopathies caused by mutations in the DMD gene and a lack of dystrophin protein in the muscle fiber in males. The review considered the prevalence of pathology, the most common causes of dystrophinopathy, and the role of dystrophin not only in the functioning of muscles but also in the architectural organization of the Central nervous system. The disease classification based on stages and forms, initial clinical manifestations of the early and late stages of the disease, as well as neuropsychological, orthopedic, respiratory and cardiovascular disorders, are described in detail. The relevant to date diagnostic algorithm for suspected DMD, biochemical blood analysis, genetic, morphological (immunocytochemical staining of muscles with dystrophin antibodies) and instrumental (ultrasound, MRI) methods of examination are presented in detail. Particular attention in the diagnosis of DMD and objectification of disorders is given to assessment tests [Bailey’s and Griffiths scales, Albert's Test of Infant Posture and Motor Assessment Scale, Expanded Hammersmith Functional Motor Scale (HFMSE), the Gross Motor Function Measure (GMFM), and the 6-minute walk test (6MWT)]. The review presents the advantages and disadvantages of modern invasive and non-invasive diagnostic techniques of the disease, indicating their reliability and the possibility of application at early stages, including prenatal. In conclusion, the treatment of DMD and its most frequent complications, both widely used in practice and at the stage of clinical research, is highlighted. It was emphasized the importance of rehabilitation measures that improve the duration and quality of life of patients with DMD. The main task of analyzing available sources on the most pressing issues of Duchenne muscular dystrophy was to stimulate research and social activity in resolving unsolved problems today.

Aim. To assess the impact of the number of children in the family on breastfeeding duration and vaccination coverage.

Methods. 1724 mothers of 1-year old children were randomly chosen from seven children's polyclinics in St. Petersburg for an anonymous survey that was conducted by a specially designed form “Questionnaire of a mother of 1-year old children”. The questionnaire comprised of 20 open-ended and closed-ended questions, and included questions about: (1) timing of the attachment to the breast in obstetric hospitals; (2) causes and timing of breastfeeding abandonment; (3) presence or absence of vaccinations in the first year of life according to the National preventive vaccination schedule; (4) and reasons for mothers refusing to vaccinate their children.

Results. The proportion of mothers who started artificial feeding in maternity wards immediately after the birth of the baby was the smallest among women for whom this baby was the first-born (3.4%), and the largest among fami­lies with many children (11.3%). On average, mothers with one child are breastfed until 7.36±0.11 months, with two children until 8.29±0.11 months, with three or more children until 8.78±0.10 months. By using one-way analysis of variance (ANOVA), it was shown the effect of the number of children in the family on the duration of breastfee­ding (F=3.3). Correlation analysis revealed the negative relationship of the number of children in the family with the proportion of women who continued breastfeeding until 3 and 6 months (r_xy=–0.82 and r_xy=–0.88, respectively), and positive relationship with the proportion of mothers who continued to breastfeeding the baby after reaching a year (r_xy=0.89). 12.3% of children of one-child families were not vaccinated according to the National preventive vaccination schedule, 17.7% with two-child families, 28.1% in families with three or more children. It was revealed the significant cross-group effect of the number of children in the family to vaccination coverage (F=48.7). With an increase in the number of children in the family, vaccination coverage decreases, both in general (r_xy=–0.88) and against individual infections, including hepatitis B, diphtheria, whooping cough, tetanus, polio, measles and rubella (r_xy from –0.80 to –0.90).

Conclusion. The number of children in a family impacts mothers' refusals of breastfeeding and vaccination; the more children in a family, the more prolonged breastfeeding, but less vaccination coverage due to the health status of children in the first year of life.

Aim. To study the structure of psychosocial maladjustment in chemical workers and assess the contribution of industrial and non-industrial risk factors in the formation of mental illness.

Methods. It was analysed of hygienic assessment of the leading harmful production factors — chemical, physical, factors of severity and intensity of labor. During the periodic medical examination, the mental health status of 1,226 people was examined, with a focus on professional experience, mental hygiene aspects of production factors, as well as individual and personal characteristics of employees. Confidence intervals and standard errors estima­ting, the logistic regression models fitting were performed using R Statistical Software with significance level 0.05.

Results. The working environment hazards in organic synthesis included chemical risk factor, continuous noise exceeding the permissible exposure limit, emotional stress and life-threatening conditions (fire and explosion hazards in the work). The general assessment of working conditions was performed using clauses 5.1–5.11 P 2.2.2006-05-harmful working conditions of the second-third degree (3.2–3.3). Working conditions at all stages of the manufacturing process of pyroxylin powders were assessed as harmful to the third-fourth degree (3.3–3.4), including the chemical factor, the severity and intensity of work, fire and explosion hazards in the work. It was revealed the dependence of the development of psychosocial maladjustment on non-work-related factors (such as the level of education, marital status), conditional work-related factors (level of material security). Also, the dependence of the structure of pre-existing mental health condition on the work-related and developmental characteristics (work experience) of labor in chemical production was found.

Conclusion. Working conditions in the studied industries correspond to the 3rd harmful class, 2nd and 3rd degrees in the production of organic synthesis (3.2–3.3), while at the production of pyroxylic powders, it is close to dange­rous (3.3–3.4); the structure and risk of the developmental process of employee maladjustment are determined by the feature effect of workplace hazards.

A lethal complication of laryngopharynx injuries by foreign bodies is a rare phenomenon. Among foreign ­bodies are ingested together with food, fishbones are the most common. They can injure the mucous membrane of the larynx and pharynx due to the sharp edges, thereby causing inflammation, resulting in edema occurs, hyperemia and increased pain. Besides, foreign bodies can provoke complications such as bleeding, cervical phlegmon, subcutaneous emphysema, esophageal perforation, sepsis and others, which can lead to the death of patients. Howe­ver, due to timely diagnosis, according to the scientific literature, such cases are extremely rare. Because the visualization of foreign bodies in the area of the larynx is difficult (especially when localized in the pyriform sinuses), laryngoscopy is used for diagnosis. Moreover, in some cases, X-ray examination and computed tomography are indicated. The paper presents a clinical observation of a 57-year-old patient M., whose cause of death was a rare complication of laryngopharynx injuries with a fishbone. When the patient was admitted to the department, the basic clinical diagnosis was established: laryngopharyngeal injury complicated by right parapharyngeal abscess. The patient underwent antibacterial, infusion, anti-inflammatory and antihypertensive therapy. At 20 hours after hospital admission, the patient had an abrupt loss of consciousness and cardiac arrest, then death. Based on the clinical picture, it was concluded that pulmonary thromboembolism was the probable cause of death. The ­autopsy revealed injury of the right external jugular vein, as a result of which develop thrombophlebitis, and then pulmonary artery thromboembolism, which caused the patient's death. No similar clinical descriptions were found in the available scientific literature.

Aim. To improve the results of surgical treatment in patients with large lipomas by using the device for closing the edges of wounds, allowing local preventive hemostasis in the surgical wound area, to create optimal conditions for atraumatic suturing and thereby reduce the amount of intraoperative bleeding and subsequently reduce the amount of postoperative wound complications.

Methods. The results of treatment of 105 patients with different localization of large lipomas were analyzed. Lipomas ranged from 8.0 to 20 cm in diameter. All patients were divided into 2 groups: the control group consisted of 53 (50.5%) patients for which used the traditional technique of tumor excision with closing surgical wounds, and the study group with 52 (49.5%) patients, for which to reduce tissue damage during tumor removal and the edges of wound suturing, one of the device variants developed by us was used, approximation-distraction device. Fisher's exact test was used for the comparison of the outcomes rate, a p-value <0.05 was considered statistically significant.

Results. Surgical wound complications occurred in 7 (6.7%) of 105 patients. In the study group, surgical wound complications occurred in 1.9% (1 observation), in the control group 11.3% (6 observations). Surgical wound complications were severity grade I and grade IIIa. Complications of the first grade did not require a debridement and will regress on its own; in grade IIIa complications, an opening, excision and drainage surgical wounds were performed without general anesthesia.

Conclusion. Moderate local selective near-tumor tissue compression that occurs when the device branches come closer to each other accelerates spontaneous thrombus formation in damaged small vessels. This creates favorable conditions for the surgeon to work in a “dry” wound.

Aim. To determine the level of lipopolysaccharide-binding protein (LBP) in acute intestinal infection, depending on the etiology and severity of the disease, and the effect of interleukin (IL)-1β and IL-10 levels on the expression of LBP.

Methods. Serum samples of 62 patients were assayed by solid phase enzyme-linked immunosorbent assay using a set of reagents ELISA (USA) and Vector-best (Novosibirsk) for levels of LBР, IL-1β, IL-10. The first group inclu­ded 33 patients with bacterial intestinal infection, the second group consisted of 29 patients with viral diarrhea, and the control group comprised 20 conditionally healthy patients. Analyses were performed using Microsoft Excel 2010 and Statistica version 6.0 software. Statistical differences were determined by using the Mann–Whitney U Test, the p-value ≤0.05 were regarded as statistically significant. Spearman’s correlation coefficient was used to examine relationships. Shapiro–Wilk W test was used to check for normal distribution of the features.

Results. We detected the presence of LBP in all the studied groups, with the content of LBP was significantly increased in the group of bacterial intestinal infections compared with other groups. With regard to disease severity, LBP level was the highest for mild acute intestinal infections caused by bacteria, and for viral diarrhea, fluctuations in LBP did not exceed the norm. In intestinal infections caused by bacteria, the levels of LBP were directly related to the levels of IL-1β and IL-10.

Conclusion. Detection of LBP concentration can be used for the initial differential diagnosis of intestinal infections caused by bacteria, which would significantly narrow the diagnostic search and determine the tactics of etiotropic therapy; also, considering the relationship between the concentration of LBP and disease severity, this indicator can be used as a predictive sign of the course of the disease.

Aim. To assess the results of the integrated treatment of women with recurrent chronic cystitis using the selective β3-adrenoreceptor (AR) agonist, mirabegron.

Methods. The results of the treatment of women diagnosed with recurrent chronic cystitis in the urological cli­nic of KSMU were analyzed. The average age of patients was 31.5±3.4 years. To assess the effectiveness of integra­ted treatment, women with recurrent chronic cystitis were randomly divided into two groups: the first group (30 patients) who received antibiotic therapy in combination with the drug mirabegron at a dose of 50 mg once a day and the second (control) group (30 patients), who received antibiotic therapy taking into account their susceptibility. All patients underwent ultrasonography of the genitourinary system, urodynamic studies with assessment of the ma­ximum urinary flow, average urinary flow, bacterial urine cultures.

Results. Analysis of the research results showed a greater reduction in the number of urinations per day (up to 7 times) in the first group. The frequency of urinary urgency decreased in 82.6% of the first group patients compared to 64% of the second group (p <0.05). In the combination therapy versus control groups, there was reduced hospital stay by an average of 4 days (11.2 vs 15 days; p <0.05). On the 15th day of treatment, control cystoscopy revealed no changes in the bladder mucosa in all patients of the first group. Also, in the first group of patients, there was a greater improvement in urodynamic parameters compared to the control group (p <0.05).

Conclusion. The selective β3-AR agonist mirabegron used in the integrated treatment of recurrent chronic cystitis increases the effectiveness of the therapy.

Because of the 100th anniversary of Kazan State Medical Academy and obstetrical-gynecological hospital, this article present outstanding scientific achievements of the first head of the department, Professor A.I. Timofeev, who was an apprentice to professor V.S. Gruzdev. Historical and literature study of primary materials was used as the method of research. In April 2020, Kazan State Medical Academy (formerly the State Institute of Advanced Me­dical Training) celebrated its 100th anniversary. Organization of work of the gynecology-obstetrics department and hospital fell on the shoulders of Professor Alexander Ignatievich Timofeev, who was an apprentice to Professor V.S. Gruzdev. The article reflects three shining moments from his working life, which made the Kazan school of obstetricians and gynecologists famous. Throughout the 19th century, scientists were seeking to answer the question of corpus luteum originating: from the connective or epithelial tissues. Professor Gruzdev has suggested that the source needs to be granulosa cells. His student, Professor Timofeev, carefully performed histological preparations finally established in 1913 that granular cells are the genesis of the human corpus luteum originated, and bring these centennial scientific disputes to an end. In 1925, Professor Timofeev was the first in the USSR to perform surgery under local infiltration anesthesia in Kazan. His publication of the results of observation in 1928 was the beginning of the further study and implementation of local infiltration anesthesia by the method of Professor A.V. Vishnevsky (“creeping infiltration method”) in obstetrics and gynecology. For 30 years, this method of analgesia was dominant and gave way only with the development of anesthesiology and resuscitation. In 1928, he, together with professor Gruzdev, report on cesarean section at the 8th All-Union Congress of Obstetricians and Gynecologists “laid the foundation” for a wider study of Caesarean section in the USSR, the result of which was genera­lized in 1979. International recognition of the epithelial nature of the corpus luteum alone deserves a monument; the school of Kazan doctors of obstetrician-gynecologists honors the memory of the outstanding apprentice to professor V.S. Gruzdev — A.I. Timofeev.

The article was prepared for the 100th anniversary of the Department of Microbiology named after academician V.M. Aristovsky of Kazan state medical university and the 120th anniversary of the Kazan Scientific research institute of epidemiology and microbiology. The paper presents the main stages of the general history of the Department of Microbiology of KSMU and the Kazan bacteriological institute (later — KNIIEM), highlights the formation of the Kazan school of microbiologists, provides brief biographical information of employees of the Department of Microbiology, whose activities were also associated with KNIIEM. The article was prepared using primary sour­ces: publications, the recollections of the employees of the Department of Microbiology and KNIIEM, documents from the archives of KSMU and KNIIEM, as well as the National archives of the Republic of Tatarstan, publications of the colleagues of the Department of Microbiology Military medical Academy and Stavropol state medical university. The main scientific achievements of representatives of the Kazan school of microbiologists, their scientific contribution to the development of microbiology and the current state of educational and scientific work of the department are described.

Эта Специальная коллекция, разработанная в сотрудничестве с группой Кокрейновских обзоров, объединяет Кокрейновские обзоры, обобщающие доказательства о поддержании здоровья и благополучия при работе из дома в связи с пандемией COVID-19. Она включает систематические обзоры, оценивающие воздействие вмешательств, связанных с поддержанием физической активности, оптимизацией рабочей среды и предотвращением проблем с опорно-двигательным аппаратом и глазами.

Почему время, проведённое на работе в положении сидя, так важно? Время, проводимое в положении сидя, и отсутствие физической активности на работе в последние десятилетия увеличились. Длительные периоды сидения увеличивают риск развития ожирения, сердечно‐сосудистых заболеваний и преждевременной смерти. Неясно, являются ли вмешательства, направленные на снижение времени, проведённого на работе в положении сидя, эффективными.