Vol 96, No 1 (2015)

Theoretical and clinical medicine
Postpartum endometritis prevention in abdominal delivery planning in pregnant with severe anaerobic vaginal dysbiosis
Voronin K.V., Alale A.M., Alale I.I., Banakhevich R.M.

Aim. Prevention of purulent and septic complications in females after planned caesarean section.

Methods. Out of 60 pregnant women, who underwent comprehensive examination during the trial, 35 (58.3%) were included in the study group and were delivered off by planned cesarean section; 25 (41.7%) pregnant women, included in the control group, were delivered off by urgent cesarean section. Considering the goal of the study, bacteriology of vaginal discharge, amniotic fluid and placental tissues, DNA detection of vaginal discharge bacterial flora before and after treatment (using «Femoflor-16» test system) according to classification by M.N. Boldyreva (2010), uterine cavity aspirate cytology according to classification by M.A. Kupert (2003), sonography of the uterus and uterine adnexa on the 4-5 day after the surgery according to classification of A.P. Milovanov were added to the training program for pregnant women. In the study group, pregnant patients with severe anaerobic vaginal dysbiosis at the 36-38 weeks of gestation were administered causal treatment of severe anaerobic vaginal dysbiosis, pregnant patients of the control group were not treated if severe anaerobic vaginal dysbiosis was diagnosed.

Results. Performed correction of vaginal microbiota in the study group has significantly improved the course of postoperative period, reduced the incidence of uterine subinvolution, signs of chorioamnionitis as a manifestation of ascending infection compared to the control group. Postpartum endometritis has developed in 1 (2.8%) patient of the study group and in 5 (20.0%) cases in the control group. Offered method for preparing the patients with vaginal dysbiosis to cesarean section reduced the risk for postpartum endometritis by 6.8 times.

Conclusion. Strategy of preparation for planned Caesarean section should include vaginal discharge bacteriology and treatment of severe anaerobic vaginal dysbiosis, which reduces the risk for postpartum endometritis by 6.8 times.

Kazan medical journal. 2015;96(1):5-9
Features during labor in women with chronic hepatitis B
Shoonaeva N.D.

Aim. To examine the course of labor in women with chronic hepatitis B.

Methods. The course of labor was studied in 391 female patients with chronic viral hepatitis B, included in the study group (mean age 22.7±2.5 years), who delivered off in the National Maternity Hospital (Bishkek). The control group included 59 healthy women in labor (mean age 22.5±1.3 years).

Results. The vast majority of patients - 53 (89.8%) of the control group and 328 (83.9%) of the study group - had delivered off at term. Post-term births were registered in both groups. Operative delivery by cesarean section was performed in 13.0% of chronic viral hepatitis B cases - by 4.5% higher compared to control group. In the study group, planned cesarean section was performed in 21 (5.4%) patients, the main indication was burdened obstetric history - in 8 (2.0%) patients; 5 (1.3%) patients had multiple indications. Emergency operations were conducted in 30 (7.7%) patients. Indications were premature rupture of membranes - 15 (3.8%) of cases, fetal hypoxia during labor and multiple indications - 10 (2.6%) cases each. The average blood loss at cesarean section in the group of patients with chronic viral hepatitis B was 870±15.2 ml, compared to 700±10.2 ml in the control group, which can be associated with low coagulation seen in hepatitis. Comparative analysis of the complications rate in the control group revealed that delayed rupture of membranes was the most frequent - 11 (18.6%) cases, followed by intrauterine fetal hypoxia - 5 (8.5%) cases, early postpartum bleeding - 4 (6.8%) cases, hypertensive disorders at labor and retained placenta - 3 (5.1%) cases each. In the group with chronic viral hepatitis B, premature rupture of membranes occurred in 51.5% of cases, (relative risk 2.8). Early postpartum bleedings were seen in 38.9% of the cases at the main group (relative risk 5.7).

Conclusion. The above data gives us every reason to include women with chronic viral hepatitis B at high-risk group for possible bad pregnancy and childbirth outcomes both for the mother and the fetus.

Kazan medical journal. 2015;96(1):10-12
Pulmonary embolism prevention in out-patients with malignancies during the first year of follow-up
Khasanov R.S., Kamalov I.A.

Aim. To decrease the one-year mortality rate in out-patients with malignancies undergoing periodic health examination.

Methods. The study included 270 patients, who were examined and followed up. The main group included 140 patients, who monthly underwent ultrasonography of inferior vena cava branches during the first year of follow-up. The control group included 130 patients, in whom ultrasonography of inferior vena cava branches was performed only if clinical manifestations of venous thrombosis were registered.

Results. Venous thrombosis was diagnosed in 35 patients of the main group, including 21 cases of venous thrombosis at very high risk for embolism. In control group, ultrasonography of inferior vena cava branches was performed in 13 patients who developed clinical manifestations of venous thromboembolic events, in whom 6 patients were diagnosed with deep vein thrombosis of the lower limbs, in 3 patients venous thrombosis was assessed as at very high risk for embolism. In 24 patients (21 in the main group and 3 in the control group), targeted measures to prevent pulmonary embolism were administered, including cava filter implantation, vein ligation above the venous thrombosis at very high risk for embolism site, and crossectomy. The rest of the patients were administered conservative prevention of thromboembolism. In the main group, no deaths associated with pulmonary embolism were registered. In the control group, 19 patients died due to developing pulmonary embolism.

Conclusion. Preventive measures for pulmonary embolism, selected according to the results of timely ultrasound diagnosis of venous thrombosis, may reduce the one-year mortality rate in patients with cancer.

Kazan medical journal. 2015;96(1):13-16
Diagnostic imaging techniques in staging of peripheral non-small cell lung cancer spreading
Laryukov A.V., Laryukova E.K.

Aim. To develop a personalized approach for using radiologic and nuclear examination methods diagnostics to improve early diagnosis of bone and brain metastases in patients with peripheral non-small cell lung cancer.

Methods. The first group included 1473 patients with peripheral non-small cell lung cancer, who underwent chest X-ray, abdominal and pelvic ultrasonography, bone scintigraphy, and chest, abdominal and pelvic X-ray computed tomography with intravenous contrast from 2006 to 2010 for diagnosing remote metastases. The second group included 55 patients with peripheral non-small cell lung cancer, who underwent comprehensive examination of the full skeleton using X-ray computed tomography and magnetic resonance imaging, single-photon emission computed tomography, positron-emission tomography. The results of brain magnetic resonance imaging in 40 patients (group 3) with peripheral small cell lung cancer with brain metastases were also analyzed.

Results.In peripheral non-small cell lung cancer, bone (23.9%) and brain (14%) metastases were the most frequent. The risk for bone metastases was significantly higher in patients with adenocarcinoma (p

Conclusion. For timely diagnosis of bone metastases, it is reasonable to administer positron-emission tomography with Fludeoxyglucose (18F) to all potentially resectable patients with peripheral small cell lung cancer, which in addition reveals metastases in other body regions. Brain magnetic resonance imaging should be administered if the primary tumor was detected.

Kazan medical journal. 2015;96(1):16-21
Staged treatment strategy in patients with acute abdomen
Polenok P.V.

Aim. To reason the strategy of staged surgical treatment in patients with acute abdomen.

Methods. The study included 72 patients, of them 32 were included in the main group, in which the staged surgical treatment strategy was implemented. To assess the effect of such approach, control group including 40 patients who were treated using the early total care strategy, was formed retrospectively. The decision on the certain strategy use (early total care strategy or staged treatment strategy («aborted operation») was made in every included patient by operating surgeon during the operation.

Results. The modern method of surgical treatment («aborted operation» strategy) was introduced into the clinical practice for treating acute surgical abdominal diseases. A new method for patient’s condition severity assessment and operative risk prognosis based on the physical signs, as well as the scale of the indications for the «aborted operation» approach were developed. An original method for laparotomy wound closure was proposed. Device for laparostomy consists of two details - frame, which is stitched to the edges of surgical wound, and replaceable cap, which can be fixed to the frame. The device is made of soft elastic organic material, which is transparent and non-reactive. The key advantage of the device is the transparency of the cap material, allowing to review the condition of abdominal organs at any moment after the surgery without additional analgesia. The device act as a «viewport», allowing to clearly visualize the changes of abdominal organs, to diagnose the possible complications and to timely recognize the indications for programmed abdominal cavity debridement. The mortality in the control group was 100%, in the intervention group - 59%.

Conclusion. Staged treatment strategy may significantly reduce the postoperative mortality, being an alternative to standard tactical and technical approaches used in emergency abdominal surgery.

Kazan medical journal. 2015;96(1):22-27
Clinical features of chronic hepatitis C and efficacy of antiviral treatment in Caucasian and Mongoloid patients
Malov S.I., Dulguun B., Malov I.V., Stepanenko L.A., Miroshnichenko I.A., Nymadawa P.

Aim. To present the comparative clinical characteristics of chronic hepatitis C infection and to estimate the effect of antiviral treatment in Caucasian and Mongoloid patients, considering interleukin-28B gene polymorphism in study populations.

Methods. Population and genetic study including 1520 healthy subjects and 267 patients with chronic viral hepatitis of Caucasian and Mongoloid race analyzed interleukin-28B gene polymorphism. 433 patients with chronic viral hepatitis C were followed up. Combined antiviral treatment by pegylated interferon alfa-2a and ribavirin was administered for 48 weeks. The rates of early and sustained virologic response were the endpoints for assessing antiviral treatment effect. 82 Caucasian patients and 42 Mongoloid patients have completed the full course of antiviral treatment and 24 weeks of follow-up.

Results. The following clinical features of chronic hepatitis C were revealed in Mongoloids: more extensive liver fibrosis, older age, longer infection duration and higher total cholesterol levels (due to triglycerides). These factors negate the expected better effect of antiviral therapy effect, associated with higher prevalence of interleukin-28B favorable genotypes in Mongolian population. The presence of the C-allele of rs12979860 gene and T-allele of rs8099917 gene reaches 89.6 and 91.7% respectively in Mongolian population, which is comparable with those in China, Japan and Korea, and is typical for the whole of Asia. Combined treatment with pegylated interferon alfa-2a and ribavirin in patients with genotype 1 of hepatitis C virus led to sustained virologic response in 78.5% of Mongoloid and in 56.1% of Caucasian patients; groups were totally comparable.

Conclusion. Mongoloid patients with chronic hepatitis C reached sustained virologic response to antiviral treatment with pegylated interferon and ribavirin significantly more frequently compared to Caucasians, in cases of no aggravating factors and minimal liver fibrosis.

Kazan medical journal. 2015;96(1):27-32
Effects of moxonidine and combination of moxonidine and ivabradine on insulin resistance in patients with metabolic syndrome
Azimova M.N., Bakhshaliev A.B., Kakhramanova S.M., Dadashova G.M.

Aim. To explore the features of insulin resistance variations in overweight and obese patients with metabolic syndrome treated with moxonidine and combination of moxonidine and ivabradine.

Methods. The study included 30 patients with metabolic syndrome, who were overweight (body mass index 26.9±0.2 kg/m2) and 30 patients with metabolic syndrome and obesity (BMI 34.2±0.3). Control group included 17 healthy volunteers matched with patients by age and sex. Patients with metabolic syndrome and excessive body weight received moxonidine twice daily in average daily dose of 0.58±0.07 mg. Patients with metabolic syndrome and obesity received moxonidine twice daily in average daily dose of 0.52±0.04 mg and ivabradine twice daily in average daily dose of 13.7±1.1 mg. Biochemical blood tests (insulin, C-peptide, glucose, glycated hemoglobin serum levels) were performed in all patients.

Results.Patients with metabolic syndrome and obesity tended to increase insulin resistance, compared to individuals with metabolic syndrome and excessive body weight. In overweight patients with metabolic syndrome treated with moxonidine, a trend for lower insulin resistance, accompanied by a decrease of insulin, C-peptide, glycosylated hemoglobin, glucose levels and homeostasis model assessment-estimated insulin resistance (HOMA-IR) index by 7.1, 2.0, 5.0, 7.3 and 12.2% respectively was discovered. Combination therapy with moxonidine and ivabradine in patients with metabolic syndrome and obesity leaded to a statistically significant improvement of insulin resistance, accompanied by a decrease of insulin levels, glucose, C-peptide, and glycated hemoglobin by 16.7%, 12.3% (p

Conclusion. In patients with metabolic syndrome, deepening of insulin resistance on the background of increased sympathetic activity is associated with higher grades of obesity. Combination therapy with moxonidine and ivabradine in patients with metabolic syndrome and obesity leads to a significant improvement in insulin resistance due to the additional sympatholytic effect.

Kazan medical journal. 2015;96(1):32-37
Current clinical features and treatment of acute enteric infections in children
Shadzhalilova M.S.

Aim. To study the current clinical manifestations and treatment of acute enteric infections in children at an early age.

Methods. 225 in the age of 4 months to 3 years were followed-up. Clinical presentations and clinical current of the disease, as well as features and type of gastrointestinal system damage and treatment effects were registered in specially developed report forms. Bacterioloicy, microbiologic, immunologic and genetic tests were used to determine the causative factor of the acute enteric infections. Principal component analysis was used for mathematical modelling and factorial analysis. The optimal number of isolated factors was determined using Kaiser criterion, Scree-test and the completeness of the factorization.

Results. The clinical picture of acute enteric infections was quite severe in all children. The disease had a typical clinical current, with relapses registered in 63 (28.0%) patients. Gastroenterocolitis was the most frequent clinical form of the disease, with prevalence of moderately severe cases (167 children, 74.2%). Severe enteric infections were seen in 58 children (25.8%) who developed acute toxemia and stage III dehydration. All children (100%) had comorbidities. Causative factor was determined in 77.6% of patients. It should be considered that acute enteric infection and its treatment using antibiotics in 100% of cases leaded to enteric dysbiosis and may be a reason of antibiotic-associated diarrhea caused by Clostridium difficile.

Conclusion. Fever duration, pain intensity, level of Escherichia coli with normal enzyme activity, causative factor and opportunistic pathogenic microbiota were the strongest factors influencing the baseline condition of children with acute enteric infections. The most effective treatment choice was gentamicin, in cases of moderate and severe cases - ceftriaxone.

Kazan medical journal. 2015;96(1):37-42
Endoscopic and morphological features of chronic subatrophic gastroduodenitis in children
Nikiforova E.M., Malyuzhinskaya N.V., Chueva M.A., Alferova V.V., Solov’ev E.N.

Aim. To identify the pecularities of clinical, functional features and morphological characteristics in children with subatrophic gastroduodenitis after eradication treatment.

Methods. Gastrointestinal tract condition was examined in 26 children with subatrophic gastroduodenitis. Esophagogastroduodenoscopy with morphological analysis of biopsy specimens, esophageal pH test and urea breath test were performed.

Results. 16 (60.7%) children reported low-grade pain, severe pain occurred in 3 (11.5%) patients, no abdominal pain was reported in 7 (27.6%) patients. A biopsy specimen was gained in 22 patients; moderate contamination with H. pylori was detected in 13 (59%) patients, severe - in 9 (41%) patients. Breath test was positive in all patients (n=26). Morphological study revealed fibrotic changes in 14 (63.6%) patients, atrophy and sclerosis lesions - in 7 (31.8%) and 17 (77.3%) patients, respectively, in addition to clear signs of inflammation. Intestinal metaplasia of the gastric mucosa was discovered in 4 (18.2%) children. Candidiasis of the stomach and duodenum was diagnosed in 7 (31.8%) children. All patients were administered standard eradication treatment. Repeated breath test after 4 weeks was positive in 9 (41%) patients, including 7 (31.8%) who were diagnosed with candidiasis by biopsy test. At 12 months, the control endoscopy performed in 19 patients: 5 patients, who failed to follow the recommendation, had marked clinical and endoscopic signs of relapse, no patients with good treatment compliance (n=14, 73.6%) had any clinical manifestations, although endoscopic signs of inflammation preserved in 9 (47.4%) children. Biopsy with histological examination was repeated in 9 patients. Signs of inflammation were significantly reduced in 6 (66.7%) patients, while the foci of atrophy, sclerosis and intestinal metaplasia retained in 2 out of 9 children. Contamination with H. pylori had significantly decreased.

Conclusion. Endoscopic signs of gastroduodenal chronic inflammation correspond to the severity of morphological characteristics in the acute stage of gastroduodenitis. Children with preserved signs of intestinal metaplasia of gastric and duodenal mucosa require intensive treatment and prolonged follow-up.

Kazan medical journal. 2015;96(1):42-45
Evaluation of systemic circulation at laparoscopic surgery for ectopic pregnancy
Lyapakhin A.B., Mazitova M.I.

Aim. To study the effect of tension carboxyperitoneum on central circulatory parameters of patients undergoing laparoscopy.

Methods. Vascular wall condition, linear blood flow velocity, pulse wave velocity, vascular wall rigidity, general and specific peripheral resistance (by the method of volumetric compression oscillometry) were evaluated. The study included patients with tubal pregnancy undergoing endovideosurgery. In the first group, 76 patients, the operation was performed without introducing carbon dioxide into the abdominal cavity; operational volume has been created using the original retractor of the anterior abdominal wall. In the second group (67 patients), classical technique of laparoscopic surgery with the use of carboxyperitoneum was applied. Measurements of systemic circulatory parameters were performed in patients twice - in the group where no gas was used - before and 15 minutes after introducing laparoscopic devices, in the group of carboxyperitoneum - before and 15 minutes after carbon dioxide introduction.

Results. The changes of systemic circulatory parameters were non-significant in patients of the first group and did not lead to statistically significant changes of mean, lateral and systolic blood pressure. Endovideosurgery using carboxyperitoneum lead to systemic circulatory disorders: blood pressure instability, increased cardiac output and index, decreased total peripheral vascular resistance, and the actual and specific peripheral resistance, as well as linear flow velocity and vascular rigidity.

Conclusion. Laparoscopic surgery using carbon dioxide are associated with the vessel compression and increased heart load, clinically manifesting as blood pressure disorders.

Kazan medical journal. 2015;96(1):45-49
Experimental medicine
Adrenergic mechanisms of myocardium contractility regulation in genetic model of Alzheimer’s disease
Leushina A.V., Nurullin L.F., Petukhova E.O., Zefirov A.L., Mukhamedyarov M.A.

Aim. Study is aimed to investigate contractility impairments and receptor mechanisms of adrenergic regulation of myocardium inotropic function in Alzheimer’s disease model on transgenic mice.

Methods. Experiments were performed on isolated preparations of atria and ventricles myocardium of mice. Transgenic mice of B6C3-Tg(APP695)85Dbo Tg(PSENI)85Dbo genotype were used as animal model of Alzheimer’s disease. Contractile responses of myocardium were registered by conventional myographic technique in isometric conditions. To evaluate the expression of adrenergic receptors, immunofluorescence staining of myocardium with specific antibodies was performed.

Results. Transgenic mice showed not only a decreased effect of norepinephrine on myocardium inotropic function but also the inversion of the effect of norepinephrine - the use of 10-5-10-4 M of norepinephrine decreased myocardium inotropic function. Immunofluorescent staining showed decrease of expression of β1- and especially β2-adrenergic receptors ventricular myocardium of transgenic mice comparing to wild type mice. Adrenergic deregulation was registered in ventricles, but not in atria. The features of adrenergic regulatory mechanisms of myocardial contractility in transgenic APP/PS1 mice aged 8-10 months are specific, although somewhat similar to wild type mice aged 8-10 months, and are evidently due to Alzheimer’s disease. The inversion of norepinephrine inotropic effect (from positive to negative) may be explained by switching the intracellular cascade pathway of β2-adrenergic receptors effects to another type of G-protein.

Conclusion. The results indicate that peripheral adrenergic mechanisms of myocardial contractility regulation are impaired in studied transgenic mice model of Alzheimer’s disease. Obtained data widen our understanding of Alzheimer’s disease pathogenesis, as well as our conception of relations between cardiovascular diseases and neurodegeneration.

Kazan medical journal. 2015;96(1):50-55
Effect of benzimidazole derivative containing dioxonium ethane cycle on the outcomes of emotional stress induced by physical overload in animals
Kataev A.V., Gizatullin T.R.

Aim. To study the outcomes of emotional stress induced by physical overload, and to assess the effects of benzimidazole derivative containing dioxonium ethane cycle of 2-[1-(1,1-dioxyethenyl 3) benzimidazolyl-2-thio] acetic acid potassium salt.

Methods. Behavioral responses were studied in experimental animals getting graduated physical exercise (swimming test) which was used as a model for physical and emotional stress. White scrub rats with a body weight of 120-180 g were used as research object. Physical overload was induced by making animals swim 30 minutes daily for 28 days. Animals were distributed into three groups of 10 animals each: the control group, the group of physical activity, and the group of physical activity exposed to the studied substance (50 mg/kg).

Results. Animals exposed to physical activity showed an increase in adrenal glands weight white blood cell count and reduced the mobility ratio and the overall research activity, as well as increased emotional anxiety, indicating stress. Benzimidazole derivative showed to be effective controller of chronic stress. Physical activity in animals exposed to study substance did not lead to an increase of white blood cell count and adrenal glands weight. Animals exposed to study substance increased mobility ratio and the overall research activity by 1.5 times, and the rate of emotional anxiety in animals has decreased by 2 times compared to the group that was exposed to physical activity without benzimidazole derivative administration. Free radical oxidation processes were more intense in brain homogenates of animals after physical activity, which was seen as increased levels of reactants interacting with thiobarbituric acid and decreased total antioxidant activity. In animals exposed to study substance, these indicators increased compared to animals exposed physical activity without administration of study substance, and were comparable to controls.

Conclusion. The use of the study substance prevents the negative effects of emotional stress and physical overload.

Kazan medical journal. 2015;96(1):56-60
Ischemic and nonischemic manifestations of antiphospholipid syndrome
Tukhfatullina S.I., Gaynetdinova D.D.
Hypercoagulability syndrome is an actual multidisciplinary problem of the last decade. Blood clotting disorders leading to hypercoagulability syndrome may manifest as different diseases in neurology, obstetrics, rheumatology, surgery, including diseases of pregnancy. Antiphospholipid syndrome is the most common form of hypercoagulability syndrome, which often develops at a young age, in children and even infants, with female-male ratio of 5. Causes and pathogenesis of antiphospholipid syndrome are not fully clear. This problem is especially important for pregnant women. Almost a third of refractory pregnancy losses are associated with antiphospholipid antibodies formation. Main manifestations of this condition include thrombotic events during pregnancy and the postpartum period, including cerebral pathology in both mother and child. Central nervous system damage in this condition may have both ischemic (cerebrovascular accident) and nonischemic (primary immune-mediated damage of the nervous system) genesis. The variety of neurological disorders associated with antiphospholipid syndrome is very wide, from cerebrovascular disorders, migraine and migrainous headaches to chorea and seizures. Headaches are the most common reason for pregnant women to seek neurologic help. Pregnancy associated with high titers of antiphospholipid antibodies often end as early gestation stage stillbirth. Children born to mothers with antiphospholipid syndrome in 20% of cases develop neurological symptoms of ischemic and non-ischemic origin. Thus, antiphospholipid syndrome requires special attention for early and timely diagnosis, especially in women planning pregnancy and in pregnant women for the preventing serious complications, both in mother and fetus.
Kazan medical journal. 2015;96(1):61-69
Diabetic macular edema. Epidemiology, pathogenesis, diagnosis, clinical features, treatment
Amirov A.N., Abdulaeva E.A., Minkhuzina E.L.
The article reviews domestic and international publications addressing the features of spectral optic coherence tomography in patients with diabetes mellitus and diabetic macular edema. Modern concepts of pathogenesis, epidemiology, diagnostic techniques and treatment of diabetic macular edema are described. Diabetes mellitus is one of the World’s most important medical and social problems. The significance of the problem is due to the prevalence of diabetes. The incidence is increasing annually in all countries, and the catastrophic positive trend can be treated as non-infective epidemics. Diabetic retinopathy is considered as one of the most severe specific eye diseases in diabetes. Despite significant advances and new directions of medical and surgical treatment in the last years, macular edema is the most common cause of central visual acuity reduction in diabetes. The most common and informative method of diagnosis of diabetic macular edema is optical coherence tomography. This non-invasive and precise method, allowing to obtain an cross section images of studied tissues in vivo, to estimate the thickness of the retina in micrometers, the volume in cubic millimeters and its structure. Introduction of this method induced revolutionary changes in the diagnosis and treatment of diabetic retinopathy. Treatment of diabetic macular edema requires compensating the set of biological and pathophysiological local and systemic changes in the eye, occurring in diabetes. Currently treatments for diabetic retinopathy include laser surgery, surgical techniques (vitrectomy), intravitreal injections of corticosteroids and anti-vascular endothelial growth factor medications. Despite the results achieved it diagnosis and treatment of diabetic macular edema, these questions require further research.
Kazan medical journal. 2015;96(1):70-76
Polycystic ovary syndrome - modern concepts
Azizova M.E.
The article reviews current concepts of etiology and pathogenesis of polycystic ovary syndrome. Currently, numerous forms of the syndrome, manifesting by a variety of clinical, morphologic signs and features of endocrine profile, exist. It was revealed that polycystic ovary syndrome is a multifactorial, genetically determined disease. Laboratory diagnosis in females with polycystic ovary syndrome is based on measuring concentrations of hormones. Results of ovarian sonography are of a great importance, allowing to diagnose polycystic ovary syndrome. Another method of instrumental diagnosis is laparoscopy, revealing two-sided growth ovarian hypertrophy and multiple subcapsular cysts. Ovarian capsule looks thickened, smooth, with a marked vascular pattern. Treatment depends on the clinical features and intensity of symptoms, as well as on patient’s interest in pregnancy. The choice of treatment options should be supported by clinical and laboratory data, considering pathogenetic type of the disease. The treatment of polycystic ovary syndrome includes conservative and surgical approaches. The main targets of drug treatment is the cessation of clinical and metabolic symptoms of the disease, decreasing the symptoms of virilescence, restoring the menstrual cycle and ovulation induction. Indication for surgical treatment is non-efficiency of drug treatment in restoring fertility. Thereby, multiple factors determining clinical symptoms and morphologic changes in ovaries, including central mechanisms of pituitary gland gonadotropic function, local ovarian factors, extraovarial endocrine and metabolic disorders, participate in pathogenesis of polycystic ovary syndrome. The early initiation of treatment in patients with polycystic ovary syndrome may preserve the fertility, as well as prevent hyper- and neoplastic diseases of endothelium, and the syndrome’s late complications.
Kazan medical journal. 2015;96(1):77-80
The role of IL-36γ/IL-1F9 in developing erythroderma in patients with psoriasis
Zaslavskiy D.V., Chuprov I.N., Sydikov A.A., Ibragimov K.U., Wolkenstein P., Skrek S.V., Nasyrov R.A.
Erythroderma is the term used for naming any inflammatory skin disease affecting over 90% of cutaneous surface. Numerous etiologic factors may background erythroderma; however, this condition is most often associated with such underlying diseases as eczema, drug hypersensitivity syndrome, cutaneous epidermotropic lymphoma, photosensitization. Being the most severe clinical form of psoriasis, psoriatic erythroderma may be a life hazard in patients with psoriasis, requiring admission and systemic treatment. The paper reviews modern data on psoriasis and psoriatic erythroderma pathogenesis. The biological role of IL-36γ/IL-1F9 - novel specific marker of psoriasis - is described in detail. Data of researches of this marker in different forms of inflammatory skin disease are discussed. Unlike other earlier described markers of psoriasis, for example, S100 A7, A8, A9 proteins, IL-36γ was highly specific to psoriasis, and rarely found at other inflammatory skin diseases (atopic dermatitis, contact dermatitis). The role of IL-36γ in diagnosing erythroderma in patients with psoriasis is described. The most specific and promising marker for distinguishing psoriatic erythroderma from other forms of erythroderma, IL-36γ can be detected at early stages of the disease, allowing to administer early causative treatment, improving treatment effect and preventing complications.
Kazan medical journal. 2015;96(1):80-84
Biologic activity of humic substances from peat and sapropel
Kitapova R.R., Ziganshin A.U.
The article reviews papers researching the biologic activity of peat and sapropel-derived humic substances, published by domestic and foreign authors. Peat is an accumulation of mainly partially decayed vegetation decomposed by microorganisms, found at mires. Sapropel is natural organic minerals that are derived from freshwater body sediment and formed by decayed vegetation and animal residues, minerals of biochemical and chemical origin and mineral components. Humic substances are a specific group of macromolecular substances derived from peat and sapropel as a result of vegetation and animal residues deterioration. It was found that drugs based on humic substances have the broadest spectrum of biological properties that are already widely used in veterinary medicine and can be used in various spheres of medicine. In particular, medications containing humic substances affect the nonspecific and specific resistance of the organism, show antioxidant, anti-inflammatory, antiviral, antibacterial, antifungal, membranotropic, hepatoprotective properties, have the ability to enhance the metabolic processes activity in the body. Sodium humate stimulates the tumor regression, helps to prevent serotonin ulcers, increases the body’s resistance to hypoxic conditions. Humic substances are do not have any toxic, teratogenic, embryotoxic and carcinogenic properties, while at the same time they are able to positively influence the health status of animals, increasing their productivity. Positive effect of humic substances on plant adaptation to ionizing radiation and pesticides was shown. Plenty of research and favorable results provides a basis for the development of a new direction in pharmacy and pharmacology related to the creation of new domestic products based on peat and sapropel.
Kazan medical journal. 2015;96(1):84-89
Healthcare mangement
Current problems of surveying sanitary and epidemiological well-being at public events with international participation
Patyashina M.A., Balabanova L.A.
Providing public sanitary and epidemiological welfare while preparing and holding public events with international participation is one of the prime tasks in ensuring state security. When large numbers of participants, officials and guests from different countries of the world arrive for public events, these conditions are always associated with increased epidemiological risks because of increased load on sanitary infrastructure of public event places and transient increase in population density in a limited area. Preparation and holding of public events are held at regional and international levels and requires the coordination of different sides and agencies of the host country, as well as interaction with other countries and international organizations. The system of measures on ensuring sanitary and epidemiological welfare of the population on the territory of our country includes the system of epidemiological surveillance and control (monitoring and analysis), safety environment monitoring, measures for sanitary-epidemiological emergency localization and containment. The problem of providing population sanitary and epidemiological welfare is divided into the following scientific areas: territorial sanitary surveillance, epidemiological surveillance of natural foci of zoonotic and other infectious diseases; sanitary-epidemiological emergency prevention and containment, arising both independently and because of natural and anthropogenic disasters. The XXVII Summer Universiade (2013, Kazan), XXII Olympic Winter Games and XI Paralympic Winter Games (2014, Sochi) highlighted the readiness of the services responsible for providing public sanitary and epidemiological welfare for conducting major sporting events. Further studying of international experience of holding international public events, its summarizing seems an important task for developing scientific rationale and better management for providing public sanitary and epidemiological welfare.
Kazan medical journal. 2015;96(1):90-95
Assessing management and quality of outpatient care for economically active population
Chirkov V.A., Serov D.V., Breusov A.V.

Aim. To evaluate the management and quality of healthcare provided by outpatient clinics of two Moscow administrative districts to economically active population in the period of 2009-2013.

Methods.937 medical charts of outpatients [518 (55.3%) males, 419 (44.7%) females, mean age 39.4±4.2 years] were processed using a specially designed registration form, based on the use of the Delphi method and medical care quality integrated index calculation. Data were processed in accordance with existing procedures for managing and conducting complex studies on social and health care and public health. Parametric and non-parametric statistics was applied. The null hypothesis was rejected in all cases if the chance for alpha-error was lower than significance level of 5% (p

Results. It was found that, despite the rather high level of medical care quality integrated index (0.87±0.04 points), there are preventable problems, such as no clear documentation of medical administrations (34.5% of cases), overdiagnosis (62%), sub-optimal administration of diagnostic tests (29.1%). In some cases, preventive measures were not administered, or administration did not comply with standards; no active follow-up to evaluate the treatment effect was scheduled. As a result, the predicted treatment outcome was only achieved in 42.4% of cases.

Conclusion. The prevention of the malpractices revealed requires systematic administrative procedures targeted at complying the requirements of the approved healthcare standards. The introduction of institutional standard protocols for patient management is also of great importance.

Kazan medical journal. 2015;96(1):96-99
Efficiency analysis of the early years of the first level trauma center in the Chelyabinsk region
Shishkin E.V.
Aim. To assess the efficiency of first level trauma center on the base of «Chelyabinsk Regional Hospital». Methods. The data were copied out from the medical charts of road accidents victims. The majority of patients who were admitted to the first level trauma center are young people of reproductive and working age, mostly males. In most of the cases, patients suffered from combined injuries involving multiple body regions (T00-T07). Results. Admission in every fourth patient of the trauma center was inappropriate, as patients had isolated injury not accompanied by shock. In 26.8% of the studied group, no surgery was performed, also stressing inappropriate admission. Spinal and brain injuries requiring neurosurgical aid were detected only in 36.8% of cases. The analysis showed miscommunication between trauma centers of levels I and II. Significant violations of road traffic accidents victims’ hospitalization orders, as well as the presence of inappropriate patients, were discovered. Conclusion. The findings highlight problems associated with trauma centers low functioning as a whole system, requiring introduction of real-time monitoring of their activities, as well as management decisions aimed at optimizing the communicative process between trauma centers, as well as with other medical institutions, which include trauma centers.
Kazan medical journal. 2015;96(1):100-104
Reasons for inappropriate ambulance calls by adult urban population
Paykov V.L., Ishmetov R.P., Akchurina I.I.
Aim. To study the reasons for inappropriate ambulance calls made by adult urban population. Methods. Emergency calls of 1016 patients, 917 of them - aged 18 years and older who sought emergency medical help for different reasons, registered 8:00 to 20:00 from January 1 to September 30, 2014 and served by the first author. Reasons for inappropriate ambulance calls were studied using specially designed questionnaire, which was used to carry out the survey in 298 patients in their places of residence. Results. The examination of the call cards revealed that majority of the calls - 826 (90.1%) - were productive, including emergency aid and inappropriate ambulance calls - 457 (49.9%) cases. Females made inappropriate ambulance calls more frequently compared to males - 277 (60.6%) and 180 (39.4%), respectively. Males under the age of 60 years (mean age 56.6 years) performed inappropriate ambulance calls more frequently compared to elderly males, with no such age-related difference in females. According to the survey, the reasons for seeking for emergency medical care were: «it was far to get to the outpatient clinic» (28 cases, 9.4%), «did not know the phone of the outpatient clinic» (7 cases, 2.3%), «for a timely aid and a doctor’s appointment» (16 cases, 5.4%), «because of the symptoms requiring treatment» (51 cases, 17.1%), «exacerbation of a chronic disease» (34 cases, 11.4%), «unaware of the fact that he/she should visit an outpatient clinic» (10 cases, 3.8%), «a non-working day» (17 cases, 5.7%), «known that he/she will be dismissed form an outpatient clinic» (23 cases, 7.7%), «nonresident» (11 cases, 3.7%). All of the above is the evidence of the population ignorance of the mechanisms of providing primary health care (66.1%). In addition, several patients indicated «long time is needed to get the appointment to a doctor» (25 cases, 8.4%), «not able to reach outpatient clinic» (12 cases, 4.0%), «do not trust doctors of the outpatient clinic» (45 cases, 15.1%), «the call to the outpatient clinic was not accepted» (11 cases, 3.7%) and «having problems of getting to a doctor» (8 cases, 2.7%) as the reason. In the latter cases, these reasons were indicators for malpractice of the outpatient clinics (33.9%). Conclusion. Reasons for inappropriate ambulance calls made by adult urban population, according to a survey - unawareness of the appropriate facility providing primary health care (66.1%) and outpatient clinics malpractice (33.9%).
Kazan medical journal. 2015;96(1):105-108
Molecular diagnosis of cancer in the large regional oncology center: possibilities and limitations for use in clinical oncology
Petrov S.V., Akhmetov T.R., Balatenko N.V., Mazitova F.M., Sabirov A.G., Galeev M.V., Zagvozkina D.O., Gordiev M.G., Khasanov R.S.

Aim. To summarize the results of 19-year activity in laboratory of immunohistochemical tumor diagnosis of Tatarstan Regional Cancer Centre of Ministry of Health, Republic of Tatarstan.

Methods. Advantages and limitations of modern molecular techniques for the diagnosis of human tumors are discussed based on our own experience and the literature data.

Results. A number of tumor cells molecular targets (e.g., growth factor receptors, differentiation antigens) are being determined in Tatarstan Regional Cancer Centre since 1996 on the daily basis for creating a «molecular portrait of tumor» and customized therapy adjustment. The total number of tumors investigated using immunohistochemistry, systematically increased from 150 in 1996 to 5910 in 2014, and for each tumor 1 to 12 (usually 4-5) or more antigens expression is evaluated. Since 2007, molecular cytogenetic studies of potential targets for the treatment of breast cancer, stomach and lung are investigated. To identify HER2 oncogene amplification performed 894 assays were performed in 2007-2011 using chromogenic in situ hybridization and 1064 assays using fluorescence in situ hybridization were performed in 2011-2014. Since November 2014 we are using fluorescence in situ hybridization to detect ALK-EML4 translocation in lung adenocarcinomas, during the last month of the 2014 38 tests were performed. For two decades, the laboratory, which has a reference status in the Volga region of Russian Federation, has verified the diagnosis in 32 thousand patients, among them 55% cases of breast cancer (prognostic markers), 18% - lymphoproliferative processes, 15% - anaplastic tumors and metastatic cancers of unknown primary source, 12% were soft tissue tumors. Error rate for immunohistochemical diagnosis was 2.6%, mainly involving central nervous system tumors, lymphomas, and metastatic cancers of unknown primary source.

Conclusion. Modern morphological tumor verification provides high quality diagnosis and treatment of cancer patients in the Republic of Tatarstan for many years.

Kazan medical journal. 2015;96(1):109-117
Physiology and pathophysiology of the lymphatic system. Research results and further prospects
Minnebaev M.M.
The review summarizes own research and literature on the role of the lymphatic system in a number of physiological and pathological conditions. The typical reaction of lymph circulation seen in shock, acute diffuse peritonitis, in postoperative period is the lymph flow volumetric rate increase. Mobilization of the lymphatic system, extravascular fluid and proteins in well-studied emergencies is explained considering the role of the lymphatic system as a natural source of circulating blood volume regulation and serum proteins replacement («autotransfusion»). These pathological processes are associated with progression of lymphatic failure on the late terms. The principle of lymph circulation targeted stimulation as a way to detoxify the body using hormones and procaine (Novocain) blockade of splanchnic nerves and the borderline sympathetic trunks was proposed based on modeled acute peritonitis. Increased microcirculation and central lymph flow, alterations in resorption, transport and filtration barrier function of the lymphatic system, as well as morphologic and functional reorganization of the lymph nodes were revealed in fever of different duration. Of particular interest are studies on the role of the lymphatic system in the immediate and long-term body adaptation to physical stress. Activation of central lymph circulation in adequate dynamic loads correlated with changes in the system lymph microcirculation (acceleration of lymph flow, increased peristalsis of the lymph microvessels walls and contractile activity of their valves). Extreme physical exhaustion was accompanied by expressed lymphovascular, extravascular and intravascular changes in the microvasculature. Lymphatic failure, as well as structural microcirculation impairments in a trained body occur only in extreme physical stress. Thus, the lymphatic system is involved in many physiological and pathological processes; its functional condition affects the course and outcome of the disease. Therefore, the treatment of the diseases requires, among other measures, correction of lymph formation and circulation (stimulation or inhibition, endolymphatic treatment, thoracic duct drainage, lymphosorption, blockade of nodal pathways and other methods - depending on the specific disease).
Kazan medical journal. 2015;96(1):118-123
Clinical observations
Clinical case of craniovertebral junction tumor simulating nasopharyngeal carcinoma
Levina I.L., Matveeva O.V., Stupnikova A.Y., Doroshilova A.V., Belykh E.V.
A rare case of the long-term observation of a patient with craniovertebral junction tumor is decribed. The presented case report includes a number of noteworthy features. The onset of the disease as the nasopharyngeal tumor symptoms, unusual anterior tumor growth towards the nasopharyngeal lumen with cuff inclusion of СI-СII vertebral bodies and posterior growth towards the spinal canal, signs of development disorder and perinatal organic brain damage were the factors creating considerable difficulty in determining the tumor nature and structure, which in turn influenced the treatment choice. Results of the patient’s examination for «nasopharyngeal carcinoma extending into the oropharynx» were analyzed. Insufficient capabilities of such methods as rheoencephalography, electroencephalography, echoencephalography, brachiocephalic arteries duplex scanning, transcranial magnetic stimulation for the diagnosis of craniovertebral junction tumor are shown. The difficulties of the biopsy histological and immunochemical study results interpretation out of clinical context and radiological data are discovered. Contrast spiral computed tomography and magnetic resonance imaging allowed to clarify the craniovertebral junction tumor nature and spreading.
Kazan medical journal. 2015;96(1):124-128

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