Vol 94, No 2 (2013)

Pediatric health care modernization in the Republic of Tatarstan: first results

Farrakhov A.Z.


Aim. To summarize the first results of pediatric healthcare modernization in the Republic of Tatarstan. Methods. Analytical, expert, comparison and systematic approaches were used as a research methods. Results. The obtained results vividly depict the main goal of the modernization performed - to improve the pediatric healthcare on the basis of the innovative medical and management technologies. Modernization is understood as a process of current healthcare facilities enhancement and renovation, bringing them in line with new requirements, norms, technical regulations, healthcare quality measurement tools and qualification of healthcare professionals. The main attention is devoted to healthcare management, computerization of healthcare facilities, modern training technologies, interdepartmental integration. Modernization priorities are shared by the whole country, however, their implementation depends on intra- and off-system healthcare features in subjects of Russian Federation. It is useful to unite the efforts of the healthcare system in the process of modernization in terms of healthcare management based on territorial responsibility of high medical technologies centers and development of governmental-private partnerships. Conclusion. One of the priority trends of prevention service of pediatric healthcare in the Republic of Tatarstan is to form the prevention policies by introduction of a new functional structure - pediatric healthcare centers. The important role should be given to quality assessment of the introduced innovations by statistical, quantitative and qualitative assessments, showing the effectiveness of the healthcare.
Kazan medical journal. 2013;94(2):145-151
pages 145-151 views

Theoretical and clinical medicine

Role of endothelial dysfunction and metabolic syndrome in interventional treatment complications development in patients with coronary heart disease

Arsenitcheva O.V., Omeljanenko M.G.


Aim. To assess the influence of endothelial dysfunction and metabolic syndrome on interventional treatment coronary complications development in patients with coronary heart disease. Methods. 57 patients with coronary heart disease and concomitant metabolic syndrome (the main group) and 64 patients with coronary heart disease alone (the comparison group) were included in the study. Control group for endothelial function parameters included 33 healthy blood donors. Endothelial function was assessed by plasma and erythrocyte nitrate level, plasma L-arginine level and desquamated endothelial cell blood count before the interventional treatment and after its completion. Results. Initial signs of endothelial dysfunction were observed in both groups of patients compared to the controls. Desquamated endothelial cell blood count was significantly higher in patients with metabolic syndrome than in the comparison group. Only the desquamated endothelial cell blood count increased significantly after the interventional treatment, the difference was more pronounced (р <0.05) in patients with metabolic syndrome. Complications of interventional treatment in patients with and without symptoms of metabolic syndrome were observed in 29.8 and 14.1% respectively (р <0.05). The number of coronary artery restenoses was significantly higher in the main group than in the comparison group (12.2 and 3.1% respectively). Conclusion. Initially endothelial dysfunction was more pronounced in patients with metabolic syndrome. A significant increase of endothelial dysfunction was observed in patients of the main group after the interventional treatment. The number of interventional treatment complications and coronary arteries restenoses was significantly higher in patients with coronary heart disease and concomitant metabolic syndrome.
Kazan medical journal. 2013;94(2):152-157
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Echocardiographic features of congestive heart failure in patients with chronic obstructive pulmonary disease

Akramova E.G.


Aim. To optimize echocardiographic diagnosis of congestive heart failure in patients with chronic obstructive pulmonary disease (COPD). Methods. Several modes of echocardiography using HD 11XE (Philips, USA) ultrasound scanner, 24-hour ECG monitoring using Microvit MT-101 (Schiller, Switzerland) 3-channel recorder and spirometry using АFD-02-«МFP» (Russia) machine were performed in 157 patients aged 39-76 years (male - 114, female - 43) who were divided into the following subgroups: (1) patients with COPD alone, (2) patients with COPD and concomitant arterial hypertension, (3) patients with COPD and concomitant ischemic heart disease, (4) patients with ischemic heart disease, (5) healthy controls. Results. 55.4% of patients with COPD had clinical signs of congestive heart failure (with signs of isolated diastolic dysfunction in 85.7% of patients with congestive heart failure). Diastolic dysfunction was associated with increase of peak isovolumic velocity (IVV) and even more significant decrease of peak early (Ea) and late (Aa) diastolic annular tricuspid vale velocities ratio at pulsed Doppler tissue imaging compared to patients without congestive heart failure. In patients with isolated COPD and isolated diastolic dysfunction echo signs of right ventricle dilatation, and in patients with COPD and concomitant ischemic heart disease - also of pulmonary artery trunk dilatation and hypertrophy of both ventricles were significantly more frequent. Systolic dysfunction was found only in patients with COPD and concomitant ischemic heart disease, causing longitudinal systolic dysfunction of the right ventricle seen as a reduction of systolic excursion and peak systolic (Sa) annular velocity, increased Myocardial Performance Index (Tei Index) and corrected isovolumic relaxation time, as well as hypertrophy of both ventricles and left ventricular dilatation. Conclusion. Echocardiography (Doppler tissue imaging) can be used for congestive heart failure diagnosis verification in patients with COPD.
Kazan medical journal. 2013;94(2):157-163
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Assessing the impact of isosorbide mononitrate on sinoatrial node pacemaker activity in patients with III and IV functional class of stable angina

Safronova E.A., Shadrina I.M.


Aim. To evaluate the peripheral autonomic effects of isosorbide mononitrate on sinoatrial node pacemaker activity using wave structure analysis by rhythmocardiography. Methods. The study included 162 patients with III and IV functional classes of stable angina, among them 122 - with hypertension. The control group consisted of 42 healthy volunteers. In addition to standard techniques (electrocardiography, echocardiography, bicycle ergometry, electrocardiogram daily monitoring), high-resolution rhythmocardiography using a KAP-RK-01-«Mikor» diagnostic complex with time and spectral analysis of the sinus rhythm wave structure was performed. The method is based on the evaluation of peripheral autonomic regulation in the sinoatrial pacemaker and influence of humoral and metabolic environment on it. Results. In all patients with III and IV functional classes of stable angina regardless of the concomitant arterial hypertension heart rate variability, as well as Valsalva maneuver response increased in a number of patients taking isosorbide mononitrate. Negative events related to isosorbide mononitrate intake were reduced parasympathetic fluctuations in a number of cases, humoral-metabolic regulation growth, and increase of sympathetic regulation role in patients with concomitant arterial hypertension. Rhythmocardiography allowed to access the influence of isosorbide mononitrate on heart rate variability in patients with ischemic heart disease. Conclusion. Both positive (increased heart rate variability) and negative (spectral features redistribution with humoral, metabolic and sympathetic components increase and parasympathetic component decrease) effects were associated with isosorbide mononitrate intake with lesser sinoatrial node dysregulation in patients with concomitant arterial hypertension.
Kazan medical journal. 2013;94(2):163-168
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Left ventricle remodeling electrocardiography criteria of survival assessment in Q-wave myocardial infarction patients

Khayrutdinova G.M.


Aim. To study the survival in patients with Q-wave myocardial infarction depending on features of left ventricle remodeling on electrocardiography. Methods. 10-year overall survival and heart diseases associated survival rates depending on features of left ventricle remodeling on electrocardiography were studied in 87 patients who had survived an acute myocardial infarction with Q wave. The first group included 45 patients who fulfilled electrocardiographic criteria for left ventricle adaptive remodeling, the second group included 42 patients with electrocardiographic features of left ventricle maladaptive remodeling. The survival in both groups was estimated using the Kaplan-Meier’s curves. Results. There was a highly significant inverse relationship between age and survival rate of the patients with Q-positive myocardial infarction. 40 patients succumbed by the end of the observation period, among them - 20 (50%) due to heart diseases. 20 (50%) patients died from non-cardiac events, among them - ischaemic stroke, neoplasms and accidents (most common - alcohol intoxication, 5,8% each). Chronic heart failure was most common reason of death in both groups, and it prevailed in the group of patients with left ventricle maladaptive remodeling electrocardiographic features. According to the gained data, there were no significant differences observed in overall survival in both groups during the whole follow-up period. In assessment of survival associated with heart diseases, the differences close to the statistically significant were found. Conclusion. The comparison of the overall survival depending on left ventricle remodeling electrocardiographic features did not detect any reliable differences, while in case of heart diseases associated survival assessment differences close to the statistically significant were found.
Kazan medical journal. 2013;94(2):168-175
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Change of the main parameters of 24-hour ekg monitoring in patients with myocardial infarction associated with ventricular arrhythmias

Logacheva I.V., Barantseva N.G.


Aim. To study the change of the main parameters of 24-hour EKG monitoring over time in patients with myocardial infarction associated with ventricular arrhythmias of different grades. Methods. The change of the echocardiography parameters, heart rhythm variability, corrected QT interval duration and dispersion, late ventricular potentials, heart rhythm turbulence were examined in 70 adult men (mean age 52.6±1.3 years) with primary Q-wave myocardial infarction on 10-14th day of the disease and after 6 months. Patients were assigned into 3 groups depending on ventricular arrhythmias severity (according to Lown classification modified by Ryan): А1 (n=29) - grade 1-2, А2 (n=23) - grade 3-4, А3 (n=18) - patients with paroxysmal ventricular tachycardia. Results. Presence of late ventricular potentials and pathologic heart rhythm turbulence in patients in acute period of myocardial infarction suggested high grade of ventricular arrhythmia. Ventricular arrhythmias were associated with severe sympathicotonia, prolongation of corrected QT interval and QT dispersion. 6 months after Q-wave myocardial infarction an autonomic imbalance increased and no positive changes of myocardial homogenicity parameters, late ventricular potentials and pathologic heart rhythm turbulence were observed with increasing ventricular arrhythmia grading and heart rate frequency. A relationship between left ventricle ejection fraction, myocardium mass and myocardial electric non-stability values was revealed. In patients with Q-wave myocardial infarction ventricular arrhythmias are mediated by several mechanisms: systolic and autonomic disorder, repolarization abnormalities, late ventricular potentials pathologic heart rhythm turbulence. The severity of abnormalities is marked by the ventricular arrhythmias grade. Conclusion. 6 months after myocardial infarction (in healing stage) the significant positive changes are found only in patients with 1-2 grades ventricular arrhythmias. The significant non-homogeneity of myocardial electrophysiological features still persists in patients with life-threatening ventricular arrhythmias.
Kazan medical journal. 2013;94(2):176-180
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Pharmacological correction of endothelium functional state in patients with atherosclerotic peripheral artery occlusive disease

Kalinin R.E., Suchkov I.A., Pshennikov A.S., Nikiforov A.A.


Aim. To evaluate the effects of medications of different pharmacological groups on endothelial cells in patients with atherosclerotic peripheral artery occlusive disease. Methods. The study included 116 patients with atherosclerotic peripheral artery occlusive disease. Patients were divided into 4 groups depending on the taken drug (first group - 29 patients receiving L-arginine; second group - 30 patients, perindopril; third group - 28 patients, losartan; fourth group - 29 patients, nebivolol). Levels of the main biochemical markers reflecting the endothelium functional state were evaluated in all patients on admission to the hospital and 1, 3, and 6 months after the beginning of treatment. Results. All studied drugs stimulated nitric oxide (II) release (р <0.05). The highest increase of nitric oxide (II) level was found in patients receiving nebivolol and losartan. Levels of endothelin-1 tended to decrease in all patients. Superoxide dismutase level change was different both by number and trend in different groups; however, by the 6th month its level has lined up in all of the study groups. Lipid peroxidation parameters variation showed the same tendency as superoxide dismutase level variation. No significant changes in ankle-brachial index were found (р >0.05). Treadmill test showed a statistically significant improvement of pain-free walking distance by approximately 25-30% by the 3rd month of treatment (р <0.05). Conclusion. The studied medications influence endothelial cells and correct the endothelial cells functional state, reflected by change of all biochemical markers levels.
Kazan medical journal. 2013;94(2):181-185
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Diagnostic value of cystatin c urine level as an early marker of diabetic nephropathy in children with type 1 diabetes mellitus

Senatorova A.S., Muratova E.G.


Aim. To improve the diagnosis of early stages of diabetic nephropathy by examining cystatin C urine excretion in children with type 1 diabetes mellitus. Methods. 83 children aged 11 to 18 years with type 1 diabetes mellitus were included in the study. Children were divided into 3 groups according to the duration of diabetes mellitus: group 1 - 1 to 2 years (n=18), group 2 - 2 to 5 years (n=24), group 3 - over 5 years (n=41). Results. The average values of glycated hemoglobin did not differ significantly between the groups and were assessed as following: group 1 - 8.61±2.1%, group 2 - 8.91±1.5%, group 3 - 8.84±2.5% (p >0,05). Development of «symptomatic» diabetic nephropathy occurred in 10% of children with type 1 diabetes with disease duration over 5 years. Cystatin C urine excretion was the highest in children with long clinical course of type 1 diabetes mellitus (p <0.01). Significant variability of cystatin C urine excretion was observed even in children with diabetes duration of 1 to 2 years. Pairwise comparison of cystatin C urine excretion levels and glycated hemoglobin values of children with type 1 diabetes did not show any statistically significant difference. Conclusion. Cystatin C urine excretion level can be an early marker of kidney damage and depict the state of tubular renal function in children with type 1 diabetes mellitus. Tubular dysfunction in children with type 1 diabetes mellitus might be diagnosed when observed cystatin C urine excretion level is over 21.9±1.4 ng/ml (sensitivity 70%, specificity 60%).
Kazan medical journal. 2013;94(2):186-189
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Comparative assessment of blood circulation at critical zones of anastomoses in urinary bladder reconstruction with iliac graft

Nesterov M.I., Akhmedov R.A., Ramazanov M.R., Galeev R.K., Ramazanov M.M.


Aim. To improve the instant results of urinary bladder reconstruction with iliac graft by examination of critical zones. Methods. Urinary bladder reconstruction using the iliac autograft was performed in 15 patients without special examination of critical zones (control group) and in 25 patients in whom these zones were examined (main group). Mean age of patients was 58 years (from 44 to 68). All patients underwent cystectomy because of urinary bladder cancer (stages T2-4N0M0). Blood microcirculation at the stitch area was performed by M.Z. Sigal, tissue viability index by M.R. Ramazanov was calculated, oxygen saturation of arterial blood was measured and microcirculatory blood flow was examined by the LAKK-01 machine. The same surgery and research methods were performed in 70 dogs with regular assessment of microcirculation at the stitch area (stitch color, arterial pulsation) and using the tensiometry by M.Z. Sigal, microcirculation at the stitch area, oxygen saturation of arterial blood and stitch tissue viability index were also determined. Results. In patients of the control group, in whom the condition of critical zones was not examined, 3 has developed a stitch dehiscence at the zones of anastomosis, with no such events registered in patients from the main group, in whom critical zones were examined. In dogs stitch dehiscence was not observed only in the group where microcirculation was assessed by tissue viability index calculation. Conclusion. It is important to examine critical zones of the iliac autograft and calculate the stitch tissue viability index performing urinary bladder reconstruction with iliac graft to prevent the stitch dehiscence.
Kazan medical journal. 2013;94(2):190-193
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Motor disorders and hip joint dysplasia in newborns and infants

Zharova E.Y.


Aim. To detect the neurogenic motor disorders in children with hip joint dysplasia. Methods. Clinical analysis of hip joint dysplasia and neurogenic motor disorders symptoms in newborns and infants was performed. Children were distributed into two groups: the first group included children with hypertonic muscles of the lower extremities and restrictions of hip abduction, the second group included children with diffuse hypotonia and hip and knee bent in a specific position («frog» symptom). Results. Analysis of perinatal life of children included in the study showed that in 100% of cases diseases of mother and fetus were observed in these children. All children with hip dysplasia were also present with clinical features of nervous system disorders. Patients with central motor lesions have symptoms of pyramidal insufficiency such as hip adductors hypertonia, often treated as restrictions of hip abduction by orthopedists. Patients with the segmental motor lesions presented with flaccid paresis accompanied by hip joint hypermobility, which leads to excessive external rotation of the hip. A similar clinical picture is observed in diffuse muscle weakness caused by neonatal posterior cerebral circulation vascular accidents. In both cases soft tissues and pelvic bone nutrition is impaired. Conclusion. The common pathogenesis of hip joint dysplasia and motor disorders implies that children with these diseases should be treated jointly by neurologist and orthopedist.
Kazan medical journal. 2013;94(2):193-198
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Prevalence and clinical variety of periodontitis in patients attending dental policlinics in Kazan, Russia

Berezin K.A.


Aim. To determine different periodontal diseases prevalence and distribution in patients attending dental policlinics in Kazan, Russia. Methods. Clinical screening, computed statistical analysis were used as a study methods. 517 medical charts of dental patients (form 043/A) were randomly selected. Different forms of periodontitis were classified according to ICD-10. Results. A high prevalence of periodontal diseases reaching 100% was found among the examined patients who had attended dental policlinics in Kazan, Russia. Chronic (34-89%) and acute (11-44%) apical periodontitis were the most prevalent types of periodontitis in all age groups of patients who had attended dental policlinics. In patients aged 18-39 years acute apical periodontitis was the most common type of periodontitis (11-44%). Conclusion. A high prevalence of periodontal diseases in patients who had attended dental policlinics in Kazan, Russia, was found, with a tendency of chronic periodontitis prevalence to grow, reaching highest levels in elderly patients. Thus, measures for periodontitis prevention and early treatment are vital.
Kazan medical journal. 2013;94(2):198-201
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Optimization of proper diagnosis of thromboses associated with high risk of embolism in patients with neoplasms

Kamalov I.A., Agliullin I.R., Tukhbatullin M.G.


Aim. To optimize a proper diagnosis of thromboses associated with high risk of embolism and pulmonary embolism prevention in patients with neoplasms. Methods. Ultrasonography of veins of lower extremities, iliac veins and the distal part of inferior vena cava was performed in patients with and without neoplasms in a prospective study to detect thromboses associated with high risk of embolism and thrombophlebitis. Ultrasonography was performed once in control group subjects, and before and during specialized antineoplastic treatment (surgical, chemotherapy, radiotherapy) in patients of the main group, the results were compared. A detection of a new thrombus in previously intact venous segment of inferior vena cava system was assessed as a high risk for pulmonary embolism. Results. Thromboses associated with high risk of embolism and thrombophlebitis were found in 6 patients of control group, in 5 patients of the main group before and in 27 patients of the main group while at specialized antineoplastic treatment. Specific measures for pulmonary embolism prevention were taken immediately in all of the cases according to ultrasonography results after the detection of thromboses associated with high risk of embolism. No fatal cases of pulmonary embolism were registered both in main (before and while at treatment) and control groups. Conclusion. Ultrasonography of veins of lower extremities, iliac veins and the distal part of inferior vena cava in patients with neoplasms before the start of specialized antineoplastic treatment allows to optimize the choice of prevention measures for pulmonary embolism and thus significantly decreases mortality from pulmonary embolism.
Kazan medical journal. 2013;94(2):202-207
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Clinical and epidemiological features of acute intestinal infections with hemorragic colitis in children

Khaertynov H.S., Semenova D.S., Sushnikov K.V.


Aim. To study the clinical and epidemiological features of acute intestinal infections associated with hemorrhagic colitis in children. Methods. The clinical and epidemiological features of hemorrhagic colitis were studied in 70 children with acute intestinal infections aged from 1 month to 14 years who were admitted to the Infectious Diseases Hospital in Kazan, Russia. The following stool tests were performed: single bacteriology test for pathogenic and conditionally pathogenic microbiota, rotavirus antigen detection by latex agglutination, campylobacter DNA detection by polymerase chain reaction and microscopy to detect protozoa. Results. Hemorrhagic colitis was present mainly in infants (56 children, 80%), the main reasons for hemorrhagic colitis were: Salmonella enteritidis - 12 (17.1%) children, Campylobacter - 6 (8.6%) children, Klebsiella pneumoniae - 6 (8.6%) children. There were single cases of hemorrhagic colitis associated with Shigella, Enterobacter, S. aureus, Ps. aeruguinosa and E. hystolitica. The diagnosis of Campylobacter infection was based on the detection of the DNA but not the bacteria itself like in other acute intestinal infections. The majority of hemorrhagic colitis cases (52 children, 74.3%) were registered in spring and summertime. Hemorrhagic colitis was moderately severe and manifested as traces of blood and mucus in stool. Hemorrhagic colitis usually lasted up to 3 days in majority of children. Conclusion. The main reasons for acute intestinal infections associated with hemorrhagic colitis were: Salmonella enteritidis, Campilobacter and Klebsiella pneumonia, hemorrhagic colitis was most common in infants in spring and summertime.
Kazan medical journal. 2013;94(2):208-211
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Clinical and epidemiologic characteristics of lyme borreliosis and tick-borne encephalitis mixed infections in Krasnoyarsk kray

Minoranskaya N.S., Minoranskaya E.I.


Aim. To reveal clinical features of Lyme borreliosis and tick-borne encephalitis mixed infections in Krasnoyarsk Kray. Methods. The main group consisted of 226 patients with mixed infection of Lyme borreliosis and tick-borne encephalitis (males - 57.1%, females- 42.9%, mean age 43.7±1.0 years), who were examined and compared to the control group of 88 patients with tick-borne encephalitis alone (males - 56.8%, females - 43.2%, mean age 43.9±1.8 years). Results. About 40% of acute Lyme borreliosis cases in Krasnoyarsk Kray are a mixed infection of Lyme borreliosis and tick-borne encephalitis, that is closely related to a large population of Ixodidae infected by both agents. There is no characteristic epidemiologic background in more than a half of all cases. Typical clinical features for mixed infection of Lyme borreliosis and tick-borne encephalitis are severe onset with toxic constant hyperthermia or hyperpyrexia, and joint pain (18.6% of cases). Erythema migrans was present in 22.6% of cases, involvement of central nervous system (35.4%) was mostly often associated with meningitis and meningoencephalitis (29.2%). Bannwarth syndrome (3.1%) is a clinical type of Lyme borreliosis not associated with erythema in mixed infection. Cardiovascular system damage is transient and associated with intoxication. In 57.1% of cases the diagnosis of mixed infection was confirmed at dispensary follow-up 1.5, 3, 6 months after the clinical manifestations of the disease. Conclusion. The most common clinical form of mixed infection is the non-erithemic form of Lyme borreliosis and febrile form of tick-borne encephalitis, late Lyme borreliosis after the suffered mixed infection was registered in 30.1% of cases.
Kazan medical journal. 2013;94(2):211-215
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Psychological profile, dietary preferences and reproductive history of pregnant women with obesity

Derdyay O.S., Khlybova S.V.


Aim. To study the psychological profile and determine dietary preferences of pregnant women with various stages of diet-induced obesity and to evaluate the relationship between the determined features and reproductive function. Methods. 120 women who were at the 1st trimester of normal pregnancy were administered the modified Life Quality Self-Assessment Questionnaire for Overweight Patients. Women were divided into groups according to body mass index (group 1 - women with normal weight, group 2 - overweight women, group 3 - women with class I obesity, group 4 - women with class II obesity). The data from exchange cards of pregnant women were also included in the analysis. Results. Women with class I and class II obesity had higher rates of concomitant diseases, complications during pregnancy and cesarean sections. The main causes of obesity were genetic predisposition, decreased physical activity, increased dietary energy supply. Such traits as hypochondria, frequent mood changes, desire to be at the center of attention were present in obese women. They evaluate their health as poor. Conclusion. The questioning makes it possible to mark out a high risk group for complications of pregnancy and delivery. A questionnaire survey and monitoring by a psychologist and a dietary specialist are recommended for this group of patients.
Kazan medical journal. 2013;94(2):216-220
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Comorbidities in chronic «overcrowded posterior cranial fossa» syndrome

Zabbarova A.T., Bogdanov E.I., Khusainova D.K., Fatkheeva L.S.


Aim. To analyze the prevalence and role of comorbidities in variety of clinical manifestations in patients with congenital occipital hypoplasia - «overcroded posterior cranial fossa» syndrome. Methods. Clinical history and physical examination of 200 patients (aged 16-74 years, males 108, females 92) with «overcrowded posterior cranial fossa» syndrome, including 134 with cerebellar ectopia, 92 with syringomyelia, 24 with hydrocephalus, were analyzed. Results. The diseases identified in patients with «overcrowded posterior cranial fossa» syndrome were combined into six groups: cardiovascular diseases (n=120; 60.0%), infectious and inflammatory diseases (n=39; 19.5%), gastrointestinal diseases (n=37; 18.5%), metabolic and endocrine diseases (n=31; 15.5%), diseases of the musculoskeletal system and connective tissue (including cervical vertebral stenosis (n=53; 26.5%), scoliosis (n=50; 25.0%), arthropathies (n=21; 10.5%), other diseases and pathological conditions (including mild traumatic brain injury (n=74; 37.0%), seizures (n=13; 6.5%). In patients with «overcrowded posterior cranial fossa» syndrome the prevalence of cardiovascular, gastrointestinal diseases, traumatic brain injury, obesity, primary or secondary cervical vertebral stenosis was significantly higher (p <0.05) compared to general population. In patients with syringomyelia a higher rate (p<0.05) of scoliosis and traumatic brain injury was revealed. Conclusion. The prevalence of comorbidities in patients with «overcrowded posterior cranial fossa» syndrome was higher compared to general population. The differences of the type and rate of the concomitant diseases in patients with various forms of the syndrome may contribute to the variety of clinical manifestations of «overcrowded posterior cranial fossa» syndrome.
Kazan medical journal. 2013;94(2):221-227
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The role of antioxidant system genes in the formation of coronary heart disease clinical phenotypes

Podolskaya A.A., Galyavich A.S., Maikova E.V., Kravtsova O.A., Alimova F.K.


Genetic predisposition alongside with environmental factors play a major role in the pathogenesis of coronary heart disease, causing the deregulation of various biochemical processes leading to the disease onset. Antioxidant system deregulation, marked mainly by lipid peroxidation products and a number of enzymes, is known to be one of the risk factors for coronary heart disease. A genetic defect might lead to a change in enzyme activity and inhibition of antioxidant protection. However, the pathogenic factors and antioxidant system deregulation mechanisms in different clinical courses of coronary heart disease are not studied enough as phenotypic expression of genetic polymorphism is largely dependent on the gene pool and the living conditions of a particular population, explaining the controversial data on the association of polymorphisms candidate genes with the risk of coronary heart disease. Currently, the role of genes encoding antioxidant system enzymes in predisposition to coronary heart disease development is not sufficiently studied, and research results are contradictory. The review summarizes the current data on the antioxidant system genes (superoxide dismutase enzymes, glutathione peroxidase and catalase) genetic polymorphisms association with the risk of coronary heart disease (as an acute myocardial infarction, angina рectoris).
Kazan medical journal. 2013;94(2):228-234
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Epilepsy in patients with ischemic brain disease

Khasanova D.R., Danilova T.V., Latypova Z.K.


Epilepsy is one of the most actual social problems in modern neurology and psychiatry. According to the results of the domestic and foreign studies, the risk of developing epilepsy increases with age. The increased rate of nervous system vascular and degenerative diseases as well as brain tumors and head injuries in elderly patients is one of the reasons for it. The review is devoted to the development of epilepsy in adults having an active cerebrovascular disease. Epilepsy is the disease with multiple causative factors. Among the etiological factors of epilepsy development in adults, the predominant place belongs to vascular diseases. The article presents the epidemiological aspects of the problem, the questions of pathophysiology, the variability of epileptic syndromes developing as a result of ischemic brain disease. It describes the characteristics of epileptic process as a result of a vascular lesion. The role of the cerebrovascular reactivity in brain vascular diseases development is described. A place of different research methods (such as electroencephalography, transcranial and extracranial duplex ultrasonography scanning of the major brain vessels, different modes of magnetic resonance imaging, functional magnetic resonance imaging and magnetic resonance spectroscopy) in identifying risk factors for seizures in patients with cerebrovascular pathology is reported. Possible exogenous and endogenous precipitants (cerebral atherosclerotic vascular disease, hypertension, cerebrovascular deregulation, increased convulsive predisposition, the external epileptic triggers, etc.) are described.
Kazan medical journal. 2013;94(2):235-239
pages 235-239 views

Unethical drug promotion by pharmaceutical industry as the main barrier to the rational use of medicines

Ziganshina L.E., Niyazov R.R.


The review surveys the problems of pharmaceutical promotion and public health. Global and domestic realities of pharmaceutical marketing are discussed. Various promotional activities of pharmaceutical industry are described with special emphasis on journal advertisements. Examples of unethical marketing practices of the global pharmaceutical companies are presented with details of the fines paid by the companies for unethical promotion of their products for «off-label» use or for long-term concealing of adverse drug reactions known by the companies long before they become freely available for the society. The review presents definition of «disease selling» as a technique extensively used by pharmaceutical industry to promote their products and increase income. Evidence of pharmaceutical promotion detrimental effects on physicians’ prescribing practices is presented in line with the evidence of funding distribution distortion: the global pharmaceutical expenditures for drug promotion are far exceeding research and development funding. The review describes, with few exceptions, the medical journal editors general lack of awareness of journal advertisements influence on prescribers’ knowledge, attitudes and medicine use. The review reveals promotional nature of advertisements as opposed to information delivery. It describes unethical marketing techniques including journal advertising used as an instrument of promotional idea delivery to physicians and the problem of promotional influence on prescribing. The review emphasizes that pharmaceutical industry self-regulation as well as medical journals peer reviewing process do not protect from misleading advertising. It concludes that pharmaceutical advertising, and advertising in medical journals as an example is not informative and threatens public health, requiring detailed regulation.
Kazan medical journal. 2013;94(2):240-244
pages 240-244 views

Epidemiology and healthcare management

Some features of acute myocardial infarction fatal outcomes on pre-admission stage

Paikov V.L., Ishmetov R.P.


Aim. To study the structure of pre-admission mortality and features of fatal outcomes due to acute myocardial infarction happened in the presence of emergency squad. Methods. In 2011, 324 fatal outcomes that happened in the presence of emergency squad were registered in Kazan, Russia, 96 of them were due to acute myocardial infarction. Ambulance charts for these 96 cases were picked out and examined. Ambulance way time, ambulance set-off time and ambulance waiting time were analyzed. Results. In 147 (45.4%) of 324 cases acute cardiovascular conditions were the reason for the fatal outcome, with acute myocardial infarction as a leading cause (96 cases, 65.3%). Fatal outcomes due to acute myocardial infarction were registered mainly at early term (first 3 hours of the disease onset) in men regardless of age (under 60 years - 9 of 15 cases, 60%; 60 years and older - 18 of 37 cases, 48.7%) and in elderly women (24 of 39 cases, 61.5%). Pre-admission fatal outcomes due to acute myocardial infarction were somewhat more frequent in winter (33.3%) and springtime (30.2%). During the day the cases of acute myocardial infarction occurred predominantly from 00:00 to 02:59 and from 09:00 to 11:59 (32.3% of all the acute myocardial infarction fatal outcomes). Ambulance waiting time varied depending on time of the call, lying between minimum of 5.6 minutes at night (from 00:00 to 05:59) and maximum of 21.2 at evening (from 18:00 to 23:59, р <0.05). Conclusion. Acute myocardial infarction is the leading cause of mortality in the presence of emergency squad, with the highest mortality rate at the first several hours of the disease, especially in males and elderly females. Mortality rate depends on time of the day and time of the year, ambulance waiting time and pre-admission aid timeliness for patients with acute myocardial infarction varies depending on time of the call.
Kazan medical journal. 2013;94(2):259-262
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Assessing current state of nursing in Mari El Republic and developing approaches for its improvement

Paybaktova T.A., Zlobina G.M.


Aim. Improving the nursing management based on a comprehensive socio-hygienic assessment. Methods. Analytical, statistical, retrospective and prospective analysis, data copying, opinion poll. Results. Positive changes in nursing service development in Mari El Republic were revealed during the period from 2000 to 2011. By January, 1, 2012, 7458 nurses with secondary medical education were employed in 50 medical institutions run by Ministry of Healthcare and in 306 village first-aid stations. The majority were certified and had a qualifying category - 97% and 67% respectively. The average value of nursing provision was 107.1 nurses per 10 000 of population, staffing - 95.5%, staffing based of the number of employed nurses - 72%. Ratio of job combining among nursing staff was 1.3, the «doctor-nurse» ratio was 1:3.6. Recently a tendency of nursing personnel outflow from nursing practice was revealed in the region. Since 2000 the number of working nursing specialists decreased by 380. The share of «young» specialists was only 7.9% of all the employed nurses, the share of nursing staff of pre-retirement and retirement age was 19%. Conclusion. According to the forecast data for the near-term outlook it is possible to expect decrease of nursing staff rates in the region. The creation of «nursing service management school» may solve the problem.
Kazan medical journal. 2013;94(2):262-265
pages 262-265 views

Economic efficiency of semi-conductor surgical laser device use in anorectal surgery

Shakhrai S.V., Gain Y.M., Gain M.Y., Sokolov A.Y.


Aim. To estimate the economic efficiency of laser technology use in complex treatment of patients with benign anorectal diseases in a day ward or as an out-patients. Methods. «Mediola-Compact» semiconductor laser (manufactured by «Fotek» ldt, Belarus) was used to treat chronic hemorrhoids and chronic anal fissures. Interstitial submucosal tissue destruction device developed by authors (Republic of Belarus Patent for effective prototype №8755) was used, allowing to cause extensional destruction while inserted into the tissue. 297 surgical interventions were performed during 3 years, among them 157 patients underwent surgery while in a day ward, 140 - as an out-patients. Prevented indirect expenses like prevented admission fees, medical certificate compensations, prevented Gross Domestic Product reduction as a result of an average hospital stay reduction were assessed for economic efficiency calculation. Results. Total economic benefit of low-invasive interventions (as a reduction of expenses on admission fees and medical certificate compensations) for 3 years term in patients with anorectal diseases treated using the examined management and laser treatment methods was assessed as 140 250 US dollars. The overall economic efficiency on low-invasive laser technology is described with cost-effectiveness coefficient of 2.36, or 236%, compared to the conventional surgical treatment. Conclusion. Laser technology use in patients with benign anorectal diseases allows to significantly decrease the hospital stay using the day ward model, economic efficiency of the low-invasive laser technology as a complex treatment component in patients with chronic hemorrhoids and chronic anal fissures allows to cover the expenses for its introduction within 1 year.
Kazan medical journal. 2013;94(2):265-270
pages 265-270 views

Experimental ground for high-intensity laser wavelength choice for chronic hemorrhoids low-invasive surgical treatment

Shakhrai S.V., Gain Y.M., Gain M.Y., Ryabtseva S.N.


Aim. To assess the morphological changes of rectal wall after the exposure to 970 and 1560 nm wavelength laser radiation and to choose the optimal wavelength for laser cauterization of hemorrhoids. Methods. Experiments to assess the effect of the exposure to 970 and 1560 nm wavelength laser radiation on rectal tissues were performed. Laser cauterization was modeled on white rats (two groups 18 animals each). «Mediola-Compact» semiconductor laser (manufactured by «Fotek» ldt, Belarus) was used. Animals of the first group were exposed to laser radiation with wavelength of 970 nm, 1560 nm wavelength was used in the second group. Animals were withdrawn from the experiment on day 1, 7 and 14 after the beginning of experiment to assess the morphologic features of the tissue fragments with destructive lesions after laser cauterization. Results. Less pronounced destructions and quicker healing were noted after the exposure to laser radiation with wavelength of 1560 nm compared to 970 nm. Statistically significant differences were revealed in general damage (U=3.5, р=0.00) and necrosis (U=0.0, р=0.00) areas depth both on day 7 and day 14 after the exposure. On day 14 no necrotic lesions were found in the second group, and general damage area was formed by granulations (U=0.00, р=0.00) compared to the first group where necrotic and inflammatory lesions persisted. Conclusion. In choosing the laser wavelength while developing rectal laser cauterization techniques for hemorrhoids, water-absorbed 1560 nm infra-red laser radiation should be preferred.
Kazan medical journal. 2013;94(2):271-277
pages 271-277 views

Assistance to the practicing physician

The method of assessment of salivary glands secretory function

Komarova K.V., Ratkina N.N., Polenichkin V.K.


Aim. To develop a method for the assessment of the secretory function of salivary glands. Methods. BK-300.1 («MASSA-K», Russia) weighting machine (presicion ±0,01 g), two standard cotton swabs and two absorbent dental pads «Dry Tips» («Mölnlycke Health Care», Sweden) were used for the assessment of the secretory function of salivary glands. Each absorbent pad and cotton swabs were weighted before the procedure. The examination was performed at morning hours on a fasting patient seated on a dentist’s chair without salivation stimulation. Absorbent pads were placed on the buccal mucosa with parotid orifice at the centre of the pad. Absorbent pads and cotton swabs soaked with saliva were re-weighted after 5 minutes. The examination was repeated thrice at different visits, the mean weight of saliva from major salivary glands was calculated. Salivary function of submandibular and sublingual salivary glands was also assessed. Saliva weight was assessed for each parotid gland separately. Results. The advantages of the offered method are: ease of use, opportunity to assess each parotid, submandibular and sublingual gland separately, express evaluation, good tolerance. Conclusion. The developed method allows to get the precise result and to assess the secretory function of salivary glands accurately.
Kazan medical journal. 2013;94(2):245-246
pages 245-246 views

Clinical observations

Clinical case of successful left coronary artery stenting in patient with acute myocardial infarction and acute decompensated left-sided heart failure

Galyavich A.S., Ivanov A.G., Yakupov I.F., Khakimzyanov A.A., Soboleva E.A.


Patients with major coronary artery involvement are a very tough group to treat in terms of emergent revascularization possibility by percutaneous coronary intervention. Concomitant myocardial infarction and pulmonary edema makes the treatment even more complicated and requires proper anesthetic approach. A patient who had underwent a coronary artery bypass graft surgery for a late stage coronary artery disease 5 years before was admitted to the cardiac intensive care unit with myocardial infarction and acute decompensated left-sided heart failure. Considering the life-threatening angina leading to a serious complications (acute pulmonary edema) and the results of the latest coronary angiography, an urgent coronary angiography with the revision of coronary arteries condition and further possible percutaneous coronary intervention due to life-threatening emergency was offered. Mechanical ventilation was started, the patient’s condition stabilized. Left coronary artery trunk stenting, a difficult approach considering the risk for complications, was performed as the second stage intervention, saving patient’s life.
Kazan medical journal. 2013;94(2):255-258
pages 255-258 views


Professoru Il'gizu Gabdullovichu Gataullinu - 60 let

Kazan medical journal. 2013;94(2):285-286
pages 285-286 views

History of medicine

Kazan medical nurses community structure and activities at the end of XIX century

Naumova O.A.


The Kazan branch of the Red Cross medical nurses was established in 1886. Its’ purpose was to professionally train women for further care for wounded soldiers at wartime, and for civil population care in hospitals at peace-time. The Kazan branch of medical nurses had started with a six students living in a shared flat. It was reported to the local Red Cross branch and was funded by it. All theoretical and practical classes were held according to the studying plan approved by the Russian National Federation of Red Cross on February 19th, 1882. After graduation all nurses were obliged to work as a nurse for at least two years, and to arrive to the Red Cross branch in case of war to be sent for military service. Nurses could also care for patients in private houses for a pay. Nurses were patient and zealous caring for ill and wounded, which wasn’t an easy job, indicating a true love and willingness for care among medical nurses. A selfless activity of medical nurses during a wartime, starvation and epidemics improved the image of a medical nurse and attracted community’s attention. During the plague and cholera epidemics in 1889-1892 15 nurses of the Kazan branch of the Red Cross were granted the medal for diligence. By the beginning of the XX century a skilled service of nursing care has been formed in the Kazan Province, becoming a prototype of modern nursery practice.
Kazan medical journal. 2013;94(2):278-282
pages 278-282 views

Vladimir Leonidovich Borman - the first pediatric surgeon of the Imperial Kazan University

Akhunzyanov A.A.


Vladimir Leonidovich Borman was the first pediatric surgeon of the Imperial Kazan University, participated in the Russo-Japanese War, World War I and the Civil War. In 1900 a novel course of pediatric surgical diseases was started at the university. A new pediatric clinic was launched among other new clinics, and Vladimir Leonidovich Borman, a surgeon and a doctor of medicine, was invited to head one of the departments there. Since then the teaching of pediatric surgical diseases for Imperial Kazan University medical faculty students has been performed at the pediatric ward of the faculty surgery clinic. Then Vladimir Leonidovich participated in surgical service foundation in many parts of the country both at peace and wartime, he became the founder of the Omsk State Medical University department of hospital surgery. The contribution of that amazing, energetic, talented doctor and teacher to Russian medicine can not be overestimated.
Kazan medical journal. 2013;94(2):283-284
pages 283-284 views

New methods of diagnosis and treatment

First experience of a single-stage simultaneous single access endoscopic surgery in a child with a disorder of sex development

Akramov N.R., Zakirov A.K.


A clinical case and treatment of a disorder of sex development (46XX, ovotesticular type) who underwent a simultaneous surgery including diagnostic laparoscopy using the single access endoscopic surgery followed by gonadectomy and the single-stage feminizing genitoplasty, is described. Endocrinology service needs for determination of treatment approach in children with disorders of sex development are closely entwined with capabilities of endoscopic surgery, particularly laparoscopy. It’s necessary to quickly determine the gonadal structure due to the high risk of malignancies while examining these patients. The most useful method is the direct visualization of the gonads in the abdominal cavity by laparoscopy. In these cases the single access endoscopic surgery technique reduces the trauma and is welcomed in pediatrics. From our point of view, the preference for the patients with disorders of sex development management with expected gonadal dysgenesis must be given to a single access endoscopic surgery.
Kazan medical journal. 2013;94(2):247-250
pages 247-250 views

An innovative technology of transumbiliсal laparoscopy in gynecology

Mazitova M.I., Kibardina N.A., Fatykhov K.K., Khairullina E.A.


Aim. To analyze the advantages and weaknesses of single-port transumbiliсal laparoscopy in treatment of disorders of female genital tract. Methods. Transumbiliсal laparoscopy was performed using the first Russian toolkit for single-port laparoscopy surgery. 70 female patients with different disorders of female genital tract (ectopic pregnancy - 41, benign ovarian tumors - 8, ovarian apoplexy - 16, leiomyoma of uterus - 5) who needed a surgery were randomized to 2 groups 35 patients each. Patients from the first group underwent single-port transumbiliсal laparoscopy surgery through a single puncture of the abdominal wall, patients from the second group underwent a surgery with ports introduced into the abdomen by several trocars. Results. In patients treated by conventional laparoscopy the surgery duration was 29.2±2.3 minutes, compared to 46.1±3.3 minutes in patients treated with single-port transumbiliсal laparoscopy. However, the duration of single-port transumbiliсal laparoscopy has decreased significantly after the first 6 surgeries were performed, and if these surgeries were excluded from the analysis, the average single-port transumbiliсal laparoscopy duration was 35.3±0.6 minutes. Postoperative pain level assessed by visual analogue scale was somewhat lower in patients after single-port transumbiliсal laparoscopy, though, the difference was not significant. An assessment of the abdominal wall and suture visual assessment were performed. Transumbiliсal suture was completely concealed in the umbilicus, thus, single-port transumbiliсal laparoscopy provides a good cosmetic effect. There were some technical difficulties associated with the single-port introduction of all medical instruments, which were overcome by medical instruments length and curvature modification and revised position of surgeons in the operating theatre. Conclusion. The advantages of the new technology were reduction of abdominal wall trauma, reduction of complications associated with the introduction of the trocar, a slight reduction of postoperative pain, good cosmetic results after surgery. Further research is needed to determine the differential approach to the choice of operation technique.
Kazan medical journal. 2013;94(2):250-254
pages 250-254 views

Book review

pages 286-288 views

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