Vol 96, No 2 (2015)

Ot redaktora
Kazan medical journal. 2015;96(2):133
Theoretical and clinical medicine
Adipose tissue dysfunction markers in obese patients with obstructive sleep apnea syndrome
Yakovlev A.V., Mayanskaya S.D., Vergazova A.N., Plutalova L.P., Mazina P.B., Mayanskaya N.N., Yakovleva N.F.

Aim. To examine the relationship between obstructive sleep apnea syndrome and metabolic dysfunction in obese patients.

Methods. The study included 66 male patients aged 53±5.11 years with previously diagnosed obstructive sleep apnea syndrome and obesity (body mass index ≥30 kg/m2). Cardiorespiratory monitoring, 24-hour blood pressure monitoring was performed in all patients; low density lipoprotein, triglycerides, high density lipoprotein, total cholesterol and glucose blood levels, as well as adiponectin and leptin blood concentrations were measured in all patients.

Results. Blood pressure level and leptin blood concentration were significantly higher in patients with severe form of obstructive sleep apnea syndrome. There was no statistically significant relationship found between the lipid profile parameters and other adipokines and the severity of obstructive sleep apnea syndrome. The data analysis also revealed association between the elevated levels of leptin and the classic cardiovascular risk factors - arterial hypertension and low density lipoprotein level.

Conclusion. The revealed associations may indicate the additional role of leptin as the biochemical marker of early development of obstructive breathing sleep disorders in patients with abdominal obesity, as well as the early manifestation of other components of metabolic syndrome - arterial hypertension and dyslipidemia with concomitant significant increase in cardiovascular risk.

Kazan medical journal. 2015;96(2):134-137
Laparoscopic endocystectomy in patients with liver echinococcosis
Mukantayev T.E.

Aim. To evaluate the efficiency and to review the indications for laparoscopic endocystectomy in liver echinococcosis.

Methods. The results of laparoscopic endocystectomy in 86 patients treated for liver echinococcosis compared to cystectomy by laparotomy in 159 patients are presented.

Results. Optimal characteristics for laparoscopic endocystectomy were types CL, CE1-CE3 of cystic echinococcosis according to cystic echinococcosis ultrasonic classification by H.A. Gharbi (1981) modified by World Health Organization (2003) with cysts localized in 2-6 liver segments; partial superficial location of cysts; cyst size not less than 5 cm; no cysts in 1, 7 and 8 liver segments or deeply located cysts of any size, as well as cysts of CE4-CE5 types. Of the 86 cases in which laparoscopic endocystectomy was completed successfully, in 4 patients the surgery was continued by a laparotomy access. The reasons for the continuation with laparotomy were unsuccessful attempts for stable hemostasis at resection of liver fibrous capsule excesses (1 case), presence of large fistula between the cyst and components of the biliary system at the bottom of the fibrous cavity (2 patients), and location of the second cyst in the segment unavailable for laparoscopic manipulation (1 case). The frequency of early complications after laparoscopic endocystectomy was 15.1% (p=0.23). Relapse occurred in 1 (1.2%) patient (p=0.23). Comparative assessment of echinococcosis recurrence risk in different periods (Kaplan-Meier analysis) after laparoscopic interventions and laparotomy, both followed by albendazole treatment, did not identify any statistically significant differences.

Conclusion. The early and long-term effects of laparoscopic endocystectomy in liver echinococcosis are not inferior to conventional laparotomy if indications are strictly followed.

Kazan medical journal. 2015;96(2):138-143
Psychological aspects of choosing between active and conservative treatment tactics in cases of liver echinococcosis with small sized cysts
Abdullaev A.M., Koychuev R.A., Akhmedov I.G.

Aim. Comparative assessment of the psychological profile in patients with liver echinococcosis with small sized cysts while diagnosing and treating the disease.

Methods. A shortened version of the Minnesota multidimensional personality questionnaire MMPI (Mini-Mult) and Personal Questionnaire of the Bekhterev Institute (PQBI) were used. 142 patients with liver echinococcosis and cyst size not exceeding 40 mm were tested at the initial diagnosis and one year after the treatment initiation.

Results.Test results support the overall suggestion that psychological profile of the patients is not associated with the features of the disease. Spearman’s rank correlation coefficient (rS) between indicators of psychological profile and some clinical data (cyst size, location, number of cysts), as well as the age and sex characteristics of the patient was not statistically significant (p >0.1), or revealed only weak correlation (rs

Conclusion. The most favorable psychological pattern is formed when choosing active treatment approach. Conservative management and postponed treatment is probably an additional stressful factor for patients.

Kazan medical journal. 2015;96(2):144-149
A novel algorithm for shock treatment in patients with injuries
Kotel’nikov G.P., Trukhanova I.G., Shabanova A.Y.

Aim. To improve the algorithm for diagnosis, intensive care and anesthesia in the acute period of traumatic disease at pre-hospital and hospital stages.

Methods. The first group included 60 patients who were admitted in 2009-2010 (standart treatment approach), the second group included 41 patient who were injured at 2011-2012 (transition period), the third group consisted of 55 patients treated using a novel algorithm in 2013. Systemic circulation parameters were measured in all patients. To characterize the severity of polytrauma, ISS (Injury Severity Score; Baker S.P., 1974) was used.

Results. Using the routine approach to shock treatment in the first group of patients (2009-2010) with shock both on pre-hospital and hospital stages had increased the duration and severity of acute shock period. Surgical interventions were performed only in life-threatening situations, and osteosynthesis surgeries were postponed. During the transition period, a specialized trauma center was formed for providing in-patient care, allowing new surgical approaches in treatment of acute shock stage. Although in 2013 mostly high energy injuries were observed (the number of separate injuries per patient increased up to 7.38±4.2), a newly introduced algorithm together with decreased transportation time to the hospital down to 20 minutes allowed to achieve more stable indicators of central circulation on pre-hospital stage (mean blood pressure 69.939±15.009 mm Hg, heart rate 97.991±9.931 per minute, stroke volume 85.815±13.667 ml, heart index 4569.862±1240.153 ml/min/m2). This allowed to imply the tactics of early surgical interventions in patients with polytrauma and improved the outcomes. A novel algorithm use decreased the hospital stay of patients with polytrauma both in the intensive care unit (from 2.98 to 1.86 days) and in the department (from 13.12 to 11.78 days).

Conclusion. The changed algorithm of care applied in 2013, is rational and effective from the practical point of view, ensures continuity of medical aid provided to patients with polytrauma both on pre-hospital and hospital stages.

Kazan medical journal. 2015;96(2):150-157
Changes in organic mental disorders features in persons who have repeatedly committed socially dangerous acts
Popov S.N., Vinnikova I.N.

Aim. Comparative analysis of the changes in clinical manifestations of organic mental disorders in persons who have repeatedly committed socially dangerous acts, and in patients without recurrence of misconduct.

Methods. 93 patients with organic mental disorders who have committed socially dangerous acts and were declared as mentally insane and in whom compulsory medical measures assigned to them by the court were used were examined. Patients who have committed repeated socially dangerous acts after treatment were included in the main group (30 persons), patients who does not commit repeated socially dangerous acts were allocated to the comparison group (63 persons).

Results. In the main group, patients with organic delusional disorder (F06.2, 20% vs 11.1%) dominated. In the control group, the share of patients with dementia of mixed origin (F02) was 22.2%, and in the main group - only 3.3%. In the main group, the prevalence of patients with psychotic conditions within the organic mental disorder was 43.3% versus 30.2% in the comparison group. At that, the rate of progression varied only slightly. The proportion of patients with no previously recorded episodes of decompensation was higher in the control group - 46.0% versus 13.3% in the study group. A few patients in both groups (10%) were supervised and regularly visited a psychiatrist. The number of patients who were not supervised or who attended psychiatrist rare was almost the same (46.7 and 47.6% in the study group and control group, respectively). At that, in the control group 12.7% of patients were not supervised due to the short disease duration (patients with dementia). There were a few more patients with a disease duration of more than 10 years in the comparison group - 54.0%, whereas in the study group - 43.3%.

Conclusion. There is a number of differences in clinical manifestations of organic mental disorder and their changes over time, affecting the criminogenic risk of this population; an integrated approach to disease prevention, which can lead to an improvement in the criminal forecast, is needed.

Kazan medical journal. 2015;96(2):157-161
Intraoperative intestinal viability assessment in acute bowel obstruction
Nesterov M.I., Ramazanov M.R., Ramazanov M.M., Aliev E.A.

Aim. To improve the results of surgical treatment of acute bowel obstruction by introducing a new device and a method for intraoperative assessment of intestinal viability and further choice of resection and enteroenteroanastomosis level.

Methods. Our team has designed a new device for checking the arterial blood hemoglobin oxygen saturation, pulse rate, perfusion and intramural pressure in intestinal wall. A novel method for checking peripheral blood circulation was used for choosing the resection level during the surgery and for enteroenterostomy in 50 patients of the main group. Suture line viability index was also calculated using the formula proposed by M.R. Ramazanov (2008), suture line arterial blood hemoglobin oxygen saturation was also determined. Control group included 44 patients, in whom intestinal resection and enteroenterostomy for acute bowel obstruction were performed without examining the peripheral blood circulation before the device was introduced.

Results.Intramural pressure in bowel obstruction area in 10 patients was significantly lower (48.4±0.6/36.3±0.6 mm Hg at arterial blood pressure of 120.2±0.8/80±0.6 mm Hg) compared to the similar parameter in 15 healthy patients (86.5±0,9/60.3±0,5 mm Hg, p

Conclusion. The developed device allows to adequately access the peripheral blood flow in bowel obstruction, intestinal viability index and arterial blood hemoglobin oxygen saturation might be used in bowel obstruction to specify the intestinal resection level during surgery.

Kazan medical journal. 2015;96(2):161-165
Influence of parental social status on intrauterine fetal growth restriction development
Garaeva S.Z.

Aim. To study the role of parental social status on the chance of intrauterine growth restriction.

Methods. We observed 315 mothers who delivered off children with intrauterine growth restriction, of which 172 mothers gave birth to children with asymmetric type, and 143 mothers - with symmetric type of intrauterine growth restriction. Control group included 119 mothers who delivered off babies with normal growth. All mothers filled in a questionnaire addressing parental education, occupation, age, living conditions and area of residence. Dispersion analysis was performed to determine the influence of the studied factors on the chance of intrauterine growth restriction.

Results. Mother’s employment had the most influence - 8.93%. Mother’s education level effect on the chance of intrauterine growth restriction was 5.51%, followed by father’s employment, which had 4.24% of impact. Living conditions influence on the chance of intrauterine growth restriction was assessed as 2.53%, followed by the family area of residence and mother’s age, which were 2.12 and 1.52%, respectively.

Conclusion. Conducted analysis of parental social status influence on the chance of intrauterine growth restriction revealed that mother’s unemployment and low educational level are the major risk factors for this condition, which might further help to develop preventive and therapeutic approaches to decrease the effects of intrauterine growth restriction consequences.

Kazan medical journal. 2015;96(2):165-170
Prevalence and structure of periodontal disease in patients with coronary heart disease preparing for coronary artery bypass surgery
Blashkova S.L., Galyavich A.S., Vasilevskaya E.M.

Aim. To study the prevalence and structure of periodontal disease in in-patients with coronary heart disease preparing for coronary artery bypass surgery.

Methods. The study included 144 male in-patients with coronary heart disease who were prepared for coronary artery bypass surgery in the department of cardiac surgery. The diagnosis of periodontal disease was set according to the World Health Organization recommendations based on the comprehensive dental examination. Exclusion criteria were: diabetes mellitus, survived blood transfusions and all teeth missing. A prognostic model based on binary logistic regression method was created for estimation of risk factors on periodontal disease risk.

Results.The prevalence of chronic generalized periodontitis in patients with coronary heart disease preparing for coronary artery bypass surgery reaches 73.6%. Mild (51.9%) and moderately severe (48.1%) chronic generalized periodontitis were the most common. Among the risk factors for periodontal disease patients, we have identified older age, smoking, hypertension and survived acute ischemic episodes. For the created model, χ2 value was assessed as 42.7, meaning statistical significance of p

Conclusion. In in-patients with coronary heart disease, prophylaxis for periodontal disease should be performed to decrease the risk for exacerbations. Using the created prognostic tool in clinical practice may be used for outlining patients with higher risk for periodontal disease.

Kazan medical journal. 2015;96(2):170-174
Determining the risk factors for xerostomia in dental out-patients
Komarova K.V., Ratkina N.N., Polenichkin V.K., Karmanov E.P.

Aim. To determine the risk factors for xerostomia.

Methods. The study included 137 patients aged 25 to 60 years (61 males, 76 females), the main group consisted of 40 patients with xerostomia (11 males, 29 females), with a median age of 44.5 years (38; 49.5). The control group included 97 patients without xerostomia (50 males, 47 females), median age - 42 years (36; 49). The questionnaire by V.V. Afanas’ev (1993) was used to collect the complaints, anamnesis and to determine the risk factors for xerostomia. Qualitative indicators are listed as absolute numbers and shares (%). In assessing the statistical significance of qualitative indicators differences, contingency tables with subsequent Pearson chi-square test were used.

Results. Among the patients of the main group, 19 (47.5%) took medications decreasing the salivation, with intake period duration ranging from 1 to 4 months. When questioned, patients with xerostomia reported statistically significant increase in the rates of cardiovascular disorders (15 patients, 37.5%), gastrointestinal tract diseases (11 patients, 27.5%), endocrine diseases (10 patients, 25%), musculoskeletal diseases (9 patients, 22.5%). The combination of three or more positive answers on V.V. Afanas’ev questionnaire questions was revealed in 12 (30%) patients of the main group, which was significantly higher compared to the control group (1 patient, 1.03%).

Conclusion. The most typical reasons for developing xerostomia were the following: taking medications decreasing the salivation, presence of cardiovascular, gastrointestinal, musculoskeletal and endocrine disorders. Three or more positive answers on V.V. Afanas’ev questionnaire questions increase the probability of detecting xerostomia in a respondent.

Kazan medical journal. 2015;96(2):174-177
Blood cells enzymes as an indicator of adaptive processes in newborns delivered off by mothers with iron deficiency anemia
Khaybullina G.M.

Aim. To explore the enzymes in blood cells of newborns from mothers with iron deficiency anemia.

Methods. During the study, 150 infants and their mothers underwent clinical and laboratory examination, of whom 130 infants had antenatal iron deficiency of different severity (main group), 20 children were included in the control group. Cytochemical analysis of peripheral blood was performed on 1st, 3rd, 7th day after birth by smear staining and determination of succinate dehydrogenase in lymphocytes, myeloperoxidase in neutrophils, acid and alkaline phosphatase in neutrophils and lymphocytes by microscopic analysis.

Results.Succinate dehydrogenase activity was reduced on the 3rd day of life in lymphocytes of the newborns of the first group who were delivered off by mothers with latent iron deficiency. Average level of acid phosphatase in lymphocytes and neutrophils was higher compared to controls throughout the study (p

Conclusion. Cytochemical studies of peripheral blood neutrophils and lymphocytes may be used as a screening test to assess the immunity in newborns who were delivered off by mothers with iron deficiency, and for personalized management of patients with comorbidities.

Kazan medical journal. 2015;96(2):177-181
Predicting the risk for preterm delivery in HIV-infected
Shteyman A.A., Okhapkin M.B., Ershova Y.V.

Aim. To outline the risk factors for preterm delivery in HIV-positive women.

Methods. Clinical histories of 146 pregnancies with a confirmed diagnosis of HIV infection were analyzed. All patients were allocated to 2 groups. The first group included 60 patients who had a preterm delivery prior to 37th week of pregnancy. The second group included 86 patients who delivered at term. To identify the risk factors for preterm delivery, odds ratios were calculated.

Results. Risk factors for preterm birth include: infection duration less than 1 year (OR=2.6, 95% CI=1.04-6.49); 4A stage of HIV infection (OR=2.67, 95% CI=1.08-6.60); antiretroviral treatment started on 28th week of pregnancy (OR=5.12, 95% CI=2.37-11.02); oligohydramnios according to the results of second scheduled ultrasonography at 21-22th week of pregnancy (OR=29.0, 95% CI=3.73-158.8) and data for intrauterine growth restriction according to the results of third scheduled ultrasonography at 21-22th week of pregnancy (OR=16.84, 95% CI=5.46-51.93). CD4 count (OR=0.42, 95% CI=0.16-1.02) and viral load (OR=0.43, 95% CI=0.17-1.03) are indicators of patient’s immune status, but do not allow predict the risk of preterm birth.

Conclusion. Factors that might be considered as preterm delivery predictors are outlined. Introducing the package of measures aimed at early treatment of HIV-positive pregnant women with the risk factors would allow to reduce the number of preterm deliveries in such patients.

Kazan medical journal. 2015;96(2):182-186
Role of immunity and endogenous antimicrobial peptides in the pathogenesis of chronic hepatitis C
Efendiyev A.M., Khidayatova Z.G.
Aim. To study the immunological parameters and the concentration of antimicrobial peptides defensins, neutrophil elastase, endotoxin and lipopolysaccharide-binding protein in patients with chronic hepatitis C, and to identify the relationship between these changes and their role in the pathogenesis of the disease. Methods. Blood plasma of 64 patients with chronic hepatitis C, including 31 patients with uncomplicated course of the disease (the first group) and 33 patients with chronic hepatitis C, accompanied by a bacterial infection (pneumonia, the second group) was studied. The concentration of total, direct and indirect bilirubin was determined by Endrashik method, alanine aminotransferase and aspartate aminotransferase - by Reitman-Frankel method, γ-glutamyl transferase enzyme activity and total protein level - using «Diasys» (Germany) commercial kits. Defensin, endotoxin, neutrophil elastase and lipopolysaccharide-binding protein levels were determined by ELISA using «Hycult Biotechnology» (The Netherlands) kit. To assess the state of cellular and humoral immunity, lymphocytes subpopulations were determined by indirect surface immunofluorescence reaction using murine monoclonal antibodies to CD3+, CD4+, CD8+, CD14+, CD16+, CD25+ lymphocyte antigens. Results. Immunological parameters changed unidirectionally in both groups of patients. The degree of the antimicrobial peptides increase was higher in the second group, which is probably due to the presence of bacterial factor, in addition to the virus. The number of CD3+-lymphocytes negatively correlated with the level of α-defensins (p <0.005) in the first group of patients. A strong positive correlation of the CD8+-cells count and elafin level (p <0.001) and elastase (p <0.001) was revealed. The number of CD16+-cells showed a strong positive relationship only with elastase level (p <0.001). Conclusion. The obtained data justify the use of defensin, neutrophil elastase, endotoxin and lipopolysaccharide binding protein as additional biomarkers for assessing the inflammatory process in the liver at viral and bacterial infections.
Kazan medical journal. 2015;96(2):186-191
Pathophysiological disturbances in complicated pancreatic pseudocysts
Gerbali O.Y., Krivoruchko I.A., Goncharova N.N.

Aim. To determine profibrogenic mediators, markers of endothelial dysfunction and hemostasis in patients with different types of complicated pancreatic pseudocysts.

Methods. The study included 47 patients aged 43.58±7.38 years: 42 males and 5 females. The patients were allocated to three groups based on the classification of pancreatic pseudocysts by A. D’Egidio and М. Schein (1991). All patients underwent surgery. Serum levels of vascular endothelial growth factor, matrix metalloproteinase-9, matrix metalloproteinase-2 tissue inhibitor, the complex of metalloproteinase-9 and inhibitor, plasma levels of interleukin-6, -8, -18 and -10 were determined by ELISA method. Blood glutathione peroxidase activity and malondialdehyde serum level were determined by spectrophotometry.

Results.Levels of Interleukin-6, -8 and -18 was higher in patients with type I of pseudocysts compared to control (p

Conclusion. Increased concentration of matrix metalloproteinase-2 tissue inhibitor and increased inhibition coefficient in patients with chronic pancreatitis may reflect favorable conditions for pancreatic remodeling and fibrosis.

Kazan medical journal. 2015;96(2):191-197
Experimental medicine
Effect of autologous mesenchymal pluripotent stem cells transplantation on liver microcirculation in rats with experimental liver cirrhosis
Dzhafarli R.E.

Aim. To study the effect of autologous bone marrow pluripotent stem cells transplantation on liver microcirculation in experimental model of liver cirrhosis.

Methods. 43 white Wistar male rats with body weight of 150-180 g aged at least 3 months were used, in which autologous pluripotent mesenchymal stromal cells transplantation was performed. Considering the animals mortality at the cirrhosis modeling stage, which was 9.3% (4 out of 43 rats), the first group included 19 rats in which stromal cells were transplanted into the portal vein; in the second group (20 rats) the cells were injected into the common hepatic artery. Liver microcirculation was studied using laser Doppler flowmetry and wavelet analysis. Examinations were performed during the operation prior to autologous pluripotent mesenchymal stromal cells transplantation in rats with experimental liver cirrhosis, as well as on the 8th week of treatment.

Results.In modeled liver cirrhosis, the microcirculation index was decreased by 24.5% (p

Conclusion. The repeated studies of microcirculation based on laser Doppler during the treatment of animals with experimental liver cirrhosis indicates the advantages of intra-arterial autologous multipotent mesenchymal stromal cells transplantation.

Kazan medical journal. 2015;96(2):198-202
Experimental assessment of 2-oxyindolin-3-glyoxylic acid derivative anticonvulsant effect
Lutsenko R.V.

Aim. To explore the anticonvulsant effect of 2-oxyindolin-3-glyoxylic acid derivative on the model of acute myoclonic seizures caused by pentylenetetrazol, picrotoxin and thiosemicarbazide.

Methods. Median effective dose (ED50) of 2-hydro-N-naphthalene-1-yl-2-(2-oxy-1,2-dyhydro-indole-3-ylidene)-acetamide diethyl ether was determined by the maximal electroshock test in experiments on adult Wistar rats of both gender. The effect of median effective dose prophylactic administration of the study medication and comparators - diazepam and sodium valproate - on chemo-induced epileptogenesis was explored. Introduction of proconvulsant drugs (pentylenetetrazol, picrotoxin and thiosemicarbazide) was accompanied by the development of seizures, which was estimated by the intensity of seizures (points), latent period of seizures onset (seconds), the number of convulsive attacks, seizures, duration (seconds) and the number of survived animals in each group.

Results. Median effective dose of 2-oxyindolin derivative was 12 mg/kg as measured by maximal electroshock test. This dose of the test compound, similar to diazepam, effectively reduced the severity of seizures caused by pentylenetetrazol, seen as the increased duration of latent period before the seizures onset by 1.9 times, decreased severity of seizures by 1.7 times, decreased number of seizures by 2.1 times, and decreased seizure duration by 2.3 times together with lower mortality. The prophylactic administration of the substance has extended the latent period of seizures by 2.0 times, significantly reduced the number, intensity and duration of seizures, decreased the mortality after administration of picrotoxin. Also, 2-oxyindolin derivative significantly increased the latent period of seizures onset and reduced the severity of seizures due to thiosemicarbazide. At that, the study substance was not inferior in anticonvulsant activity compared to the diazepam as the reference drug.

Conclusion. The dose of 12 mg/kg of 2-hydro-N-naphthalene-1-yl-2-(2-oxy-1,2-dyhydro-indole-3-ylidene)-acetamide was effective in preventing seizures associated with gamma-aminobutyric acid (GABA)-convulsants.

Kazan medical journal. 2015;96(2):203-208
Acute toxicity of nanosized beet pectin
Alimzhanov N.Y., Chakeev I.S., Zhorobekova S.Z., Kudaybergenova I.O., Lepshin B.N.

Aim. To determine the acute toxicity and hazard class of nanosized low-esterified beet pectin.

Methods. To study the acute toxicity of substances, Kerber’s method was used. Probit analysis for different values of lethal dose calculated by least squares method, as well as morphologic studies, statistical analysis (non-parametric methods - Wilcoxon-Mann-Whitney test) were used. Pectin toxicity was studies on 40 mature Wistar rats of both gender and body weight of 160-230 g.

Results. Enteral administration of 12 000 mg/kg of pectin did not affect the general condition and did not lead to lethal outcome. The following values of lethal doses were calculated using probit analysis: LD16=34 990.6542056074≈35 g/kg, LD50=74 242.9906542057≈74 g/kg, LD84=113 495.327102804≈113 g/kg, LD100=133 121.495327103≈133 g/kg. Histological study of rat organ tissues that received 12 000 mg/kg of pectin showed no structural changes in tissues of examined organs. Study drug - nanosized low molecular weight pectin, might be referred to hazard class IV (low hazard substances) according to GOST 12.1.007-76. and classification K.K. Sidorov Pectin substance may be considered as practically nontoxic drug (LD50 >10,000 mg/kg), which corresponds to Class V compounds according to Hodge and Sterner classification and classification by K.K. Sidorov.

Conclusion. The results indicate complete safety of nanosized forms of pectin, which opens up prospects for further studies of the biological properties of this substance.

Kazan medical journal. 2015;96(2):208-213
Intra-abdominal pressure monitoring in postoperative period in patients with diffuse peritonitis
Salakhov E.K., Salakhov K.K.
Epidemiology, etiology, pathologic and morphologic changes associated with increased intra-abdominal pressure are described. The most common ways of its measuring and monitoring are presented. Intra-abdominal pressure is increased by more than 15 mm Hg in patients with diffuse peritonitis. Increased intra-abdominal pressure is associated with the disease severity: the higher the intra-abdominal pressure, the more severe is the disease. If intra-abdominal pressure is increased over 20 mm Hg, treatment strategy depends on the signs of organ failure. In the absence of organ failure, intra-abdominal pressure should be monitored every 4 hours as long as the patient is in critical condition. Intra-abdominal pressure monitoring in case of peritonitis must be attributed to the mandatory manipulation, as pressure changes precede the clinical manifestations of intra-abdominal complications. Measurement of intra-abdominal pressure allows to detect the early signs of multiple organ failure, which is essential for the correction of systemic complications in pancreatogenic peritonitis. In this case, monitoring of intra-abdominal pressure in diffuse postoperative peritonitis should be considered only as a screening test for assessing of the organ dysfunction severity, as the development of multiple organ dysfunction syndrome involves complex pathophysiological mechanisms. Predictions that are more accurate can be made using such integrated indicators as APACHE II (Acute Physiology And Chronic Health Evaluation scale, which is used for assessing various acute and chronic diseases), SAPS (Simplified Acute Physiology Score - a simplified scale for acute functional changes assessment), SOFA (Sepsis-related Organ Failure Assessments Score - scale for dynamic assessment of organ failure in sepsis), MPI (Mannheim Peritonitis Index) scales.
Kazan medical journal. 2015;96(2):214-219
Vascular endothelial growth factor role in predicting vascular disorders in pregnant with fetal growth restriction syndrome
Ul’yanina E.V., Fatkullin I.F.
The review covers the up-to-date data of vascular endothelial growth factor role in forming of placental blood circulation in non-complicated pregnancy and in fetal growth retardation syndrome. It is shown that the normal trophoblast invasion to the spiral arteries wall in the myometrium and adequate remodeling of spiral arteries are essential for the normal fetal growth and development. The processes of blood vessels formation - vasculogenesis and angiogenesis - are described in detail. The process of angiogenesis regulation by growth factors and their receptors is reviewed. The importance of angiogenic and antiangiogenic factors coordinated action for the adequate placental microvasculature formation and normal fetal development is described. The growth factor complexes and their receptors formation processes and competition for receptor binding, as well as the role of placental growth factor in uteroplacental complex angiogenesis are analyzed. It is shown that the serum growth factors represent the mechanisms of pathologic reactions in placental insufficiency and fetal growth restriction syndrome. Special attention is given to the family of vascular endothelial growth factor as for the most important angiogenesis regulator. To determine the physiological role of vascular endothelial growth factor and to assess the its influence on angiogenesis and adequate uteroplacental and fetoplacental blood circulation formation, the features of vascular endothelial growth factor chemical structure are described. Determining the vascular endothelial growth factor in blood may be used to assess the mother-placenta-fetus system formation. The need for developing the criteria for choosing the optimal delivery term in pregnant with fetal growth restriction syndrome is discussed.
Kazan medical journal. 2015;96(2):220-223
Healthcare mangement
Modern aspects of disability due to eye diseases
Nazaryan M.G., Arbukhanova P.M.
Despite current successes of ophthalmology, during the last decades, blindness and low vision affect the population of both developed and developing countries. In United States, the prevalence of blindness in 1940 was 17.5 per 10 thousand in 1960-1979, this figure reached 20.0, and nowadays - 50.0 per 10 thousand. population. According to the World Health Organization data of 2014, the World has 285 million blind and visually impaired people, 90% of visually impaired live in developing countries. The main causes of blindness in underdeveloped and developing countries are cataract, trachoma, onchocerciasis, xerophthalmia. In highly developed countries, the causes are different - glaucoma, degenerative myopia, cataract, chorioretinal degeneration, diabetic retinopathy, congenital eye diseases. In the Russian Federation, the prevalence of blindness and low vision, as well as the structure of nosologies leading to these conditions are similar to those in developed countries. The prevalence of blindness and low vision in Russia, according to E.S. Liebman, for the 1985-2002 increased from 13.6 to 17.0 per 10 thousand, and the prevalence of blindness - from 7.0 to 7.8 per 10 thousand. The maximum rates observed in the Central and Volga economic regions (25.6 and 20.3), in the Udmurt Republic (39.6), Lipetsk (41.1) and Yaroslavl (34.3) regions (per 10 thousand). The World Health Organization has developed a long-term plan of action for the prevention of eye diseases in the global initiative «Vision 2020: the Right to Sight». A good progress has been made, particularly in combating infectious causes of blindness by supporting the Member States and attracting long-term resources. Thus, an active work is ongoing to reduce the disability due to eye diseases worldwide. Up to 80% of cases of blindness can be avoided with early diagnosis and treatment of patients.
Kazan medical journal. 2015;96(2):224-226
Medical cybernetics
The effect of hospital information systems on healthcare facilities efficiency indicators
Gimadeev S.M., Latypov A.I., Radchenko S.V., Khaziakhmetov D.F.

Aim. Comparative assessment of an automation facilities influence on labor input and business processes’ productivity indicators related to primary functions of healthcare facilities of different types.

Methods. We performed medical personnel’s work timing in emergency rooms, as well as medical records timing in clinical departments. The automated electronic health records processing while operating hospital information systems created by authors among different types of healthcare facilities was also performed. Output data included personal health record operation periods values and system events timestamps.

Results. The data concerning hospital information systems’ influence on electronic health records operating time changes and hospitalization delays was obtained. A correlation between the initial hospitalization delay and hospital capacity was discovered (r=0.917). The emergency room automation significantly reduces hospitalization delays. Under clinical information system operating conditions, the primary examination time recording increases twice, while the time spent for all other electronic health records decreases in higher order. Considerable difference between primary examination recording time and the time, necessary for other personal health record registrations, has satisfactory interpretation within the heterogeneous medical data sources integration model, but not within usability model. In general, the gained data does not confirm results of previously published researches pointing the increased time doctors spent for data management in automation conditions.

Conclusion. Hospital information systems implementation improved the specialist’s labor productivity and main working processes work capacity. The obtained data indicate a greater influence of automation in large healthcare facilities and reject usability hypothesis of hospital information systems efficiency.

Kazan medical journal. 2015;96(2):227-233
Sports medicine and rehabilitation
Injuries and diseases in top professional watersports athletes
Takhavieva F.V.
On the eve of the World Swimming Championship in 2015, which will be held in Russia, a review of literature analyzing injuries and diseases in top professional watersports athletes that may be acquired at competitions is presented. Modern professional sport is characterized by an intense training process, is highly competitive on the international level. Setting each new sports record becomes more and more complex. Top professional sport is associated with risk of injury, and the proper organization of biomedical support of training and competitive process is the key to reducing the incidence of injuries in sports. Literature review allowed making the following conclusions. Firstly, insufficient attention was paid to the registration of injuries in specific sports and their classification if occurred not only during competitions, but also during the training period. Secondly, during competitions the number of injuries increases in all watersports except synchronized swimming. Thirdly, the most traumatic sport is water polo, where most injuries occur during competitive activities. Fourthly, Watersports World Championships are associated with increased risk for diseases, although already implemented preventive measures reduced the incidence of infectious diseases of the upper respiratory tract. Fifthly, there is a need for further thorough study of the injuries and diseases frequencies to create preventive and rehabilitation measures in athletes involved in water sports. Thus, injuries and diseases are a significant risk for the health of athletes involved in water sports. All medical professionals involved in providing medical aid at the sporting competitions should know the specific features of injuries and diseases common for the certain sporting competitions, and develop the preventive measures.
Kazan medical journal. 2015;96(2):234-237
Features of quantity elements and essential trace elements concentrations in saliva of young athletes
Troegubova N.A., Rylova N.V.

Aim. To explore the concentrations of quantity elements and essential trace elements (calcium, potassium, magnesium, zinc, iron, chromium, and selenium) in saliva of young athletes.

Methods. The study included 111 children aged 12-17 years who were allocated to three groups. The first group included 28 schoolchildren, the second group - 36 adolescents (students of the «Kasatka» swimming sports school) and the third group - 47 athletes (students of the Republican specialized youth sports school of Olympic reserve for grass hockey «Dynamo» of the Republic of Tatarstan). Mass spectrometry with inductively coupled plasma was performed on «Elan-9000» mass spectrometer; optical emission spectrometry with inductively coupled plasma was performed on «Optima 2000DV» optical emission spectrometer.

Results. In young athletes of cyclic sports, there was a significant reduction of salivary calcium (by 1.16 times) and potassium (by 1.8 times) levels compared to control group. Salivary levels of magnesium, zinc, chromium and selenium were significantly increased in athletes.

Conclusion. Revealed differences of quantity elements and essential trace elements salivary concentrations reflect the features of their metabolism at high physical and emotional stress.

Kazan medical journal. 2015;96(2):238-241
Using modern information technologies for sanitary and epidemiologic well-being maintenance during mass events with international participation
Patyashina M.A., Yuzlibaeva L.R.

Aim. To assess the system for registration and account of infectious and parasitic diseases in Republic of Tatarstan useing software products for epidemiological situation managing, sanitary-and-epidemiologic emergencies prevention, hazards of infectious diseases onset and spreading that might be potentially dangerous for participants, visitors and local residents during XXVII Worldwide Universiade 2013 in Kazan.

Methods. Statistical forms №1 and №2 «Data on infectious and parasitic diseases» in the Republic of Tatarstan for the period of 2004 to 2013, 058/у forms (emergency notifications), «Infectious diseases registry» (journal №60) were used for data gaining. To analyze the prevalence of the diseases, software products («Population disease prevalence analysis»), «Social and hygienic monitoring» - «Krista» automated system, «Automated information system of epidemiological survey and emergencies prevention in the sphere of public healthcare during the 2013 Universiade» («Epidemiological safety» automated information system) software were used. Methods of epidemiological diagnosis and common methods of variance analysis (calculations of relative and mean values, statistical series analysis and statistical significance assessment) were used.

Results. Retrospective epidemiological analysis of infectious and parasitic diseases in Republic of Tatarstan and in Kazan city, monitoring of background epidemiological conditions in Kazan city using the «Population disease prevalence analysis» software products and «Krista» automated system, as well as on-stream epidemiological analysis of infectious and parasitic diseases prevalence among participants, visitors of the 2013 Kazan Universiade by introducing the «Epidemiological safety» automated information system increased the epidemiological diagnosis quality, allowed to timely identify epidemiological deviations, provide targeted sanitary and anti-epidemic measures and to assess their effect. Continuous interaction between the Tatarstan Regional Agency of the Federal Service for Surveillance in the Sphere of Consumer Rights Protection and Human Welfare, Russian scientific and research institute for fighting plaque «Mikrob», Hygiene and epidemiology Center of the Republic of Tatarstan and healthcare institutions was provided during the 2013 Universiade.

Conclusion. Complex use of modern information technologies and introduction of «Epidemiological safety» automated information system while carrying out the 2013 Universiade allowed to completely implement the targeted management and technologic tasks for infective and parasitic diseases prevalence monitoring.

Kazan medical journal. 2015;96(2):241-248
Clinical observations
Common variable immune deficiency in clinical practice
Yagudina L.A., Khakimova D.M.
Primary immunodeficiencies are rare but severe diseases. Out of all primary immunodeficiencies, most commonly diagnosed conditions belong to the group of common variable immune deficiencies. According to criteria of European Society for Immunodeficiencies (ESID) the diagnosis of common variable immune deficiency is extremely likely at considerable decrease (over 2 standard deviation values compared to median value) of two or three main isotypes of immunoglobulins (classes A, G, M). The mean prevalence of variable immune deficiency in general population ranges from 1:50 000 to 1:70 000. This disease has two age peaks of onset: the first peak is between the age of 6 and 10 years; the second peak - between the age of 26-30 years. Moreover, before the disease onset patients are considered as healthy. The range of clinical manifestations, which may help to suspect common variable immune deficiency, is very wide: some patients have repeated pneumonia, others have thrombocytopenic purpura, autoimmune hemolytic anemia or colitis. Low prevalence of primary immunodeficiency in population, a variety of its clinical forms, insufficient awareness of practical doctors dictate the need for detailed description of this pathology on a clinical example. The article presents a case of firstly diagnosed case of common variable immune deficiency in a 26 years old female. Issues of epidemiology, etiology, pathogenesis, clinical symptoms and diagnosis of this disease are described. It is necessary to draw the attention of doctors of various specialties to the fact that changes in the immune system, up to hereditary, genetically determined immunodeficiencies can often be the cause of recurrent inflammatory processes of different localization with a low response to conventional therapy.
Kazan medical journal. 2015;96(2):249-252
Body shape index - a novel premature death risk factor
Oslopov V.N., Bogoyavlenskaya O.V.
The article covers the topic of stratifying risk factors for premature death associated with cardiovascular disease, such as gender, age, smoking, dyslipidemia, fasting serum glucose levels, target organ damage, obesity and others. Overweight and obesity are the main risk factors for death; according to the World Health Organization, about 3.4 million people in the World die each year due to overweight and obesity. Conventionally, body mass index is used as the standard international index, which characterizes the constitution to classify obesity. In assessing the risk of cardiovascular disease and type 2 diabetes, the ratio of waist circumference to hip circumference is also determined. It is known that central obesity is more significant compared to body mass index change in predicting insulin resistance and cardiovascular disease risk. In addition, high body mass index values may falsely indicate obesity in individuals with increased muscle mass and/or «boned» skeleton. Currently, a new, improved index - body shape index is proposed as a tool to quantify the risk associated with abdominal obesity (the ratio between waist circumference, height and weight). Body shape index is transient indicator that can be easily calculated, and is a strict statistical indicator of the premature death risk, more informative than body mass index.
Kazan medical journal. 2015;96(2):253-256
History of medicine
The Role of Professor V.I. Razumovskiy and His Disciples in Pediatric Surgery Formation in Kazan
Akhunzyanov A.A.
The history of pediatric surgery development at the Medical Faculty of the Kazan Imperial University and Kazan city is full of white spots. The most important among them, in our opinion, is that published biographies of Imperial Kazan University’s and Kazan State Medical Institute’s prominent pediatricians and surgeons almost do not contain information about their role in the formation of pediatric surgery as a separate specialty. Even in detailed biography of professors Nikolay Aleksandrovich Tolmachev and Vasiliy Ivanovich Razumovskiy, we only find a description of their activities as a pediatrician and a surgeon. In view of the above, this paper provides unpublished reliable information to reflect their contribution to the development of pediatric surgery in Kazan. The initial stage of the official establishment of the pediatric surgical diseases course at the Kazan Imperial University medical faculty, followed by foundation of pediatric surgery faculty at the Kazan State Medical Institute, is described. Biography of the first pediatric surgeon of Kazan Imperial University Vladimir L. Borman is presented. While analyzing the historical facts, it’s worth noticing that many organizational and personnel matters of delivering pediatric surgery classes to the students of Kazan Imperial University Medical Faculty and Kazan State Medical Institute were mainly resolved due to the efforts of outstanding for their time Kazan Imperial University professors: pediatricians N.A. Tolmachev, P.M. Argutinskiy-Dolgorukov, surgeon V.I. Razumovsky and his disciples - V.L. Borman, V.L. Bogolyubov, I.F. Kharitonov.
Kazan medical journal. 2015;96(2):257-264
Names of the Kazan scientists in the history of medicine of the Arkhangelsk oblast
Andreeva A.V., Chirtsova M.G.
Article focuses on the role of Kazan scientists in the development and foundation of a number of departments of Arkhangelsk State Medical Institute, founded in 1932. The teaching staff for the most northern institution for higher medical education in the country was recruited from all over the Soviet Union. Founders and first heads of departments were the representatives of major scientific schools and leading universities, including the Kazan University/Kazan Medical Institute. Highly qualified specialists, scientists and healthcare managers with extensive experience played an important role in the development of healthcare in the European North of Russia. One of the first scientists of Kazan, who arrived at Arkhangelsk State Medical Institute, was psychiatrist I.N. Zhilin, whose activities are immortalized in the history of the department and the psychiatric hospital. Next Kazan representative, A.I. Labbok - anatomist, surgeon, doctor of sciences, professor, founder and first head of the department of operative surgery and topographic anatomy of the Institute. Surgeon A.A. Vechtomov became a professor and head of the Department of General Surgery, the head of the clinic, where during the Great Patriotic War the wounded from the Karelian Front and the Northern Fleet were treated. The founder of the Department of Pediatrics at Arkhangelsk State Medical Institute - Professor Yu.V. Makarov, came to Arkhangelsk from Kazan and his wife, G.A. Khayn-Makarova, who contributed much to military pediatrics. They were succeeded by associate professor A.G. Suvorov, who raised a galaxy of eminent pediatricians. Research of the data on many of Kazan scientists are still ongoing at the museum complex of the Northern State Medical University.
Kazan medical journal. 2015;96(2):264-267
Hard lines of the fifth Kazan state medical institution principal, associate professor of the department of ophthalmology Suleyman Bek-Mukhametovich Enaleev (devoted to the 120th birth anniversary)
Nugumanova A.M., Khamitova G.K.
The article is devoted to the 120th birth anniversary of the fifth principal of the Kazan State Medical Institute, associate professor of the ophthalmology department Suleyman Bek-Mukhametovich Enaleev, whose life journey was short and thorny. His curiosity, thirst for knowledge and self-sacrificing work had raised him from a simple village boy to the principal of the Kazan State Medical Institute and the People’s Commissar of Healthcare of Tatarstan. The article describes the successful start of his career as manager, but false accusations tragically cut short his life. For a long time his name was noteless because documents showing his activities during this period were seized from the Institute archives. Only official orders were preserved, which shed light on active work he performed in this post: not only taking the great interest in his employees’ lives, covering the cost of their treatment and other needs, but also supported the scientific, medical and educational work of his colleagues. In addition, associate professor S.B. Enaleev actively participated in launching new schools and hospitals in Tatarstan, creating new departments at the Institute (departments of pathophysiology, surgery of the pediatric faculty and the faculty of public health, 4th department of internal medicine), recruiting their personnel, organizing repair of university buildings and dormitories, etc. However, despite the progress made by S.B. Enaleev while he was in charge of the Institute, in 1938 the NKVD arrested him on a false denunciation. Unable to withstand the torture and beatings, S.B. Enaleev died. Many years later, a special commission of the KGB under the Council of Ministers of Tatarstan rehabilitated his good name.
Kazan medical journal. 2015;96(2):267-269
Professoru Marselyu Zakeevichu Mirgazizovu - 80 let
Kazan medical journal. 2015;96(2):270-271
Irina Vsevolodovna Karamysheva
Kazan medical journal. 2015;96(2):272

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