Vol 101, No 1 (2020)

Theoretical and clinical medicine

Pregnancy complications in type 1 diabetes mellitus in combination with urinary tract infections with various treatment options

Alekseenko I.V., Ivanova L.A.


Aim. To assess the frequency of pregnancy complications in women with type 1 diabetes mellitus and without diabetes combined with urinary infection and the effect of various treatment options for urinary infection on the frequency of pregnancy complications in type 1 diabetes.

Methods. Pregnant women with urinary tract infection were examined: 110 people with type 1 diabetes (main group) and 133 women without diabetes (comparison group). The diagnosis of urinary infection was confirmed by a double bacteriological culture. Patients of the main group were divided into three subgroups depending on the method of treatment of urinary tract infection: subgroup A received antibiotic therapy and phytopreparation (Centaurium + Lovage root + Rosemary leaves), subgroup Б received antibiotic therapy, subgroup B received phytopreparation. After treatment, the preservation of pregnancy complications such as the threat of miscarriage, proteinuria, intrauterine infection of fetus, anemia, premature birth, which developed on a background of urinary tract infection, was evaluated. The significance of differences in groups was evaluated using the Pearson chi-square tests, and the effectiveness of each type of therapy was evaluated using the McNemar test.

Results. The risk of miscarriage, intrauterine infection, anemia, and premature birth was higher in pregnant women of main group with all types of urinary infection, preeclampsia with pyelonephritis, and asymptomatic bacteriuria. Both complex therapy of pyelonephritis (antibiotics with phytopreparation) and monotherapy with antibiotics were effective in eliminating the threat of miscarriage, intrauterine infection and anemia. Adding herbal medicine to antibiotic therapy for pyelonephritis reduced the preterm birth rate compared with antibiotic monotherapy, and other complications did not reveal differences between subgroups. In asymptomatic bacteriuria, complex therapy and monotherapy with antibiotics were effective in eliminating the threat of miscarriage, intrauterine infection and anemia. Monotherapy with a phytopreparation in pregnant women with type 1 diabetes did not lead to the elimination of these complications. Combination therapy asymptomatic bacteriuria was more effective than antibiotic monotherapy in terms of the effect on preterm delivery and equally effective in terms of the threat of miscarriage, intrauterine infection and anemia.

Conclusion. Adding phytopreparation to antibiotic therapy for pyelonephritis and asymptomatic bacteriuria in pregnant women with type 1 diabetes mellitus to prevent premature birth seems appropriate; monotherapy of asymptomatic bacteriuria with a phytopreparation is ineffective for eliminating the threat of miscarriage, intrauterine infection, anemia, therefore antibiotics should be prescribed at the beginning of therapy for asymptomatic bacteriuria.

Kazan medical journal. 2020;101(1):5-12
pages 5-12 views

Effect of oxidative stress on endothelium in patients with heart failure and type 2 diabetes ­mellitus

Mammadova F.I.


Aim. To estimate the severity of endothelial dysfunction and effects of nitric oxide, thiol status and cystatin on the progression of chronic heart failure and chronic heart failure in type 2 diabetes mellitus.

Methods. 80 patients (men and women) with chronic heart failure were included. All patients were divided into two groups: the first group — 39 patients with chronic heart failure, the second — 41 people with chronic heart failure and type 2 diabetes mellitus. The control group consists of 20 healthy donors. To obtain statistically significant differences with the control group the minimum sample size for observations was determined based on the target variance of a small sample (n=10). The lipid profile and carbohydrate metabolism, endothelin-1, cystatin, nitric oxide were evaluated. Statistical processing was performed using Microsoft Office Excel and IBM SPSS Statistics 20 software.

Results. Changes in lipid metabolism were found in both groups, while an increase in carbohydrate metabolism was observed in patients with chronic heart failure with type 2 diabetes mellitus. Under conditions of oxidative stress in patients with chronic heart failure, a decrease in the content of thiol status and an increase in the amount of nitric oxide in the blood serum were recorded. The endothelin-1 level was elevated, particularly in the second group, which indicates a more serious endothelial dysfunction with increased glucose content in patients with chronic heart failure.

Conclusion. The level of cystatin C as an atherogenic risk factor was equally increased in the studied patients, possibly it affected by the rate of disease progression; feasible to use these markers to detect the progression of chronic heart failure in the early stages.

Kazan medical journal. 2020;101(1):13-17
pages 13-17 views

Features of coronary artery patterns and percutaneous coronary intervention in patients with acute coronary syndrome and stable angina in patients aged below 40 years

Abdullaev F.Z., Babaev N.M., Shikhieva L.S.


Aim. To study the features of risk profile, coronary artery patterns, and percutaneous coronary intervention in patients aged below 40 years with acute coronary syndrome and stable angina.

Methods. 208 patients with coronary artery disease aged below 40 years were examined: 51 (24.5%) patients aged 35 years and younger and 157 (75.5%) aged 36–40 years. 98 (47.1%) patients were admitted with acute coronary syndrome; 110 (52.9%) patients with stable angina. In groups of acute coronary syndrome and stable angina, myocardial infarction in past medical history was revealed in 23.5% and 36.4%, respectively. 165 patients underwent percutaneous coronary intervention: 84 (50.9%) with acute coronary syndrome; 81 (40.1%) with stable angina.

Results. Patients with stable angina differed by prevalence of myocardial infarction in past medical history, overweight, and family history of coronary artery disease. In group of acute coronary syndrome urban cohort prevailed as well as consumption of energy drinks among patients below 35 years; high prevalence of left ventricular dysfunction. Patients with acute coronary syndrome were characterized by involvement of one and three coronary arteries, and patients with stable angina — by pathology of two and three coronary arteries. Involvement of three coronary arteries was equal in both groups. In both groups, anterior interventricular artery was target coronary artery. Patients with stable angina had the same rate of right coronary artery and left circumflex artery involvement. In patients with stable angina, right coronary artery involvement was rarer, and left main coronary artery involvement was two times more frequent than in patients with acute coronary syndrome. The group with acute coronary syndrome was characterized by predominance of discrete lesions and coronary occlusions over diffuse lesions; and the group of stable angina — by diffuse lesions, and two-times less frequent coronary occlusions.

Conclusion. Among patients with acute coronary syndrome aged below 36 years, revascularization of right coronary artery was predominant, and among patients aged 36–40 years with acute coronary syndrome — revascularization of left circumflex artery.

Kazan medical journal. 2020;101(1):18-24
pages 18-24 views

Comparison between the efficacy plant and synthetic origin dental products in the treatment of chronic catarrhal gingivitis.

Lyamin Y.S., Fedorova Y.S., Kulpin P.V., Suslov N.I., Kucheryavyi D.V.


Aim. Comparative clinical study of hygienic dental product of plant origin based α-mangostin [1,3,6-Trihydroxy-7-methoxy-2,8-bis(3-methyl-2-butenyl)-9H-xanthen-9-one], a xanthone from mangosteen fruit, having antimicrobial and anti-inflammatory activity in the treatment of chronic generalized catarrhal gingivitis.

Methods. The study included 319 patients aged 22 to 45 years. All patients were divided into two groups: the control group — 20 people (males — 40%, females — 60%), average age 34.8±8.00 years; the comparison group — 20 people (males — 45%, females — 55%), average age 35.0±7.10 year; the main group — 20 people (males — 40%, females — 60%), average age 34.9±7.86 years. There were no statistically significant differences between all groups (p <0.05). The nosological form of the disease in the studied patients is chronic generalized catarrhal gingivitis (K05.1). Treatment in all groups was carried out using the standard regimen of complex therapy of chronic generalized catarrhal gingivitis. Therapy of the main group patients was supplemented by the use of the hygienic gel containing 1% α-mangostin [1,3,6-Trihydroxy-7-methoxy-2,8-bis(3-methyl-2-butenyl)-9H-xanthen-9-one], whereas treatment of the comparison group patients was supplemented by the complex preparation containing 1% metronidazole and 0.25% chlorhexidine digluconate. The dental examination included a questionnaire with the registration of subjective data (patient complaints) and objective data on the state of the tissues of the mouth (index score) before and after therapy, as well as the dynamics of the indicators fixing during the entire treatment.

Results. The performing a comparative study of the treatment effectiveness of chronic generalized catarrhal gingivitis, using a dental hygienic gel containing 1% α-mangostin [1,3,6-Trihydroxy-7-methoxy-2,8-bis(3-methyl-2-butenyl)-9H-xanthen-9-one] as a part of complex therapy in comparison with the standard complex treatment regi­men supplemented by dental product containing 1% metronidazole and 0.25% chlorhexidine digluconate, showed a marked improvement in subjective quality of life of patients. Pain during individual oral hygiene and food intake (decrease to 0%, p1 <0.05, p2 <0.05), a feeling of “bursting” in the gum (decrease to 0%, p1 <0.05, p2 <0.05), bad breath (decrease to 0%, p1 <0.05, p2 <0.05) and bleeding gums (decrease to 0%, p1 <0.05, p2 <0.05) were completely eliminated. Compared to the control group, OHI-S index of the main group decreased by 79% (from 1.9 to 0.4, p1 <0.001, p2 <0.001), PI index decreased by 80.6% (from 3.1 to 0.6, p1 <0.001, p2 <0.001) and SBI index decreased by 100% (from 3 to 0, p1 <0.001, p2 <0.001). During the course of treatment of patients with chronic generalized catarrhal gingivitis, a decrease in the average values of the PMA index was observed. In the group of patients using hygienic gel as a supplement to treatment, the decrease in this index was 85% (from 65±1.53 to 10±0.82%; p1 <0.001, p2 <0.05), and when using a complex drug containing 1% metronidazole and 0.25% chlorhexidine digluconate, the value of the PMA index decreased by 51% (from 61±1.17 to 30±1.4%; p1 <0.001), in the control group, the index value decreased by 28% (from 67±1.67 to 48±1.26%; p1 <0.001).

Conclusion. In assessing of the subjective quality of life and index indicators of the periodontal status in the treatment of chronic generalized catarrhal gingivitis, the best results were observed in the group using a dental hygiene gel based on α-mangostin [1,3,6-Trihydroxy-7-methoxy-2,8-bis(3-methyl-2-butenyl)-9H-xanthen-9-one], a xanthone from mangosteen fruit, compared with the control group and the group using a complex drug (1% metronidazole and 0.25% chlorhexidine digluconate).

Kazan medical journal. 2020;101(1):25-30
pages 25-30 views

Adaptive immunity in the mucous membrane of the duodenum in neonatal sepsis

Khaertynov K.S., Anokhin V.A., Burganova G.R., Pevnev G.O., Mavlikeev M.O., Kiyasov A.P., Rizvanov A.A., Gil'manov A.A., Lyubin S.A., Mikheeva E.G., Pchenitchnyi P.V.


Aim. To assess of adaptive immunity of the duodenal mucosa in neonates with sepsis.

Methods. A study of duodenal biopsy specimens obtained during duodenoscopy from neonates who had signs of suspected ulcerative lesions of the digestive tract. Five of them were obtained from infants with clinical and laboratory signs of neonatal sepsis (NS), two — from infants without sepsis (comparison group). Immunohistochemical staining was performed using the Novolink Polymer Detection System imaging system with commercial antibodies to CD4, CD8, CD20 and Bcl-2, and the CSAII Biotin-free Tyramide Signal Amplification System imaging system with commercial antibodies to caspase-3 and caspase-9 in accordance with the manufacturer’s instructions.

Results. It was found that the number of CD4+ T-lymphocytes of the duodenal mucosa in neonatal sepsis group in 4 of 5 infants did not differ from the control group. The number of CD8+ lymphocytes in neonates with sepsis in 3 of 5 cases was even higher than in the control group. The number of CD20+ B-lymphocytes in 4 infants with sepsis was significantly less compared with the control. Activation of apoptosis in mucosal cells was detected, which was manifested by a large number of caspase-3-positive cells (in 4 of 5 cases) in comparison with the control group. The number of caspase-9-positive cells in the studied groups was almost equal. A substantial decrease in the number of Bcl-2-positive mucosal cells in all 5 infants with sepsis was noted as compared with the control indicators.

Conclusion. The study revealed moderate immunosuppression in the duodenal mucosa in neonates with sepsis, manifested by low values of CD20+ B-lymphocytes in the absence of a significant decrease in the number of CD4+ and CD8+ T-lymphocytes. The detected moderate activation of apoptosis processes against the background of reduced antiapoptotic potential creates the conditions for a possible translocation of the intestinal microbiota into the bloodstream.

Kazan medical journal. 2020;101(1):31-39
pages 31-39 views

Experimental medicine

Features of the dynamics of corticosteroid receptors in the myocardium of animals with different resistance to hypoxia in the post resuscitation period

Bayburina G.A.


Aim. To characterize the peculiarities of the dynamics of the level of corticosteroid receptors in the myocardium of animals with different resistance to hypoxia in the post-resuscitation period.

Methods. Experimental studies were carried out on male non-inbred white rats, divided into 2 groups by hypoxia resistance. A 5-minute arrest of the systemic circulation was modeled under ether anesthesia with intrathoracic clamping of the cardiovascular cluster with subsequent resuscitation. The observation period was 35 days. The content of corticosterone and aldosterone was determined in the blood plasma, the concentration of glucocorticoid and mineralocorticoid receptors in myocard homogenates was determined as well.

Results. On days 1 to 3 of the post-resuscitation period in rats highly resistant to hypoxia, the dynamics of plasma corticosterone concentration and the content of corticosteroid receptors was unidirectional. Starting from the 5th day, against the background of a statistically significant decrease in the level of plasma corticosterone, a gradual increase in the density of corticosteroid receptors, mostly glucocorticoid, was observed, most pronounced on the 14th day and remaining until the end of the observation. In animals with low resistance to hypoxia, the dynamics of corticosteroid receptors was characterized by a predominance of mineralocorticoid content in almost all periods of observation. On days 1–3 of post-resuscitation period on the background of high concentrations of corticosteroid hormones, the minimum content of glucocorticoid receptors was noted. A decrease in the mineralocorticoid receptor level was recorded only on the first day, and in all subsequent periods of the experiment, the control indicators were significantly higher by 1.4–1.6 times. Strengthened mineralocorticoid signaling in the myocardium, characteristic of animals with low resistance to hypoxia, may be associated with the development of hypertrophy and fibrosis, inflammation, impaired electrical function. An increase in glucocorticoid receptors, characteristic of animals with a high resistance to hypoxia, has an adaptive effect, limiting the inflammatory response, the potential mechanism may be associated with increased expression of type 11β-hydroxysteroid dehydrogenase.

Conclusion. The identified features can have a significant influence on the course of the post-resuscitation period and determine the long-term forecast.

Kazan medical journal. 2020;101(1):40-46
pages 40-46 views

Endothelial dysfunction and impaired lymphatic drainage of the heart in the pathogenesis of cardiovascular complications in diabetes

Aliyev M.K., Mamedzade A.I., Agamaliev U.D., Zhakhverdiyev G.G., Aliyeva D.T., Hadzhiyeva S.I.


Aim. To study the role of activation of lipid peroxidation and endothelial dysfunction in disorders of lymphatic coagulation and lymphatic drainage of the heart in streptozotocin-induced diabetes mellitus.

Methods. The experiments were performed on 25 rabbits. To simulate diabetes mellitus, animals were injected intraperitoneally with streptozotocin at a dose of 50 mg/kg. Indicators of lipid peroxidation, coagulation, and endothelial dysfunction were examined in lymph obtained by draining the thoracic lymphatic duct. We also examined the state of lymphatic drainage of tissues at the level of the thoracic lymphatic duct and at the level of the heart, before and after inducing diabetes.

Results. On the 5th day after inducing diabetes mellitus, the concentration of diene conjugates in lymph exceeded the initial level by 66.6% (p <0.001), and the concentration of malondialdehyde increased by more than 2.6 times (p <0.001); 30 min later these indicators of diene conjugates and malondialdehyde exceeded the initial values by 3.2 and 2.2 times, respectively (p <0.001), and the concentration of reduced glutathione decreased by 73.8% (p <0.001). At the same time, the indicators of lymph coagulation, activated partial thromboplastin time and thrombin time, were shortened by 42.2 and 32.9%, respectively (p <0.01). The rate of lymphatic drainage from the thoracic duct decreased by 81.8% (p <0.01). Such dynamics persisted throughout the experiment. The duration of the removal of a lymphotropic dye from the heart at stage I was increased on the 30th and 60th days of the study by 28.1% (p <0.05) and 57.9% (p <0.001), respectively. At stage II, this indicator decreased, starting from the 2nd month of the experiment it exceeded the initial level by 22.2% (p <0.05), and subsequently by 32.7% (p ≤0.001)

Conclusion. The activation of lipid peroxidation and intravascular coagulation of lymph, followed by inhibition of lymphatic drainage of tissues at the level of the thoracic lymphatic duct, especially the heart, creates favourable conditions for the accumulation of toxic products of impaired metabolism in the myocardium, contributing to the development of cardiovascular complications.

Kazan medical journal. 2020;101(1):47-52
pages 47-52 views

The main arterial vessels of pancreatic isthmus and their importance in surgery

Tarasenko S.V., Tarakanov P.V., Natalskiy A.A., Pavlov A.V., Dronova E.A.


Aim. To optimize the ways of cross-section of the pancreas in its isthmus, taking into account the topography of the main arteries of this area.

Methods. 43 organocomplexes representing pancreas with duodenum were studied. Injection mass was injected into arterial vessels with subsequent fixation in 4% formalin solution and final preparation of complexes. The main arteries of the isthmus of the pancreas, their places of origin and topography were evaluated.

Results. The main arteries of the isthmus of the pancreas are the peripancreatic artery and the additional artery of the isthmus of the pancreas. Peripancreatic artery was observed in 97.67% of cases; it departed from the dorsal pancreatic artery in 93% of cases, from the third branch of the splenic artery in 7% of cases. The diameter at the point of departure was 1.61±0.12 mm. In 95.3%, the artery passed along the lower edge of pancreatic isthmus. The peripancreatic artery was connected to the gastroduodenal artery or its branches. The diameter of peripancreatic artery at the junction was 1.55±0.1 mm. An additional artery of the isthmus of the pancreas was found in 93% of cases. In 76.74% it departed from the basin of the dorsal pancreatic artery, in 9.3% from another branch of the splenic artery, in 13.95% directly from the splenic artery itself. The diameter at the point of departure was 1.06±0.1 mm. It passed along the upper edge of pancreatic isthmus and connected to the pool of the gastroduodenal artery. The diameter at the junction was 0.98±0.1 mm. The diameter of peripancreatic artery was 1.95±0.05 mm in the trunk type versus 1.48±0.05 mm in the branched type of blood supply. The diameter of the additional artery of the isthmus of the pancreas had no pronounced changes depending on the type of blood supply to the pancreas.

Conclusion. The topography of the main arteries of the isthmus of the pancreas is constant and does not depend on their diameter and place of origin. The most vascularized zones of the isthmus of the pancreas are its lower and upper edges.

Kazan medical journal. 2020;101(1):53-57
pages 53-57 views


Cardiovascular events and mortality in the long term in young patients with acute disorders of ­cerebral circulation

Shamkina A.R., Galeeva S.S.


This review presents the results of various studies on the problem of cardiovascular events and the risk of their development as well as long-term mortality in young patients with cerebrovascular accidents or strokes. In recent decades, there has been a tendency to rejuvenation of cerebrovascular diseases often leading to fatal outcomes. At present, the question of the course of stroke in the acute stage of the disease is most studied. Meanwhile, the study of late, including long-term (5 years or more) results of the stroke is important for planning the organization of medical care using the principles of evidence-based medicine. The long-term prognosis for young patients who underwent strokes is of particular interest from a medical and social point of view due to the increase of life expectancy and basic responsibilities at a difficult stage of life. According to a meta-analysis carried out on the results of prospective studies, it was found that the prognosis of a “young” stroke is not as favorable as it was previously thought with respect to the development of cardiovascular diseases or psychosocial consequences as well as mortality. It was shown that the risk of death among young patients aged 18 to 49 years who survived a 30-day primary stroke, compared to the risk of death in the general population, remained increased even after 15 years. However, this issue remains still insufficiently studied. Further research is needed in this area.

Kazan medical journal. 2020;101(1):58-66
pages 58-66 views

Social hygiene and healthcare management

Functional matrix of administrative processes in medical organizations and expert assessment of their labor input

Mendel S.A., Berseneva E.A.


Aim. To assess the complexity of administrative-economic (auxiliary) business-processes in a medical organization based on functional work matrices.

Methods. Using the process approach, the composition of auxiliary business-processes of a medical organization was determined and functional matrices were developed. These included the designation of the work (of the components of the process), the frequency, and the performers of the process. The assessment of the complexity of processes and the components (of the work) was carried out using expert methods and a method of functional-cost analysis. Questioning of the members of the working groups on the development of functional matrices of processes was carried out to assess the complexity of each process and its components. The final grade was based on the calculation of the arithmetic mean except for answers that lay outside three standard deviations from the originally calculated arithmetic mean. The work was carried out in the The Clinical Hospital of the Federal Public Health Institution “The Medical Sanitary Unit of the Ministry of Internal Affairs of Russia for the city of Moscow”, Moscow, Russia, in 2017–2019.

Results. In the course of the research, 30 supporting business-processes were identified. For each auxiliary business-process, a functional matrix of the work was developed with an assessment of its labour intensiveness. This article provides a functional matrix for business-processes for the organization of internal meetings with an assessment of the labour-intensiveness of the work included in the business-processes, and the results of the assessment of the labour-intensiveness of all the identified business-processes (without working out the components of speci­fic works in detail).

Conclusion. A methodological processes approach using functional matrices of work and a functional-cost analysis expert method can be used to assess: the labour-intensiveness of a business-process; the appearance of the most labour-intensive areas of the work; the definition of the main directions for their optimisation. The main problem in studying methodological approaches in the daily practical work of medical organisations is their labour-intensiveness.

Kazan medical journal. 2020;101(1):67-72
pages 67-72 views

Analysis of satisfaction with the accessibility and quality of primary health care for patients with pathology of lower limb arteries

Pogosyan V.A., Mikhaylova D.O.


Aim. To study the opinion of the population about satisfaction with the accessibility and quality of primary health care for diseases of the arteries of the lower extremities in institutions of the Sverdlovsk region, as well as to identify problems in the organization of its provision.

Methods. From January to June 2019, an anonymous survey of 384 patients with diseases of the arteries of the lower extremities who applied for a consultative appointment with a cardiovascular surgeon at the clinic of the Sverdlovsk Regional Clinical Hospital No. 1 was carried out. A representative sample was determined by formulae, in which, out of the general population the number of registered cases of arterial disease of the lower limbs in the Sverdlovsk region, was acceptable. The survey involved 301 (78.4%) men and 83 (21.6%) women.

Results. More than 90% of respondents were over 50 years old. More than 35% of respondents expected a referral for a consultation with a specialist later than 1 month away. The accessibility and timeliness of obtaining specialized medical care were influenced by the geographical remoteness from the regional center. The presence of queues in outpatient clinics at the place of residence, the difficulty in obtaining a coupon for an appointment with a doctor, the inaccessibility of free research, as well as the inconvenient work schedule of specialist doctors were the main reasons for not obtaining medical care. When examined in the clinic at the place of residence, more than half of the respondents used their own money. Just over a third of patients (35.2%) thought that the level of medical care has improved over the past decade, 19.5% thought that it had become worse, 16.4% that it had not changed, and 28.9% found it difficult to answer. About half of the respondents (48.8%) were satisfied with the result of the medical care provided, 11.2% were not satisfied, and 40% of the patients found it difficult to answer.

Conclusion. The shortcomings identified in the organization of outpatient care in medical institutions of the Sverdlovsk region indicate the need to improve primary health care for patients with lower limb arterial disease. Such improvements will achieve the goals and objectives of the National Healthcare project through the development of telemedicine technologies and the development of organizational and functional patient routing models, standard operating procedures for examining more patients with cardiovascular pathology by primary care physicians, and their active introduction into public health practice.

Kazan medical journal. 2020;101(1):73-79
pages 73-79 views

Features of social and hygienic factors of young primiparаs

Shchetinina N.A., Lavlinskaya L.I., Lavlinskaya T.A., Chernykh E.A.


Aim. To assess the health status of young primiparae by studying the basic social and hygienic and demographic factors.

Methods. The study involved 48 female patients of the women's consultation office registered with the pregnancy. The age ranged from 12 to 17 years, and averaged 15.7±1.4 years. We distinguished three clusters allowing to divide young primiparae into study groups: young — 12–13 years (n=15; 31.2%), middle — 14–15 years (n=20; 41.7%) and senior — 16–17 years old (n=13; 27.1%). The gestational age of young primiparae averaged 12.3±4.5 weeks. We conducted an anonymous survey of young primiparae, which included questions regarding the social hygienic and demographic factors of pregnancy. Differences were considered significant at a confidence level of p ≤0.05.

Results. Most primiparae were raised in single-parent families (n=36; 75%), while in the young cluster, this social factor was identified among almost all girls (n=14; 93.3%). 30 young primiparae had random sexual activity (62.5%), the most pronounced indicator was found in the senior cluster (n=10; 76.9%). Assessment of social economic factor of primiparae taking into account the living conditions, found that 21 (43.8%) of them lived in a rented apartment. None of the primiparae from a young cluster lived in her own apartment or house. Most of the respondents were not satisfied with their living conditions (n=37; 77.1%). Evaluation of social economic factor of primiparae taking into account the income revealed that low income per family member of young primiparae amounted to 33.3% (n=16). In the young cluster, material income was low in most cases (60%).

Conclusion. Young primiparae aged 12–13 years have the most pronounced adverse sociohygienic and demographic factors of early pregnancy in contrast to older age groups.

Kazan medical journal. 2020;101(1):80-83
pages 80-83 views

Mortality of the population of the Omsk region as a result of acute poisoning and exposure to ­toxic substances in 2009–2018

Sabaev A.V., Goleva O.P.


Aim. To study the dynamics of mortality rates in the Omsk region as a result of acute poisoning and toxic effects for 2009–2018.

Methods. In the statistical processing of research materials, alternative (intensive indicators) analysis and graphical analysis methods were used, time-series parameters were calculated, time series was modelled on the basis of the approximating function using a polynomial of the 2nd degree.

Results. In the Omsk region the mortality rate recorded due to acute poisoning and exposure to toxic substances decreased by 2.0 times during the survey period, including decrease in the urban population by 2.3 times and among rural residents by 1.5 times. The mortality rate of the population due to the toxic effects of alcohol and its surrogates was decreased by 2.0 times, due to narcotic substances — 6.5 times, due to corrosive poisons — 2.0 times, due to toxic gases — 2.1 times, due to non-classified poisons — 3.0 times. The dynamics of mortality as a result of drug poisoning and poisoning by industrial poisons in the region was unstable, decrease in the level of indicators by the end of the analyzed period is statistically insignificant. Since 2015, fatal cases of toxic effects of psychodysleptics based on modern modified substances with narcotic effects were recorded in the region; by the end of the study period, mortality increased by 77.0% due to this pathology, which has a statistically significant confirmation.

Conclusion. With an obvious improvement in the medical and demographic indicators due to poisoning and toxic effects in the region, there are changes associated with the emergence and spread of new chemicals with narcotic effects that affect the formation of the toxicological situation in the region.

Kazan medical journal. 2020;101(1):84-90
pages 84-90 views

The results of the subjective professional activities assessment of neonatologists in a metropolis

Moiseeva K.E.


Aim. To assess the attitude to the professional activities of neonatologists in St. Petersburg.

Methods. A questionnaire of 179 neonatologists working in state medical organizations of St. Petersburg was conducted. The representativeness of this sample was checked using the method of Professor A.M. Merkov, with the error not exceeding 4%. Statistical processing was performed using Microsoft Office Excel software.

Results. Among neonatologists of St. Petersburg, women are prevalent (95.2%), with an average age of 44.13±0.13 years. The majority of doctors work at the neonatal departments of obstetric hospitals, they have 18.10±0.11 years of professional experience. 37.4% of neonatologists hold more than one rate. Of the sections of work prescribed in the job descriptions, 91.2% of doctors most like clinical work, 85.2% do not like medical document management mostly, which 32.1% of doctors would like to exclude from their duties completely. According to 37.8% of neonatologists, the professional standard does not fully reflect their job responsibilities. When assessing labour functions, doctors on the first place put the providing of medical care for newborns and premature babies immediately/directly after birth (in the delivery room), and the last — analysis of medical and statistical information and medical records management. More than 80% of neonatologists use additional professional education, trainings in simulation centres and participation in meetings, congresses, conferences, master classes and other educational events for professional growth and qualification category assignment. Almost all neonatologists feel fully responsible for the quality of their work (99.4%). Most doctors do not want to change their medical speciality (91.4%) and they are satisfied with the professional choice (91.6%).

Conclusion. In their professional activities, most neonatologists feel responsible for the quality of their work, they put providing of medical care to newborns on the first place and use all the opportunities for professional growth in most cases; the most negative reaction of doctors is caused by medical document management, which they consider the least important in their work.

Kazan medical journal. 2020;101(1):91-96
pages 91-96 views

Issues of children with disabilities registered as disabled

Sadykova D.I., Solov’ev N.A., Kulakova G.A., Kurmayeva E.A.


Aim. To analyze the medical and social characteristics of children's disability at the stage of primary medical and social care in the polyclinics of Kazan.

Methods. 185 case reports of development of children with disabilities aged 0 to 17 years were analyzed as well as the questionnaires for their parents and 96 case reports of healthy peers of the same age group based on the data from children polyclinics N. 9 and 7 of Kazan. Relative values were calculated to process the results.

Results. The conducted analysis revealed that children with the status of disabled persons were more often born in aged and young mothers, with pathological pregnancy and first birth. In the structure of disability causes, psychiatric disorders and nervous system diseases are prevailing. Disabled children acquire acute diseases more often than their healthy peers that causes additional expanses for the family, including those due to the care for acutely ill child, and requires additional provision with medications. Individual lessons in the rehabilitation of a child with disabilities require additional financial investments from the family budget. We revealed the need for implementation of educational courses for the parents of disabled children due to that every second family did not have specific knowledge and skills of care and rehabilitation, when a child had functional limitations found.

Conclusion. Families with children with disabilities in the status of a disabled child need additional assistance in solving medical and social problems.

Kazan medical journal. 2020;101(1):97-101
pages 97-101 views

Clinical observations

Terlipressin as the element of medicamentous technique redicing blood loss in proximal ­resection of pancreatic head in a patient with extrahepatic form of portal hypertension as the outcome of chronic pancreatitis

Borodenko E.A., Gureev A.D., Kolesnik I.V., Trukhanova I.G.


The article presents a case of the use of medicamentous technique redicing blood loss with terlipressin — a long-acting synthetic analogue of antidiuretic hormone. This pharmaceutical drug causes constrictin of arterioles, veins and venules, which leads to the reduction of blood flow in the visceral organs and pressure reduction in the portal system. In our federal institution of healthcare, a patient with chronic pancreatitis complicated by segmentary portal hypertension and portal cavernoma underwent proximal resection of pancreatic head by C. Fray, placing of a longitudinal pancreatojejunoanastomosis and azigoportal disconnection. The description of this case is aimed at drawing attention to relatively new and developing methods of medicamentous technique redicing blood loss, which in combination with surgical methods allows reducing perioperative blood loss in upper abdominal surgeries.

Kazan medical journal. 2020;101(1):102-106
pages 102-106 views

Abnormalities of brain development as a cause of epileptic seizures

Nabiev T.M., Melikova S.Y.


Brain abnormalities can cause resistant epileptic seizures and significant neurological deficits. In this article we present the clinical cases of cerebral hemiatrophy (Dyke–Davidoff–Masson syndrome) and polymicrogyria with a description of their classical clinical features and radiological and electrophysiological characteristics. The classical signs of Dyke–Davidoff–Masson syndrome in neuroimaging are cerebral hemiatrophy, calvarial thickening, and hyperpneumatization of the frontal sinuses. Polymycrogyria characterized by a gross defect of the cortex with multiple small superficial gyri can manifest as hemi- or tetraparesis, focal epilepsy, and developmental delay. Further study of brain abnormalities, obtaining high-quality images with neuroimaging and their careful analysis can help improve the efficiency of diagnosis and treatment of patients with this pathology.

Kazan medical journal. 2020;101(1):107-111
pages 107-111 views

Clinical experiences

The ordinal scale of X-ray assessment of venous congestion in chronic heart failure

Kolyadich M.I.


Aim. To develop an ordinal scale for x-ray assessment of venous congestion in chronic heart failure based on the results of the standard assessment of chest radiographs.

Methods. The ordinal assessment on the scale consists of a numerical expression of four radiological symptoms: cardiomegaly, pleural effusion, and changes in the pulmonary pattern due to vascular and interstitial components. The presence of each of these symptoms corresponds to a score of 1 point. In the result, ordinal X-ray assessment varies from 0 to 4 points. Simultaneously objective clinical, instrumental and laboratory measures of the severity of congestive heart failure were recorded in patients.

Results. Cardiomegaly, the presence of pleural effusion and changes in the pulmonary pattern due to vascular and interstitial components was numerically estimated according to the standard assessment of chest X-rays for the scale of radiological assessment of venous congestion. Correlation between numerical estimates of the ordinal scale and objective clinical, instrumental and laboratory measures of venous stasis in the sample of 225 patients showed the validity of the assessment. The statistically significant direct relationships between value of the ordinal scale for X-ray assessment of venous congestion with functional class and stage of chronic heart failure, the level of NT-terminal fragment of brain natriuretic peptide, the frequency of respiratory movements, the scale of clinical state, the index of the left atrium, the systolic pressure in the pulmonary artery, as well as an inverse dependence with the 6-minute walk test values were proved. Sufficient internal consistency of the ordinal scale was demonstrated (Cronbach's alpha 0.73). We also found that the scale demonstrated predictive informativeness, which was manifested by a significant increase in the mortality of patients with chronic heart failure in cases where the scale values increase to ≥2.

Conclusion. The proposed ordinal scale for x-ray assessment of venous congestion has sufficient reliability (internal consistency) for practical application, as well as criteria and prognostic validity; the scale can be considered as a simple, accessible and informative addition to the standard examination of polymorbid patients with chronic heart failure, which may be useful for advanced assessment of the patient's condition and risk of death within the next year.

Kazan medical journal. 2020;101(1):112-118
pages 112-118 views

Oncoplastic resection with trasferred perforator flaps for breast cancer patients with small/­moderate volume breasts

Shatova Y.S., Vashchenko L.N., Maksimova N.A., Chernikova E.N., Ratieva A.S.


Aim. To analyze the results of oncoplastic resection with local perforator flaps for breast cancer patients with small/moderate volume breasts.

Methods. The study uncluded 31 patients undergoing oncoplastic resection with LICAP/LTAP and AIAP/MICAP flaps. Inclusion criteria: histologically confirmed breast cancer, cT1c–2N0–1M0 stage, small/moderate volume breasts, perforator presence according to Doppler ultrasound, color and energy ultrasound with linear array probe (4–18 MHz), and the patient’s desire to have the breast-conserving surgery. Exclusion criteria: large volume of breast, cT ≥3, cN ≥2, M1.

Results. LICAP-flaps were used in 19 (61.3%) cases, AIAP in 7 (22.6%) cases and LTAP-flap in 5 (16.1%) cases. Average flap width was 8.9±1.2 cm, average length 21.1±2.1 cm. In all cases the surgical margins were clear. Mean follow-up was 17.4 months. Complications occurred in 1 (3.2%) patient (hematoma with positive dynamics on conservative treatment). The necessary symmetry was achieved in 1 step in all cases. 30 (96.8%) patients were completely satisfied with the aesthetic results (excellent and good).

Conclusion. Oncoplastic resection with transferred perforator flaps can be successfully used for breast cancer patients with small/moderate volume breasts; the method does not require symmetrisation surgery, has minimum of complications and allows achieving good esthetic result.

Kazan medical journal. 2020;101(1):119-123
pages 119-123 views

A trial of the use of perfusion computed tomography of the brain in combination with transcranial Doppler ultrasonography of blood vessels in patients with acute cerebrovascular accident

Valeeva K.G., Perminova S.K., Nazipova A.Y., Kurochkin S.V., Yakupova A.A.


Aim. Assessment of cerebral blood flow in various vascular beds in patients with an acute cerebrovascular accident in the acute period by perfusion computed tomography in combination with transcranial Doppler ultrasonography of cerebral vessels.

Methods. Data was analyzed from perfusion computed tomography of the brain and transcranial Doppler ultrasonography in 35 patients with an acute cerebrovascular accident, based at the vascular centre of the City Clinical Hospital No. 7 of Kazan. The study included 18 (51.4%) women and 17 (48.6%) men who had arrived in the first hours after a vascular accident. When analyzing the stroke subtype, atherothrombotic subtype was determined in 27 (77.1%) patients, cardioembolic subtype in 5 (14.3%) patients, and 3 (8.6%) patients had had a transient ischemic attack.

Results. Perfusion computed tomography is a method that allowed evaluation of the structure of the brain, and blood supply to the anterior cerebral (in 2.9% of the studied patients), middle cerebral (in 62.9% of the studied patients), posterior cerebral (in 11.4% of the studied patients) and vertebral (in 14.2% of the studied patients) arteries of patients with a stroke. The method revealed a zone of “critical” perfusion (ischemic penumbra) by quantitatively processing perfusion indicators in the anterior cerebral blood flow system (decrease in rate and increase in ave­rage volume of cerebral blood flow and average transit time) and in the posterior cerebral circulation system (decrease in blood flow and prolongation of transit time) in the bed of the right vertebral artery). The method also aided the construction of perfusion maps. Transcranial Doppler ultrasonography of cerebral vessels revealed breaches in the cerebral circulation: a decrease in the linear velocity of blood flow in the right middle cerebral arterial bed and in the posterior circulatory system of blood flow in the brain, and an increase in the pulsatility index in all the stu­died vascular beds.

Conclusion. Perfusion computed tomography of the brain in combination with transcranial Doppler ultrasonography is applicable to patients with stroke in various vascular beds, followed by determination of indications for thrombolytic therapy and thrombectomy.

Kazan medical journal. 2020;101(1):124-131
pages 124-131 views

Influence of various methods of hernia repair on the state of blood flow in the vessels of the ­spermatic cord and germination function of the testicle in men with inguinal hernias

Guseynova G.T.


Aim. Study of the influence of various methods of hernia repair (auto- and allo-) on testicular blood supply and hormonal background in mature men with inguinal hernias.

Methods. Among 82 male patients aged 18–60 years with various clinical forms of inguinal hernias, the effect of Trabucco allohernioplasty (20 patients) on the blood supply and reproductive function of the testicles was ­studied in comparison with Girard (19 patients) and Postempskiy autohernioplasty (22 patients), as well as Lichtenstein alloplasty (21 patients) in dynamics before and after 1, 6 and 12 months after surgery. The linear velocity of blood flow in the testicular artery (a. testicularis) was determined at the point of its exit as part of the spermatic cord from the outer ring of the inguinal canal using the ultrasonic diagnostic system using a linear sensor with a scanning frequency of 7.5 MHz. After identification of the testicular artery, the systolic linear velocity of blood flow in this artery was determined on the side of hernial protrusion, as well as on the intact side. At the same time, the concentration of total testosterone in the peripheral blood was studied by the ELIZA method.

Results. In the postoperative period (for 1 year) we recorded a decrease in linear velocity of blood flow in compa­rison with the baseline preoperative level in patients with inguinal hernias after all methods of hernioplasty. Howe­ver, the greatest decrease of linear velocity of blood flow was observed afer local tissue hernioplasty by Girard (by 2.8 cm/sec, 14.9%; p <0.01) and by Postempskiy (by 3.4 cm/sec, 17.5%), and the least — after alloplasty by Lichtenstein (by 0.5 cm/sec, 2.7%; p >0.05) and alloplasty by Trabucco (by 0.1 cm/sec, 0.5%; p >0.05). It was revealed that in patients (men) with inguinal hernias, testosterone level in the blood 1 year after autohernioplasty by Postempsky significantly (p <0.01) decreased by 6.8%, after autoplasty by Girard — by 4.3% (p <0.05), after hernioalloplasty by Lichtenstein — by 3.4% (p <0.05). At the same time, after Trabucco allohernioplasty, a decrease in the level of testosterone in the blood did not occur, and, on the contrary, a non-significant (p >0.05) trend of its increased production by 0.5% 12 months after surgery was revealed.

Conclusion. The studied methods (especially autoplasty by Postempskiy and Girard) have a pronounced negative impact on the blood supply and the germination function of testicles with significant reduction in the concentration of testosterone in the blood; except allohernioplasty according to the method of Trabucco, after which along with the smallest flow reduction (by 0.5%; p >0.05) no increase of the concentration of this hormone occurs.

Kazan medical journal. 2020;101(1):132-138
pages 132-138 views

Orbital proportion indices and microlipografting for correction of secondary post-traumatic enophthalmos

Sultanova N.N., Alieva M.S.


Aim. Aesthetic rehabilitation of patients with secondary post-traumatic enophthalmos.

Methods. From 2013 to 2018, 14 patients with secondary post-traumatic enophthalmos were treated at the maxillofacial surgery clinic of the Azerbaijan Medical University. All patients underwent reconstruction of the damaged orbital wall, so its bone volume was restored. However, in the postoperative period, a deficiency of the orbital soft tissue was noted. In preparation for the surgery, all patients underwent the following types of examination: three-­dimensional computed tomography, photographic, anthropometric measurements with the determination of proportional indices and computer simulation. Based on the data obtained, the orbital proportion indices were calculated: intercanthal index (en-en)×100/(ex-ex); orbital protrusion index (ex-ex)×100/(ex-en,r&l)+(en-en); orbital width index (ex-en,l)×100/(en-en); eye fissure (palpebral) index (ps-pi, l)×100/(ex-en,l); orbital index (os-or,l)×100/(ex-en,l); eyebrow orbital height index (os-or,l)×100/(sci-or,l); index of vertical orbital contour (os-or,l)×100/(ps-os+pi-or)+(ps-pi); eyelid height index (pi-or,l)×100/(ps-os,l). Microlipografting was performed according to the Coleman method with modification by T. Marten. Fat aspiration was performed with a blunt cannula with a diameter of 2.1–2.4 mm and a 10 ml syringe, without anesthetic administration. Prior to microlipografting, fibrotic cords between the skin and underlying tissues were dissected using a sharp needle and a V-shaped cannula. Microlipografting was performed using microcannulas of 0.7–1.1 mm. The fat microtransplant was introduced in two layers: under the circular muscle of the eye and subperiostally in the orbit.

Results. In 11 cases, with an unexpressed form of secondary post-traumatic enophthalmos, a good aesthetic result was recorded. In 3 patients with a pronounced form of enophthalmos, a satisfactory aesthetic result was obtained; in these cases, repeated microlipografting was carried out.

Conclusion. Microlipografting based on the calculation of the orbit proportions indices during rehabilitation of patients with secondary post-traumatic enophthalmos is a minimally invasive and effective procedure.

Kazan medical journal. 2020;101(1):139-144
pages 139-144 views

Features of immunophenotypic finding B-cell lymphoproliferative diseases by flow cytometry

Chuksina J.J., Kataeva E.V., Mitina T.A.


Aim. To assess the information content of conventional and additional immunophenotypic markers (CD200, CD305) in the differential diagnosis B-cell lymphoproliferative diseases by flow cytometry.

Methods. An immunophenotypic study using 4-color flow cytometry was performed in 204 patients with diffe­rent variants of B-cell non-Hodgkin's lymphomas. The study material included peripheral blood and bone marrow. The expression of CD45, CD19, CD20, CD22, CD79b, CD79a, CD5, CD10, CD23, FMC7, CD43, CD38, CD11c, CD103, CD25, CD 200, CD 305, light chains of immunoglobulins (kappa/lambda) using monoclonal antibodies (Becton Dickinson, USA) was evaluated. The intensity of antigen expression was assessed using mean fluorescence intensity (y. e.).

Results. Conventional FMC7-positive expression revealed only half patients with different variants of leu­kemization of non-Hodgkin's lymphomas, whereas atypical positive expression of CD23 was observed in patients with marginal spleen lymphoma and follicular lymphoma in 27.3 and 28.6% of cases, respectively. In mantle cell lymphoma, expression of CD200 in B-cell was detected in a significantly smaller number of observations, accompanied by a significant decrease in the average intensity of CD200 fluorescence compared to B-cell chronic lymphocytic leukemia (B-CLL) cells. The mean fluorescence intensity (MFI) of CD305 in hairy cell leukemia is significantly higher than in splenic marginal zone lymphoma (SMZL) with “villous” lymphocytes.

Conclusion. Different levels of the information content of some conventional markers were revealed in differential immunophenotypic diagnosis of B-cell lymphoproliferative diseases by flow cytometry; the use of additio­nal markers CD200 and CD305 was highly informative in differential diagnostics between different variants of B-cell lymphoproliferative diseases with similar immunophenotypic and morphological characteristics of lymphoid elements.

Kazan medical journal. 2020;101(1):145-152
pages 145-152 views


60 years to Professor Ayrat U. Ziganshin

Kazan medical journal. 2020;101(1):153-156
pages 153-156 views

Cochrane Review Summaries

Planned early delivery versus expectant management for hypertensive disorders from 34 weeks gestation to term


В чем суть проблемы? У женщин с высоким кровяным давлением (гипертензией) во время беременности или при развитии преэклампсии (высокое кровяное давление с наличием белка в моче или вовлечение других систем и органов, или всё вместе) могут развиться серьёзные осложнения. Возможными осложнениями у матери являются усугубление преэклампсии, развитие судорог и эклампсии, HELLP-синдрома (гемолиз, повышенный уровень ферментов печени и низкое количество тромбоцитов), отслоение плаценты, печёночная недостаточность, почечная недостаточность, а также проблемы с дыханием из-за накопления жидкости в лёгких.

Kazan medical journal. 2020;101(1):157-158
pages 157-158 views

Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more)


В чем суть проблемы? Если воды у беременной женщины отходят без наступления схваток (дородовой разрыв плодных оболочек — ДРПО) на 37-й неделе беременности или в более поздник сроки, есть два варианта: первый заключается в вызывании родов искусственными методами, чтобы ребёнок родился как можно скорее (планирование ранних родов); второй вариант подразумевает ожидание начала естественных родов (выжидательная тактика).

Kazan medical journal. 2020;101(1):158-159
pages 158-159 views

Planned early birth versus expectant management for women with preterm prelabour rupture of membranes prior to 37 weeks' gestation for improving pregnancy outcome


В чем суть проблемы? В случае если отхождение околоплодных вод у беременной женщины происходит без схваток до 37-й недели беременности, есть два варианта: как можно быстрое рождение ребёнка или же ожидание естественного начала родов. Нам необходимо тщательно изучить риски и пользу обоих вариантов.

Kazan medical journal. 2020;101(1):159
pages 159 views

Planned early delivery versus expectant management of the term suspected compromised baby for impro­ving outcomes


В чем суть проблемы? Какую помощь следует оказывать при предполагаемых проблемах у плода (ребёнка) в конце беременности (после 37 нед)? Ребёнок может испытывать проблемы, если плацента перестает правильно функционировать, и это означает, что ребёнок получает недостаточно питания или кислорода. В этом Кокрейновском обзоре мы задались вопросом, что лучше — стимулировать роды, проводить кесарево сечение (оба способа обеспечивают ранние роды) или пролонгировать беременность до тех пор, пока роды не начнутся сами.

Kazan medical journal. 2020;101(1):160
pages 160 views

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