Vol 95, No 4 (2014)

Theoretical and clinical medicine

Association of arterial stiffness and cardiovascular system remodeling in patients with hypertension

Bastrikov O.Y., Grigoricheva E.A., Belov V.V., Milegov V.V.


Aim. To study the indices of arterial wall local stiffness and it association with structural and functional parameters of cardiovascular system remodeling in hypertensive patients. Methods. Cross-sectional population study included 213 industrial workers, among them 106 patients with stage I-II hypertension and 107 healthy individuals. The stage of arterial hypertension and additional cardiovascular risk category was performed in accordance with national guidelines. All patients underwent echocardiography, carotid arteries ultrasonography, including arterial stiffness evaluation. Results. In patients with hypertension, significant association of arterial wall stiffness indices and «intima-media» complex thickness (total impact of 91%) and echocardiographic parameters describing the left heart chambers volume were revealed. The fact of identifying the relatively high rate of altered arterial wall stiffness parameters, as well as its association with «intima-media» complex thickness in healthy individuals with normal blood pressure (total impact of 81%) may suggest that vascular wall rigidity change may premise vascular remodeling. Conclusion. Arterial wall stiffness indices may be a marker of effective control of risk factors in individuals with normal blood pressure and effect of drug therapy in patients with hypertension.
Kazan medical journal. 2014;95(4):485-490
pages 485-490 views

Integrated ultrasound for early diagnosis of visceral ischemic syndrome

Barkhatov I.V.


Aim. To study the incidence of unpaired visceral arteries occlusive disease and clinical types of visceral ischemic syndrome in patients with persistent abdominal pain. Methods. The study included 326 patients with chronic atrophic gastritis and duration of abdominal pain over 3 months. The first group included 184 patients with inflammatory conditions. The second group consisted of 142 patients with visceral ischemic syndrome associated with visceral arteries stenosis. The mean age of patients with inflammatory conditions did not exceeded 60 years, and duration of abdominal pain syndrome was less than 6 months. In patients with visceral ischemic syndrome, patients’ age was over 60 years, and abdominal pain persisted for more than 12 months (p <0.01). All patients underwent an integrated ultrasonography and two-staged functional Doppler ultrasonography of visceral arteries. Results. At endoscopy, atrophic gastritis was associated with atrophic colitis and bowel motility disorders in 14.7-15.3% of patients with visceral ischemic syndrome and in 2.1% of patients with inflammatory conditions (p <0.001). On Doppler, 53.5% of patients with visceral ischemic syndrome had clinical picture of subcompensated celiac trunk arterial insufficiency (36.8%) or a combination of two visceral artery diseases (13.2-18.4%). 46.5% of patients with visceral ischemic syndrome had clinical signs of decompensated visceral arteries chronic arterial insufficiency caused by external compression (69.7%) or atherosclerosis (30.3%). The classification of ultrasonic stages of visceral ischemic syndrome was developed, which allows optimizing patients’ follow-up, treatment tactics and better assessing their effectiveness. Conclusion. Integrated ultrasound of visceral arteries revealed visceral arteries disease in 43.6% of patients with persistent abdominal pain, as well as the stage and degree of the disease. In 46.5% of visceral ischemic syndrome cases, arterial stenosis was diagnosed, and in 53.5% of cases - functionally reduced visceral blood flow.
Kazan medical journal. 2014;95(4):490-495
pages 490-495 views

Assessing treatment efficiency in patients with hepatic encephalopathy

Kutepov D.E.


Aim. Comparative analysis of the efficacy of conservative and extracorporeal methods of treatment in patients with hepatic encephalopathy. Methods. The study included 117 patients with chronic liver failure. In all patients hepatic encephalopathy, registered in 100% of cases, was one of the major syndromes, with its severity ranging from stage 2 to 4. All patients were distributed to 4 groups, conservative treatment was continued in all groups. In the 2nd group plasma exchange, in 3rd - plasma exchange + high volume venovenous hemofiltration, in 4th - Molecular Adsorbent Recirculating System (MARS) were added. Treatment effect was assessed by the number of patients with positive changes in mental status (assessed by number connection test) and by the number of patients with varying degrees of hepatic encephalopathy regression (in points). Results. Data analysis showed that both conservative and extracorporeal methods of treatment leaded to the reduction of hepatic encephalopathy severity, as well as better results in number connection test, but the improvement was more significant in patients treated with extracorporeal methods. Among them, better effect was seen in patients treated with Molecular Adsorbent Recirculating System use. At the time of discharge, no signs of deterioration was seen in patients treated by Molecular Adsorbent Recirculating System and plasma exchange + high volume venovenous hemofiltration. Conclusion. Extracorporeal methods of treatment are more effective for hepatic encephalopathy severity reduction compared to conservative therapy, Molecular Adsorbent Recirculating System is the most effective method compared to other extracorporeal methods.
Kazan medical journal. 2014;95(4):496-501
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Role of heritable connective tissue diseases phenotypes in assessing the risk for internal diseases

Tyurin A.V., Davletshin R.A., Muratova R.M.


Aim. To identify the prevalence of main phenotypes of polygenic heritable connective tissue diseases in patients with internal diseases and to assess the prevalence of different internal diseases in such patients. Methods. The study involved 600 patients (254 males, 346 females) aged 18 to 64 years. Average age of males was 52±3.8 years, females - 47±2.2 years. Patients were examined to reveal the signs of different phenotypes of heritable connective tissue diseases in patients with internal diseases, as well as the severity of connective tissue diseases, and possibilities for it screening using the wrist and thumb hypermobility tests. Results. Signs of heritable connective tissue diseases were revealed in 147 (24.5%) patients with internal diseases. In females, those signs were observed in 104 (30.0%) cases, of which 44 (42.3%) were graded as mild, 35 (33.7%) - moderate, 25 (24.0%) - severe. In males, signs of heritable connective tissue diseases were revealed in 43 cases (16.9%), including mild - 17 (39.5%), moderate - 14 (32.5%) and severe - 12 (28.0%). Ehlers-like phenotype was the most common (52.0%), Marfan-like phenotype was observed in 14.0% of cases, primary mitral valve prolapse was diagnosed in 7.0% of patients, unclassifiable phenotype was observed in 11.0% of cases. Joint hypermobility syndrome was revealed in 31.0% of patients, presenting both as specific phenotypes (Marfan-like, Ehlers-like) and as a self-phenotype (31.9% of all the patients with heritable connective tissue diseases phenotype). Benign joint hypermobility was observed in 6.1% of cases. Symptoms of heritable connective tissue diseases were more frequent in patients with gastrointestinal and musculoskeletal diseases. Conclusion. The most common phenotype of heritable connective tissue diseases is Ehlers-like with skin, bone and systemic manifestations. Presence of heritable connective tissue diseases was most commonly associated with gastrointestinal and musculoskeletal diseases.
Kazan medical journal. 2014;95(4):501-505
pages 501-505 views

Original method of esophagojejunal anastomosis after gastrectomy for stomach cancer, allowing post-operative complications prevention

Akhmetzyanov F.S., Borisov V.P., Akhmetzyanova F.F., Borisov S.V.


Aim. To perform the comparative assessment of postoperative complications and mortality rate associated with two types of cuff esophagojejunal anastomosis after gastrectomy. Methods. Follow-up data of short-term post-operative complications rate in two groups of patients who underwent gastrectomy for gastric cancer, are described. Comparative results are presented on after gastrectomy in two groups of patients with gastric cancer: 193 patients were operated using the original method - single-row esophageal-intestinal anastomosis (main group), and 164 patients - using a double-row anastomosis (comparison group). Results. Among the patients who underwent an operation, 229 (64.1%) were older 60 years of age. Post-operative complications were observed in 25.4% of cases in the main group and in 36.6% of cases - in comparison group, including complications leading to unfavorable outcome - in 8.3 and 16.5% of cases, respectively. Post-surgical mortality in non-combined interventions was 5.1% in the main group and 13.7% in comparison group. After combined gastrectomy, post-surgical mortality was assessed as 10.5 and 17.7%, respectively. Early post-operative complications were subdivided into 2 groups: (1) associated with the method of anastomosis and (2) not associated with the method of anastomosis. The first group consisted of anastomosis suture failure, esophagojejunal anastomosis afferent loop obstruction syndrome, pancreatitits. Those complications were combined in one group because of pathogenesis unity. The number of such complications was lower by 2.2 times in the main group, including those with fatal outcome - by 3.2 times. Conclusion. Early post-surgical complications and mortality rate in patients who underwent gastrectomy with original method of single-row esophageal-intestinal anastomosis (main group) was significantly lower compared to patients who underwent gastrectomy with double-row anastomosis. Good reliability of the method of single-row esophageal-intestinal anastomosis allows to recommend its wide use in daily practice by surgeons and oncologists.
Kazan medical journal. 2014;95(4):505-510
pages 505-510 views

FAS-receptor expression in peripheral blood lymphocytes and monocytes in pregnant women with fetal growth restriction

Kazantseva E.V., Dolgushina N.V., Tereshkov P.P.


Aim. To study the expression of Fas-receptor on peripheral blood monocytes and lymphocytes in women who have given birth to children with low birth weight. Methods. Population-based study recruited 242 women who have given birth at the gestation term of more than 35 weeks. Group 1 (n=108) included mother-newborn pairs with low birth weight of newborns, group 2 (n=134) - mother-newborn pairs with normal birth weight for the gestational age. Peripheral blood lymphocytes and monocytes total count and subpopulations, CD95 (Fas-receptor) apoptosis receptor expression level (using four- and five-parametric phenotypic test) were determined, using a combination of monoclonal antibodies to differentiation and activation markers. Results. CD3+CD95+ cells levels were significantly higher in women who delivered of low birth weight children. In T-cell subpopulation of group 1 women, there was a statistically significant increase in relative values of Fas-receptor expression on T-helpers and T-cytotoxic lymphocytes - by 1.6 (p <0.001) and 6.3 (p <0.001) times, respectively, and by 2.9 (p <0.001) and 2.6 (p <0.001) times, respectively, in absolute values. There was a reduction in absolute counts of CD3+CD4+ and CD3+CD8+ T-lymphocyte subpopulations in women who delivered of low birth weight children compared to controls. The ratio of CD95+-expressing T-lymphocyte subpopulations in group 1 women was the following: CD4+CD95+/CD8+CD95+ ratio was 4.9 times higher compared to the second group (p <0.001). Increased absolute and relative Fas-receptor expression on B-lymphocytes [by 63.9% (p <0.001) and 33.3% (p=0.002), respectively] was found in women who delivered of low birth weight children compared to women who delivered of children with normal birth weight. CD14+CD95+ expression analysis revealed increased absolute and relative counts of Fas-receptor expressing monocytes. Conclusion. Marked expression of CD95+ in circulating monocytes and raised CD4+CD95+/CD8+CD95+ ratio in women who delivered of low birth weight children may be a laboratory test for detecting higher chance for fetal growth restriction.
Kazan medical journal. 2014;95(4):511-515
pages 511-515 views

Analyzing the reasons for patients’ dissatisfaction with the results of multifocal intraocular lens implantation

Ivonin K.S.


Aim. To analyze the causes for patients’ dissatisfaction with the results of multifocal intraocular lens implantation. Methods. The research is based on the results of cataract surgeries in 220 patients (50 patients were implanted multifocal refractive intraocular «M-flex» lens, 40 - multifocal intraocular «Gradiol» lens, 64 - multifocal intraocular «Accord» lens, 66 - monofocal intraocular lens). Pre-and post-operative examination included visual acuity test (with and without correction to near, far and moderate distances), determination of the nearest point of clear vision, contrast sensitivity study using the «Zebra» software, stereo vision test, pupil diameter measuring, refractometry, keratometry, binocular vision color tests, patient questioning. Pre-operative evaluation was performed 1 day prior to surgery. Post-operative observation was carried out 1 week, 1, 3, 6 and 12 months after the surgery. Results. No statistically significant difference (p >0.05) in uncorrected visual acuity at different light intensity - 102 lux and 416 lux - was found between the groups with different types of multifocal intraocular lenses. In groups with multifocal intraocular lenses light side effects were observed in 46-52.5% of patients. However, there was no link between the light side effects and patients’ satisfaction with results of the surgery. Reduction of spatial contrast sensitivity parameters was registered in all groups of multifocal intraocular lenses patients compared to patients with monofocal intraocular lenses (p <0.05). According to the survey results, 92.5 to 94% of patients with multifocal intraocular lenses did not report decreased visual acuity on moderate distance. Conclusion. The most important reason for patients’ dissatisfaction with the results of the multifocal intraocular lenses implanting was the reduction of spatial-contrast sensitivity parameters. Bilateral multifocal intraocular lenses implanting improved the contrast ratio.
Kazan medical journal. 2014;95(4):515-519
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Eye disorders in patients with chronic alcoholism

Fazlyeva R.R., Saifullina F.R.


Aim. To study the features of ophthalmic disorders in patients with chronic alcoholism. Methods. Sixty patients (120 eyes) with chronic alcoholism (the main group), including 20 people (40 eyes) with the first stage, and 40 people (80 eyes) with the second stage of chronic alcoholism. Control group consisted of 30 healthy volunteers aged 18 to 46 years. All patients underwent ophthalmologic examination, which included visual acuity test, refractometry, biomicroscopy, biomicroophthalmoscopy, visual field test using chromatic and achromatic colors, color vision test using the tables by E.B. Rabkin (1972), tonometry, flicker fusion rate, and bulbar conjunctiva microcirculation examination. Results. In patients of the control group, eye condition complied with a person’s age, a few changes of the conjunctiva microcirculation were revealed, perivascular changes index was assessed as 1.26±0.05 points, vascular changes index - 1.2±0.05 points, capillary changes index - 1.28±0.05 points, intravascular changes index - 2.3±0.05 points, total conjunctival index - 5±0.13 points. Patients with chronic alcoholism showed reduction of central vision in 26% of cases; white color perception visual field decrease - in 80% of cases, red color - in 40%, green - in 13% of cases. Color perception change was an acquired one in 88% of cases, inherited - in 22% of cases; unilateral reduction of visual flicker fusion rate to red light was observed in 35% of cases, bilateral decrease - in 23% of cases. All patients with chronic alcoholism had bulbar conjunctiva microcirculation disorders: perivascular changes index was assessed as 3.48±0.06 points, vascular changes index - 11.25±0.32 points, capillary changes index - 10.51±0.06 points, intravascular changes index - 2.36±0.06 points, total conjunctival index - 27.61±0.48 points. Conclusion. Alcohol intoxication causes profound pathological changes in the eye seen as visual field decrease, color vision disorders, reduced flicker fusion rate, presence of perivascular, intravascular and vascular disorders of bulbar conjunctiva microvasculature, which should be considered at main process monitoring and choosing the appropriate treatment.
Kazan medical journal. 2014;95(4):519-523
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Clinical features of enteroviral infection in pregnancy

Geydarova N.F.


Aim. To explore the modern clinical features of enteroviral infection in pregnancy. Methods. Comprehensive survey of 262 pregnant women was carried out. 203 patients were diagnosed with enteroviral infection, control group consisted of 59 pregnant women without enteroviral infection. All patients underwent ultrasonic fetometry, cardiotocography, placentography, ultrasonic fetometry, amniotic fluid quantitative and qualitative analysis, feto-placental, utero-placental and fetal circulation Doppler ultrasound. Results. Asymptomatic form of enteroviral infection was more frequently found in pregnant women aged 30-39 years, typical and atypical forms - in the age group of 20-29 years. The onset of menarche and the duration of the menstrual cycle were not associated with the risk for enteroviral infection. Enteroviral infection was often seen in combination with other infections and gynecological diseases. The rate of multi-infection was significantly higher in the group with typical form of entroviral infection, while atypical form of infection were mostly seen along with comorbidities. Conclusion. Immune status has a great influence on developing of clinically manifesting forms of enteroviral infection in pregnant women. Co-existence of enteroviral infection with other infectious and gynecological diseases may alter the clinical features, lead to development of atypical forms and become a significant burden to the pregnancy.
Kazan medical journal. 2014;95(4):523-527
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Serum lipid profile in differential diagnosis of salmonellosis-associated and acute alcoholic gastroenteritis

Makarov V.K., Starikov S.V., Makarov P.V.


Aim. To assess serum lipid spectrum profile as a potential tool for differential diagnosis of gastroenteritis associated with salmonellosis and acute alcoholic gastroenteritis. Methods. Serum lipid profile was examined in 50 healthy volunteers, 50 patients with acute alcoholic gastroenteritis and 50 patients with gastroenteritis associated with salmonellosis of moderate severity. Lipids were extracted by Folch method and fractionated by a modified method; the percentage of separate lipid fractions was determined by densitometry using the «Shimadzu CS-9000» scanner. General lipid level was determined by Marsh method. Total serum lipid level and their fractions: phospholipids total level, free cholesterol, free fatty acids, triglycerides and cholesterol ethers levels were measured. Results. Total serum lipid level was almost 2 times higher in patients with acute alcoholic gastroenteritis compared to patients with gastroenteritis associated with salmonellosis. Relative total level of phospholipids was significantly higher in patients with gastroenteritis associated with salmonellosis compared to patients with acute alcoholic gastroenteritis. However, difference in absolute levels of phospholipids was not significant between the patients with gastroenteritis associated with salmonellosis and patients with acute alcoholic gastroenteritis. Absolute level of free cholesterol was significantly higher in patients with acute alcoholic gastroenteritis than in patients with gastroenteritis associated with salmonellosis. Free fatty acids levels in patients with gastroenteritis associated with salmonellosis did not differ from a respective parameter in patients with acute alcoholic gastroenteritis. Relative level of cholesterol ethers in patients with gastroenteritis associated with salmonellosis was significantly lower compared to patients with acute alcoholic gastroenteritis. Absolute and relative levels of triglycerides in patients with acute alcoholic gastroenteritis were significantly higher, compared to patients with gastroenteritis associated with salmonellosis. Conclusion. Lipid profile detection can be used as an additional test for differential diagnosis of gastroenteritis associated with salmonellosis and acute alcoholic gastroenteritis.
Kazan medical journal. 2014;95(4):527-530
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Antioxidant system blood enzymes activity in patients with echinococcosis

Maslennikova N.A., Sergeeva E.Y., Tikhonova E.P., Burakov A.Y., Titova N.M., Fefelova Y.A., Ruksha T.G.


Aim. To study the activity of antioxidant enzymes and concentration of malondialdehyde - lipid peroxidation product - in patients with echinococcosis. Methods. 22 patients aged 32 to 74 years [females - 9 (40%), males - 13 (60%), mean age 37.6 years] with established diagnosis of liver echinococcosis confirmed by ELISA, were examined. Mean disease duration was 10 years. 12 patients, in whom the diagnosis of liver echinococcosis was excluded, were included in the control group. Superoxide dismutase activity was determined based on adrenaline auto-oxidation inhibition, as well as catalase activity and malondialdehyde level were determined. Results. Statistically significant decrease in the malondialdehyde concentration from 5.9 [5.6÷6.6] to 3.7 [3.3÷4.1] mmol/g of hemoglobin (p <0.001), superoxide dismutase activity - from 764 [744÷796] to 666 [627÷695] i.u./min.×g of hemoglobin (p <0.001) was revealed in patients with echinococcosis. Catalase activity did not change significantly (maintained at the level of control group), which may indicate a temporary activation of the compensatory abilities of the body. Conclusion. Revealed data suggest that gradual development of oxidative stress and decrease in body adaptive abilities play a significant role in the pathogenesis of liver echinococcosis which should be considered while working out the new treatment options for the disease.
Kazan medical journal. 2014;95(4):531-533
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Clinical features of bacterial dysentery caused by shigella flexneri and associated with severe neurologic disease

Khaliullina S.V., Anokhin V.A., Khaertynov K.S., Urmancheeva Y.R., Sushnikov K.V., Alatyrev E.Y., Valiullina A.N., Khasanova E.A.


Aim. To assess clinical and epidemiological features of bacterial dysentery caused by Shigella Flexneri 2а in children with severe neurologic comorbidities. Methods. 27 case histories of children with the clinical picture of shigellosis were analyzed. All patients were admitted to the pediatric ward of the hospital of infectious diseases from specialized neuropsychiatric care home in October-November 2013. Results. Clinical picture of bacterial dysentery in examined children was classic. 22 out of 27 children (81.5%, CI 66.9-96.1) had mild disease, 3 (11.1%, CI -0.7-22.9) - moderate, 2 (7.4%, CI -2.5-17.3) - severe form of the disease. In majority of cases, intestinal involvement was manifesting as enterocolitis - in 20 out of 27 patients (74.1%, CI 57.6-90.6). In 3 patients (11.1%, CI -0.7-22.9), shigellosis was manifesting as gastroenterocolitis. In 4 cases (14.8%, CI 1.4-28.2) clinical signs of hemorrhagic colitis were observed. Severe dehydration (2nd and 3rd degree) was registered in 4 out of 27 patients, (14.8%, CI 1.4-28.2), moderate - in 2 (7.4%, CI -2.5-17.3). In 4 out of those 6 patients (66.7%, CI 29-104.4) dehydration was isotonic, in 2 (33.3%, CI 0.4-75) - hypotonic. Conclusion. The infectious disease did not influence the clinical course of concomitant neurologic disorder and did not lead to development of neurologic complications in the admitted patients. In most of the cases shigellosis was mild, and patient’s condition was mostly determined by a concomitant disease.
Kazan medical journal. 2014;95(4):534-537
pages 534-537 views

Optimizing antibacterial treatment in acute pancreatitis (experimental and clinical research)

Zainutdinov A.M., Malkov I.S.


Aim. To examine the effectiveness of interstitial electrophoresis in antibacterial treatment in animals with experimental pancreatitis and in patients with acute pancreatitis. Methods. Cefotaxime concentration was studied by highly effective chromatography at different routes of administration in 40 rats of both gender with body weight of 150-250 g at the department of surgery of Kazan State Medical Academy and department of pharmacology of Kazan State Medical University. The clinical part of the research compared treatment results in group of patients (n=27) in whom interstitial electroforesis was performed together with antibacterial treatment with group of patients (n=26) who were treated conventionally. Results. Antibiotic introduction using galvanizing in experimental pancreatitis is more effective compared with traditional antibiotic introduction 24 hours after acute pancreatitis modulation. In the clinical part of the research in the main group complications were registered in 14.8% of cases, localized forms of infection (3 effusions, 1 retroperitoneal abscess) were the most common. In control group complications were seen in 34.6% of cases, generalized infections were the most common type (omental and retroperitoneal abscess - in 15.4% of cases, retroperitoneal pyogenic cellulitis - in 19.2% of cases). So, in the basic group less invasive procedures were more common compared with laparotomy, marsupialization, lumbotomy being more common in control group. Mortality rate was 11.1% in the main group and 15.4 in control group (р >0.05). Conclusion. Using interstitial electrophoresis in antibacterial treatment decreases the frequency of purulent complications, with localized forms of the infection being more prevalent, and allows to decrease the mortality rate in patients with acute destructive pancreatitis.
Kazan medical journal. 2014;95(4):538-543
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Methods of improving treatment results for patients with postoperative ventral hernia

Malkov I.S., Mukhtarov Z.M., Malkova M.I.


Aim. To improve the results of surgical treatment for patients with postoperative ventral hernia by improving complex preoperative physical examination and better prevention of wound complications. Methods. Results of surgical treatment of 160 patients [mean age - 64 years, females - 120 (75%), males - 40 (25%)] with postoperative ventral hernia treated from 2003 to 2012 were analyzed. The surgeries were performed routinely. All patients were distributed to 2 groups depending on postoperative wound complications prevention. The main group included 60 patients who underwent a vacuum therapy (authors’ technology) during postoperative period for preventing wound complications. Perioperative management of patients with large and huge hernias in this group was performed according to recommendations of the European Society of Cardiologists and All-Russian Scientific Cardiologic Society for cardiovascular risk assessment at surgeries excluding heart surgery. Comparison group included 100 patients who underwent surgery for postoperative ventral hernias using a conventional vacuum drainage and common methods of patient examination according to recommended standards. Results. Using vacuum therapy in patients of the main group limited the number of Redon-drainage procedures, reduced the rate of local pyoinflammatory complications by 4.2 times (p <0.05). Cardiovascular risk identification and proper preoperative preparation allowed avoiding unfavorable outcomes associated with cardiovascular complications in patients with high cardiovascular risk. Conclusion. High efficiency of a complex approach in preventing postoperative complications after ventral hernias surgical treatment allows to recommend its use in clinical practice.
Kazan medical journal. 2014;95(4):543-548
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Prevalence of bronchial asthma in young people living in industrial city

Zakharova I.A.


Aim. To reveal the true prevalence of asthma in young people living in a large industrial city. Methods. 1518 young persons aged 18-44 years (males - 698, females - 820, mean age 30.34±5.7 years) who attended outpatient clinics of the Clinical Hospital №4 of Chelyabinsk (12.9% of the total population served by the hospital) were randomly picked out. Respondents surveys were conducted, the determination of total immunoglobulin E levels were measured, patients underwent spirometry and were consulted by pulmonologist. Results. Diagnosis of bronchial asthma has been previously confirmed in 2.8% of patients, while in accordance with the Global Initiative for Asthma (GINA) criteria (2013), the true prevalence is 7.8%. In patients with newly diagnosed bronchial asthma body mass index was 26.32±6.3 kg/m2 compared to 24.53±4.9 kg/m2 in patients without asthma; level of total immunoglobulin E was 259.6±16.5 ME/ml vs 47.8±12,6 ME/ml respectively. Not only a decrease in spirometric indices of respiratory function (forced expiratory volume in 1st second (FEV1) was 69.2±8.1% of the expected value vs 105.6±9.1% in the group of healthy individuals, FEV1/FVC (forced vital capacity) ratio - 75.62±13.7% vs 84.2±12.9% respectively), but also a significant increase in total lung capacity (up to 94.5±18,8% of the expected value compared to 78.1±14.1% in the group of healthy subjects) and the residual lung volume (up to 102.2±14.5% vs 79.5±5.9% respectively), was registered in newly diagnosed patients with bronchial asthma indicating pathological process in the small airways, even in patients with small term of the disease. Conclusion. The incidence of bronchial asthma is more than 3 times higher than the official statistics report; in individuals with newly diagnosed bronchial asthma higher body mass index and total immunoglobulin E levels were registered in comparison with the general population.
Kazan medical journal. 2014;95(4):548-552
pages 548-552 views

Experimental medicine

Protein oxidative modification and cathepsin H activity in rats’ thymocytes at nitrogen oxide (II) synthesis modulation in vitro

Abalenikhina Y.V., Fomina M.A.


Aim. To study the influence of substrate for nitrogen oxide (II) synthesis - L-arginine - and non-selective NO-synthase inhibitor - N-nitro-L-arginine-methyl ester - on protein oxidative modification in combination with rats’ thymocytes cathepsin H activity estimation in vitro. Methods. The study was performed on male Wistar rats with body weight of 280-320 g. Freshly-separated thymocytes were incubated in vitro in the full nutrient medium containing 5 мМ of N-nitro-L-arginine-methyl ester (n=8) or 5 мМ of L-arginine for 24 hours at the temperature of 37 °C (n=8). Control group consisted of thymocytes incubated in the same conditions in the full nutrient medium (n=8) for 24 hours. Nitric oxide metabolites levels were measured by spectrophotometry in the visible spectrum using the reaction with Griess reagent. Cathepsin H activity was estimated by Barrett&Kirschke spectrofluorimetry. Protein oxidative modification was measured by R.L. Levine method in E.E. Dubinina modification followed by carbonyl derivatives absorption spectrum quantitative analysis. Results. In nitrogen oxide (II) synthesis deficiency model, protein oxidative modification degree increased, mainly due to basic and neutral aldehyde- and ketone-dinitrophenylhydrazones level increase. Those changes were accompanied by increased activity of cathepsin H. In nitrogen oxide (II) synthesis stimulation model, level of oxidative-modified proteins decreased, mainly due to lower levels of neutral amino acid derivatives, cathepsin H activity didn’t change. Conclusion. In vitro nonselective inhibitor of inducible NO-synthase - N-nitro-L-arginine-methyl ester - stimulates protein oxidative modification and increases activity of cathepsin Н; substrate of NO synthesis - L-arginine - showes antioxidant effect.
Kazan medical journal. 2014;95(4):553-557
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Experimental study of hypoglycemic effect of medicago sativa leaves extract

Eremenko R.F., Maloshtan L.N., Yatsenko E.Y.


Aim. To study the hypoglycemic effect of the Medicago Sativa leaves extract in intact rats and in rats with a glucose load. Methods. At the first stage, hypoglycemic effect of Medicago Sativa leaves extract was determined in intact rats. 50 mg/kg of metformin and 18 mg/kg of herbal anti-diabetic «Arfazetin» tea were used as comparator drugs. At the second stage, hypoglycemic effect of Medicago Sativa leaves extract was determined in rats with glucose load. Blood samples for glucose analysis were taken before and in 15, 30, 60 and 120 minutes after loading. Blood glucose level was determined by glucose oxidase method. Results. Medicago Sativa leaves extract showed hypoglycemic effect both in intact animals and in animals with glucose load. 25 mg/kg of Medicago Sativa leaves extract decreased blood glucose level in intact animals at 4, 6 and 8 hours by 1.04, 1.14 and 1.11 times compared to the baseline level; the effect was comparable with herbal anti-diabetic «Arfazetin» tea and was inferior to metformin. A single 25 mg/kg dose of Medicago Sativa leaves extract showed hypoglycemic effect in animals with glucose load and significantly reduced blood glucose level in 15, 30, 60 and 120 minutes compared to control. Conclusion. The findings suggest that 25 mg/kg of Medicago Sativa leaves extract can be used as a herbal medication in the complex treatment of type II diabetes mellitus for its hypoglycemic properties.
Kazan medical journal. 2014;95(4):557-561
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Healthcare mangement

Public awareness of the arterial hypertension preventive measures

Agaev A.A.


Aim. To explore the public opinion on provided information load about arterial hypertension preventive measures. Methods. Prospective study including adult population of Baku city was performed. Modified international questionnaire SF-36 (the Azerbaijan version) was administered to the study subjects, 2584 completed questionnaires were received. Subject were distributed to 3 groups. All subjects were additionally provided questionnaires studying public need for the medical information on arterial hypertension. Of all study subjects, 374 subjects of the 1st group, 212 of the 2nd group and 632 of the 3rd group responded back. Results. Public awareness of the arterial hypertension was overall assessed as unsatisfactory. Even in subjects with controlled arterial hypertension, despite constant doctor visits and undergoing treatment, only 18.4±2.0% of questioned showed reported knowledge, and 12.6±1.7% were under-informed. Level of knowledge of the majority of questioned subject was assessed as moderate - 37.7±2.5%, and sufficient - 31.3±2.4% of subjects. Situation was even worse in subjects with uncontrolled arterial hypertension and in control group, where 30.7±3.2 and 36.9±1.9% of subjects, respectively, were under-informed, and 18.9±2.7 и 21.4±1.6% were completely not informed about arterial hypertension. Priority sources of medical information were doctors, followed by television and environment. At the same time, information got from doctors was described by the subjects as scarce, matter of common knowledge, non-specific. Meanwhile, the need for the risk factors and ways of their control was high. The main part of the questioned subjects were motivated in terms of the blood pressure, blood glucose level, body weight control, proper nutrition and physical exercise, smoking cessation and low alcohol consumption. Conclusion. Public awareness of the medical care and disease prevention, including arterial hypertension, is insufficient. Active informing targeted to public preventive behavior correction is required.
Kazan medical journal. 2014;95(4):562-566
pages 562-566 views

Changes in prevalence of diabetes mellitus in the Republic of Azerbaijan in 1994-2012 and prospects for 2030

Alieva T.T.


Aim. To study the changes in prevalence of diabetes mellitus in the Republic of Azerbaijan in 1994-2012 and to predict the changes by 2030. Methods. The data of the number of patients with diabetes mellitus in the Republic of Azerbaijan were gained by analyzing official statistics of Ministry of Healthcare of the Azerbaijan Republic. The population of Azerbaijan in 1994-2012 was also analyzed. Microsoft Excel software package was used for prognosis calculation and graphical representation. Results. In 1994 40 438 patients with diabetes mellitus were registered in the Republic of Azerbaijan, in 2003 - 49 083 pa-tients, and in 2012 the number of patients with diabetes mellitus has reached 151 667 which was 375.06% compared to 1994 and 309.00% compared to 2003. Mid-annual change of the country’s population was calculated, with the gained data used for population prediction for 2030. According to the calculations, the number of officially registered patients with diabetes mellitus should reach 3.73% of the Azerbaijan Republic population by 2030. Conclusion. Statistical data show considerable growth in diabetes mellitus prevalence in the Republic of Azerbaijan. The prediction based on the last 9 years data allows to predict the increase of the number of officially registered patients with diabetes mellitus up to 380 178 patients by 2030, which will make 3.73% of the country’s population.
Kazan medical journal. 2014;95(4):566-569
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Occupational hygiene

Assessment of health damage due to exposure to mineral wool fine dusts

Kopytenkova O.I., Levanchuk A.V., Tursunov Z.S.


Aim. To develop the rapid method for cardiovascular diseases risk assessment among employees exposed to mineral wool fine dusts. Methods. Concentrations of particles smaller than 10 and 2.5 μm were measured in the air of mineral wools producing working area using «OMPN-10.0» dust meter. The mass fraction of heavy metals in mineral wools was calculated by atomic absorption method. Statistical analysis of 40 out-patient charts data and discharge summaries of occupational diseases department was performed. Cardiovascular risk mathematical model parameters were calculated using SPSS Statistica 17.0 software package. Results. Dust concentration in the air of working area where mineral wools are used was 8.2±1.3 mg/m3, including 1.8±0.4 mg/m3 of particles smaller than 10 μm and 1.25±0.3 mg/m3 of particles smaller than 2.5 μm. Heavy metal compounds, such as Cu, Zn, Pb, Cd, Ni, were revealed in the dust. Relation between the cardiovascular risk and duration of service in unfavorable environmental conditions and hygienic standards overage ratio was established. The risk for a disease for workers with term of service of 4 years was assessed as high, with term of service of 14 years - as extra-high. Conclusion. Results showing the dependence of cardiovascular risk on contact with mineral wool fine dust and length of service and hygienic standards overage ratio can be used as an express cardiovascular risk assessment method in employees exposed to mineral wool fine dusts with the particles size smaller than 10 and 2.5 μm.
Kazan medical journal. 2014;95(4):570-574
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Arterial stiffness as a cardiovascular events risk marker and possibilities for its downregulation by contemporary antihypertensive medications

Zagidullin N.S., Zulkarneev R.K., Scherbakova E.S., Safina Y.F., Zagidullin S.Z.


Arterial blood pressure measured by Korotkov’s method is a non-valid predictor for possible cardiovascular events, which requires introduction of new methods of arterial hypertension diagnostics. Recently, the effect on arterial stiffness has become a very important characteristic of antihypertensive drugs overall efficacy. Evaluation of arterial stiffness (central aortic pressure, augmentation index and pulse wave velocity) contributes to more precise cardiovascular risk stratification and reflects target organ damage and the effectiveness of antihypertensive treatment. In particular, pulse wave velocity exceeding 12 m/s is a significant risk factor of cardiovascular events. Arterial compliance can be determined by applanation tonometry, pulse wave shift at the carotid and femoral arteries, finger photoplethysmography, volume pulsoxymetry, echo-tracking, suprasystolic pulse waves recording method and cardio-ankle vascular index. Different effects of antihypertensive drugs on arterial stiffness at the same blood pressure reduction have been repeatedly shown. The article discusses the impact of the most commonly used antihypertensive drugs, including contemporary antihypertensive drugs combinations, on arterial stiffness. Effect of beta-blockers greatly varies depending on the characteristics of the drug, diuretics have neutral effect, calcium antagonists (especially amlodipine) decrease the pulse wave speed and arterial wall stiffness. Both angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers (more data for enalapril, perindopril and valsartan) were effective in decreasing arterial wall stiffness. A significant reduction in arterial wall stiffness was mainly found if antihypertensive drugs combinations were used, especially the combination of calcium antagonists and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers.
Kazan medical journal. 2014;95(4):575-581
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Reasons for immunologic inefficiency of antiretroviral therapy in patients with HIV

Oleynik A.F., Fazylov V.K.


The main component of the treatment of patients with HIV infection is highly active antiretroviral therapy (HAART), which can help to control the disease. The main goal of HAART is to increase the life duration and to maintain the quality of patients’ life. Improved survival among HIV-infected patients receiving highly active antiretroviral therapy is achieved mainly by a decrease of HIV RNA viral load, which increases CD4 lymphocytes count. However, some patients may present with discordant response to treatment, when there is no CD4 lymphocyte count elevation associated with the virus disappearing from the blood. Such patients retain immunodeficiency, despite long-term treatment. The risk of opportunistic infections on the background of insufficient immunological response, despite viral replication suppression, is higher than in patients with good immunological response to treatment. Consistently low CD4 cell counts are associated with an increased risk of AIDS diagnosis. Furthermore, this group of patients shows a slight increase in mortality not associated with AIDS-defining illnesses. The reasons for the low CD4 lymphocytes count increase in some patients achieving virologic response to HAART remain unclear. The immunological efficacy of treatment depends on many factors: baseline CD4 count, duration of HIV infection prior to HAART initiation, age, co-infection with HCV, presence of secondary diseases and comorbidities, HAART regimens, IL-2 use and others. Literature review covers the phenomenon of immunological «non-response» to HAART, factors leading to its development, and possible methods of correction. Currently, there are more questions than answers in the area of immunological non-effectiveness of HAART in HIV-infected patients.
Kazan medical journal. 2014;95(4):581-588
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Coronary artery disease involving left main coronary artery (diagnosis, main treatment approaches)

Khalimova G.Z., Galyavich A.S.


The review analyzes diagnostic and treatment methods and controversies in coronary artery disease involving left coronary artery trunk. Significant occlusion of left main coronary artery is seen in 5-7% of patients with coronary artery disease and is associated with high risk, because this artery gives blood supply for 75-100% of left ventricle myocardium. Involvement of left main coronary artery is considered as an independent predictor for higher prevalence of coronary artery disease and mortality associated with coronary artery disease. Coronary angiography is an appropriate test for diagnosing it. Two types of left main coronary artery involvement are identified - «protected» and «non-protected». In patients on treatment with significant involvement of left main coronary artery, 3-year mortality rate is 50%. Currently a combination of drug treatment and interventional approaches is successfully used to treat coronary heart disease with significant left main coronary artery involvement. The rate of stent angioplasty for such stenosis is currently raising. However, bypass surgery remains to be the «gold standard» treatment in patients with «non-protected» left main coronary artery involvement, and the techniques are constantly improving. Bypass surgery is indicated in patients with left main coronary artery stenosis over 50% and signs of angina pectoris or silent myocardial ischemia. Urgent bypass surgery is preferred in cases of combination of acute coronary syndrome and marked stenosis of left main coronary artery. Presence of unstable angina is an independent predictor for severe concomitant cardiovascular events.
Kazan medical journal. 2014;95(4):588-592
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Assistance to the practicing physician

Staged medical aid in acute myocardial infarction management as a key for successful treatment of elderly patients with severe comorbidities

Yakupov I.F., Galyavich A.S., Korchagina K.V.


During the recent years, since the start of coronary artery stent era not only coronary artery bypass graft surgery, but percutaneous transluminal angioplasty became common in patients with left main coronary artery stenosis. Mechanical complications of myocardial infarction, such as ventricular septal rupture, left ventricle free wall rupture and mitral regurgitation due to papillary muscle rupture, are straight indications for cardiac surgery. However, studies show that the age of over 70 years is a high-risk factor for cardiac surgery. In elderly patients, the duration of cardiopulmonary bypass and aortic cross-clamping time have a major impact on the surgery outcome. Therefore, strategies aimed at reducing the volume of cardiac surgery, should be more successful in elderly patients. On the other hand, elderly patients should be well prepared for surgery, and it should be performed when concomitant diseases are compensated. A case of 82-year patient admitted to the intensive care unit with acute myocardial infarction and chord papillary muscles partial rupture associated with severe mitral regurgitation, is presented. Due to the progression of pulmonary edema, mechanical ventilation was started and emergency percutaneous intervention was administered as a life-saving measure. Stents were placed in obtuse marginal branch, circumflex artery and anterior interventricular artery. Because of existing mitral regurgitation of 3-4 grade, after 2 weeks the patient was re-evaluated ex consilio. Considering relatively stable condition, mitral valve replacement with cardiopulmonary bypass was administered, which was successfully done. The successful treatment of this patient was possible because of the proper and timely staging of the patient’s management.
Kazan medical journal. 2014;95(4):593-596
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History of medicine

To the 100th anniversary of the Kazan imperial university clinic of mental disorders

Sozinov A.S., Mendelevich D.M.


The article is devoted to the history of Kazan Imperial University clinic of mental disorders form its foundation to the modern days. The priority of V.M. Bekhterev in claiming the need for building the contemporary clinic of mental disorders for Kazan Imperial University is highlighted. The role of University professors N.M. Popov, V.P. Osipov, G.Ya. Troshin, T.I. Yudin, M.P. Andreev, clinic’s head doctor S.V. Kurashov in construction, arrangement and organizational management of the hospital, is outlined. Construction decision-making and its timeline, including functioning difficulties during the First World War and Soviet Union establishment, are described. The mental disease studying process management is described, as well as the order and terms of other Kazan University departments’ temporary accommodation in the building of the hospital. The activity of the clinic during the Second World War, as well as the structural post-war and modern time changes are depicted.
Kazan medical journal. 2014;95(4):597-601
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Outstanding representative of Kazan scientific school of ophthalmology: professor V.V. Chirkovsky (dedicated to the 140th anniversary of his birth)

Nugumanova A.M., Khamitova G.K.


Article is devoted to the jubilee of V.V. Chirkovsky, who headed the Department of Ophthalmology of the Kazan University from 1922 to 1929, and was a rector of the University from 1923 to 1925. He was also the director of the wWorld’s first Trachoma Research Institute named after E.V. Adamyuk (Kazan). The article outlines his outstanding organizational skills, resulting in creating ophthalmologic departments and scientific schools of ophthalmology in Tomsk, Irkutsk, Perm, Kazan and Leningrad (Saint Peterburg). During his work in Kazan, V.V. Chirkovsky was elected as a rector of the Kazan University, in this position he served until 1925. He led the university during a harsh period: the country experienced economic collapse, university professors led a beggarly life, but he managed to preserve the two most important faculties of the university - medical and physic-mathematical, and to keep the professors of the university. The creation of Trachoma Research Institute allowed not only to strengthen the fight against trachoma in Tatarstan, but also to completely eliminate it in our and neighboring regions (Republic of Mari El, Bashkortostan, Udmurtia, etc.). In 1929 professor V.V. Chirkovsky moved to Leningrad, where he headed the Department of Ophthalmology of the 1st Leningrad Medical Institute and headed the Leningrad Research Institute of Ophthalmology named after Girschman until 1952. During his active life, professor V.V. Chirkovsky authored about 100 scientific papers on various aspects of ophthalmology. His main publications were related to the study of trachoma, the disease that he has defeated.
Kazan medical journal. 2014;95(4):601-604
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The history of biliary surgery

Fedorov I.V.


From the ancient times biliary surgery attracted a great attention of the doctors and other specialists all over the world. In medieval times, main efforts of medical workers were targeted to the liver and biliary anatomy research. Until the XV century doctors were not aware of the cholelithiasis, first steps in diagnosing and treating this disease were related to obstructive jaundice and biliary abscesses. Surgical treatment in XVIII-XIX centuries included intra-abdominal abscess drainage, pus and bile drainage, gall bladder lithotomy. If biliary colic was associated with local skin hyperemia in right hypochondrium, a surgeon would make an incision in this area, leading to biliary fistula formation and further recovery in some patients. In the middle of XIX century, surgeons started to perform cholecystostomy, removing the stones out of the gall bladder and performing the cholecystopexy to the laparotomy wound. Only in 1882 27-year old Langhenbuch, who was appointed as a head doctor in a hospital in Berlin, was the first one in the world to perform a cholecystectomy in 43-year old patient, who suffered from biliary colics for 16 years. Langhenbuch started to do surgeries on biliary system after many years of training on dead bodies. The peculiar progress in biliary surgery was observed during the last century. Minimally invasive and endoscopic technologies along with general anesthesia and antiseptics made this specialty safe for most of the patients, with cholecystectomy becoming one of the world’s most common surgeries. During the last decades laparoscopic cholecystectomy became the surgery of choice in treating cholelithiasis, and endoscopic papillosphincterotomy and choledocholithotomy - in treating choledocholithiasis.
Kazan medical journal. 2014;95(4):604-607
pages 604-607 views

Documentary archives of the Museum of History of Kazan state medical university as historical source

Ivanova R.G.


The aim of the research - to evaluate complex documentary archives stored in the Museum of History of Kazan State Medical University as a source providing evidence needed for the reconstruction of various historic events linked to high medical education in Kazan. Source-classification methods, as well as external and internal criticism of historical documentary sources were applied. The article discusses the features of the documentary sources study analysis of the documentary archives stored at the Museum of History of the Kazan State Medical University. Stages of forming of a number of documentary collections that became the product of faculties, institute and later university clinical and theoretical departments’ activities, are characterized. While structuring an array of written sources, the decision to allocate three fundamental stages that determined the particular characteristics of documentary collections creation was made. The features of numerous documents were considered; their value for reconstruction of separate aspects of national medical science development in general, as well as the activities of the Kazan medical schools in particular, were defined. As a result of the source-study analysis of the written sources deposited in the Museum of History of Kazan State Medical University five independent groups were allocated. These are collection of business documents; collection of state certification documents; collection of personal papers; collection of official documents reserving copyrights; collection of manuscripts of scientific researches of scientists-physicians. Results of research allow to determine the source value and information potential of documentary archives of the Museum of history of the Kazan State Medical University. Written sources fund is an important historical source for studying the history of the Kazan medical schools, in general, and individual medical scientists, in particular. From the source-study point of view, an extensive array of documents that were not previously included in the scientific examination and require comprehensive analysis, are of considerable interest. Among them there are documents of healthcare manager V.V. Treiman, internist V.F. Bogoyavlenskiy, neurologist L.I. Omorokov, etc. Thus, documentary collections contribute to the expansion of the source base for researches.
Kazan medical journal. 2014;95(4):608-611
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