Vol 95, No 2 (2014)

To the 200th anniversary of Kazan State Medical University

The stages of the glorious path: to the 200th anniversary of Kazan state medical university

Sozinov A.S., Ivanov A.Y., Ivanova R.G.


Aim. To describe the main stages of formation and development of one of the leading scientific and educative medical centers in Russia - Kazan State Medical University. Methods. Comparative historical analysis was applied. Results. The article depicts the main stages of university formation, main scientific interests and outstanding discoveries of the scientists representing Kazan medical school. The main attention is devoted to formation of the clinical education. The specific factors influencing the development of medical faculty of Kazan Emperor’s University and putting in new facilities, including anatomy theatre, laboratories of physiology, university hospital, the participation of medical scientists in foundation and development of leading spheres of public health and hygiene are showed. In this context, the impact of outstanding medical scientists of the second half of the XIX century representing Kazan medical school in development of basic medical sciences is described. The specific development of higher medical education in Kazan during social disasters associated with revolution of the beginning of XX century is characterized. The role of Kazan State Medical Institute in medical training and science development during the Second World War and post-war period is presented. The development of Kazan State Medical Institute (University) during second half of the XX century is described. Conclusion. The modern state of education and researches at Kazan State Medical University as the result of long-term efforts of consolidated team developing 200-year old educational and scientific traditions is described.
Kazan medical journal. 2014;95(2):145-151
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The history of kazan medical scientific societies and their role in solving crucial questions of medicine and healthcare

Abrosimova M.Y., Artemyeva I.Y., Pospelova E.Y.


The second half of the XIX century and the beginning of the XX century is rightly named «The Golden Age of Russian science». At this time, scientific schools in Russia, including Kazan Emperor’s University and its medical faculty, established at May 14, 1814, were uprising. On the eve of 200-year jubilee of Kazan State Medical University the study of cooperation between Kazan medical scientific schools with medical scientific societies is of major importance. Their shared impact in public healthcare development is the subject of the article. The first medical scientific society established in 1868 was the society of Kazan doctors. Its history can be divided to 3 periods. The first period - 1868 to 1875 - is the establishment of the society as an independent scientific institution. The second - 1877 to 1917 - is the activity affiliated with Kazan University. The third - 1917 to 1931 - activities during the Soviet era, associated with establishment of a novel healthcare system. After the first Russian revolution (1905-1907) the process of creating specialized medical scientific societies, intimately connected to the appropriate medical scientific schools, has started. In 1931, the society of Kazan doctors was reorganized into the Regional association of medical scientific societies. Together with the society of Kazan doctors, there were: a society of natural scientists in Kazan University (1869), Kazan society of military medicine and sanitation (1886), Kazan branch of the Russian society of the healthcare (1880), Kazan society for fighting with children’s mortality and infective diseases (1909), League for fighting tuberculosis (1912) and sexually transmitted diseases (1918), also making an impact in developing medicine and healthcare. Independent medical scientific societies are created in the thirties of the XX century. Kazan medical scientific societies had a great impact in healthcare development in the XIX-XX centuries and promoted the development of Kazan medical scientific schools. Medical faculty of Kazan Emperor’s University, Kazan State Medical Institute and Kazan State Medical University played a great role in foundation and development of medical scientific societies in the Republic of Tatarstan.
Kazan medical journal. 2014;95(2):151-157
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The department of normal anatomy - veteran department of the Kazan medical school

Valishin E.S.


Kazan State Medical University, Kazan, Russia. The development of the Kazan anatomy scientific school from its foundation to modern days is shown. The period when the department was headed by E.F. Aristov, an outstanding medic, tutor, reformist, the alumna of Moscow Medical and Surgical Academy, who founded the basis of teaching descriptive and general anatomy and pathology in Kazan University, raised several generations of doctors and is rightly considered to be the founder of Kazan anatomy scientific school, is traced. The period when the faculty was headed by an outstanding anatomist and further founder of physical culture science, progressive public man P.F. Lesgaft is also described. The activity of V.N. Tonkov, an outgoing expert in anatomy and related sciences - comparative anatomy, histology and embryology, who has published the first part of the «Handbook of normal anatomy», which was the beginning of a considerable book series for students, is detailed. The works of the brilliant anatomist and medicine historian, excellent lecturer and great tutor V.N. Ternovsky are overlooked. His scientific legacy consists of over 100 works on morphology and history of medicine. The translations, publishing and editorship of treatises of the ancient doctors made by him are of special value. The activities of the department headed by the student of V.N. Ternovsky - professor V.N. Murat, who was a talented scientist, manager and tutor, is described. He was surpassed by A.G. Korotkov, E.S. Valishin, A.P. Kiyasov. Nowadays O.N. Eremeeva heads the department of normal anatomy. The history of the senior department that had laid the foundation of higher medical education in Kazan over than 200 years ago, still continues.
Kazan medical journal. 2014;95(2):157-160
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Ideas of V.Z. Golubev - freelance university lecturer of the Kazan Emperor’s university - in modern studies of renal microcirculation

Kaplunova O.A.


In 1894 V.Z. Golubev, freelance university lecturer of the Kazan Emperor’s University, presented his thesis «Of the renal blood vessels in mammals and humans». In this work, V.Z. Golubev described the structure of two capillary networks of the renal cortex: glomerular and peritubular. He has identified true straight arterioles, false straight arterioles and direct venules of pyramids as parts of the renal medulla direct vessels. V.Z. Golubev described glomerular capillaries, located along the arcuate arteries of the kidney in the boundary layer and assigned these to the perivascular circulation, as well as noted the important role of the true direct arteriolar blood circulation to the kidneys. According to scientific researches of the second half of the XX century, the structure of the renal circulatory system is subordinated to differentiated renal blood flow in the cortex and medulla, and this is achieved by cortical and juxtamedullary blood flow. Significant increase and the duration of juxtaglomerular bypass cause severe circulatory disorders of the surface layers of kidney cortex and acute renal failure. Modern data on renal blood circulation prepared by researches of V.Z. Golubev, explain the development mechanism of various pathological conditions: acute blood loss, hydronephrosis, vasorenal hypertension, glomerulonephritis, pyelonephritis, cardiogenic shock, cardiorenal syndrome in uncontrolled coronary heart disease, arterial hypertension, sudden cardiac death etc. V.Z. Golubev created a scientific basis for further studies of renal microcirculation. The principles, outlined in his thesis, anticipated later researches of renal juxtamedullary circulation and renal circulation in healthy people and in case of a disease. The thesis of V.Z. Golubev, published 120 years ago, is still of present interest and highlights the problems requiring further research.
Kazan medical journal. 2014;95(2):161-163
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The founder of russian gynecology Alexander Alexandrovich Kieter

Kira E.F., Fatkhullin I.F.


In 2013, it is 200th birthday anniversary of the first student of the outstanding N.I. Pirogov, brilliant Russian doctor and scientist, surgeon, obstetrician and gynecologist, the founder of the Russian surgical obstetrics Alexander-Ludwig Alexandrovich von Kieter. He was born on August 20, 1813 in Venden (nowadays - Latvia), studied at Riga gymnasium and medical faculty of Tartu University, from which he graduated magna cum laude, after that he was offered a job at the surgical clinics, where he was an assistant and a student of N.I. Pirogov. In 1839 as a successor of N.I. Pirogov, he took charge over the department of surgery in Tartu University. In 1840 he had transferred to Kazan, where he got the position of associate professor, and in 1848 - ordinary professor of the department of theoretical surgery of Emperor’s Kazan University. Apart from surgery, he was also interested in obstetrics. Together with F.I. Elachich, he performed the transvaginal oncotomy with a favorable outcome. Published description of that case made the authors globally famous. In 1849, he returned to Saint Petersburg as a professor of the department of obstetrics, gynecology and children’s diseases of the Emperor’s Medical and Surgical Academy and headed the department of obstetrics in 2nd Infantry hospital. In 1858, he took a charge over «Pirogov’s» department of hospital surgery, and was appointed as the head doctor of the surgical department in 2nd Infantry hospital. He retired in 1870, and died on March 22, 1879. He was buried at Volkovo Lutheran Cemetery of Saint Petersburg.
Kazan medical journal. 2014;95(2):163-168
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The role of the Kazan university in formation of medical faculty at Novorossiysk university

Vasilyev K.K., Vasilyev Y.K.


The medical faculty at Novorossiysk University in Odessa (nowadays - Odessa National Medical University) was established in 1900. The aim of the review is to outline the impact of medical scientists from Kazan University on forming the lecturing staff of the medical faculty in Odessa. The article reviews previously published and newly discovered source data. The first head of the department of diagnostic medicine and propaedeutics of the medical faculty was Sergey Vasilyevich Levashov, professor of Kazan University. He took up the position of professor at the department of internal medicine of the teaching hospital of Kazan University in June of 1886. In January of 1903, he was transferred to Novorossiysk University, which was a solid addition for the new faculty. Professor Leontiy Ivanovich Uskov followed professor Levashov on his way from Kazan to Odessa. In 1889 he graduated from gymnasium in Tambov, in 1894 - from medical faculty of Kazan State University magna cum laude, worked as a military doctor, since 1900 - as an ordinary resident of professor Levashov at the department of internal medicine of the teaching hospital of Kazan University. In 1903, Professor Nikolay Mikhaylovich Popov (in 1894-1903 - professor of the department of mental diseases at Kazan University) also transferred to Odessa. Professor Popov was the founder and the first head of the department of neurology and mental diseases in Odessa. Alexey Erastovich Yanishevsky, who was the student of Professor N.M. Popov in Kazan, followed him to Odessa. Another student of Professor Popov, Vladimir Nikolaevich Obraztsov, who graduated from medical faculty of Kazan University in 1898 and was recommended by Professor Popov for extraordinary residency at the department of mental diseases at Kazan University a year after, transferred to Odessa in 1904. Another alumnus of Kazan University, Bronislav Ivanovich Vorotynsky, was teaching at Novorossiysk University. In 1901 he left the position of extraordinary assistant professor of the department of mental diseases at Kazan University after being appointed as a head doctor of the Odessa city mental hospital; since 1905 he was a freelance university lecturer of the department of neurology and mental diseases at Novorossiysk University. Therefore, the lecturing staff of one of the country’s oldest medical schools contributed to establishing the new site of higher medical education in Russia.
Kazan medical journal. 2014;95(2):169-174
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Studies of neurotrophism morphological basis - developing traditions of Kazan medical school

Shvalev V.N., Rogoza A.N., Reutov V.P., Sosunov A.A., Kovalev V.P., Batyrshyn T.R.


Ending second century of higher medical education in Kazan is characterized by a significant impact of its alumni to studies of nervism. The student of K.A. Arnshtein N. Lavdovsky, professors A.E. Smirnov and A.S. Dogel, students of A.N. Mislavsky B.I. Lavrentyev and N.G. Kolosov, their colleagues Yu.M. Lazovsky, A.Ya. Khabarova and V.N. Shvalev expanded knowledge on heart innervation. We summed up the results of decades-long analysis of changes of autonomous nervous system, reviewed the innervation of the cardiovascular system during the ontogenesis, level of NO-synthase in heart ganglions in health and disease, as well as functional data. The basis of our studies was set on the department of histology of Kazan State Medical University, headed by A.N. Mislavsky. Increasing with age loss of sympathetic innervation of cardiovascular system, which is compensated by humor factors according to Cannon-Rosenblueth rule, was discovered in quantitative neurohystochemical studies. Loosing sympathetic innervation, allowing to immediately mobilize their activity and activating neurotrophic factors, myocardial fibers produce more and more adrenoreceptors, reacting on catecholamines brought with the bloodstream. We were able to reveal intimate relation with central and peripheral nervous system damage while studying patients with cardiomyopathies. Firstly, antibodies to the components of the nervous system were found by immunocytochemistry in blood serum drawn from patients with various forms of cardiomyopathies. Secondly, our own quantitative neurohystochemical studies revealed that myocardial damage is associated with the deep lesions of its sympathetic nerve plexus, and there is de-afference (receptor degenerative damage) together with sympathetic denervation. The studying of the basis of the neurotrophism performed by Kazan neurohistologists and physiologists are deepened: conceptions of neurotrophic control are developed, the role of the neuroregulins - cytokines, produced in neurons - is studied, stimulating of neuroregulation using genic neurotrophic factors is used, direct cell gene therapy in patients with spinal injury is applied, molecular aspects of nerve regeneration stimulation are examined.
Kazan medical journal. 2014;95(2):175-180
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Attendants - «research scientists» of Kazan University (reprint, 1930)

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Kazan medical journal. 2014;95(2):184-186
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Centennium of Kazan Anatomy Theatre (reprint, 1935)

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Kazan medical journal. 2014;95(2):187-189
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Theoretical and clinical medicine

SVCAM-1 vascular cell adhesion molecules and heart structural and functional changes in patients with acute left ventricular aneurism following myocardial infarction

Kiselev S.M.


Aim. To study the expression of sVCAM-1 soluble vascular cell adhesion molecules in patients with acute left ventricular aneurysm following myocardial infarction and assess the relationship with the processes of heart remodeling. Methods. 170 patients diagnosed with acute myocardial infarction in the presence of Q-wave were examined. The expression of sVCAM-1 soluble vascular cell adhesion molecule, electrocardiogram and Doppler echocardiography changes were studied depending on comorbidities and the development of acute left ventricular aneurysm following myocardial infarction. Results. ST-segment elevation was still detectable in patients with left ventricular aneurysm compared to patients with no aneurism on the 3rd and 5th day after the disease onset, its amplitude was significantly higher, no dynamic changes of the T-wave in the anterior chest leads were registered. The prevalence of left ventricular dilatation, mitral regurgitation, reduced systolic function of left ventricle and type II diastolic dysfunction was higher in patients with left ventricular aneurysm. The relationship between sVCAM-1 vascular adhesion molecules expression with early remodeling after the myocardial infarction and left ventricular aneurysm development in acute stage of myocardial infarction in the presence of Q-wave was revealed. Conclusion. In the presence of such comorbidities as hypertension and diabetes, a higher level of sVCAM-1 vascular adhesion molecules expression was revealed in patients with left ventricular aneurysm following myocardial infarction. ST-segment elevation and no dynamic changes of the T-wave were still registered by electrocardiography till the 5th day after the disease onset. Amplitudes of ST-segment and T-wave were significantly higher in patients with left ventricular aneurysm following myocardial infarction compared to patients with no complications of myocardial infarction.
Kazan medical journal. 2014;95(2):193-198
pages 193-198 views

Risk factors and clinical features of recurrent stroke in the Tyva Republic

Mongush K.D., Ondar A.B., Chylbak-ool R.C., Balchir M.B., Mongush C.O.


Aim. To determine risk factors and clinical features of the recurrent stroke. Methods. A prospective 3-year cohort study was conducted including 120 patients with stroke admitted to the neurological department of the Republican Hospital №1 of Kyzyl at 2010-2012, 60 of whom had recurrent stroke (group 1), and 60 had primary stroke (group 2). Results. Recurrent stroke was by 16.66% more common in men. The mean age of males having recurrent stroke was younger compared to females (р <0.05). Patients with family history of arterial hypertension in closest relatives were significantly more prevalent among those with recurrent stroke (70 versus 35%, p <0.05). The rate of excessive alcohol consumption was also significantly higher in patients with recurrent stroke (18.33 versus 6.67%, p <0.05). Mortality associated with the recurrent stroke was higher in males of all age groups, difference was statistically significant in male patients over 70 years of age (p <0.05). Combined first 28-day mortality was 26.67% (32 cases), and was higher in patients with primary stroke (p >0.05). Only 21.67% of patients took antihypertensives regularly prior to the primary stroke, among patients with recurrent stroke this share reached 70%. Antiplatelet drugs were taken by 5% of patients prior to the primary stroke, in patients who suffered the stroke the share was higher and reached 53.33%. Conclusion. Family history of arterial hypertension was the most important risk factor for recurrent stroke. Male patients had higher risks of recurrent stroke and fatal outcome, which may be associated with lower drug compliance (including antiplatelet drugs and anticoagulants, antihypertensives) and higher exposure to other risk factors (smoking, excessive alcohol consumption).
Kazan medical journal. 2014;95(2):199-202
pages 199-202 views

Influence of GSTM1, GSTT1 and GSTP1 xenobiotic metabolism genes polymorphisms on treatment efficiency in patients with chronic hepatitis C

Ostapchuk E.V., Godovan V.V.


Aim. To analyze the influence of GSTT1, GSTM1 and GSTP1 genes polymorphism on treatment effectiveness in patients with chronic hepatitis C in Odessa Region using different treatment protocols. Methods. Three groups of patients with chronic hepatitis C were included. Patients of the first group (n=33) were treated with peginterferon alfa-2a and ribavirin, of the second group (n=18) - with tilorone and ribavirin, of the third group (n=26) - with silybi mariani fructuum extract. GSTT1, GSTM1 genes polymorphisms, as well as A313G polymorphism of GSTP1 gene were determined. The treatment effect was assessed by changes of biochemical parameters and viral load. Results. Patients of the first group with AG + GG genotypes had higher rate of rapid and early virologic response (73.7 and 27.3% respectively, р=0.013). Level of alanine transaminase also normalized earlier, and was significantly lower after 12 weeks of treatment in patients with AG + GG genotypes (0.57±0.28 mmol/l×h) compared to patients with АА genotype (0.99±±0.77 mmol/l×h, р=0.033). There was no influence of GSTT1 and GSTM1 genes polymorphisms on the chance of rapid and early virologic response and alanine transaminase levels. No response was found only in 4 patients with GSTT1+/GSTM1+ genotype. Conclusion. GSTT1 and GSTM1 deletion genes polymorphisms did not influence the speed of virologic response in patients with chronic hepatitis C treated with peginterferon alfa-2a and ribavirin. No virologic response in patients with chronic hepatitis C treated with peginterferon alfa-2a and ribavirin was only found in patients with GSTT1+/GSTM1+ genotype. AG + GG GSTP1 genotype was associated with more rapid alanine transaminase level normalization and rapid virologic response in patients treated with peginterferon alfa-2a and ribavirin. GSTT1+, GSTM1+ genotypes and АА genotype of GSTP1 gene are associated with better treatments results in patients treated with silybi mariani fructuum extract.
Kazan medical journal. 2014;95(2):202-208
pages 202-208 views

Features of tissue doppler ultrasonography in patients with viral liver cirrhosis

Chistyakova M.V., Govorin A.V., Radaeva E.V.


Aim. To study the influence of pulmonary hypertension, viral load, and presence of ascites on indicators of longitudinal global and segmental systolic and diastolic ventricular functions in patients with liver cirrhosis as an outcome of viral hepatitides. Methods. The study included 75 patients with liver cirrhosis class A, В, C by Child-Pugh as an outcome of viral hepatitides who were distributed into 3 groups depending on the presence of pulmonary hypertension, ascites, and of viral load. All patients underwent Doppler echocardiography and tissue Doppler echocardiography. Results. Decreased global longitudinal systolic and diastolic function of the left and right ventricles was revealed in patients with virus-related liver cirrhosis, which decreased in the presence of pulmonary hypertension, moderate viral load and ascites. While studying an association between the structural and functional heart indices and hepatic and portal blood flow, it was found that average mitral and tricuspid valve peak systolic velocity was associated with left ventricle ejection fraction (r=0.71, p <0.05), liver veins diameter and blood flow speed parameters (r=0.32-0.81, p <0.05), pulmonary artery pressure (r=0.37-0.84, p <0.05), and viral load (r=0.92, p <0.05). Conclusion. Patients with virus-related liver cirrhosis have decreased global longitudinal systolic and diastolic function of the left and right ventricles, deteriorated by pulmonary hypertension, ascites, and moderate viral load.
Kazan medical journal. 2014;95(2):208-211
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Management of intraperitoneal hemorrhage bleeding as a complication of a gynecologic disease

Nazarenko O.Y., Timofeyeva S.V.


Aim. To evaluate the effectiveness of intra- and post-surgical resuscitation targeted at blood loss replacement in patients with moderate, severe and profuse intraperitoneal hemorrhage caused by ectopic pregnancy and ovarian apoplexy. Methods. Heart rate variability and cardiac intervals assessment were used as additional criteria for patient monitoring. 97 female patients with intraperitoneal hemorrhage of 500-1500 ml underwent endoscopic surgery. Autologous blood transfusion, as well as packed blood products and blood substitutes were used for blood loss replacement. Heart rate variability assessment and analysis of cardiac intervals indicate that pathogenesis of adaptation and blood loss compensation in female patients with intraperitoneal hemorrhage exceeding 500 ml depends on blood loss volume and methods of blood loss replacement. Results. Parameters of adaptation and blood loss compensatory mechanisms in patients with moderate and severe blood loss, who underwent intrasurgical autologous blood transfusion, were close to normal values at days 7 and 14 after treatment. Patients with severe and profuse intraperitoneal hemorrhage treated with packed blood products had the longest red blood count and heart rate variability recovery period. Conclusion. Heart rate variability assessment allowed effectively estimating the treatment effect in female patients with intraperitoneal hemorrhage as a complication of a gynecologic disease exceeding 500 ml.
Kazan medical journal. 2014;95(2):211-216
pages 211-216 views

Effect of subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound on risk of urological complications in patients with localized prostate cancer

Pryanichnikova M.B., Nizamova R.S., Gubanov E.S., Zimichev A.A., Boryaev E.A.


Aim. To assess the rate and reasons for urological complications of subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound. Methods. The study included 101 patients with localized prostate cancer treated by high-intensity focused ultrasound. Two groups of patients were allocated. Patients, who did not undergo transurethral resection of prostate prior to high-intensity focused ultrasound, were included in group 1 (21 patients). Second group included patients in whom subtotal transurethral resection of prostate was performed prior to high-intensity focused ultrasound to decrease anteroposterior diameter of the prostate and urethral canal compression. The impact of treatment tactics on complications rate was defined by factor analysis. Results. Early post-surgical complications were rare, complications mostly occurred at late period. The most frequent, severe and poorly controlled complications included urinary incontinence [58 (57.8%) patients] and urethral stricture [30 (29.7%) patients]. Most of complications were registered in second group of patients compared to the first: first group - in 10 (12.5%) of cases, second group - in 77 (95.0%) of cases. Urinary incontinence was observed in 7 (33.3%) patients and urethral stricture - in 4 (19%) of patients in the first group; in 51 (63.7%) and 26 (32.5%) patients in the second group respectively; the difference was statistically significant. Conclusion. Comparative analysis of different approaches to treatment of localized prostate cancer using high-intensity focused ultrasound revealed that subtotal transurethral resection of prostate performed prior to high-intensity focused ultrasound significantly increases the risk for developing urinary incontinence and urethral strictures.
Kazan medical journal. 2014;95(2):216-219
pages 216-219 views

Clinical and functional rationale for the use of intraosseous composite materials-covered screw retainers for mandibular fracture osteosynthesis

Safarov S.A., Shcherbovskih A.E., Petrov Y.V., Bayrikov I.M.


Aim. To increase the effectiveness of mandibular fracture osteosynthesis by using the composite materials-covered intraosseous screw retainers with active combined cutting edge. Methods. 282 patients with mandibular fractures were examined and operated in the clinic of Oral and Maxillofacial Surgery and Dentistry of Samara State Medical University from 2011 to 2013. Surgeries were performed in 257 (91.1%) patients, including plate osteosynthesis - in 133 (47.2%), intraosseous composite materials-coated screw retainers - in 42 (14.9%), uncoated pins - in 65 (23.0%), bone sutures - in 17 (6.0%). Orthopedic and other methods of bone fragments fixation were used in 25 (8.9%) patients. Proposed composite materials-coated osteosynthesis retainer is a square pin with cutting angle of 60-80° and 4 longitudinal grooves of 5-10 mm. The main part is a two-tier helical ribbon with alternating cutting portions, wherein some areas have the same diameter as the main part of the retainer, and the others are 20-100 microns thinner and are covered with TiC0, 65+25% Ca10(PO4)OH2. RESULTS. A comparative analysis with the traditionally used methods was carried out. The main advantages of the proposed method are rigid fixation of mandibular bone fragments and optimal osteogenesis in complex treatment of patients with trauma. Conclusion. The use of the proposed method of mandibular fractures surgical treatment using intraosseous screw retainers with bioactive coating reduced the risk of complications and the length of hospital stay.
Kazan medical journal. 2014;95(2):219-223
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Relationship between basic dental polymethyl methacrylate polymer roughness and surface topography and microbial biofilm formation using different polishing techniques

Arutyunov S.D., Ippolitov E.V., Pivovarov A.A., Tsarev V.N.


Aim. To determine the relationship between surface roughness and surface topography of the basic dental polymethyl methacrylate polymer polished by different methods and microbial adhesion of microorganisms (Porphyromonas gingivalis, Fusobacterium nucleatum and Streptococcus sanguis) and fungi (Candida albicans) causing periodontal diseases. Methods. Surface topography of the basic dental polymethyl methacrylate polymer was studied by atomic force microscopy; microbiological methods were used to study the adhesion of bacteria and Candida fungi causing periodontal diseases to the surfaces of the samples polished by different methods. Results. It was shown that Streptococcus sanguis had the highest adhesion degree to the polymer surface after milling, Porphyromonas gingivalis and Candida albicans had moderate, and Fusobacterium nucleatum - low adhesion degree. The adhesion dropped significantly after the sample had been polished in dental laboratory or using the «Ergo Boxing» compared to dental unit polishing, where the decrease was less significant. The article contains 2D- and 3D-atomic force microscopy pictures of polymer surface after different polishing methods use. Images obtained by atomic force microscopy clearly display the surface of the basic dental polymethyl methacrylate polymer polished by different methods. Conclusion. Polymer samples processed by «Ergo Boxing» and dental laboratories are characterized by minimal microbial adhesion when compared with other methods.
Kazan medical journal. 2014;95(2):224-231
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Analysis of risk factors for developing complications while treating pulpitis

Aksenova T.V., Bondarenko A.N.


Aim. To study the influence of different risk factors on complications rate while treating pulpitis. Methods. Retrospective analysis of 130 patients with pulpitis outpatient’s cards, who were treated by vital and devitalized pulp extirpation without additional rehabilitation (63 patients) and with addition of individually selected rehabilitation program (67 patients), was carried out. The presence and rate of risk factors for complications in both study groups were analyzed, the level of their impact in complications formation was assessed. The data were processed by analysis of variance. Results. The most significant risk factors for developing complications while treating pulpitis were low local dental and general recovery potential, multiple foci of dental and periodontal infection, mastication muscles malfunction, malocclusion, mental disorders. 60% of patients had the combination of 3 and more risk factors, which in half of all cases were associated with developing complications, if endodontic treatment of pulpitis was not associated with individually selected rehabilitation. Rehabilitation included physiotherapy (if indicated), e.g. low-frequency alternating magnetic field, intra-channel iodine electrophoresis, individually selected homeopathic drugs, Bach flower essences and kinesiotherapy in addition to full mouth debridement. Conclusion. The impact of a range of risk factors, which can be revealed in conditions of common outpatient dental practice, on pulpitis treatment effectiveness was revealed. The addition of individually selected rehabilitation program, targeted on revealed risk factors elimination, to traditional pulpitis treatment decreases the complications rate.
Kazan medical journal. 2014;95(2):231-235
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Clinical and psychological characteristics and quality of life in teenagers with а long-lasting low-grade fever both associated and not associated with hypothalamic syndrome

Semenova L.Y., Kolesnikova M.B.


Aim. To describe clinical and psychological characteristics and quality of life in teenagers with a long-lasting low-grade fever associated with hypothalamic syndrome. Methods. Life history, objective status were assessed, clinical, laboratory and instrumental examinations were performed, quality of life and psychological status were estimated throughout the study. Clinical and laboratory investigations included complete blood count, urinalysis, stool examination; blood immunochemistry for mycoplasma, chlamydia, herpes virus, cytomegalovirus; blood biochemistry; bacteriology of nose and the pharynx swabs. Instrumental investigations included skull and cervical spine X-Ray, neurophysiological examinations (electroencephalography, echoencephalography, rheoencephalography), cranial and cervical blood vessels ultrasonography. The quality of life was estimated using special pediatric questionnaires (proposed by Molchanova L.F., Izhevsk State Medical Academy). Psychological status was assessed by questionnaires of H. Eysenck (temperament assessment) and C.D. Spielberg (research of personal and situation anxiety). Results. All teenagers underwent a complex treatment according to diagnosis, including antimicrobial treatment in case of chronic infections, antimicrobial treatment and immunostimulators in case of upper and lower airway infections caused by chlamydia and mycoplasma, correction of functional conditions of central nervous system (nootropics, vasoactive drugs, diuretics, anxiolytics, metabolic medications, hypotensives), massages, exercise therapy, physiotherapy, herbal treatment. After the course of treatment relapse of low-grade fever was 4-fold more often in teenagers with hypothalamic syndrome compared to those without. Teenagers with low-grade fever associated with hypothalamic syndrome had higher rates of melancholy, higher anxiety levels, leading to significant alterations of physical and mental health. Those changes may lead to mental and social adaptation problems, borderline social and family behavior, and increased rate of psychosomatic diseases. Conclusion. As it was revealed that relapsing low-grade fever might lead to reduced quality of life, further exacerbations of borderline mental problems, aggravate mental adaptation and social and family behavior problems, these teenagers require family and individual mental therapy, repeated treatment with nootropics, vasoactive drugs, diuretics, anxiolytics.
Kazan medical journal. 2014;95(2):235-240
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Age-related variation of lung intervascular connective tissue at different stages of postnatal histogenesis

Nickel’ V.V., Kasimtsev A.A., Efremova V.P.


Aim. To study the structure of lung intervascular connective tissue at different stages of postnatal histogenesis. Methods. Lung autopsies from 20 mature males aged 22-35 years, 30 males aged 61-74 years and 30 males aged 75-89 years who died of causes unrelated to respiratory diseases were studied using standard histological techniques. Results. In lungs of young males, two separated zones of intervascular connective tissue - the central and peripheral, which differ in fiber quantity and their spatial orientation - were revealed. Collagen fibers were the main component of the extracellular matrix of lungs, accounting for 69.9% [69.5, 70.7] of matrix. The share of the base material was 30.1% [29.4, 30.5]. For older age, the share of collagen fibers increased together with decrease of the shares of elastic and reticular fibers up to the complete absence of the latter in subjects over 75 years of age. Strands of collagen fibers were strongly deformed, twisted spirally, clustered in thick bundles. Conclusion. Described age-related changes of lung intervascular connective tissue may reduce the vascular wall contractility, affecting the pulmonary circulation.
Kazan medical journal. 2014;95(2):240-244
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Epidermis of amputated limbs in patients with diabetes mellitus - immunohistochemical study

Gorshunova G.N., Dzamukov R.A., Valiullin V.V.


Aim. To examine the skin morphological changes in different areas of the amputated lower limbs of patients with diabetes mellitus. Methods. Skin samples of lower limbs of 6 patients with diabetic foot syndrome were studied using immunohistochemistry methods. Proliferation of epidermal cells, their resistance to apoptosis, as well as the degree of cells differentiation (using antibodies to proliferating сell nuclear antigen, Bcl-2 anti-apoptotic activity marker, epidermal cells terminal differentiation marker cytokeratin 1) were assessed. The color intensity was assessed using ImageJ software and was displayed as «mean greyscale intensity» (an integral value summarizing color intensity of three basic colors - red, green and blue - by V=0,299R+0,587G+0,114B formula, where V - mean intensity of a mean pixel, R, G, B - color intensity of red, green and blue pixels appropriately). Results. Patients with diabetic foot syndrome had reduced proliferative activity of epidermal cells as they approach the sphacelous area of the affected limb, together with decreased resistance to apoptosis in the same areas. The share of cells positive for proliferating cell nuclear antigen was 58.74±4.8% in skin samples from the area of necrosis (n=6) compared to 77.41±3% (p <0.005) in skin samples of the healthy controls. The study of Bcl-2 marker expression by cells of the sphacelous area (n=6) revealed that mean greyscale intensity in patients with diabetic foot syndrome was 57.74±4.3, which was significantly lower compared to skin samples of the healthy controls (n=6, 89.69±3.4, p <0.005). Based on the expression of cytokeratin, it was shown that suprabasal layers of the epidermis cells were less differentiated in case of diabetic foot syndrome compared to the same cells of the epidermis of the control group. Conclusion. In advanced stages of diabetes, the combined effect of the disease is reduced number of epidermis proliferating cells, the reduction of their anti-apoptotic activity and loss of skin as an organ.
Kazan medical journal. 2014;95(2):244-249
pages 244-249 views

Improving medical care in patients with chronic catarrhal gingivitis while using fixed orthodontic appliances

Khaliullina G.R., Blashkova S.L., Mustafin I.G.


Aim. To study the immunostimulating effect of glucosaminyl muramyl dipeptide in the treatment of chronic catarrhal gingivitis in patients undergoing orthodontic treatment using fixed appliances. Methods. The data of clinical and laboratory examination of the oral health status in 54 patients aged 14-24 years with inflammatory periodontal diseases, undergoing orthodontic treatment using fixed appliances were analyzed. The first group included 26 patients in whom glucosaminyl muramyl dipeptide (1 mg sublingual tablets daily for 10 days) was additionally administered. The second group included 28 patients receiving standard treatment. The treatment efficacy estimation was based on subjective assessment, clinical, microbiological and immunological examinations. Results. After 6 weeks of treatment, there was a statistically significant reduction of simplified oral hygiene index (OHI-s) to 0.85±0.03 in patients of the first group, compared to 1.64±0,061 before treatment. Periodontal index (PI) and PMA index values were 0, reflecting good level of hygiene and no inflammation in periodontal tissues. In the second group, the OHI-s was 1.5±0.06, PI 0.71±0.04 and PMA 18±1.046%, reflecting mild gingivitis after the 6 weeks of treatment. Bacteriology showed that the number of colonies in the first group was reduced by 1-2 orders of magnitude on average after 6 weeks of treatment. Patients of the second group showed a significant (p <0.05) increase in the number of bacterial colonies potentially causing the periodontal inflammation. The level of secretory IgA after 6 weeks of combined treatment in the first patients group was 249.5±39.1 mg/ml, whereas in the second patients group it was 182.2±14.9 mg/ml, indicating the immunostimulating activity of the complex treatment administered in patients of the first group. Conclusion. This study shows the effectiveness of glucosaminyl muramyl dipeptide as immunostumulating drug in combined treatment of chronic catarrhal gingivitis in patients with dental braces.
Kazan medical journal. 2014;95(2):250-253
pages 250-253 views

Health problems of the region with low population density according to data of the Amur oblast

Agarkova O.A., Voyt L.N.


Aim. To estimate the present health status of the population of Amur Oblast. Methods. The evaluation was based on analysis of statistical data on mortality, morbidity, disability in population. Intensive and extensive statistical parameters were calculated and compared. Results. The top three reasons for death in Amur Oblast were: cardiovascular conditions, external factors and malignancies (in Russia overall, malignancies rated the 2nd and external factors the 3rd). Mean survival rate has increased significantly both in Russia and Amur Oblast over the last 5 years (by 4.5 and 1.5 years accordingly). Overall disease prevalence has increased by 1.1 times over the last 5 years, with disease prevalence among children and adolescents increasing the most. Tuberculosis prevalence and mortality rate in Amur Oblast have dropped, although still higher compared with the whole Russia (prevalence - by 1.5 times, mortality rate - by more than 2 times). Syphilis prevalence rate has also dropped, although still exceeding the prevalence in Russia by 2.9 times. The prevalence of malignancies in Amur Oblast increased by 1.1 times, but it is by 1.1 times lower compared to Russian. Malignant tumors of lungs, skin, breast and stomach are the most prevalent types. Conclusion. Positive changes of public health characteristics can be expected at improving the life conditions and quality of life, the active promotion of healthy lifestyles and the high quality of medical care.
Kazan medical journal. 2014;95(2):254-257
pages 254-257 views

Healthcare mangement

Accessibility and quality of medical care in public out-patient clinics and private medical centers of the Amur oblast as reported by patients with back pain

Dobrovinskaya K.Y., Voyt L.N.


Aim. To study the opinion of patients with low back pain of judgement of assessibility and quality of medical care in public and private medical centers. Methods. Back pain patients to assess the quality of medical care filled in specially designed questionnaires for each type of medical facilities (two types of questionnaires for each patient who underwent treatment in both outpatient public clinics and private medical centers, total of 600 questionnaires). The poll was anonymous and was performed at one of the private medical centers in august 2013. Patients were randomly picked out from all patients who seek for medical aid in private center being unsatisfied with the quality of medical aid offered at public medical centers or who were on the waiting list for a doctor visit, or with disease worsening not within the working hours of public medical centers (600 questionnaires). The poll included patients of active working age: men aged 20 to 60 years (118 patients, 39.3%) and females aged 20 to 55 years (182 patients, 60.7%). Results. The majority of patients were more satisfied with the quality of the treatment, examination and attitude of medical personnel in private medical centers compared to public institutions. The following issues of providing medical aid to back pain patients were discovered both in private and public settings: untimely referral to specialist, or consultation only by general practitioner without subsequent consultation of neurologist, long waiting lists, incomplete neurologic examination, and low qualification of doctors in choosing appropriate examinations, treatment approach and further prophylaxis. Abovementioned issues were more significant in public settings. Conclusion. The research showed that there is a need in developing uniform standards of medical care in case of a back pain in outpatients that do not yet exist.
Kazan medical journal. 2014;95(2):257-261
pages 257-261 views

Current structure, organization and evaluation of effectiveness of the specialized outpatient medical care for patients with blood diseases in a metropolis

Zhiguleva L.Y.


Aim. To analyze the structure, organization and effectiveness of outpatient medical care for patients with blood diseases in St. Petersburg, Russia. Methods. 83 reports submitted by the heads of hematological offices at 2000-2012 were analyzed. The effectiveness was evaluated using routine statistical tests. The prevalence of the diseases was assessed by registration forms №7, 35, the data provided by information and analytical center of the Healthcare Committee and the City cancer registry. Medical aid provided to patients at 2010-2012 was studied, for this purpose 250 outpatient files (025/y form) were randomly picked out, the data were collected using specially designed registration cards (254 parameters). Results. Municipal, federal and departmental institutions provide hematologic outpatient medical care in St. Petersburg. The major burden of providing medical care to hematologic patients lays on interdistrict hematological offices, which actively follow-up and treat patients with hematologic cancers. Every sixth patient has complications, and 75% - comorbidities. During the period of study, the attendance rate increased by 33.4% (from 64 766 in 2000 to 86 405 in 2012), the number of the newly-diagnosed patients with hematologic cancers increased by 13.9% (p <0.05), the share of patients with hematologic cancers increased from 28.0 to 50.4%. Cumulative incidence of lymphomas increased from 69.9 to 96.0 per 100 thousand of population; leukemia - from 49.7 to 79.3. Mortality due to lymphomas decreased from 8.1% in 2001 to 5.3% in 2012, and due to leukemia - from 9.2% to 3.6%. Five-year survival rate of patients with leukemia increased from 56.6% to 63.2 % over the period of 2010-2012. Conclusion. The study shows the effectiveness of outpatient hematologic care in St. Petersburg. To further improve the efficiency of outpatient hematologic care in metropolis, it is important to improve the knowledge of hematologic diseases by doctors and pediatricians of general healthcare network, to review the workload of hematological office staff, to focus on preventive component of hematologic care (quality of occupational medical examinations), to develop and implement the new organizational techniques providing costs reduction and improving quality of life.
Kazan medical journal. 2014;95(2):261-267
pages 261-267 views

Assessing the structure and importance of medical and social risk factors in pipeline companies’ employees

Pyltsova S.V., Pozdeeva T.V.


Aim. To assess the influence of medical and social risk factors in pipeline companies’ employees and to design measures to reduce unfavorable influence. Methods. The study included 369 employees of OJSC «Volgogaz» working on pipelines at 2007-2009. A special form for social and hygienic study was designed, including information about health and living conditions, eating habits, family relationship, obsessive habits and family history. Results. Employees aged 30-49 years and older (190 subjects, 51.4%), with technical secondary education (151 subjects, 40.8%) were the most common. The majority of employees assessed their job as hard, 48 (13.0%) and 261 (70.7%) patients reported significant and extreme fatigue after the working shift. 260 (70.5%) subjects lived in a separate apartments, mostly in rural areas (216 subjects, 58.5%), most have complete families with children (297 subjects, 80.5%), despite most having one-parent family at childhood. Over a half of all employees (192 subjects, 52%) had 3 meals per day, 310 (84%) subjects slept for 6-7 hours per day, 222 (60.2%) subjects are current smokers, 27 (7.3%) subjects drink alcohol more than 1 time per week. 149 (40.5%) assessed their living conditions, and 50 (40.7%) - their fare as satisfactory. The majority of all employees (175, 47.5%) were ailing less than 2 times per year, 228 (61.8%) assessed their health status as satisfactory. Thus, medical and social risk factors in pipeline companies’ employees were associated with significant physical efforts, bad working conditions, including rotational team method, and unhealthy behavior. Conclusion. Rehabilitative measures should include improving the social factors (work, living and leisure conditions), healthy behaviors, increasing motivation for perceiving information of healthy way of living and measures to improve health.
Kazan medical journal. 2014;95(2):267-271
pages 267-271 views

Introducing adaptation program for nursing staff to a new work environment and the work place

Kasimovskaya N.A., Efremova V.E.


Aim. To find a scientific rationale and to develop a comprehensive system to adapt nursing staff at federal healthcare facilities. Methods. The following methods were used: direct observation, sociological, expert evaluation, analytical, statistical. The study included 526 nurses, among them 8 were principal chief nurses, 114 - senior nurses of the departments, 328 - ordinary nursing staff, 79 - newly accepted employees who completed the developed adaptation program for nursing staff. Special questionnaires were designed for adaptation program development. The existing system of nursing staff professional development was assessed by processing «Nursing staff adaptation program» documents. Results. A new program of adaptation of new employees to the workplace and professional requirements for a future position was designed while improving nursing staff management, according to the study results. The program includes the use of modern adaptation process methodology and contains teaching materials. The comparative analysis of the answers of executive nursing staff revealed that principal chief nurses admitted the need for the program: 7 (87.5%) out of 8 nurses considered it necessary before it was introduced, 100% of principal chief nurses recognized the importance of adaptation program after it was introduced. Senior nurses admitted the need for introducing the program in 70 (61.4%) of cases, however, after its introduction 108 (94.7%) of respondents confirmed that it was necessity. Conclusion. Adaptation program to a professional environment and new workplace for nursing staff is actual and is a necessary part of preparing the new employees to a professional environment and activities at the new workplace.
Kazan medical journal. 2014;95(2):272-275
pages 272-275 views

Evaluating the provision of antihypertensive drugs in the Republic of Kazakhstan on example of Almaty

Abuov J.Z., Kalmatayeva Z.A., Stepkina E.L., Rustemova A.S.


Aim. To study the opinion of doctors and pharmacists of providing free prescriptions for antihypertensive drugs in primary healthcare in Almaty. Methods. Medical and demographical data of the Agency of the Republic of Kazakhstan on Statistics on prescribing free antihypertensive drugs to special categories in primary healthcare in Almaty in 2008-2012, as well as the data of special questionnaires filled in by doctors authorized to make free prescriptions and by pharmacists supplying patients with free antihypertensive drugs were analyzed. The data were collected in primary healthcare facilities of Almaty in 2012. Results. Sociological survey showed that 90.8% of primary healthcare facilities were adequately equipped for entering free and preferential drug prescription data to the national database. In 9.2% of cases, facilities were underequipped (not every examination room had a computer). Examples of correctly filled in prescriptions for free and preferential drug supply were available in every facility. The question «Do you think that the system of preferential/free drug prescription provision improves the treatment effectiveness?» was answered positively by over a half of the respondents (50.6%), 31.6% believed that it provided better compliance for medication intake. Conclusion. 21.0% of physicians and 21.4% of pharmacists rated the current system as «excellent», and 47.4% and 53,6% accordingly - as «good». At that, 5.3% of physicians who rated the work as «unsatisfactory» expressed the willingness to switch to the system of 50% preferential provision.
Kazan medical journal. 2014;95(2):275-281
pages 275-281 views

Assistance to the practicing physician

Assessment of angiogenic factors activity variation in the prediction of diabetic retinopathy progression after phacoemulsification

Kuntysheva K.E.


Aim. To evaluate the variations of vascular endothelial growth factor and pigment epithelium-derived factor balance as a prognostic factor for diabetic retinopathy progression after phacoemulsification. Methods. The study analyzed 4 samples of tear fluid taken from 2 patients (2 examples per patient). Clinical and functional tests, such as visual acuity test, tonometry, refractometry, visual field test, biomicroscopy, direct ophthalmoscopy, immunoassay, optical coherence tomography, fluorescein angiography, were performed. Clinical and laboratory parameters of homeostasis, including tear concentration of vascular endothelial growth factor and pigment epithelium-derived factor, blood glycosylated hemoglobin level were examined before and after phacoemulsification. Dynamic ophthalmologic control of diabetic retinopathy clinical course was performed. Results. The concentration of pro-angiogenic vascular endothelial growth factor was noted in both cases after the surgery. Hence, in one patient its growth (375 pg/ml before surgery, 467 pg/ml after surgery) exceeded the changes of pigment epithelium-derived factor concentration (2.08 ng/ml before surgery, 1.6 ng/ml after surgery). The progression risk index was estimated as 1.245 for vascular endothelial growth factor and 0.77 for pigment epithelium-derived factor. In second patient, vascular endothelial growth factor also increased after surgery, although, it’s increase (from 335 pg/ml before surgery to 358 pg/ml after surgery) was similar to pigment epithelium-derived factor change (2.15 ng/ml before surgery, 2.02 ng/ml after surgery). The progression risk index in second patient was estimated as 1.07 for vascular endothelial growth factor and 0.94 for pigment epithelium-derived factor. These changes allowed to predict pro-angiogenic potential increase and progression of vascular damage from diabetic retinopathy, in first patient. The second patient had stable balance of pro- and anti-angiogenic factors, allowing to predict a favorable clinical course. Conclusion. The change in vascular endothelial growth factor and pigment epithelium-derived factor ratio over time may be used as a prognostic factor for diabetic retinopathy progression after phacoemulsification.
Kazan medical journal. 2014;95(2):284-287
pages 284-287 views

Effects of alcohol on pregnancy and the fetus. the role of preventive measures in daily practice of an obstetrician

Marianian A.Y.


Alcohol consumption during pregnancy can cause serious birth defects and developmental disorders. The article reviews scientific literature describing modern conceptions of alcohol-associated teratogenicity. Problems of public awareness of alcohol negative impact on pregnancy and the fetus (particularly by informing women of reproductive age and pregnant women) are raised. Literature review revealed that there is a lack of information on fetal disorders associated with alcohol consumption by the mother. Nowadays, alcohol consumption in Russia is one of the highest in the world (15.8 liters per capita per year, including newborns, 2011), which is significantly higher than the absolute level of alcohol consumption associated with serious health risk for an individual and for the population as a whole. Awareness among women of reproductive age and pregnant women is very low. Therefore, it is necessary to inform and teach physicians screening methods of medical problems associated with alcohol intake and brief intervention strategies that will help to identify and inform women at risk for having children with fetal alcohol syndrome and fetal alcohol spectrum disorders and prevent the birth of mentally retarded children. The problem of fetal alcohol syndrome and the whole spectrum of fetal alcohol disorders is of great theoretical and practical significance in Russia.
Kazan medical journal. 2014;95(2):287-291
pages 287-291 views

The experience of access application to recurrent laryngeal nerve and parathyroid glands as the way of the postoperative complications prevention in case of video-assisted surgery

Slavin L.E., Chugunov A.N., Khasanshin M.M.


Aim. To justify the application of surgical access to thyroid and parathyroid glands by means of videoendoscopic equipment. Methods. 14 video-assisted surgeries on thyroid and parathyroid glands were performed during the period of 2011-2014 using low-invasive midline cervical access by means of videoendoscopic equipment. Results. The surgery was carried out with a skin access of less than 3 cm, the section was made 1.5-2 cm above than jugular notch. Tissue dissection was performed by means of «channel» formation with mobilization of tissues while looking for recurrent laryngeal nerve and parathyroid glands up to allocation of the superior pole of a thyroid gland lobe under the laparoscopic control. In case of parathyroidectomy due to adenoma special attention was paid to presurgical topical diagnostics which included neck organs ultrasound examination with the use of expert class equipment as well as thyroid and parathyroid glands scintigraphy. Intrasurgical ultrasound examination of the area of surgery to specify the pathologically changed parathyroid gland location was performed in some cases. Jugular notch of sternum, lower pole of thyroid gland, lateral surface of trachea, tracheo-oesophageal groove, and inferior thyroid artery were used as reference points for identification of recurrent laryngeal nerve and parathyroid glands while using video equipment. As a rule, the recurrent laryngeal nerve was located behind and below the parathyroid glands. The distance from a skin section to a recurrent laryngeal nerve and lower parathyroid glands was 3.6 and 3.1 cm respectively. Conclusion. Use of video endoscopic equipment allows to reduce traumatic surgeries on neck organs and promotes the better visualization of anatomical structures in an area of surgery.
Kazan medical journal. 2014;95(2):282-284
pages 282-284 views


The origin, development and current concepts of «comorbidity» and «polymorbidity»

Nurgazizova A.K.


The article aims to study the current concepts of polymorbidity and comorbidity by a literature review. This article presents the terms used to denote a combination of several diseases for one person, named as «combined», «concomitant», «associated» diseases or conditions, «comorbidity», «polymorbidity», «multimorbidity», «multifactorial disease», «polypathia», «co-disease», «dual diagnosis», «plural diseases». Definitions for currently commonly used terms «comorbidity», «polymorbidity» and «multimorbidity» are given, the historical aspects of their occurrence are discussed. The differences between the concepts of «comorbidity» and «polymorbidity», despite their frequent use as synonyms, are listed. The existing classifications of comorbidity, including definitions of trans-systemic, trans-nosologic and chronological comorbidity, are reviewed. The classification developed by H.C. Kraemer and M. van den Akker (1998), which presents a causal, complicated, iatrogenic, unclear and random comorbidity, is described. The assessment scales for the evaluation of this phenomenon, such as Cumulative Illness Rating Scale, Kaplan-Feinstein index, Cumulative Illness Rating Scale for Geriatrics, Index of Co-Existent Disease, Geriatric Index of Comorbidity, Functional Comorbidity Index, and Total Illness Burden Index, are presented. Detailed description of the comorbidity assessment by Charlson index as the most used and having the least disadvantages, is given. Description of the quantitative evaluation of polymorbidity is given, variation of the number of diseases depending on patient’s age is shown. The list for the most common pathologies that can be combined in a single patient is outlined. Diseases typical for the patients of elderly and senile age are described. The problem of comorbidity becomes more and more important in the areas where social conditions promote the increase of the life expectancy of elderly and senile patients, which requires a common approach to the problems of comorbidity.
Kazan medical journal. 2014;95(2):292-296
pages 292-296 views


75 years to Professor Anatoliy Vasilyevich Ivanov

Kazan medical journal. 2014;95(2):297
pages 297 views

75 years to Аcademician Nail Khabibullovich Amirov

Kazan medical journal. 2014;95(2):298
pages 298 views

75 years to Professor Ildar Iskhakovich Kamalov

Kazan medical journal. 2014;95(2):299-300
pages 299-300 views

85 years to Professor Vadim Nikolaevich Shvalev

Kazan medical journal. 2014;95(2):300-301
pages 300-301 views


Professor Yakov Mikhaylovich Myloslavsky

Kazan medical journal. 2014;95(2):302
pages 302 views

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