Vol 101, No 2 (2020)

Aim. To assess the effectiveness of the complex treatment of patients with stable angina pectoris using the method of external counterpulsation (ECP).

Methods. 92 patients with chronic stable angina were included in the comparative analysis, which divided into 2 groups: 57 patients received one course of treatment using the ECP method (main group), 35 patients received only drug treatment (control group). Before and after the therapy, a general clinical examination (including determining the functional class of angina pectoris and the need to use nitroglycerin preparations), coronary angiography, echocardiography, exercise stress test (stress ECG), and quality assessment using the Seattle Angina Questionnaire (SAQ) was performed.

Results. The decrease in the average functional class of angina was more significant in the main group compare to the control group — from 2.28±0.73 to 0.93±0.80 (p <0.05) versus from 2.34±0.73 to 1.83±0.71 (p <0.05). A decrease of at least 1 functional class more often occurred in the main group — 78.9% of patients versus 57.1% (p=0.0258). The use of nitroglycerin sharply decreased after treatment in the group, that use the ECP method (by 51.6%; p=0.002), whereas in the control group, despite a slight decrease (by 22.7%), the changes did not reach statistical significance (p=0.0736). Both groups showed similar dynamics of changes in echocardiography. The diffe­rences were obtained only for the dynamics of the ejection fraction of the left ventricle (LVEF), which was greater in the main group — an increase of 4.69±5.56% versus 1.75±5.15% (p=0.0448). The dynamics of all indicators of exercise stress test significantly differ between groups, and if for the main group it is positive, in the control group it is negative. Some indicators of quality of life change insignificant and similar for both groups (for example, on the scale for limiting physical exertion), and on some scales (stability scales for attacks and the frequency of angina attacks), the improvement in the main group is much more significant in comparing with the control group: 30–37 points versus 12–13 points, respectively (p <0.0001). The overall quality of life assessment score improved more in the group, that use the ECP method: +96.10±40.73 versus +45.31±35.06 the control group (p <0.0001).

Conclusion. The method of external counterpulsation (ECP) can be used in clinical practice as part of a comprehensive treatment of patients with stable angina pectoris; it can significantly reduce the class of angina pectoris and the need to use nitroglycerin preparations, improve a number of indicators of echocardiography, electrocardiography with exercise and quality of life indicators.

Aim. To study the rate of human neutrophil antigens (HNA) alloimmunization in donors of blood and blood components.

Methods. The study included blood samples of 1,127 donors who donated blood and its components in the Russian Scientific and Research Institute of Hematology and Transfusiology, Saint Petersburg, 635 male and 492 female. 36.18% of female donors were aged between 18 and 30 (n=178) and 63.82% were aged between 30 and 60 (n=314). The medical histories of all donors did not contain the records about the transfusion of blood components. Screening and identification of HNA alloantibodies were performed using the flow cytometric granulocyte immunofluorescence test with monoclonal antibodies CD16-PE, CD45-PC7, CD19-APC, Goat F(ab')2 Anti-Human IgG-FITC and the panel of donor neutrophils with detected HNA genotypes.

Results. The frequency of HNA alloantibodies in blood donors was 0.35% (n=4). No HNA alloantibodies were found in the male donors. Alloantibodies were detected only in female blood donors aged between 30 and 60. HNA antibody frequency in female donors was 0.81%. It were detected anti-HNA-1a, anti-HNA-3b and anti-HNA-4b antibodies of the IgG immunoglobulin class. In one donor, the specificity of antibodies could not be established. To establish whether detected antibodies in immunized donors were alloantibodies, HNA genotypes were determined.

Сonclusion. HNA alloantibodies occur with low frequency and are determined in 0.35% of blood donors. Alloantibodies were detected only in female donors and were directed against HNA-1a, HNA-3b and HNA-4b. The frequency of HNA antibodies in female donors was 0.81%. HNA genotyping confirmed that detected antibodies were alloantibodies.

Aim. To study clinical, gender, and age-related aspects of Internet addiction.

Methods. The study includes 400 people related to computer technology, which was divided into 4 study groups by age and gender: 100 adolescents aged 14.1±0.6 years was in the first group, 100 professional computer engineers aged 30.6±4.2 years in the second group, 100 male students at the age of 22.3±3.6 years in the third group and 100 women students aged 22.1±3.1 years. Clinical-psychopathological and experimental psychological methods were used: interviewing, using a modified Internet Addiction Test (IAT) divided into three categories of questions by conditions. In the work, we used the data of a previous study with increasing of the sample and numbers of objectives.

Results. A study of the clinical features of Internet addiction revealed the presence of “Internet-related paranoiac reactions”, which was most in the second group (52.2±9.8), most rare in the first group (8.3±1.7), and equally in the third and the fourth groups (24.4±4.3 and 32.1±6.4). For the study of gender differences in Internet addiction, were included in the third and fourth groups. 48.7±3.6% of all included respondents preferred virtual communication to real, 46.3±3.1% had signs of Internet dependence on being in cyberspace, 30.8±2.4% there were deviations in the psycho-emotional sphere. Male was more likely to experience severe impairment of working capacity and a decrease in energy potential (45.6±3.8). Communication in social networks turned out to be more relevant for women (60.3±8.7). The study of the age-related aspect of Internet addiction was performed in the first group. It was revealed the presence of computer games addiction in 16.3±2.4% adolescents, addiction to the virtual communication in 48.2±3.9% adolescents, web surfing addiction in 10.4±1.7% adolescents, mixed forms of Internet addiction in 26.7±2.9% respondents and also correlation of Internet addiction with the level of intelligence of the adolescents.

Conclusion. A retrospective analysis of Internet addiction developmental dynamics showed alternation various forms of this addiction and the presence of age stages.

Aim. To identify the causes affecting hypocalcemia and its frequency of causing after thyroidectomy.

Methods. The study included 402 patients after thyroidectomy, 361 (89.8%) women and 41 (10.2%) men, for the period 2015–2019. The patients were between the ages of 14 and 77 years (average 45±27.2 years). Patients were tested for the presence of hyperthyroidism, the volume of tissue removed and type of thyroidectomy, presence of repeated thyroid operations and accidental parathyroidectomy, the results of parathyroid autotransplantation and pathohistological reports. To determine the effect of these factors on hypocalcemia, patients were divided into three groups. The first group included patients (n=51, 12.7%) were underwent surgery for Graves’ disease, the second (n=335, 83.3%) — for nodular goiter, and the third (n=16, 4%) — for recurrent goiter. Statistical data analysis was performed with IBM SPSS 16.0. The results were analyzed by one-way analysis of variance or Kruskal–Wallis test and the median test. Results were considered statistically significant at p <0.05 (two-sided criterion).

Results. In the early postoperative period, 20 (5%) of 402 patients had hypocalcemia, of which 12 (3%) had transient hypocalcemia, and 8 (2%) had permanent hypocalcemia. Postoperative hypocalcemia was detected in 9 (17.6%) patients the first group, 8 (2.4%) patients — in the second group, and 3 (18.8%) patients of the third group. Patients’ hypocalcemia was characterized based on the types of underwent operations as follows: in 14 (5.3%; p <0.05) patients after total thyroidectomy, in 1 (3.2%) patient after close to total thyroidectomy, in 1 (16.7%) patient after total thyroidectomy with central lymphatic dissection, in 1 (20%) patient after total thyroidectomy with central and lateral lymphatic dissection, in 3 (18.8%) patients after repeated surgery. Postoperative hypocalcemia was identified in 5 of 44 patients of the second group with thyroid carcinoma, as well as in 1 patient of the third group with the same pathology (p=0.246).

Conclusion. Incidence of hypocalcemia was more frequent after surgery for hyperthyroidism, especially after total thyroidectomy; in 40% of cases, transient hypocalcemia was identified in patients with autotransplantation of the parathyroid gland after an accidental parathyroidectomy.

In everyday practice, the doctor rarely encounters only one specific disease, more often a patient with comorbid pathology comes to him. Such a group of concomitant diseases are mental disorders. Their prevalence in cardiology practice reaches 80%. Mood affective, anxiety and somatization disorders, as well as cognitive impairment are observed most often. The review looked at mental disorders that occur in cardiac diseases with the highest number of deaths, such as coronary heart disease, including myocardial infarction and cardiac arrhythmias, arterial hypertension and cerebrovascular diseases. Including attention is paid to the senile asthenia syndrome, which is accompanied by cognitive impairment, loss of previous vital interests and depression. The review highlights the questions of re­gular and adequate psychopharmacotherapy of cardiovascular diseases, which leads to a statistically significant decrease in the frequency of their exacerbations, which reduces the number of doctors who come to see for somatoge­nic symptoms, and also allows to improve the prognosis of the underlying disease and significantly reduce mortality. It was observed that the doctor should take into account the fact that modern cardiological preparations have effects that can cause side effects in the form of mental disorders when choosing a therapy. Understanding the processes of formation and occurrence of mental diseases in a patient with cardiovascular pathology, as well as methods for their correction, can increase the effectiveness of the therapy and improve the prognosis of the underlying disease.

Vascular implants in contact with blood must have high thrombotic resistance. However, in some cases, their implantation is associated with thrombosis and subsequent impaired patency of the blood vessel. Most often, this problem affects implants intended for reconstruction of small diameter vessels, which is associated with hemodynamic features in this part of the bloodstream. These include blood vessel prostheses, tissue-engineered vascular grafts, and endovascular stents. The features of the implant material are of great importance when choosing a method for its modification in order to improve biocompatibility and thromboresistance. The review analyzes current experience in using various methods of immobilizing drugs to the surface of vascular prostheses and endovascular stents made from stable and biodegradable polymers. The prospects of creating thromboresistant vascular grafts and stents by joint immobilization on the surface of the polymer material of drugs with antithrombogenic activity and biologically active molecules that regulate the reaction to a foreign body and implant remodeling were evaluated. Numerous studies in the review demonstrating a wide range of ways to modify blood vessel prostheses, tissue-engineered vascular grafts, and endovascular stents with antithrombotic drugs to increase their thrombosis resistance. The main approaches of antithrombotic modification include conjugation of drugs and biologically active molecules on the implant surface. At the same time, new technologies are aimed not only at inhibiting the process of thrombus formation, but also at reducing the intensity of the inflammation process and stimulating the reparation of vascular tissue.

Aim. To analyze the characteristics of primary childhood disability due to diseases of the ear and mastoid process in St. Petersburg from 2001 to 2018.

Methods. It was analyzed the indicators of primary childhood disability due to diseases of the ear and mastoid process in St. Petersburg over 18 years (2001–2018) since the beginning of the pediatric medical and social examination service appeared in the city: number, rate and structure. For the calculation we used the statistical data of the St. Petersburg Health Committee (reporting forms No. 12 and No. 30), the Federal Treasury Institution “The Main Bureau of Medical and Social Expertise across St. Petersburg” — form 7-D (social security), and data of a single automated vertically integrated information and analytical system for conducting. Statistical methods for studying disability were used: continuous observation (indicators of the number and rate of primary disability), nesting (serial) sampling to study the structure of disability (910 children recognized as disabled by the city’s Bureau of Medico-social Examination from the moment of their occurrence).

Results. The rate of primary disability of children due to pathology of the ear and mastoid process for 18 years ranged from 0.34 to 1.4 per 10 thousand children , the average over the entire period of 0.77 per 10 thousand. In the structure of primary disability due to diseases of the ear and mastoid process in children, was 54.8% boys and 45.2% girls. It was recorded, that increase of the number of children recognized as disabled for the first time due to this pathology was related with an increase in the share of coverage of newborns with hearing screening, as well as an increase in the average annual number of children in St. Petersburg. Also, indicators of primary childhood disability depend on indicators of the primary incidence of ear diseases and mastoid process.

Conclusion. Indicators of the number and rate of disability of the children who were first recognized as disabled due to ear and mastoid diseases in St. Petersburg increased from 2001 to 2018, which is associated with an increase in birth rates, primary morbidity and primary detection of ear and mastoid diseases in children.

Aim. To assess the possibility of using indicators of potentially preventable hospitalizations of cardiovascular diseases to assess the quality of medical care.

Methods. Indicators of quality of cardiovascular disease treatment were formed based on the analysis of literature, current clinical recommendations and the structure of potentially preventable hospitalizations in the districts and cities of the Republic of Tatarstan. The proposed indicators were studied in the districts of the Republic of Tatarstan in 2011–2015.

Results. It is revealed that the distribution of indicator values in the regions of the Republic of Tatarstan differs from normal and is characterized by high variation. Median, minimum and maximum of hospitalization levels for hypertension in 2015 were 8.4, 1.3 and 26.8‰ respectively; unstable angina, myocardial infarction — 2.2, 0.02 and 8.6‰. Indicators for hospitalization due to stable angina, chronic ischemic heart disease also had a high level of variation (6.3, 0.2 and 17.4‰). As criteria for quality and optimal use of resources, it is proposed to use nonparametric estimates, one of which is the upper quartile. According to this study, in 2015, upper quartile for hypertension was 11.2‰; for unstable stenocardia, myocardial infarction — 3.4‰; for stable angina, chronic ischemic heart disease — 8.6‰.

Conclusion. The results of this study prove that indicators of potentially preventable hospitalizations may be part of a comprehensive assessment of the quality of care.

This paper presents our experience of implantation and operation of the spinal access port system on the example of patient P, 78 years old. The admission diagnosis: malignant neoplasm of pancreas. Surgical treatment is contraindicated due to multiple metastases to the abdominal organs and lymph nodes. On admission to the hospital, the patient complained of persistent abdominal pain [6–8 points on Visual Analog Scale for Pain (VAS Pain)] was not relieved by the injection of NSAIDs and narcotic analgesics (morphine hydrochloride). We have decided to implant the spinal access port system to the patient aimed at neuraxial analgesia techniques. According to the World Health Organization (WHO), about 3.5 million people every day around the world suffer from cancer-related pain every day. The difficulties associated with the ineffectiveness of traditional pharmacological interventions for pain management lead to search alternative pain management. One of the aims of the paper is to attract the attention of treating doctors, surgeons, anesthesiologists to this technique because since it allows to reduce or relief of pain in this group of patients and improve their quality of life.

Aim. To assess the changes in endothelial dysfunction in patients undergoing cardiac surgery with minimally invasive extracorporeal circulation (MiECC).

Methods. The study included 50 patients who were undergoing coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). The patients were divided assigned to either a minimally invasive cardiopulmonary bypass system (group 1, n=15) or standard extracorporeal circuit (group 2, n=35). Changes in the laboratory parameters were assessed 5 times: before the operation, 5 minutes after protamine sulfate administration, 12 hours after the operation, 7 days after the patient's discharged from the hospital and one month after the operation. The activity of von Willebrand factor, factor VIII, and the number of activated platelets were examined in all patients in venous blood.

Results. After protamine sulfate administration, the activity of von Willebrand factor was increased to 164% in the group 1, and up to 193% in the group 2, with a tendency to increase the indicator after 12 hours. The peak of endothelial dysfunction, with the growth of von Willebrand factor and factor VIII, occurs on the 7th day after the operation. In patients of the group with MiECC, von Willebrand factor activity was decreased at the hospital discharge and returned to normal in 1 month. The number of activated platelets increases mainly in group 2 (6% versus 4% in group 1, p=0.29). The expression of P-selectin was significantly higher in group 2 at the hospital discharge (5.5% versus 3.1% in group 1, p <0.001), and in 1 month (4.5% versus 2.3% in group 1, p <0.001).

Conclusion. In patients with minimally invasive cardiopulmonary bypass, platelet activation decreases, endothelial dysfunction, accompanied by an increase in the von Willebrand factor and factor VIII activity, is less pronounced; the seventh day after surgery is a period of the high risk of thrombogenic complications.

Aim. To study and assess the clinical effectiveness of medical laser technologies in the complex treatment of complicated forms of sexually transmitted infections (STIs).

Methods. Modern technologies of molecular biological laboratory diagnostics in real time with Real-time amplifier CFX96 Bio-Rad Laboratorias (USA), were used for etiological diagnostics of pathogens. Determination of infectious and inflammatory lesions of tissues of the genital system was carried out using ultrasound on ALOKA CCL-680 device (Japan) using cavity sensors with an operating frequency of 5 MHz. Drug therapy was carried out in accordance with the Federal clinical recommendations of the Russian society of dermatovenerologists and cosmetologists “Dermatovenerology” (Moscow, 2015). To assess the effectiveness of laser technologies in complex treatment, patients with complicated forms of STIs were randomly divided into 2 groups: the control group (32 patients), where only traditional therapy was used, and the main group (108 patients), in which, in addition to traditional therapy, treatment was supplemented with laser therapy.

Results. The effectiveness of antibiotic therapy in the main group was 14.0%, and treatment using laser technology was 33.1% higher than the effectiveness of treatment in the control group. This shows the effectiveness of laser technologies in the treatment of infectious and inflammatory structural changes in the tissues of the organs of the reproductive system.

Conclusion. The use of medical laser technologies in the treatment of complicated forms of STIs with a change in exposure parameters depending on the revealed inflammatory-structural changes in the tissues of the affected organs showed high efficiency (79.6%); this technology can be recommended for use in practical health care for the treatment of complicated forms of STIs.

The article highlights the life path, pedagogical and social activities of an outstanding therapist, pupil of V.N. Vinogradov, Alexei Nikolaevich Kazem-Bek. An analysis of his scientific heritage, as well as his scientific and social activities in those areas of the clinic of internal diseases that later took shape as cardiology and phthisiology, suggests that at the turn of the 19–20th centuries he was among the most prominent research therapists. So, his works on the problems of physiology and pathology of the cardiovascular system indicate that he can be attributed to the pioneers of the emerging domestic cardiology. Activities A.N. Kazem-Bek as the chairman of the Society of Physicians at Kazan University (1903–1907) and editor of the Kazan Medical Journal also allows him to be considered one of the representatives of the therapeutic elite in Russia at the beginning of the 20th century. The article also presents materials that are not well known to the medical reader, revealing the exceptionally attractive appearance of this person-a citizen-doctor. Along with the “Holy doctor” F.G. Yanovsky in Kiev and N.Ya. Chistovich in St. Petersburg, the death of A.N. Kazem-Bek summed up the gaazov (coming from the Moscow doctor F.P. Gaase) tradition of medical asceticism in domestic medicine.

Хотя респираторные вирусы обычно вызывают только незначительные заболевания, они могут вызывать эпидемии. Приблизительно от 10 до 15% людей во всём мире заболевают гриппом ежегодно, а во время крупных эпидемий уровень заболеваемости достигает 50%. Глобальные пандемические вирусные инфекции были разрушительными. В 2003 г. эпидемия тяжёлого острого респираторного синдрома (ТОРС) затронула около 8000 человек, убила 780 человек и вызвала огромный социальный и экономический кризис. В 2006 г. глобальную тревогу вызвал новый птичий грипп H5N1, а в 2009 г. — новая угроза пандемии свиного гриппа H1N1. Единичных и потенциально дорогостоящих мер (особенно использования вакцин или противовирусных препаратов) может быть недостаточно для прекращения распространения. Поэтому мы провели поиск доказательств эффективности простых физических барьеров (таких, как мытьё рук или ношение масок) в снижении распространения респираторных вирусов, включая вирусы гриппа.

Какова цель этого обзора? Выяснить, какие стратегии могут быть использованы для улучшения соблюдения медицинскими работниками системы действий, известных как «стандартные меры предосторожности», для снижения инфекций в учреждениях здравоохранения.