Vol 101, No 3 (2020)

Theoretical and clinical medicine
Peculiarities of antibiotic resistance of Staphylococcus aureus strains isolated from nosocomial infections
Atakishizade S.A.
Abstract

Aim. To study of the antibiotic resistance of S. aureus strains isolated from nosocomial infections (pneumonia, surgical site infections and sepsis) in a multidisciplinary surgical clinic.

Methods. Microbiological testing of sputum in 41 patients with pneumonia, of samples (wound, abscess, drainage) obtained from 40 patients with surgical site infections (SSI) and of blood from 46 patients with signs of sepsis was performed. The obtaining cultures were identified by conventional methods (including morphological, cultural, biochemical features, etc.). Disc diffusion method was used to detect methicillin-resistant S. aureus (MRSA) strains. Inducible clindamycin resistance (ICR) of S. aureus strains was determined by double disk approximation test (D-test).

Results. Methicillin-resistant S. aureus was found in 14.3% (2 of 14) of the patients with surgical site infections, in the sputum 27.3% (3 of 11) of the patients with pneumonia, and in the blood 50.0% (7 of 14) of the patients with sepsis (p >0.05). The rate of inducible clindamycin resistance of isolated S. aureus strains in patients with surgical site infections (2 of 14 cases, 14.3%) and with pneumonia (2 of 11 cases, 18.2%) did not statistically significant difference with the rate of methicillin resistance (p >0.05). However the rate was significantly lower septic infections — 7.1% and 50.0% respectively (p=0.0328).

Conclusion. Among S. aureus strains isolated from nosocomial infections, the rate of methicillin-resistant S. aureus had not depended on the type of nosocomial infection; the rate of inducible clindamycin resistance in septic infections was lower than resistance to methicillin.

Kazan medical journal. 2020;101(3):325-329
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Phage sensitivity profiles of a nasopharyngeal opportunistic pathogen in Streptococcus pneumoniae carrier children with recurrent respiratory infections
Bayazitova L.T., Tupkina O.F., Chazova T.A., Konyshev N.S., Syuzev K.N., Isaeva G.S.
Abstract

Aim. To study the nature of microbiota and estimating the susceptibility to antibiotics and bacteriophages of conditionally pathogenic microflora of the nasopharynx in children-pneumococcal carriers with recurrent respiratory infections.

Methods. Researching microflora was conducted in 182 pneumococcal carriers receiving help in Kazan Scientific and Research Institute of Epidemiology and Microbiology. Microbial identification, testing of susceptibility to antibiotics and bacteriophages was carried out following the regulatory documentation. Bacterial isolates were confirmed by mass spectrometry. The phage titer was determined by the method of agar layers according to Grazia.

Results. Nasopharyngeal S. pneumoniae species was presented by Staphylococcus spp., Moraxella spp., Haemophilus spp., Corynebacterium spp., Klebsiella spp and Candida spp. The antimicrobial resistance profiles of Streptococcus pneumoniae: resistant to oxacillin was detected in 20.7% of strains, to erythromycin in 45.9%, to clindamycin in 20%, to trimethoprim-sulfamethoxazole in 18.4%. 19.6% of isolates were multidrug-resistant (MDR, resistant to 3 or more antimicrobial agents). Phage susceptibility test of S. pneumoniaе showed that 97.2% of isolates were resistant to streptococcal bacteriophage, 75% to pyobacteriophage. All antibiotic-resistant strains remained susceptible to Streptococcus phages. The phage titer of Klebsiella in agreement with Grazia method of Kl. pneumoniae ranged from 9×10–6 to 5×10–5 PFU/mL. The ranking results of activities of antistaphylococcal antibiotics (effectiveness descending): fusidic acid > mupirocin > chloramphenicol > cyprofloxacin erythromycin.

Conclusion. Nasopharyngeal microbiota of pneumococci carriers children is represented by a variable polymicrobial association; nasopharyngeal strains are effectively lysed by bacteriophages; mono- and polyvalent bacteriophages can be used as an alternative to antibacterial treatment in Streptococcus pneumoniae carriers children with recurrent respiratory infections.

Kazan medical journal. 2020;101(3):330-336
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Studying of biofilm formation by clinical strains of Candida albicans in interaction with Fusarium solani to predict the severity of atopic dermatitis
Lisovskaya S.A., Valieva R.I., Sharifullina A.A., Fayzullina E.V., Khismatullina I.M., Khaldeeva E.V., Isaeva G.S.
Abstract

Aim. To assess the ability to form biofilms by clinical strains of the yeast Candida albicans isolated from patients with atopic dermatitis in exacerbation and remission stages under the effect of Fusarium solani micromycete and its absence.

Methods. The study included 70 strains of C. albicans and one strain of F. solani. Fungal biofilms formed accor­ding to the method of Ramage. The optical density of the biofilms measured using a micro plate reader at 620 nm. The effect of associated fungi on the biofilm-forming properties of C. albicans strains was studied by an extract from opportunistic F. solani fungi.

Results. The greatest biofilm formation was observed in strains isolated at the remission stage. The strains isolated in the acute period were inferior to them in the ability to form biofilms (average values of film formation were 0.143 and 0.087, respectively). Co-cultivation of C. albicans strains with F. solani fungus extract stimulated biofilm formation of C. albicans strains at a concentration of 1:10.

Conclusion. This study showed a possible synergism between C. albicans and F. solani in polymicrobial skin infections, because the products of the fungus F. solani increase one of the virulence factors of the fungus C. albicans; the possibility to assess of a stimulating effect of associated fungi on the virulence one of an agent of infectious disease process will allow predicting the disease severity.

Kazan medical journal. 2020;101(3):337-341
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Analysis of BRCA1 and BRCA2 genes mutations in breast cancer patients in an experiment
Saрtarova L.M., Cogina E.N., Khasanshina L.M., Galimov S.N.
Abstract

Aim. To assess the presence of mutations based on the analysis of the prevalence of polymorphisms in the BRCA1 and BRCA2 genes in patients admitted to the Republican clinical Oncology dispensary of the Ministry of Health of the Republic of Bashkortostan with breast cancer.

Methods. 137 patients with breast cancer aged 25 to 80 years underwent molecular genetic testing to detect BRCA1 and BRCA2 mutations by using allele-specific real-time polymerase chain reaction. Venous blood from 105 healthy donors was used as a control group.

Results. The study of genetic modifiers of cancer risk for BRCA1 and BRCA2 mutation carriers revealed mutations in the genes BRCA1 185delAG, 4153delA, 5382insC, T300G and BRCA2-6174 del T, which help identify genetic susceptibility to breast cancer (NSCLC). The most common form of genetic variation in patients with breast cancer was 5382insC mutation in BRCA1 gene, which was 14.59% of the total number of examined patients and 90% of the total number of positive results. BRCA1 and BRCA2 genes mutations lead to producing truncated protein, which cannot properly perform its functions and ensure DNA cell stability.

Conclusion. Considering high breast cancer risk in BRCA1 and BRCA2 genes mutations carriers, our results show the advisability of including screening for 5382insC, 4153delA and T300G mutations in the BRCA1 gene to the screening programs for determining the risk of breast cancer.

Kazan medical journal. 2020;101(3):342-346
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Induction of apoptosis and autophagy in T-lymphocytes of patients with Systemic Lupus Erythematosus
Skibo Y.V., Fathullina A.R., Ibragimov B.R., Abramov S.N., Ismagilova R.R., Biktagirova E.M., Andrianova I.A., Maksudova A.N., Abramova Z.I.
Abstract

Aim. To analyze the expression of key apoptosis (Bcl-2, caspase-3) and autophagy (Beclin 1, Vps34, p62 and LC3) proteins regulators in peripheral blood T-lymphocytes of patients with systemic lupus erythematosus.

Methods. The object of the study was peripheral blood T-lymphocytes of healthy donors and patients with systemic lupus erythematosus. To obtain T cells, we used the immunomagnetic separation method. Protein expression was analyzed using the Western blot method. Statistically analyzing the results was performed using the R software environment. The data was represented using boxplots. Groups were compared using the Mann–Whitney test.

Results. According to the results of the study of the apoptotic proteins, we found an increased content of caspase-3 and the absence of significant changes in the content of the anti-apoptotic protein Bcl-2 in patients with lupus, which indicates active apoptotic activity. A comparative analysis of Beclin 1 and Vps34 showed their increased content in the cells of patients, which indicates the activation of autophagy. The analysis of two isoforms of LC3 protein revealed their low content in the group of patients. Since the scatter of indicators was very different from the average value, we analyzed these indicators depending on the severity of the disease. In the acute course group, high content of protein LC3-I was detected, the content of form II was lower. In the group with the subacute course, the number of both isoforms is lower than in the other groups. In the group with a chronic course, significant increases of protein LC3-II and a decrease in the ratio of LC3-I/LC3-II were found.

Conclusion. The study showed that depending on the severity of systemic lupus erythematosus, the content of protein LC3 isoforms changes, which can be used for differential diagnosis of disease forms.

Kazan medical journal. 2020;101(3):347-355
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Clinical and laboratory assessment of the application efficacy of antibacterial combinations in the treatment of chronic generalized periodontitis
Puri-Zahidan S.V.
Abstract

Aim. To determine the efficacy of the combination of metronidazole and co-trimoxazole in the treatment of chro­nic generalized periodontitis.

Methods. The studies included patients with slight and moderate chronic generalized periodontitis without concomitant pathology. Patients were divided into two groups with similar age and severity of periodontal diseases. In the first group, metronidazole was administered into the periodontal pocket; in the second group co-trimoxa­zole and metronidazole combination was used. Oral fluid testing was used to detect ureolytic and glycolytic activity, malondialdehyde (MDA) content, conjugated dienes, catalase activity, Salivary Secretory Immunoglobulin (SIgA) and Lysozyme. Changes in periodontal disease were assessed before and after treatment. The duration of treatment was 12 days.

Results. Co-trimoxazole and metronidazole combination more effectively stimulated ureolytic activity and reduced glycolytic effect. It had a more effective antioxidant effect that manifested in: a statistically significant decrease in malondialdehyde levels by 32.8% (p <0.01) and by 36.6% (p <0.01) in patients with slight and moderate periodontitis, respectively; decrease in diene conjugates by 25.0% (p <0.001) and 37.7% (p <0.001); and increased catalase activity 2.6 and 2.9 times (p <0.001). After treatment, it was revealed an increase in lysozyme activity by 11.3% and 17.6% (р <0,001) in patients with slight and moderate periodontitis, respectively, and increase secretory IgA le­vels by 37.4% (p <0.001) and 53.2% (p <0.001). In the first group, the amount of SIgA in the oral fluid increases by 35.8% (p <0.001), and by 45.6% (p <0.001) compared to the value before treatment in patients with slight and mo­derate periodontitis, and in the second group by 37.4% (p <0.001) and 53.2% (p <0.001), respectively.

Conclusion. The combined treatment with co-trimoxazole + metronidazole leads to the positive changes in the studied parameters causes rapid disappearance of the symptoms characteristic of chronic generalized periodontitis; this 2-drug combination is recommended to be included in the complex therapeutic measures for inflammatory periodontal diseases.

Kazan medical journal. 2020;101(3):356-364
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Dental status of professional athletes
Hajiyev J.G.
Abstract

Aim. To reveal the rate and severity of clinical manifestations of common dental diseases and dentofacial anomalies in professional athletes

Methods. The effect of intense physical exertion and “overtraining syndrome” on the state of the organs and tissues of the dental system were examined in 200 professional athletes aged 18–25 years between 2014 and 2016. Five groups where each has the same number of athletes (n=40) included: team sport athletes (volleyball, handball), martial arts athletes (wrestling, boxing), gymnasts, swimmers, athletes. The control group consisted of 40 individuals who were not professionally involved in sports. The state of the oral cavity, in particular periodontal tissues, was judged by changes in the following indicators: prevalence of dentofacial anomalies, the incidence of dental caries, state of the oral cavity hygienic using by simplified oral hygiene index (OHI-S) ( Green J.С., Vermillion J.R., 1963), degree of gums bleeding by using the Muhlemann–Cowell bleeding index, degrees of severity of periodontopathy by using the papillary-marginal alveolar index (RMA) [Massler, Schour (1949) in Parma modification (1960)].

Results. According to the values of the simplified oral hygiene index the worst state of the oral cavity hygienic was in wrestlers (2.12±0.022 points) and boxers (2.03±0.029) compared to the control group (1.62±0.026, p=0.049 and p=0.001, respectively). Catarrhal gingivitis and generalized chronic periodontitis are most often diagnosed in the groups of wrestling (82.5±6.01%), gymnastics (77.5±6.60%), boxing (70.0±7.25%) and swimming (70.0±7.25%). Dentoalveolar anomalies were more often detected in boxers (77.5% of cases, p=0.001) and in gymnasts (34.0%, p=0.365) compared to the control group. In these groups, diastema was also more often diagnosed.

Conclusion. Periodontal inflammation indicators were higher in wrestlers and gymnasts groups compared to the dental status of all other groups of athletes; caries and maximum level of dental anomalies are more common for boxers.

Kazan medical journal. 2020;101(3):365-370
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Reviews
Coronavirus infection and ophthalmology
Akhmetshin R.F., Rizvanov A.A., Bulgar S.N., Kamalov Z.G., Gainutdinova R.F., Usov V.A.
Abstract

This article presents a review of the ocular manifestations of coronavirus disease 2019 (COVID-19) by using materials of Russian and international researchers. After the outbreak of COVID-19 began in China in December 2019, isolated works on ocular manifestations of coronavirus infection began to appear in the literature. The review article summarizes data on the origin and species of viruses that infect humans, the structure of coronaviruses, and intermediate hosts of the virus. A separate chapter is devoted to the mode of transmission for infectious. It is shown that the main route of COVID-19 transmission from person to person is airborne. Of great interest to the ophthalmologists is the review of works devoted to the virus detection in the conjunctival sac. In particular, some studies have shown that in patients with COVID-19, the virus is present in the lacrimal fluid. According to the authors, it indicates that coronavirus might be transmitted through the conjunctiva. These statements are confirmed by clinical and experimental researches. The presence of coronavirus in tears indicates the possibility to cause disease by the ocular route. That is a potential infection source for different types of physicians during routine examinations of patients, and especially by ophthalmologists. Therefore healthcare workers should wear eye protection when dealing with patients who may have COVID-19. Ophthalmologists must take necessary safety precautions, even in conducting a routine physical examination. It is also worth noting that conjunctivitis can be the first symptom of COVID-19. It is proved that the virus in the conjunctiva was detected even in patients without symptoms of eye inflammation. Also interesting for researchers is the manifestations of coronavirus infection in animals, which, according to the authors, is essential for understanding the possible mechanisms of disease development and manifestations in humans.

Kazan medical journal. 2020;101(3):371-380
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Children and adolescents’ obesity is the 21st century health problem
Bocharova O.V., Teplyakova E.D.
Abstract

The article presents a literature review which devotes to one of the major issues of healthcare today — obesity in children and adolescents. The consequences of childhood obesity, methods of determination and pathophysiology of obesity are described in detail. It was considered the influence of genetic factors in the formation of obesity, the effect of intestinal microbiota in the pathogenesis of obesity. The literature search was carried out in the databases of NCBI, PubMed, PubMed Central, eLIBRARY.ru, etc. Obesity in children and adolescents is one of the most important issues for people from most countries in today's world. Worldwide, the prevalence of this pathology has increased over the past three decades. Obesity in children and adolescents is a complex, multifactorial disease in which genetic and non-genetic factors can be identified. Although the vast majority of childhood obesity incidents are exogenous, a small proportion may have endogenous causes. Currently, particular importance is attached to the study of hereditary predictors of obesity and its main complications. Being a complex and inherited trait (disease), obesity is a consequence of the interaction of genetic predisposition, epigenetics, metagenomics, and the environment. Also, recent experimental and clinical data show the importance of intestinal microbiota, which can cause overweight and obesity in some patients. Molecular genetic studies have confirmed changes in intestinal biocenosis with developing obesity in children and adolescents. Obesity, which began in childhood, causes short-term and long-term adverse effects on physical and psychosocial health and largely becomes a risk factor for the development of various metabolic disorders and cardiovascular pathology. Understanding the multifactorial mechanisms involved in the formation of obesity in children and adolescents provides opportunities for the early prevention of obesity and its complications.

Kazan medical journal. 2020;101(3):381-388
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Chronic bacterial prostatitis associated with androgen deficiency
Zubkov A.Y., Antonov N.A.
Abstract

Inflammation of the prostate gland occupies a significant proportion of inflammatory diseases of the genitourinary system. According to J. Potts et al. (2007), prostatitis is detected in 5–10% of the general male population. Today, one of the main problems associated with prostatitis is the narrowly targeted, often unwarranted treatment with its antibacterial drugs without taking into account the multifactorial nature of the pathogenesis and androgen dependence of the prostate gland. As a result, this leads to ineffective treatment of prostatitis amid growing antibiotic resistance. In turn, recent studies demonstrate key issues of testosterone and prostate gland relationship. These researches show that prostate metabolism is dependent on testosterone levels. The level of the hormone affects the course of chronic inflammation in the prostatic tissues. And also, that the number of bacterial agents that provoke pathological processes in the prostatic parenchyma directly depends on the degree of decrease in testosterone levels. This point of view is also supported by other studies. It was found that most patients with inflammation of the prostate gland had androgen deficiency, and correction of testosterone levels of these patients was highly effective in the treatment of chronic prostatitis. Thus, the androgen dependence of the prostate gland and the effect of hypogonadism on the incidence of prostatic parenchymal inflammatory changes allow us to radically revise the approach to the diagnosis and treatment of chronic bacterial prostatitis. The development and implementation of new algorithms in which the diagnosis and subsequent correction of concomitant androgenic are becoming a promising direction for this group of patients.

Kazan medical journal. 2020;101(3):389-393
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Social hygiene and healthcare management
Organizational and technological algorithm of primary specialized health care at cardiovascular diseases
Abramov A.Y., Goloshchapov-Aksenov R.S., Kicha D.I., Rukodayny O.V.
Abstract

Aim. To develop an algorithm for primary specialized cardiovascular care with a priority of endovascular strategy.

Methods. The study was conducted in 2018–2019 based on the Central Clinical Hospital “Russian Railways-Medicine” and 14 polyclinics in the regions of the Russian Federation. The subject of the study is cardiovascular surgeons (n=2), possessing the skills of endovascular care. The object of the study was patients (n=1018) attended regional polyclinics of the Russian Federation. Patients were divided into two groups: group A consisting of 673 patients with clinically significant atherosclerosis of the coronary, brachiocephalic and peripheral arteries and abdominal aortic aneurysm; group B consisting of 345 patients with chronic lower limb ischemia that does not require surgical treatment. The average age of patients in group A was 69±6.1 years, in group B — 63±7.2 years. There were 467 men in group A (69.4%), and 339 in group B (98.3%). An organizational and technological algorithm was developed to improve the primary specialized cardiovascular care. The results were assessed by the presence of outcomes (heart attack, stroke, bleeding, death), the availability of endovascular care and patient survival follow up 12 and 24 months. A content analysis of scientific publications on the issue under study has been performed.

Results. An organizational and technological algorithm of primary specialized cardiovascular care has been deve­loped, including the activities of the cardiovascular surgeon, who has the skills of endovascular care and a nurse in an outpatient clinic. The implementation of the algorithm ensured continuity, 100% availability, safety and quality of cardiovascular care using endovascular technology. Outcomes are not registered in both groups. Both patient groups showed 100% one and two-year survival.

Conclusion. The developed algorithm of primary specialized cardiovascular care has provided high quality ­healthcare.

Kazan medical journal. 2020;101(3):394-402
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Multidisciplinary health care monitoring and training program: impact on antibiotic use
Aleksandrova E.G., Abakumova T.R., Evstigneev S.V., Titarenko A.F., Khaziakhmetova V.N., Ziganshina L.E.
Abstract

Aim. To develop a program for monitoring the use of antibacterial agents and training in their rational use using the information on consumption and expenses in a multidisciplinary healthcare institution.

Methods. From 2011 to 2014, a group of clinical pharmacologists developed and implemented a monitoring program for the use of antibacterial agents using the ATC/DDD and ABC/VEN methodology in SBIH “Penza Regional Clinical Hospital named after N.N. Burdenko”. Hospital doctors were trained in the principles of rational use of drugs and antibiotics as part of continuing education in clinical pharmacology using monitoring results — analysis of the costs and consumption of antibacterial agents.

Results. Over the four years of monitoring and three years of educational activities, the most pronounced changes have occurred in the use of fluoroquinolones, aminoglycosides, macrolides and carbapenems. Fluoroquinolones consumption reduced 2 times, and it cost of purchase reduced 6 times (of total). Aminoglycosides consumption increased 3 times, primarily due to amikacin 5 times consumption increase. Macrolides consumption reduced 3 times, primarily due to clarithromycin decrease in consumption. At the same time, the antibacterial agents of the cephalosporin group leading in consumption, with their cost had decreased 2-fold. However, carbapenems consumption increased 3 times, with their costs increase 7 times.

Conclusion. Over the three years of the program, expenses and consumption of antibacterial agents of the fluoroquinolone and macrolide group were reduced, with an increase in the consumption of aminoglycosides and carbapenems without changes in the consumption of cephalosporins; costs of cephalosporins and carbapenems led to an increase in overall antibiotic costs; further efforts and studies are needed to study the use of antibacterial agents.

Kazan medical journal. 2020;101(3):403-411
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The results of a subjective assessment of the organization of inpatient care for newborn parents and neonatologists
Moiseeva K.E., Berezkina E.N., Kirilenko V.V.
Abstract

Aim. To study the opinion of mothers of newborns and neonatologists about the organization of inpatient care for newborns in St. Petersburg.

Methods. An anonymous survey of 2123 mothers of newborns and 172 neonatologists of St. Petersburg was conducted. The representativeness of the sample was checked by using the method of Professor A.M. Merkov, with the errors do not exceed 4 and 3%, respectively. Mathematical processing and data analysis were carried out by using the statistical software package PASW STATISTICS.

Results. 28.9% of mothers were partially or completely unsatisfied with the organization of inpatient care for newborns, in most cases due to the unfriendly and inattentive attitude by the medical staff (22.4%), the unsatisfactory provision by child care products (12.8%) and poor material and technical equipment of a medical organization (12.5%). On average, the human qualities of neonatologists were rated quite high by mothers at 4.63±0.09 (out of 5) points, and in mid-level practitioners were significantly lower — 3.91±0.08 points (p <0.05). In general, ­staying a newborn in a medical organization required financial costs for 37.3% of women, and 13.9% of respondents who received help through compulsory medical insurance paid for individual laboratory and other tests on their own. Mothers rated the organization of inpatient care for newborns on average 4.01±0.09 points. Compared to ­mothers, neonatologists rated it higher in the medical organization they work for and lower overall in St. Petersburg (M=4.11±0.10 points and M=3.78±0.12 points; p <0.05). According to the doctors, the main disadvantages of organizing inpatient care for newborns are poor material and technical equipment and problems associated with the staffing and qualifications of medical personnel.

Conclusion. There is a need to improve the process of providing inpatient care to newborns.

Kazan medical journal. 2020;101(3):412-417
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Use and costs of pain management in cesarian section
Tashtanbekova C.B., Chuenkova E.A., Evstratov A.A., Ziganshina L.E.
Abstract

Aim. To study the use of drugs for pain management for cesarean section and their cost on time and the first day after surgery.

Methods. A retrospective analysis of 117 anesthesia cards and childbirth histories of women after a cesarean section was performed. We analyzed drug therapy aimed at reducing pain during 1 day after cesarean section and performed a comparative analysis of the cost of drugs used in spinal and epidural anesthesia.

Results. Regional methods of anesthesia, epidural and spinal, were used in 95% of all cases. Spinal anesthesia was performed in 77 women, epidural — in 34 women. The frequency of prescribing opioid analgesics was higher with spinal anesthesia compared with epidural: trimeperidine (intramuscular) was used in 62 (83%) of 77 patients for spinal anesthesia and 1 (3%) of 34 for epidural anesthesia (p <0.05). There were no differences in the use of ketoprofen in the postoperative period with epidural and spinal anesthesia. The total cost of medicines used to control pain during and on the 1st day after surgery, with epidural anesthesia, was almost 10 times higher than that of spinal anesthesia: 938 and 98 rubles, respectively.

Conclusion. To control pain during cesarean section, in addition to local anesthetics, trimeperidine was used more often with spinal than epidural anesthesia; in the postoperative period, ketoprofen and trimeperidine were used with the equal frequency with greater use of ropivacaine with epidural anesthesia through a stored catheter; this has caused a higher cost of pain management during and in the first day after cesarean section with epidural anesthesia.

Kazan medical journal. 2020;101(3):418-425
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Clinical observations
Eczema herpeticum in a child in the first year of life: a clinical case report
Vahitov H.M., Makhmutova A.G., Ziyatdinova L.M., Pospelov M.S.
Abstract

This article describes up-to-date information about aetiology and pathogenesis of course of herpetic eczema. The authors highlighted new approaches to diagnosis and therapy of Kaposi varicelliform eruption in children of early age. It was described the results of own observations of the child in the first year of life with Kaposi varicelliform eruption and experience of application-sorption therapy in the treatment of this disease. The high efficiency of application-sorption therapy in skin lesions caused by combination of infection and allergy in children was noted. The clinical case examined allowed to assess the full complexity of differential diagnostic approaches in verification of eczema herpeticum. For a wide range of paediatricians and surgeons, algorithms for diagnosis and therapeutic tactics were described in the case of Kaposi varicelliform eruption.

Kazan medical journal. 2020;101(3):426-430
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Diagnostic difficulties of lichen planus: how to avoid medical error
Fayzullina E.V., Yusupova Z.T., Khismatulina I.M., Zinatulina G.M.
Abstract

The article presents a clinical case of lichen planus, misdiagnosed as “psoriasis” in the elderly patient. The case demonstrates difficulties in the differentiation of papulosquamous disorder experienced by dermatovenereologists, both dermatology residents and specialists with practical experience in the clinic of skin conditions. There are difficult to compare the clinical symptoms and histological conclusion of pathologists when diagnosing psoriasis and lichen planus. A variety of lichen planus according to 10th revision of the International Statistical Classification of Diseases and Related Health Problems, L43.8 “Other lichen planus”, a pigmented form presents a particular difficulty. Clinical and pathomorphological criteria for the diagnosis of psoriasis and lichen planus have been developed.

Kazan medical journal. 2020;101(3):431-434
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Clinical experiences
Risk factors for rebleeding in patients with peptic ulcer bleeding
Valeev M.V., Timerbulatov S.V.
Abstract

Aim. To analyze the results of treatment of patients with ulcerative bleeding, to identify the main risk factors for rebleeding in patients with peptic ulcer bleeding.

Methods. A retrospective analysis of the treatment results of 240 patients with acute peptic ulcer bleeding who were hospitalized in the Beloretsk Central District Hospital from 2008 to 2018 was carried out. Patients were divided into two groups: group 1 — 52 patients with rebleeding, group 2 — 188 patients in whom rebleeding did not occur.

Results. Rebleeding in patients with peptic ulcer was observed in 21.7% of cases. The surgical rate was 22.9% and mortality 6.3%. Based on the obtained data, rebleeding should recognize as a risk factor for death [odds ratio (OR) 68.9; 95% confidence interval (CI) 8.8 to 539.7; p <0.001]. Surgical treatment for rebleeding had unsatisfactory results (postoperative mortality in group 1 — 26.8%, in group 2 — 0). Risk factors for rebleeding in peptic ulcer bleeding include localization of the ulcer on the lesser curvature of the stomach (OR=2.37; 95% CI=1.18 to 4.74) and the posterior wall of the duodenum (OR=3.84; 95% CI=1.69 to 8.73), as well as Forrest type IIA ulcer (OR=2.67; 95% CI=1.55 to 6.48). Forrest IIc and III ulcers reduce the risk of rebleeding (OR=0.24; 95% CI=0.10 to 0.56). It was found that a shock index, a decreased level of total protein and red blood cells, and an increasing level of urea have a statistically significant relationship with rebleeding in peptic ulcer bleeding.

Conclusion. Rebleeding in patients with peptic ulcer is a serious complication of the disease that significantly increases mortality, and predicting the risk of rebleeding is one of the possible tools that can improve treatment outcomes and reduce mortality.

Kazan medical journal. 2020;101(3):435-440
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Experience of the laparoscopic-assisted stoma creation use in patients with colorectal cancer
Brezhnev D.G., Khvostovoi V.V., Frolova O.G., Moskalev A.S., Makhova O.Y.
Abstract

Aim. To demonstrate the advantages of laparoscopic surgery in patients with colorectal cancer compared to traditional surgical intervention.

Methods. A retrospective analysis of 40 patients treatment (the main group) in the Department of abdominal Oncology of the Kursk Regional Oncology Center for the period 2017–2019, who had a pronounced violation of the passage through the intestine due to stenosing by the tumour, was conducted. As a control group, 30 people who underwent open surgery in the volume of a colostomy for the period 2017–2019 was taken.

Results. According to the average duration of surgical intervention, the groups significantly differed (p <0.05), the average duration of surgery in the laparoscopic group was less — 40.5±13.6 min, with laparotomy — 54.5±18.5 min. The volume of blood loss during the operation was greater in the control group and reached 75±40 ml against, 10.5±5.5 ml the differences were statistically significant (p <0.05). The average length of stay in hospital in the laparoscopic group was 4±1 days, which is significantly less than in patients who underwent laparotomy 11±4 days (p <0.05). Postoperative complications occurred in 10% of patients in the control group: seroma of the median wound in 2 patients, ligature fistula in 1 patient. There were no postoperative fatalities in both groups.

Conclusion. The comparison of methods of surgical intervention showed that the results of laparoscopic operations are much better than traditional “open” operations in patients with colorectal cancer since they significantly reduce the duration of the rehabilitation period, accompanied by minor blood loss.

Kazan medical journal. 2020;101(3):441-445
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First experience of one and two-step endoscopic submucosal dissection of colorectal neoplasms
Sayfutdinov I.M., Slavin L.E., Khayrullin R.N., Mukharyamov M.S., Zimagulov R.T., Ivanov A.I., Panasyuk M.V., Sayfutdinova D.I., Ivanov I.A.
Abstract

Aim. To analyze the results of one and two-step endoscopic submucosal dissection in the treatment of colorectal neoplasms.

Methods. Between 2018 and 2019, 17 patients (6 men and 11 women) aged 33 to 79 years underwent 21 endosco­pic submucosal dissections of colorectal neoplasms ranging in size from 1.0 to 6.0 cm. Submucosal fibrosis was identified in 2 (11.8%) patients, epithelial neoplasms in 15 (88.2%) patients including laterally spreading tumors in 9 (60%), and large sessile colorectal polyps in 6 (40%) patients. Histological examination revealed a carcinoid tumor (11.8%), adenoma with low-grade (64.7%) and high-grade (23.5%) intraepithelial neoplasia. 13 patients were subjected to the one-step operation, and 4 patients required the two-step operation with a 1-day interval. Follow-up examinations after the operation were performed, on average, between 2 and 6 months.

Results. En bloc endoscopic submucosal dissection was performed in 11 (64.7%) patients, 4 of them in combination with mucosal resection. Endoscopic piecemeal resection of the neoplasia was performed in 6 (35.3%) patients. The average operative time was 155±73 minutes (range 40–320 min). Intraoperative complications, which were eliminated endoscopically, occurred during 8 (38.1%) of 21 operations: intensive bleeding in 6 (75%) patients, diastasis of muscle fibers in 1 (12.5%) patient, perforation of the intestinal wall in 1 (12.5%) patient. At the follow-up at 6 months, all patients formed the scar at the surgical area, while 3 patients required endoscopic removal of residual adenoma 2 months after the operation.

Conclusion. Endoscopic submucosal dissection is an effective method for removing colorectal neoplasms, while two-step dissection is a promising approach to the development of the technique.Keywords: one and two-step dissection, endoscopic submucosal dissection (ESD), colorectal neoplasms.

Kazan medical journal. 2020;101(3):446-451
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History of medicine
Child Infectious Morbidity in the USSR during the World War II
Sher S.A., Albitskiy V.Y., Baranov A.A.
Abstract

This article presents the results of a historical and medical research reflecting infectious morbidity among children during the Second World War (the Great Patriotic War 1941–1945). The research, based on archival and lite­rary sources, aims to highlight the situation with infectious morbidity of children in the USSR during the war. The study is relevant because the majority of historical and medical research devoted to the war had been carried out in the Soviet epoch and did not always depict an objective image due to the ideological concepts of that time, which often prohibited the publication of certain information. Inconsiderable in number studies have been conducted on this topic in post-Soviet Russia, yet are selective or localized. A review of a wide range of sources provides an independent perspective on the dramatic situation concerning the significant increase of childhood infections during the war both in the occupied territory and in the regions of children’s evacuation. As a result of systemic control measures carried out by central and regional public health services, childhood infections had not become endemic. Despite the rising number of tuberculosis cases, sexually transmitted diseases, and malaria in the early years of the war, further spread of the socially significant pathologies was prevented.

Kazan medical journal. 2020;101(3):452-458
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For the 90th anniversary of Davydov Vasily Yakovlevich — doctor, scientist, teacher
Nikolaeva I.V., Zagidullina A.I., Gilmullina F.S., Galeeva N.V., Sozinova J.M.
Abstract

The article presents the course of life, personality formation and becoming a doctor of Vasily Yakovlevich Davydov and dedicated to the 90th anniversary of his birth. Vasily Yakovlevich Davydov (13.02.1930–15.07.2016) — an outstanding representative of the Kazan school of infectious diseases, associate Professor of the Department of infectious diseases, Kazan state medical University, person with special clinical thinking, who trained more than a ge­nerations of doctors. He was awarded the “Excellence in Healthcare” prize by the USSR People's Commissariat of Health, Honored Doctor of the Republic of Tatarstan. He was awarded the medals: “For valiant and dedicated work in the Great Patriotic War of 1941–1945”, “Veteran of Labor”, “Winner in Social Competition”, “Millennium of RT”, five anniversary medals “For Victory over Fascist Germany”. The life course of V.Ya. Davydov is an incentive for the younger generation of doctors. His philanthropy, dedication and high professionalism should be a worthy example of the ministry of his profession.

Kazan medical journal. 2020;101(3):459-462
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The pride of the Kazan school of microbiology is Professor Rudolf Robertovich Geltzer and his students (on the 130th anniversary)
Isaeva G.S., Stremoukhova M.V., Bazikov I.A., Kartashev I.V., Kartashev A.V.
Abstract

The article was prepared for the 130th anniversary of the Head of the Department of Microbiology of Kazan State Medical University, Professor Rudolf Robertovich Geltzer. The milestones of R.R. Geltzer’s biography, and highlights the historical aspects of the formation of the Kazan school of microbiologists, which he represented are shown. The paper was prepared using primary sources — scientific articles and monographs published in the period of his activity, memories of colleagues from the Stavropol State Medical University, archival materials of the Department of Microbiology named after V.M. Aristovsky of Kazan State Medical University, as well as the ­National Archives of the Republic of Tatarstan. The main scientific achievements of R.R. Geltzer and his scientific contribution to the development of microbiology as one of the founders of the teaching of spirochetosis are described. The description of experimental studies on the development of culture medium for the isolation of Treponema pallidum, the search methods for diagnosing syphilis and other aspects of the scientific activity of R.R. Geltzer and his students is presented.

Kazan medical journal. 2020;101(3):463-471
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Obituary
Professor Vsevolod Vasilievich Talantov
 
Kazan medical journal. 2020;101(3):472
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Cochrane Review Summaries
Коронавирус (COVID-19): доказательства, касающиеся интенсивной терапии
 
Abstract

Эта Специальная коллекция создана в ответ на пандемию COVID-19 и регулярно обновляется. Она направлена на обеспечение немедленного доступа к систематическим обзорам, самым непосредственным образом относящимся к тактике ведения и лечения людей, госпитализированных с тяжёлыми острыми респираторными инфекциями. Эта коллекция включает обзоры, имеющие отношение к этапному руководству ВОЗ, которые были собраны Группой Кокрейновских обзоров по экстренной и неотложной помощи, а также опирается на знания Групп Кокрейн в поражённых регионах.

Kazan medical journal. 2020;101(3):473
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Высокопоточные носовые канюли для поддержания дыхания у взрослых реанимационных пациентов
 
Abstract

Распространённой причиной поступления в отделение реанимации и интенсивной терапии (ОРИТ) является потребность в дыхательной (или респираторной) поддержке. Высокопоточные носовые канюли (HFNC) представляют собой небольшие пластиковые трубки, которые расположены в ноздрях пациента и доставляют нагретую смесь воздуха и кислорода с высокой скоростью пациенту, нуждающемуся в поддержании дыхания. Эти трубки часто используются в ОРИТ, однако нет убедительных доказательств, свидетельствующих о том, что они предоставляют пациентам долгосрочную пользу, такую как уменьшение продолжительности пребывания в ОРИТ или улучшение шансов на выживание.

Kazan medical journal. 2020;101(3):473-474
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Использование кроватей с поднятым головным концом в сравнении с плоскими кроватями для предотвращения вентилятор‐ассоциированной пневмонии (ВАП) у взрослых, нуждающихся в механической вентиляции лёгких
 
Abstract

Взрослые, находящиеся в критическом состоянии, часто нуждаются в аппаратах, которые помогают им поддерживать дыхание. Одним из побочных эффектов использования этих аппаратов является повышенный риск развития пневмонии. Эта проблема известна как вентилятор‐ассоциированная пневмония (ВАП). Она становится основной причиной смерти у больных, находящихся в критическом состоянии, а также может увеличивать продолжительность пребывания пациентов в стационаре и увеличивать расходы здравоохранения. Положение, в котором находятся пациенты во время вентиляции (угол наклона тела или головного конца кровати), может играть важную роль в предотвращении развития инфекционного процесса в лёгких.

Kazan medical journal. 2020;101(3):474-475
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Положение на животе (лицом вниз) при искусственной вентиляции лёгких у взрослых при острой дыхательной недостаточности
 
Abstract

Пациенты, поступившие в отделение интенсивной терапии (реанимации) и нуждающиеся в искусственной вентиляции лёгких вследствие повреждения лёгких из‐за заболевания, имеют высокий риск смерти. Если лёгкие вовлекаются в процесс при заболевании, например при пневмонии, то они состоят из нормальных и поражённых участков. Восстановление нормальной воздушности занимает время, и пациенту может потребоваться механическая поддержка с помощью аппарата ИВЛ. Вентиляция лёгких является потенциально спасающим жизнь мероприятием, так как с её помощью поддерживается надлежащий уровень кислорода в крови и удаляется двуокись углерода. Тем не менее, само использование аппарата ИВЛ может вызвать воспаление и таким образом привести к дополнительным осложнениям со стороны лёгких. Чем интенсивнее аппарат ИВЛ должен работать, чтобы добиться нормальной оксигенации и удаления углекислого газа, тем больше вероятность того, что здоровые участки лёгких могут быть повреждены и состояние человека ухудшится. ИВЛ в положении лицом вниз (на животе) вместо ИВЛ в положении лёжа на спине может улучшить эффективность работы аппарата ИВЛ, тем самым снижая эти нежелательные побочные эффекты.

Kazan medical journal. 2020;101(3):475-476
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Экстракорпоральная мембранная оксигенация (ЭКМО) для критически больных взрослых
 
Abstract

Экстракорпоральная мембранная оксигенация — это форма жизнеобеспечения, направленная на обеспечение работы сердца и лёгких. Для пациентов с тяжёлой дыхательной недостаточностью ЭКМО обеспечивает экстракорпоральный газовый обмен. Для людей с тяжёлой сердечной недостаточностью или остановкой сердца ЭКМО (EСMO) [экстракорпоральная сердечно‐легочная реанимация (ЭКСЛР, ECPR)] обеспечивает газообмен и системное кровообращение. Применение ЭКМО связано с некоторыми рисками (например, кровотечения, образование тромбов).

Kazan medical journal. 2020;101(3):476-477
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Различные методы искусственной вентиляции (с контролируемым давлением в сравнении с контролируемым объёмом) у людей с острой дыхательной недостаточностью вследствие повреждения лёгких
 
Abstract

Мы хотели выяснить, эффективнее ли искусственная вентиляция лёгких с контролируемым (управляемым) давлением путём изменения объёма воздуха (ИВЛ с контролируемым давлением) по сравнению с ИВЛ с изменяющимся давлением лёгких с фиксированным объёмом подаваемого воздуха (ИВЛ с контролируемым объёмом).

Kazan medical journal. 2020;101(3):477
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Высокие и низкие уровни положительного давления в конце выдоха у пациентов с острым повреждением лёгких и острым респираторным дистресс‐синдромом
 
Abstract

Острое повреждение лёгких (ALI) и острый респираторный дистресс‐синдром (ARDS) являются острыми и тяжёлыми состояниями, влияющими на структуру и функцию лёгких, которые вызваны повышенной проницаемостью альвеолярно‐капиллярного барьера, приводящей к воспалительному повреждению. Смертность от ALI и ARDS снизилась с течением времени и в настоящее время составляет 43%. Пациентам с ALI и ARDS требуется искусственная вентиляция лёгких (ИВЛ), но это вмешательство может вызвать повреждение лёгких, вызванное ИВЛ-аппаратом (вентилятором). По этой причине терапевтическая цель для таких пациентов основана на защитной вентиляции лёгких.

Kazan medical journal. 2020;101(3):478
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Использование качественных данных для выявления факторов, влияющих на использование медицинскими работниками отделения интенсивной терапии руководств по выведению взрослых и детей из режима искусственной вентиляции лёгких
 
Abstract

Многие критически больные взрослые и дети, находящиеся в отделении интенсивной терапии (ОИТ), не могут самостоятельно дышать. Когда это происходит, их переводят на механическую (искусственную) вентиляцию лёгких (ИВЛ) с помощью аппарата, который помогает им дышать. Слишком долгое пребывание на аппарате ИВЛ увеличивает вероятность его вредного воздействия, включая травмы и инфекции лёгких, а также осложнения, связанные с длительной неподвижностью, такие как образование сгустков крови (тромбов) в ногах или лёгких. Соответственно исследователи пытаются найти способы снятия людей с этих аппаратов (вентиляторов), то есть отлучения от ИВЛ, насколько можно быстрее и безопаснее. Одним из способов является использование руководящих принципов (рекомендаций) или протоколов. 2 недавних Кокрейновских обзора объединили доказательства их различных исследований. Некоторые исследования показали, что протоколы были успешными в сокращении времени, проведённого на аппарате ИВЛ, в то время как другие исследования показали, что использование протоколов не влияло на время, проведённое на аппарате ИВЛ. Эти противоречивые результаты могли быть вызваны целым рядом факторов. Учёные, изучающие эти факторы, использовали методы качественного анализа [в противоположность методам количественных исследований], которые обычно включают в себя общение с людьми или наблюдение за поведением людей, или и то, и другое.

Kazan medical journal. 2020;101(3):478-479
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Corrections
Correction to the article Kazan medical journal. 2020; 101 (2): 284-288. DOI: 10.17816/KMJ2020-284.
 
Abstract

Исправление к статье Сазанов Г.В., Белоконь О.С. Казанский медицинский журнал. 2020; 101 (2): 284-288. DOI: 10.17816/KMJ2020-284.

На странице 284 в названии статьи вместо «Влияние предилатации на частоту возникновения нарушений коронарного кровообращения у пациентов с острым коронарным синдромом с подъёмом сегмента ST» следует читать «Влияние предилатации на частоту возникновения феномена no/slow-reflow у пациентов с острым коронарным синдромом с подъёмом сегмента ST».

Kazan medical journal. 2020;101(3):480
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