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Vol 101, No 4 (2020)

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Theoretical and clinical medicine
Recommendations for the prevention and correction of thrombotic complications in COVID-19
Safiullina S.I., Litvinov R.I.
Abstract

The new coronavirus infection caused by the SARS-CoV-2 virus (COVID-19) is characterized by a high frequency of thrombotic complications varying from venous or, more rarely, arterial thrombosis to the development of disseminated intravascular coagulation (DIC) and/or diffuse pulmonary vascular microthrombosis, which aggravates the disease and becomes one of the leading causes of deaths. Timely and personalized anticoagulant thromboprophylaxis with low-molecular-weight heparins may prevent a severe course of the disease and improve outcomes. This applies to outpatients, hospitalized patients and patients in the early post hospital period. In the future, to develop comprehensive and evidence-based guidelines on the management of patients with COVID-19, it is necessary to conduct comprehensive systematic studies and comparative clinical trials of prophylaxis and treatment of hemostatic disorders in patients with COVID-19.

Kazan medical journal. 2020;101(4):485-488
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Complex analysis of coagulation tests in patients undergoing the combination of hemostatic and antithrombotic therapy following large joint arthroplasty
Golovko L.S., Safronenko A.V., Gantsgorn E.V., Sukhorukova N.V., Maklyakov Y.S.
Abstract

Aim. To assess the dynamics of coagulation parameters and the influence of its initial values on the development of postoperative thrombohemorrhagic complications in male and female patients undergoing large joint arthroplasty and received combination hemostatic and anticoagulant therapy.

Methods. A retrospective analysis of the medical records (n=253) of patients with arthroplasty, were divided into two groups based on the time differences between prescription of hemostatic and anticoagulation therapy. The first group includes 145 patients (57.31%, 112 women and 33 men) with time differences ≤17 h, and the second group includes 108 patients (42.68%, 78 women and 30 men) with time differences 18–24 h. The dynamics of coagulation test results were analyzed, and the influence of its initial value on the risk of postoperative thrombosis or bleeding was assessed.

Results. Thrombohemorrhagic complications were recorded in 27 (10.67%) patients, of which 22 (81.48%) were observed in group 1. In the first group, thrombosis developed in regimens with tranexamic acid (p=0.038) with 2.2 times higher incidence than in group 2 (p=0.023). The risk of thrombosis of women in the group 1 was increased by an initially low level of international normalized ratio [relative risk (RR) 13.333, p=0.00032] and activated partial thromboplastin time (RR=5.8, p=0.037). The risk of bleeding in group 1 increased by an increasing preoperative ­level of activated partial thromboplastin time (RR=18, p=0.0012 and RR=28, p=0.00022, respectively) for all patients and by a decreasing fibrinogen level (RR=23.25, p=0.00065) and platelets count (RR=10.2, p=0.038) for women.

Conclusion. To minimize the risks of thrombosis and bleeding after arthroplasty, especially in patients with initial deviations of hemostasis parameters from the norm, and, in particular, when using tranexamic acid as a hemosta­tic agent, it is recommended to observe the time interval between hemostatic and anticoagulant pharmacothe­rapy for at least 18 hours.

Kazan medical journal. 2020;101(4):489-500
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Association of expression of pSTAT3, pAKT1 with the survival of patients with diffuse large B-cell lymphoma
Vaneeva E.V., Rosin V.A., Dyakonov D.A., Samarina S.V.
Abstract

Aim. To assess the relationship between isolated and combined expression of pSTAT3, pACT1 in tumor cells with the survival of patients with diffuse large B-cell lymphoma (DLBCL).

Methods. The study included 100 patients with the first diagnosed diffuse large B-cell lymphoma, observed in the institute's clinic between 2010 and 2018 who received standard first-line R-CHOP (rituximab + cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy. The relative number of expressing pSTAT3 and pAKT1 ­tumor cells was determined by using immunohistochemical and morphometric methods. The optimal cut-off level of expression on tumor cells estimated by using receiver operating characteristic (ROC) curve analysis for pSTAT3 was 68% and for pACT1 — 70%. Given these values, all patients with DLBCL were divided into groups with a high and low degree of expression of the biomarkers. As a result, 53 patients were enrolled in the pSTAT3 high expression group (≥68% tumor cells) and 47 patients to the pSTAT3 low expression group (<68% tumor cells). Spearman’s correlation coefficient was used to examine relationships. Overall survival and event-free survival were estimated by Kaplan–Meier curves. The log-rank test was used for groups comparison.

Results. The five-year overall survival rate in the pSTAT3 high expression group was 55% versus 87% in the low expression group, p=0.015. A significant difference was found in the assessment of event-free survival: 43% for the group of pSTAT3 high expression, 66% for the group of low expression, p=0.011. A statistically significant value of a high level of pACT1 expression was revealed for 5-year overall and event-free survival (p <0.001 and p=0.003). Overall survival rate was 81% for the pACT1 low expression group and 43% for the high expression group while event-free survival rate was 64 and 41%, respectively. Also, patients with рАКТ1+/рSTAT3+ (high level) co-expression had extremely low rates of overall and event-free survival rates compared with the рАКТ1–/рSTAT3– (low ­level) group (p=0.001; p <0.001).

Conclusion. The pSTAT3 and pAKT1 biomarkers can be used as additional prognosis criteria for diffuse large B-cell lymphoma.

Kazan medical journal. 2020;101(4):501-506
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Endovascular biometrics and engineering
Goloshchapov-Aksenov R.S., Kicha D.
Abstract

Aim. To study technical problems in the provision of endovascular care and to develop technological solutions for its improvement based on endovascular biometry.

Methods. For the period 2015–2019 an expert analysis of the results of endovascular treatment of 1546 patients with chronic lower limb ischemia was performed, in which it was not possible to perform lower limb revascularization according to the standard method using a guide catheter, guidewire and balloon catheter. The expert group inclu­ded 5 interventional radiologists who performed endovascular procedures. The results were assessed by the effectiveness of revascularization using the developed innovative technology from a system of catheters of various diameters and stiffness in comparison with the results of using standard endovascular technique. Calculation of adequate statistical indicators and their reliability were undertaken using Statistica software (version 6.0).

Results. The “critical” and “weak” zones of the vascular bed were identified for the first time to substantiate the development of a technology for safe and effective endovascular revascularization. It has been established that technical difficulties in catheterization of vessels create the prevalence of atherosclerotic lesions and the limited technical capabilities of catheters and guidewires, which are manipulated under the conditions of increasing high friction with the vessel wall caused by tortuosity and atherosclerosis, the presence of “weak” and “critical” zones of the blood vessels, as well as a significant distance from the surgeon's hands to the area of medical manipulation, ­reaching 130–200 cm. The developed innovative design from the catheter system ensured the effectiveness of endovascular lower limb revascularization in all patients (100%) using the femoral and brachial accesses compare to the standard technique of endovascular care (p <0.001).

Conclusion. Endovascular instruments offered on the domestic market do not guarantee the effective completion of revascularization. The technology of vascular catheterization developed based on endovascular biometry ensures the successful completion of revascularization in 100% of cases.

Kazan medical journal. 2020;101(4):507-512
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Indoor fungal contamination as a biological risk factor
Khaldeeva E.V., Glushko N.I., Lisovskaya S.A., Parshakov V.R., Khaidarova G.G.
Abstract

Aim. To assess the degree of fungal contamination and the species composition of the fungal microbiota of residential apartments in Kazan

Methods. A mycological study of 90 air samples and 60 samples from sites of fungal biodeterioration from the re­sidential buildings of Kazan was carried out using cultural and microscopic methods.

Results. The presence of micromycetes fungi were detected in 90% of air samples and 100% of samples from sites of biodeterioration. Higher fungal species diversity was noted in the sites, compared with air samples. Fungal concentrations in indoor air varied between 8 and 360 CFU/m3. Fungal community composition analysis of the sites of biodeterioration showed that the surfaces were more frequently contaminated by undemanding and capable of growth at different moisture levels fungal species (Penicillium spp., Aspergillus spp., Rhizopus stolonifer). The resulting fungal plaque can create conditions favorable for aggressive fungal species that actively damage materials (Chaetomium spp., Acremonium spp., Aureubasidium spp). Allergenic fungi, as well as potentially pathogenic and toxin-forming species, were widespread in the air that can be a health risk factor. A quantitative assessment of air mycobiota indicated the moderate level of fungal contamination.

Conclusion. The presence of potentially pathogenic, allergenic and biodegradable fungal species in the sites of biodeterioration has been confirmed, as well as the relationship between airborne fungal contamination and the spread of fungi in indoors, confirming the need to prevent fungal biodeterioration and control indoor air quality.

Kazan medical journal. 2020;101(4):513-518
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The features of the intrafascicular structure of the thoracodorsal nerve trunk in terms of ­restoring afferent innervation in breast reconstruction
Gorbunov N.S., Kober K.V., Kasparov E.V., Protasyuk E.N.
Abstract

Aim. To study of anatomical and topographic features and the intrafascicular structure of the thoracodorsal nerve trunk in the brachial plexus.

Methods. The study was performed on the brachial plexus preparations of 80 male and female corpses. Short and long branches, secondary bundles, primary trunks, spinal nerves, anterior and posterior roots of the spinal cord were layer-by-layer anatomically prepared from brachial plexus. The angles of inclination from the arising site of the thoracodorsal nerve, the topography throughout and after entering the latissimus dorsi muscle were studied. The length and thickness of the thoracodorsal nerve, including the extramuscular and intramuscular parts, were measured. ­After isolation and fixation of the preparations, intrafascicular dissection of the thoracodorsal nerve was performed throughout the brachial plexus, by using microsurgical instruments and a binocular magnifier.

Results. The length of the thoracodorsal nerve consists of extramuscular and intramuscular parts and was equal to 17.9 cm, of which the extra-muscular part was three-quarters of the total length of the nerve. The nerve trunk dissection revealed that the thoracodorsal nerve consists of 1–4 nerve fascicles and most frequently, in 46.2% of preparations, the thoracodorsal nerve arises from the C7 nerve root. The presence of motor and sensory portions of nerve fibers in the thoracodorsal nerve was found. In 90.2% of the preparations, the motor portion was located in the posterior-lateral part of the nerve and sensory in the anterior-medial. In most cases, both the sensory and motor fas­cicles arose from C7, or motor fascicle from C7 and sensory from C8.

Conclusion. The intrafascicular dissection of the thoracodorsal nerve revealed microtopography of the sensitive and motor portions of nerve fibers in the nerve and along the entire length of the brachial plexus; in breast reconstruction, after mastectomy with thoracodorsal flap for the preservation of afferent innervation, it is recommended to cross only motor fibers of the thoracodorsal nerve.

Kazan medical journal. 2020;101(4):519-523
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Experimental medicine
Histomorphological changes in various rat tissues following chronic exposure to copper-zinc-pyrite ore
Ziyakayeva K.R., Kayumova A.F., Kayumov F.A., Fazlyakhmetova M.Y.
Abstract

Aim. To assess the histomorphological state of lung, gastrointestinal and kidney tissues following exposure to ­copper-zinc-pyrite ore in the long-term model experiment.

Methods. The study was performed on 60 outbred albino male rats, aged 3–4 months, weighting 200±30 g. The ­toxic effect of heavy metal salts of copper-zinc-pyrite ore on the animal's body was analyzed by the model of dosed oral injection of water with ore in a dose 600 mg/kg body weight for 120 days. Pieces of the stomach, small and colon, liver, lungs and kidneys were taken from control and experimental rats for histomorphological study on the 30th, 60th, 90th and 120th day of the experiment.

Results. The structural disorders of the stomach lining were observed on the 30th day of the experiment: desquamated and dilapidated epithelial cells appeared in the preparations. On the 120th day, along with signs of epithe­lial desquamation and diffuse lymphocytic infiltration, the preparations contained large lymphoid follicles that occupy the full thickness of the gastric mucosa. The epithelial layer of the small intestine mucosa was disrupted on the 60th day. At day 120 diffuse infiltration and necrotic changes in the lining of the small intestine were recorded. Lymphomacrophagia infiltrations were observed during portal triad and inside the liver wedges of experimental ani­mals on the 30th day of the experiment. By the end of the experiment, toxic hepatocyte dystrophy developed. On the 60th day, signs of bronchopneumonia appeared in the lung tissue. After 3 months, tubulopathy and tubulointerstitial nephritis were observed in the experimental animals.

Conclusion. Prolonged administration of ore has led to pronounced inflammation and degenerative changes in the gastrointestinal tract, liver, kidney and lung tissues, accompanied by lymphocytic tissue reaction.

Kazan medical journal. 2020;101(4):524-529
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Reviews
Current diagnosis and treatment of Duchenne muscular dystrophy
Gaynetdinova D.D., Novoselova A.A.
Abstract

Duchenne muscular dystrophy (DMD) is an X-linked progressive disease from the group of primary myopathies caused by mutations in the DMD gene and a lack of dystrophin protein in the muscle fiber in males. The review considered the prevalence of pathology, the most common causes of dystrophinopathy, and the role of dystrophin not only in the functioning of muscles but also in the architectural organization of the Central nervous system. The disease classification based on stages and forms, initial clinical manifestations of the early and late stages of the disease, as well as neuropsychological, orthopedic, respiratory and cardiovascular disorders, are described in detail. The relevant to date diagnostic algorithm for suspected DMD, biochemical blood analysis, genetic, morphological (immunocytochemical staining of muscles with dystrophin antibodies) and instrumental (ultrasound, MRI) methods of examination are presented in detail. Particular attention in the diagnosis of DMD and objectification of disorders is given to assessment tests [Bailey’s and Griffiths scales, Albert's Test of Infant Posture and Motor Assessment Scale, Expanded Hammersmith Functional Motor Scale (HFMSE), the Gross Motor Function Measure (GMFM), and the 6-minute walk test (6MWT)]. The review presents the advantages and disadvantages of modern invasive and non-invasive diagnostic techniques of the disease, indicating their reliability and the possibility of application at early stages, including prenatal. In conclusion, the treatment of DMD and its most frequent complications, both widely used in practice and at the stage of clinical research, is highlighted. It was emphasized the importance of rehabilitation measures that improve the duration and quality of life of patients with DMD. The main task of analyzing available sources on the most pressing issues of Duchenne muscular dystrophy was to stimulate research and social activity in resolving unsolved problems today.

Kazan medical journal. 2020;101(4):530-537
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Social hygiene and healthcare management
The impact of the number of children in the family on the breastfeeding duration and vaccination coverage
Alekseeva A.V., Berezkina E.N., Moiseeva K.E., Kharbediya S.D.
Abstract

Aim. To assess the impact of the number of children in the family on breastfeeding duration and vaccination coverage.

Methods. 1724 mothers of 1-year old children were randomly chosen from seven children's polyclinics in St. Petersburg for an anonymous survey that was conducted by a specially designed form “Questionnaire of a mother of 1-year old children”. The questionnaire comprised of 20 open-ended and closed-ended questions, and included questions about: (1) timing of the attachment to the breast in obstetric hospitals; (2) causes and timing of breastfeeding abandonment; (3) presence or absence of vaccinations in the first year of life according to the National preventive vaccination schedule; (4) and reasons for mothers refusing to vaccinate their children.

Results. The proportion of mothers who started artificial feeding in maternity wards immediately after the birth of the baby was the smallest among women for whom this baby was the first-born (3.4%), and the largest among fami­lies with many children (11.3%). On average, mothers with one child are breastfed until 7.36±0.11 months, with two children until 8.29±0.11 months, with three or more children until 8.78±0.10 months. By using one-way analysis of variance (ANOVA), it was shown the effect of the number of children in the family on the duration of breastfee­ding (F=3.3). Correlation analysis revealed the negative relationship of the number of children in the family with the proportion of women who continued breastfeeding until 3 and 6 months (rxy=–0.82 and rxy=–0.88, respectively), and positive relationship with the proportion of mothers who continued to breastfeeding the baby after reaching a year (rxy=0.89). 12.3% of children of one-child families were not vaccinated according to the National preventive vaccination schedule, 17.7% with two-child families, 28.1% in families with three or more children. It was revealed the significant cross-group effect of the number of children in the family to vaccination coverage (F=48.7). With an increase in the number of children in the family, vaccination coverage decreases, both in general (rxy=–0.88) and against individual infections, including hepatitis B, diphtheria, whooping cough, tetanus, polio, measles and rubella (rxy from –0.80 to –0.90).

Conclusion. The number of children in a family impacts mothers' refusals of breastfeeding and vaccination; the more children in a family, the more prolonged breastfeeding, but less vaccination coverage due to the health status of children in the first year of life.

Kazan medical journal. 2020;101(4):538-543
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The practice in applying and ways to improve criteria for establishing the degree of occupational disability in the territory of the Russian Federation
Sevastianov M.A., Penina G.O., Dedeneva I.V., Chistyakova N.P., Bozhkov I.A.
Abstract

Aim. To assess the practice in applying “Temporary criteria of determination of extent of loss of professional wor­king capacity” currently in force in various constituent entities of the Russian Federation and to substantiate the main directions for their improvement.

Methods. The analysis of expert decisions to establish the degree of occupational disability, adopted in the pe­riod from 2015 to 2017, was carried out in 77 subjects of the Russian Federation for two nosological forms: (1) consequences of lower limb injuries (T93) and (2) bilateral sensorineural hearing loss (H83.3). A comparative analysis of expert decisions made using current and proposed by the authors’ criteria in 2 constituent entities of the Russian Federation in 2018 was carried out. For data analysis, we used descriptive statistics methods.

Results. Taking into account a high variability in expert decisions making in the constituent entities of the Russian Federation for similar cases (coefficient of variation 21.6%), the authors conclude that it is necessary to change approaches to the methodology for assessing the type of professional activity (qualifications, quality and volume of work, ability to perform it). Using the authors propose criteria based on the concept of reasonable accommodation allowed us to significantly reduce the variability of the decisions made in the “pilot” regions, the coefficient of variation decreased from 21.25 to 7.43%.

Conclusion. High variability of decisions made during the examination of the degree of occupational disability is associated with the imperfection of the methods and criteria for assessing the victim's professional activities; the use of the criteria proposed by the authors allows for a higher reproducibility of the results of the examinations.

Kazan medical journal. 2020;101(4):544-549
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Mental health of chemical workers: violation risk factors
Kuzmina S.V., Garipova R.V., Berhkeeva Z.M., Yakhin K.K.
Abstract

Aim. To study the structure of psychosocial maladjustment in chemical workers and assess the contribution of industrial and non-industrial risk factors in the formation of mental illness.

Methods. It was analysed of hygienic assessment of the leading harmful production factors — chemical, physical, factors of severity and intensity of labor. During the periodic medical examination, the mental health status of 1,226 people was examined, with a focus on professional experience, mental hygiene aspects of production factors, as well as individual and personal characteristics of employees. Confidence intervals and standard errors estima­ting, the logistic regression models fitting were performed using R Statistical Software with significance level 0.05.

Results. The working environment hazards in organic synthesis included chemical risk factor, continuous noise exceeding the permissible exposure limit, emotional stress and life-threatening conditions (fire and explosion hazards in the work). The general assessment of working conditions was performed using clauses 5.1–5.11 P 2.2.2006-05-harmful working conditions of the second-third degree (3.2–3.3). Working conditions at all stages of the manufacturing process of pyroxylin powders were assessed as harmful to the third-fourth degree (3.3–3.4), including the chemical factor, the severity and intensity of work, fire and explosion hazards in the work. It was revealed the dependence of the development of psychosocial maladjustment on non-work-related factors (such as the level of education, marital status), conditional work-related factors (level of material security). Also, the dependence of the structure of pre-existing mental health condition on the work-related and developmental characteristics (work experience) of labor in chemical production was found.

Conclusion. Working conditions in the studied industries correspond to the 3rd harmful class, 2nd and 3rd degrees in the production of organic synthesis (3.2–3.3), while at the production of pyroxylic powders, it is close to dange­rous (3.3–3.4); the structure and risk of the developmental process of employee maladjustment are determined by the feature effect of workplace hazards.

Kazan medical journal. 2020;101(4):550-560
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Current state and development of the sanatoriums-health resorts potential of the Republic of Tatarstan
Knni Y.A., Radchenko O.R., Urazmanov A.R., Balabanova L.A.
Abstract

Aim. To analyze the current state of the sanatoriums-health resorts system of the Republic of Tatarstan and identify the demand by the population of sanatoriums-health resorts services for recreation and health promotion at the regional level.

Methods. To analyze the functioning of the sanatoriums-health resorts of the republic, we used data from the official website of the Federal State Statistics Service (2002–2018). We calculated the long-term mean values, standard deviation, growth rate, linear regression, the approximation coefficient in comparing the Republic of Tatarstan, Volga Federal District and the Russian Federation. The population proportion, which used the sanatoriums-health resorts services, bed provision per 10,000 population and bed turnover were calculated to assess the provision of the population with sanatorium-resort services. The study of the demand for sanatorium services by the population was carried out using a sociological survey.

Results. In the comparative analysis, it was found that the Republic of Tatarstan is the region with a developed, rela­tively stable sanatoriums-health resorts system. The increase in the number of beds in sanatoriums (from 23.86 beds per 10,000 population in 2002 to 24.94 in 2018) and bed turnover rate (from 12.84 in 2002 to 16.59 in 2018) during the studied period indicated the continuity between curative and restorative-rehabilitation medicine. An increase in the proportion (from 3.07% in 2002 to 4.15% in 2018) with an overall increase in the number of stayed ­people (1.39 times) indicated the interest of the population in rehabilitation treatment and recreation in regional sanato­riums-health resorts. As a result of the survey, a “portrait” of the modern consumer of sanatoriums-health resorts was drawn up, and priorities in sanatorium choosing were determined.

Conclusion. The Republic of Tatarstan belongs to the regions with a developed system of sanatoriums-health resorts and significant potential to its development, which is confirmed by the presence of natural healing factors, improved provision of sanatoriums-health resorts care and increasing demand of the population for services for rehabilitation treatment and recreation in regional sanatoriums.

Kazan medical journal. 2020;101(4):561-569
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Clinical observations
A rare lethal complication of larynxopharynx injuries by a foreign body
Fedin A.V., Poyarkova V.S., Aschina L.A., Shkurova N.A.
Abstract

A lethal complication of laryngopharynx injuries by foreign bodies is a rare phenomenon. Among foreign ­bodies are ingested together with food, fishbones are the most common. They can injure the mucous membrane of the larynx and pharynx due to the sharp edges, thereby causing inflammation, resulting in edema occurs, hyperemia and increased pain. Besides, foreign bodies can provoke complications such as bleeding, cervical phlegmon, subcutaneous emphysema, esophageal perforation, sepsis and others, which can lead to the death of patients. Howe­ver, due to timely diagnosis, according to the scientific literature, such cases are extremely rare. Because the visualization of foreign bodies in the area of the larynx is difficult (especially when localized in the pyriform sinuses), laryngoscopy is used for diagnosis. Moreover, in some cases, X-ray examination and computed tomography are indicated. The paper presents a clinical observation of a 57-year-old patient M., whose cause of death was a rare complication of laryngopharynx injuries with a fishbone. When the patient was admitted to the department, the basic clinical diagnosis was established: laryngopharyngeal injury complicated by right parapharyngeal abscess. The patient underwent antibacterial, infusion, anti-inflammatory and antihypertensive therapy. At 20 hours after hospital admission, the patient had an abrupt loss of consciousness and cardiac arrest, then death. Based on the clinical picture, it was concluded that pulmonary thromboembolism was the probable cause of death. The ­autopsy revealed injury of the right external jugular vein, as a result of which develop thrombophlebitis, and then pulmonary artery thromboembolism, which caused the patient's death. No similar clinical descriptions were found in the available scientific literature.

Kazan medical journal. 2020;101(4):570-573
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A clinical case of central cancer of the lung and infiltrative tuberculosis
Naumov A.G., Pavlunin A.V., Golova A.Y., Nikolskaya N.A., Mansurskaya K.V., Samarina O.E.
Abstract

The scientific challenge of combining the tuberculosis process and lung cancer has not been fully disclosed in mo­dern literature. This primarily involves the low incidence of these two pathologies at the same time. This may contribute to difficulties in the qualitative and timely diagnosis of these diseases. Tuberculosis “hides” the radiological manifestations of a malignant tumor for a long time that contributing to its progression and the development of high mortality among patients. Lung cancer facilitates hemato- and lymphogenous spread of a specific pathogen. As an example, a clinical case of simultaneous occurrence of pulmonary tuberculosis and lung cancer which was observed in the patient admitted to the Department for patients with respiratory tuberculosis of Nizhny Novgorod regional clinical tuberculosis dispensary, was presented. We concluded that compliance with the algorithm of the mandatory diagnostic minimum when patients admitted to the general healthcare network, as well as compliance with the rules for population screening, especially among people over 45, will minimize the risks of delayed diagnosis in case of coexistence of respiratory tuberculosis and lung cancer.

Kazan medical journal. 2020;101(4):574-578
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Clinical experiences
Optimization of the technique for removal of benign tumors and wound suturing in a general surgical hospital
Izmaylov A.G., Dobrokvashin S.V., Izmaylov S.G., Leontev A.E., Lukoyanychev E.E., Bodrov A.A., Kapustin K.V., Vorontsov A.Y., Volkov D.E.
Abstract

Aim. To improve the results of surgical treatment in patients with large lipomas by using the device for closing the edges of wounds, allowing local preventive hemostasis in the surgical wound area, to create optimal conditions for atraumatic suturing and thereby reduce the amount of intraoperative bleeding and subsequently reduce the amount of postoperative wound complications.

Methods. The results of treatment of 105 patients with different localization of large lipomas were analyzed. Lipomas ranged from 8.0 to 20 cm in diameter. All patients were divided into 2 groups: the control group consisted of 53 (50.5%) patients for which used the traditional technique of tumor excision with closing surgical wounds, and the study group with 52 (49.5%) patients, for which to reduce tissue damage during tumor removal and the edges of wound suturing, one of the device variants developed by us was used, approximation-distraction device. Fisher's exact test was used for the comparison of the outcomes rate, a p-value <0.05 was considered statistically significant.

Results. Surgical wound complications occurred in 7 (6.7%) of 105 patients. In the study group, surgical wound complications occurred in 1.9% (1 observation), in the control group 11.3% (6 observations). Surgical wound complications were severity grade I and grade IIIa. Complications of the first grade did not require a debridement and will regress on its own; in grade IIIa complications, an opening, excision and drainage surgical wounds were performed without general anesthesia.

Conclusion. Moderate local selective near-tumor tissue compression that occurs when the device branches come closer to each other accelerates spontaneous thrombus formation in damaged small vessels. This creates favorable conditions for the surgeon to work in a “dry” wound.

Kazan medical journal. 2020;101(4):579-585
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The treatment of sialolithiasis by sialolithotripsy
Aliyev S.Z.
Abstract

Aim. To study the effectiveness of treatment of sialolithiasis by sialolithotripsy.

Methods. Between 2015 and 2018, extracorporeal shockwave lithotripsy of salivary stones of 39 patients was performed in the Nasreddin Tusi Memorial Clinic. The stone was located in the submandibular gland and its duct for 33 patients and the parotid salivary glands and its duct for 6 patients. The average age of patients was 50±3.38 (between 22 and 77).

Results. Stone fragmentation as a result of sialolithotripsy was achieved in 36 (92.7%) of 39 examined patients (p=0.031). In 3 patients the stone was completely fragmented, but due to the narrow lumen of the main duct, it did not move away. In 3 patients with calculus size more than 2 cm, the stone was not fragmented. According to our results, the necessary effect was achieved in 85% of cases and was unachieved in only 15% of cases.

Conclusion. Given the complexity of the surgical treatment in patients with salivary stone and potential postoperative complications, especially with the stone localization within the parotid gland, we concluded that extracorporeal shockwave lithotripsy is a promising alternative treatment for patients with salivary stone.

Kazan medical journal. 2020;101(4):586-589
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The level of lipopolysaccharide-binding protein in acute intestinal infections, the effect of IL-1β and IL-10 on its production
Epifantseva N.V., Emelyanova A.N., Kalinina E.N., Karavaeva T.M.
Abstract

Aim. To determine the level of lipopolysaccharide-binding protein (LBP) in acute intestinal infection, depending on the etiology and severity of the disease, and the effect of interleukin (IL)-1β and IL-10 levels on the expression of LBP.

Methods. Serum samples of 62 patients were assayed by solid phase enzyme-linked immunosorbent assay using a set of reagents ELISA (USA) and Vector-best (Novosibirsk) for levels of LBР, IL-1β, IL-10. The first group inclu­ded 33 patients with bacterial intestinal infection, the second group consisted of 29 patients with viral diarrhea, and the control group comprised 20 conditionally healthy patients. Analyses were performed using Microsoft Excel 2010 and Statistica version 6.0 software. Statistical differences were determined by using the Mann–Whitney U Test, the p-value ≤0.05 were regarded as statistically significant. Spearman’s correlation coefficient was used to examine relationships. Shapiro–Wilk W test was used to check for normal distribution of the features.

Results. We detected the presence of LBP in all the studied groups, with the content of LBP was significantly increased in the group of bacterial intestinal infections compared with other groups. With regard to disease severity, LBP level was the highest for mild acute intestinal infections caused by bacteria, and for viral diarrhea, fluctuations in LBP did not exceed the norm. In intestinal infections caused by bacteria, the levels of LBP were directly related to the levels of IL-1β and IL-10.

Conclusion. Detection of LBP concentration can be used for the initial differential diagnosis of intestinal infections caused by bacteria, which would significantly narrow the diagnostic search and determine the tactics of etiotropic therapy; also, considering the relationship between the concentration of LBP and disease severity, this indicator can be used as a predictive sign of the course of the disease.

Kazan medical journal. 2020;101(4):590-594
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An integrated approach to treatment of patients with complicated forms of gastroesophageal reflux disease
Moroshek A.A., Burmistrov M.V.
Abstract

Aim. To justify the appropriateness of applying the integrated algorithm of treatment, including the sequential application of conservative antireflux treatment and antireflux surgery, in patients with complicated forms of gastroesophageal reflux disease.

Methods. The main group of the study included 554 patients with complicated forms of gastroesophageal reflux disease (erosive esophagitis in 301, peptic stricture in 36, Barrett's esophagus in 90 and a combination of several complications in 127 patients), and the control group included 229 patients with uncomplicated gastroesophageal reflux disease and indications for surgical treatment. At the diagnostic stage, fiberoptic esophagogastroduodenoscopy with chromoendoscopy using a double dye staining technique (Lugol and methylene blue) and biopsies of ­areas suspicious for metaplasia, as well as a barium contrast multi-positional radiographic examination of the esophagus and gastroesophageal junction were used. At the treatment stage, both groups received conservative antireflux treatment lasting 4–8 weeks, comprising lifestyle regulation, diet, antisecretory drug therapy (proton pump inhi­bitors — omeprazole or rabeprazole 20 mg orally twice a day, antispasmodic agent — domperidone 20 mg orally 3 times a day or itopride 50 mg orally 3 times a day), followed by either laparotomic or laparoscopic antireflux surgery. In the main group, antireflux surgery was supplemented with endoscopic argon plasma coagulation during the postoperative period in the patients with Barrett's esophagus and esophageal bougienage under endoscopic control during the pre- and postoperative period in the patients with a peptic stricture.

Results. The frequency of intraoperative [6.3% (95% CI 1.4–5.8%), p=0.0462] and early postoperative complications [41.5% (95% CI 37.4–45.7%), p=0.0011] in the main group were statistically significantly higher than in the control group. There was no clinically important difference. Frequency of late postoperative complications in the main group [5.4% (95% CI 3.7–7.6%)] did not have statistically significant differences from the control (p=0.1239). The integrated algorithm of treatment has proven to be safe with provision for the need to develop measures to reduce the overall incidence of early postoperative complications. Excellent and satisfactory immediate treatment results were achieved in 91.7% (95% CI 89.1–93.9%), and excellent and satisfactory long-term results were achieved in 91.3% (95% CI 88.7–93.5%) patients of the main group, and were statistically significantly worse than in the control group, p=0.0008 and p=0.0021 for the immediate and long-term results, respectively. The difference was attribu­table to the extremely high efficiency of the treatment algorithm in the control group and had no clinical significance.

Conclusion. The use of the integrated algorithm of treatment based on the implementation of antireflux surgery is appropriate in all patients with complicated forms of gastroesophageal reflux disease.

Kazan medical journal. 2020;101(4):595-602
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Combination therapy in the integrated treatment of recurrent chronic cystitis
Sayapova D.R., Zubkov A.Y.
Abstract

Aim. To assess the results of the integrated treatment of women with recurrent chronic cystitis using the selective β3-adrenoreceptor (AR) agonist, mirabegron.

Methods. The results of the treatment of women diagnosed with recurrent chronic cystitis in the urological cli­nic of KSMU were analyzed. The average age of patients was 31.5±3.4 years. To assess the effectiveness of integra­ted treatment, women with recurrent chronic cystitis were randomly divided into two groups: the first group (30 patients) who received antibiotic therapy in combination with the drug mirabegron at a dose of 50 mg once a day and the second (control) group (30 patients), who received antibiotic therapy taking into account their susceptibility. All patients underwent ultrasonography of the genitourinary system, urodynamic studies with assessment of the ma­ximum urinary flow, average urinary flow, bacterial urine cultures.

Results. Analysis of the research results showed a greater reduction in the number of urinations per day (up to 7 times) in the first group. The frequency of urinary urgency decreased in 82.6% of the first group patients compared to 64% of the second group (p <0.05). In the combination therapy versus control groups, there was reduced hospital stay by an average of 4 days (11.2 vs 15 days; p <0.05). On the 15th day of treatment, control cystoscopy revealed no changes in the bladder mucosa in all patients of the first group. Also, in the first group of patients, there was a greater improvement in urodynamic parameters compared to the control group (p <0.05).

Conclusion. The selective β3-AR agonist mirabegron used in the integrated treatment of recurrent chronic cystitis increases the effectiveness of the therapy.

Kazan medical journal. 2020;101(4):603-608
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History of medicine
The bright diamond in the crown of Professor Gruzdev scientific school for 100th anniversary of Kazan State Medical Academy and obstetrical-gynecological hospital
Kozlov L.A., Yakovlev N.V.
Abstract

Because of the 100th anniversary of Kazan State Medical Academy and obstetrical-gynecological hospital, this article present outstanding scientific achievements of the first head of the department, Professor A.I. Timofeev, who was an apprentice to professor V.S. Gruzdev. Historical and literature study of primary materials was used as the method of research. In April 2020, Kazan State Medical Academy (formerly the State Institute of Advanced Me­dical Training) celebrated its 100th anniversary. Organization of work of the gynecology-obstetrics department and hospital fell on the shoulders of Professor Alexander Ignatievich Timofeev, who was an apprentice to Professor V.S. Gruzdev. The article reflects three shining moments from his working life, which made the Kazan school of obstetricians and gynecologists famous. Throughout the 19th century, scientists were seeking to answer the question of corpus luteum originating: from the connective or epithelial tissues. Professor Gruzdev has suggested that the source needs to be granulosa cells. His student, Professor Timofeev, carefully performed histological preparations finally established in 1913 that granular cells are the genesis of the human corpus luteum originated, and bring these centennial scientific disputes to an end. In 1925, Professor Timofeev was the first in the USSR to perform surgery under local infiltration anesthesia in Kazan. His publication of the results of observation in 1928 was the beginning of the further study and implementation of local infiltration anesthesia by the method of Professor A.V. Vishnevsky (“creeping infiltration method”) in obstetrics and gynecology. For 30 years, this method of analgesia was dominant and gave way only with the development of anesthesiology and resuscitation. In 1928, he, together with professor Gruzdev, report on cesarean section at the 8th All-Union Congress of Obstetricians and Gynecologists “laid the foundation” for a wider study of Caesarean section in the USSR, the result of which was genera­lized in 1979. International recognition of the epithelial nature of the corpus luteum alone deserves a monument; the school of Kazan doctors of obstetrician-gynecologists honors the memory of the outstanding apprentice to professor V.S. Gruzdev — A.I. Timofeev.

Kazan medical journal. 2020;101(4):609-616
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To the question of S.S. Zimnitsky on the origin of the giant T wave after ventricular extrasystole on an electrocardiogram
Oslopov V.N., Mishanina Y.S.
Abstract

The study of life, medical and scientific activities of the outstanding domestic scientist S.S. Zimnitsky always causes and will cause great interest. The versatility of his talent as a scientist continues to amaze. Many of the issues that remain relevant today raised by S.S. Zimnitsky, not fully resolved in the XXI century. There were no answers to the well-known question asked by the seriously ill S.S. Zimnitsky to another prominent Russian scientist, the beacon of Russian physiological science — A.F. Samoilov. This question concerned the origin of the giant positive T wave in the first QRS complex after the ventricular extrasystole on the electrocardiogram. The question remained unanswered. We believe that this was because by the end of the 20s of the XX century (S.S. Zimnitsky died in 1927), the delicate mechanisms of repolarization processes were not able to understand, in both healthy and diseased myocardium. The article sets forth our original point of view on the genesis of such a T wave in S.S. Zimnitsky. We believe that a scientific discussion on this issue is quite possible. There is no doubt that both life and scientific activities of S.S. Zimnitsky has always attracted and will attract the attention of both medical historians and practical doctors, scientists and inquisitive students.

Kazan medical journal. 2020;101(4):617-621
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The General page of the glorious history
Isaeva G.S.
Abstract

The article was prepared for the 100th anniversary of the Department of Microbiology named after academician V.M. Aristovsky of Kazan state medical university and the 120th anniversary of the Kazan Scientific research institute of epidemiology and microbiology. The paper presents the main stages of the general history of the Department of Microbiology of KSMU and the Kazan bacteriological institute (later — KNIIEM), highlights the formation of the Kazan school of microbiologists, provides brief biographical information of employees of the Department of Microbiology, whose activities were also associated with KNIIEM. The article was prepared using primary sour­ces: publications, the recollections of the employees of the Department of Microbiology and KNIIEM, documents from the archives of KSMU and KNIIEM, as well as the National archives of the Republic of Tatarstan, publications of the colleagues of the Department of Microbiology Military medical Academy and Stavropol state medical university. The main scientific achievements of representatives of the Kazan school of microbiologists, their scientific contribution to the development of microbiology and the current state of educational and scientific work of the department are described.

Kazan medical journal. 2020;101(4):622-630
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Jubilees
90 years to Professor Lev A. Kozlov
 
Kazan medical journal. 2020;101(4):631-632
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Obituary
In memory of Professor Geoffrey Burnstock
Ziganshin A.U.
Kazan medical journal. 2020;101(4):633-636
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Cochrane Review Summaries
Coronavirus (COVID-19): optimizing health in the home workspace
 
Abstract

Эта Специальная коллекция, разработанная в сотрудничестве с группой Кокрейновских обзоров, объединяет Кокрейновские обзоры, обобщающие доказательства о поддержании здоровья и благополучия при работе из дома в связи с пандемией COVID-19. Она включает систематические обзоры, оценивающие воздействие вмешательств, связанных с поддержанием физической активности, оптимизацией рабочей среды и предотвращением проблем с опорно-двигательным аппаратом и глазами.

Kazan medical journal. 2020;101(4):637
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Workplace interventions for increasing standing or wal­king for decreasing musculoskeletal symptoms in sedentary workers
 
Abstract

В последние десятилетия увеличилось число людей, работающих сидя. Многие из этих людей жалуются на симптомы со стороны опорно‐двигательного аппарата. Вмешательства по стимуляции ходьбы или стояния на работе эффективны в сокращении времени сидения на работе. Однако до сих пор неясно, эффективны ли эти вмешательства для уменьшения интенсивности костно‐мышечных симптомов у офисных работников.

Kazan medical journal. 2020;101(4):637-638
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Workplace interventions (methods) for reducing time spent sitting at work
 
Abstract

Почему время, проведённое на работе в положении сидя, так важно? Время, проводимое в положении сидя, и отсутствие физической активности на работе в последние десятилетия увеличились. Длительные периоды сидения увеличивают риск развития ожирения, сердечно‐сосудистых заболеваний и преждевременной смерти. Неясно, являются ли вмешательства, направленные на снижение времени, проведённого на работе в положении сидя, эффективными.

Kazan medical journal. 2020;101(4):638-639
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Ergonomic interventions for preventing work-related musculoskeletal disorders of the upper limb and neck among office workers
 
Abstract

Целью этого Кокрейновского обзора было выяснить, могут ли эргономические вмешательства предотвратить боль или дискомфорт в костно‐мышечной системе или и то, и другое (заболевания опорно‐двигательного аппарата — ЗОДА) среди офисных работников. Мы собрали и проанализировали все соответствующие исследования, чтобы ответить на этот вопрос, и обнаружили 15 исследований.

Kazan medical journal. 2020;101(4):639-640
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