Vol 98, No 2 (2017)

Theoretical and clinical medicine
Role of conservative treatment of chronic venous insufficiency for regression of the features of desadaptive cardiac remodeling in patients with comorbid obesity
Leukhnenko I.N., Teplyakova O.V., Grishina I.F.

Aim. To evaluate the influence of conservative treatment tactics for chronic venous insufficiency on the processes of cardiac remodeling in patients with comorbid obesity.

Methods. 32 males with obesity class 1 (BMI 32.57±2.25 kg/m2) at the age of 40.7±11.5 years and with clinical and instrumental signs of chronic venous insufficiency were divided into 2 groups: patients from group 1 (n=14) followed the recomendations to wear compression stockings and to use hesperidin + diosmin 500 mg twice a day, and the patients from group 2 (n=18) did not follow those recommendations. All patients had echocardiography performed before the treatment and 2 months after the first visit. For the evaluation of echocardiographic dynamics paired Student’s t-test was used.

Results. After 2 months statistically significant dynamics of the following echocardiographic findings was revealed: in group 1 index of eccentric left ventricular shape increased from 0.94±0.06 to 1.01±0.03, in group 2 - from 0.96±0.08 to 0.97±0.07 (р=0.023). In group 1 tricuspid annular plane systolic excursion decreased from 30.07±5.31 to 26.64±4.14 mm, in group 2 - from 29.6±4.72 to 29.88±6.04 mm (р=0.008), and the right atrial volume in group 1 decreased from 53.57±11.48 to 46.64±13.18 ml, in group 2 - from 52.77±11.27 to 51.38±8.54 ml (р=0.044). In group 1 statistically significant trend to decreased ratio of maximal velocity of RV early diastolic filling to maximum diastolic tricuspid valve lateral annular velocity was revealed (from 4.75±1.35 to 4.25±1.23 cm/sec) compared to group 2 (from 4.79±1.62 to 4.75±1.58 cm/sec; р=0.076).

Conclusion. Conservative treatment of chronic venous insufficiency in patients with obesity is associated with indirect indicators of decreasing volume overload of the heart and can influence positively on heart geometry leading to regression of spheric LV remodeling and decrease of RA volume.

Kazan medical journal. 2017;98(2):165-171
Features of platelet reaction in acute pancreatitis
Chikaev V.F., Aydarov A.R., Zinkevich O.D., Petukhov D.M., Galyautdinov F.S., Safina N.A.

Aim. To identify the features of platelet reaction in peripheral blood in patients with acute pancreatitis.

Methods. We conducted a retrospective analysis of changes of platelets concentration in 19 patients with acute pancreatitis admitted to Kazan City clinical hospital №7. The age of patients ranged from 35 to 76 years, 45±12 years in average. All patients received complex treatment. The main method of surgical treatment was navigation drainage of fluid collections, peripancreatic mass and retroperitoneal space under ultrasound control performed in 11 patients. Subsequently in 4 patients due to progressive pyoinflammatory process midline laparotomy, sanitation, drainage of omental sac and purulent cavities were performed. In 4 cases aseptic pancreonecrosis resolved after conservative treatment. All patients dynamically had erythrocytes and platelets count and mean platelet volume checked.

Results. Analysis of platelets concentration in peripheral blood in patients with acute pancreatitis showed multidirectional character depending on the severity of pathological process. In mild acute pancreatitis the platelet count remains within normal limits. In severe pancreatitis its number increases. The highest numbers of platelets were observed on days 10-20. On discharge platelet count remained elevated. Severe pervasive pancreonecrosis (n=4) with fatal outcome was characterized by thrombocytopenia on admission with further progression.

Conclusion. The nature of the changes in platelet reaction in patients with acute pancreatitis depends on the severity of the pathological process and can be used as a criterion for evaluation of treatment effectiveness and prognosis of the outcome of the disease.

Kazan medical journal. 2017;98(2):172-175
Efficacy of combined antipyretic drug in the treatment of acute respiratory diseases
Pikuza O.I., Fayzullina R.A., Zakirova A.M., Vakhitov K.M.

Aim. To evaluate efficacy of combined antipyretic drug in the treatment of acute respiratory diseases.

Methods. 97 children aged 3 to 6 years admitted in 2014-2015 were observed. Children were divided into 3 groups: in group 1 (23 children) paracetamol with single dose 10 to 15 mg/kg was administered, in group 2 (36 children) ibuprofen (single dose 6-10 mg/kg) was used, in group 3 (38 patients) combined antipyretic drug (100 mg of paracetamol and 125 mg of ibuprofen) was administered with daily dose not exceeding 3 tablets for less than 3 days. Clinical and instrumental and laboratory studies were performed in all children, specialists’ consultations were administered if necessary. Compliance (number of refusal to take medication because of inefficacy, intolerance of a drug or dissatisfaction with organoleptic properties of a drug) was assessed by parents’ surveys. Satisfaction with the results of treatment with a combined drug was evaluated by patients’ parents by means of integral scale IMPSS. Verification of certain etiologic factors was performed by means of direct immunofluorescence assay of nasal smear.

Results. As a result of the study it was found that among the etiologic factors of acute respiratory diseases of observed patients parainfluenza viruses and adenoviruses were predominant. When the combined drug was used, almost all parents were sure of children’s treatment safety. Administration of the combined drug was associated with faster and persistent fever reduction and decrease of children’s hospital stay. Due to long-term normal temperature when treated with combined drug children had better well-being, that positively influenced their sleep. In groups 1 and 2 with separately administered paracetamol and ibuprofen 28.3% of parents were unsatisfied with the medication while among the parents, whose children received a combination of ibuprofen and paracetamol, only 5.3% were unsatisfied (p <0.05 in comparison with groups 1 and 2).

Conclusion. Combined medication of ibuprofen and paracetamol approved itself to be safe and effective for fever reduction in children with acute respiratory diseases.

Kazan medical journal. 2017;98(2):175-181
Clinical and pathogenetic features of congenital heart disease in newborns with intrauterine infection
Beniova S.N., Figol’ S.Y., Kornilova O.A., Stolina M.L., Blokhina N.P.

Aim. Investigation of the features of diagnosis and treatment of congenital heart disease in newborns with intrauterine herpes and cytomegalovirus infections.

Methods. A comparative analysis of risk factors, clinical signs and dynamics of serum levels of matrix metalloproteinases in 91 newborns with congenital heart disease during the early neonatal period was performed. All patients were divided into 2 groups: group 1 (study group) - 51 patients with congenital heart disease and intrauterine Herpes or Cytomegalovirus infection, group 2 (comparison group) - 40 children with heart disease without the signs of intrauterine infection. The control group consisted of 20 relatively healthy full-term newborns.

Results. Mothers of children with congenital heart disease and intrauterine infection more often compared to mothers of children from group 2 had inflammatory disease of reproductive system (49.1 and 22.5% respectively, р ≤0.05), medical abortions in past medical history (84.3 and 27.5% respectively, р ≤0.01), acute respiratory viral infections during pregnancy (21.6 and 7.5% respectively, р ≤0.05). Levels of matrix metalloproteinase 9 in umbilical blood plasm were statistically significantly increased in all newborns with congenital heart disease compared to control levels. The highest concentration of enzyme was registered in patients with congenital heart disease and nervous system disorders associated with intrauterine infection and in newborns with severe heart disease. Inflammatory extracardial changes in patients with congenital heart disease associated with intrauterine infection caused by Herpes Simplex virus and Cytomegalovirus were accompanied by significant increase of matrix metalloproteinase 8.

Conclusion. The association between matrix metalloproteinase 9 in blood serum of newborns and clinical signs of a congenital heart disease during early neonatal period was revealed; high levels of metalloproteinase 8 can indicate intrauterine infection in newborns with congenital heart disease during early neonatal period.

Kazan medical journal. 2017;98(2):181-188
Improvement of dental health in professional athletes engaged in power sports
Safaraliev F.R., Safarov A.M., Mamedov F.Y.

Aim. Evaluation of dental diseases prevalence in professional athletes engaged in power sports and of the influence of biologically neutral products based on propolis on the level of their dental health.

Methods. The examination of organs and tissues of the oral cavity of professional athletes engaged for a long time in power sports was carried out. With the use of the developed specialized questionnaire dental status of the athletes was determined. Based on the analysis of the results of clinical and laboratory studies anti-inflammatory and anti-bacterial effectiveness of products based on propolis were evaluated.

Results. The results of the survey showed that not all athletes are informed about the possibility of aggravation of pathological processes in soft and hard tissues of oral cavity during active training, mainly, in power sports. Lack of awareness of surveyed athletes about the need for timely individual oral hygiene procedures and regular dentist visits was revealed, especially during intense training before and after competitions. On evaluation of dental status of professional combat athletes high prevalence and intensity of inflammatory periodontal disease and caries were found. High anti-inflammatory efficiency of the product «Pomegranate Balm» for correction of dental status of professional athletes was proven.

Conclusion. High incidence of inflammatory periodontal diseases of mild to moderate severity was revealed in athletes during prolonged and intense physical training; efficacy of biologically neutral products based on propolis was established.

Kazan medical journal. 2017;98(2):189-194
Efficacy of alpha-lipoic acid in chronic generalized periodontitis in patients with infiltrative pulmonary tuberculosis
Lunina N.A., Velikaya O.V., Kunin V.A.

Aim. To study clinical efficacy of chronic generalized periodontitis treatment in patients with infiltrative pulmonary tuberculosis with the use of α-lipoic acid.

Methods. 50 patients with chronic generalized periodontitis and infiltrative pulmonary tuberculosis randomly divided into 2 groups were examined. The study group included 25 patients who had received α-lipoic acid «Octolipen» in complex treatment for 3 months. The comparison group included 25 patients who were administered complex treatment of tuberculosis and periodontitis without α-lipoic acid. All patients on admission and dynamically after 3 months of treatment had routine clinical studies, cytology analysis of capillary gingival blood and gingival fluid and cytokine status testing of oral fluid.

Results. Patients with chronic generalized periodontitis combined with infiltrative pulmonary tuberculosis who received «Octopilen» had statistically significant positive dynamics of clinical signs and decrease of basic dental indices after 3 months of treatment compared to baseline data. Dynamics of IL-1β, tumor necrosis factor α and IL-4 revealed significant decrease of these cytokines concentration in gingival fluid in patients from both groups after 3 months of treatment.

Conclusion. Inclusion of α-lipoic acid product to complex treatment of patients with chronic generalized periodontitis combined with infiltrative pulmonary tuberculosis leads to faster clinical remission.

Kazan medical journal. 2017;98(2):194-199
Features of coronary artery disease in patients with different genotypes of PAI-1 gene
Babaev A.M., Zul’fugarova D.B.

Aim. To investigate the relation of different genotypes and alleles of PAI-1 gene with the course of coronary artery disease.

Methods. We observed 80 patients with coronary artery disease (51 males and 29 females) aged 39 to 65 years living in the city of Baku. Genotyping of a polymorphic marker 4G(-675)5G was performed by means of polymerase chain reaction followed by restriction fragment length analysis. Genomic deoxyribonucleic acid (DNA) was extracted from venous blood leukocytes. To determine the frequency distribution of genotypes and alleles of PAI-1 in ischemic heart disease all patients were divided into 6 groups depending on the course of the disease and its outcomes.

Results. In the population of Baku genotype 44 of PAI-1 gene is significantly more common in people with coronary artery disease compared to individuals without coronary artery disease and is a risk factor for this disease. Genotype 55 of PAI-1 gene is more common in people without coronary artery disease and thus is a protective genotype against this disease. Allele 4 of PAI-1 was statistically more frequently recorded in patients with ischemic heart disease, and allele 5 was significantly more frequently observed in patients without this pathology. Therefore, allele 4 is a risk factor for the occurrence of coronary heart disease and allele 5 is protective against this disease. Alleles 5 and 4 are not associated with the course and outcomes of ischemic heart disease.

Conclusion. According to the results of the study on the population of Baku, genotype 44 of PAI-1 gene is a risk factor of ischemic heart disease, genotype 55 of PAI-1 gene is protective against this pathology, allele 4 is characteristic for people with coronary artery disease (a risk factor), allele 5 is characteristic for people without it (protective role) whereas the named genotypes of PAI-1 are not connected to the course and outcomes of this disease.

Kazan medical journal. 2017;98(2):199-203
Characteristics of dental status of patients with inflammatory periodontal diseases
Vasil’eva N.A., Bulgakova A.I., Soldatova E.S.

Aim. Evaluation of dental status in patients with inflammatory periodontal diseases.

Methods. The study of dental status was performed with the use of clinical and historical data from 269 patients with inflammatory periodontal diseases at the age of 18-65 years. Among examined patients there were 75 (27.9%) people with gingivitis, 54 (20.1%) with mild periodontitis, 66 (24.5%) with moderate and 74 (27.5%) with severe periodontitis. Control group consisted of practically healthy donors at the age of 18-52 years (40 people) with sanitized oral cavity.

Results. From history and interviewing it was found that 72% of the surveyed patients brush their teeth twice a day, 24% - once a day and 4% of patients do not brush their teeth. Family history of periodontal diseases among parents was recorded by 86% of participants. Dental status was characterized by the increase of the values of all dental indices with increasing disease severity regardless of gender. Need for correction of the depth of the vestibule, lips, cords, and bridles was identified in 51.7% of cases in patients with gingivitis and in 96.6% of cases of periodontal diseases. With increasing severity of periodontitis index (sum) of teeth with decay and fillings and removed teeth was increased by 1.5 times in gingivitis, by 2.2 times in mild periodontitis, by 2.6 times in moderate and by 2.9 times in severe periodontitis compared to control group. Partial adentia in gingivitis is 3 times more prevalent in males than in females and in severe periodontitis is 1.6 times more prevalent in females than in males.

Conclusion. Dental status of the patients with inflammatory periodontal diseases was characterized by increased values of all dental indices compared to control group that demonstrates typical course of inflammatory periodontal diseases and decrease of local immunologic resistance of oral cavity and the organism in total; timely correction of local factors (local trauma), anatomical and topographical features of dentofacial system and status of oral soft tissues allows prevention of pathologic processes in periodontal tissues.

Kazan medical journal. 2017;98(2):204-210
Experimental medicine
The possibility of using cell test-systems for screening for anti-inflammatory activity of novel 5(S)-menthyloxy derivatives of 2(5H)-furanone
Cong H.H., Sibgatullina R.R., Khabibrakhmanova A.M., Kurbangalieva A.R., Ziganshina L.E.

Aim. Study of the possibility of using cell experimental models (erythrocytes hemolysis and platelet aggregation) for screening for anti-inflammatory activity of novel synthesized 5(S)-menthyloxy derivatives of 2(5Н)-furanone (compounds R1-R6).

Methods. Evaluation of membrane-stabilizing activity of the test compounds was performed by means of models of erythrocyte hemolysis induced by hypotonic environment (osmotic hemolysis) and free radicals. Antiplatelet effect of the compounds was studied by inducing platelet aggregation by 1 mM arachidonic acid. Study of anti-inflammatory activity of novel potential anti-inflammatory molecules was performed with the use of the model of carrageenan-induced paw edema in mice.

Results. Compounds R1, R2, R3, and R4 increase the degree of osmotic hemolysis. Compounds R5, R6 decrease the intensity of hemolysis at different concentrations. Compounds R1, R2, R4 and R6 promote free-radical erythrocyte membrane damage at all tested concentrations. Compound R3 protects erythrocytes at low concentrations and promotes erythrocyte damage with increasing concentration. Compound R5 protects erythrocytes at concentrations 3×10-9 и 3×10-5 М. Compounds R1, R2, R4 enhance platelet aggregation at different concentrations. Compound R3 inhibits platelet aggregation at concentration 10-6 М, and at concentrations 10-8 and 10-5 М it induces platelet aggregation. Compound R5 does not affect platelet aggregation. Compound R6 inhibits platelet aggregation at all tested concentrations. On the basis of the results obtained from in vitro test systems compound R6 was selected for further studies of anti-inflammatory activity as it demonstrated maximum effect based on two out of three evaluation criteria. Compound R6 posseses anti-inflammatory activity in the model of inflammation.

Conclusion. The novel derivative of 2(5Н)-furanone bearing l-menthol moiety (compound R6) protects erythrocyte membrane from damaging action of hypotonic environment, inhibits platelet aggregation and demonstrates anti-inflammatory activity; cell experimental models can be used for the first phase of screening of novel chemical compounds for anti-inflammatory activity.

Kazan medical journal. 2017;98(2):211-217
Evaluation of the possibility to use calcium channel blockers for prevention of intra-abdominal adhesions formation
Sokolova T.F., Skal’skiy S.V., Turok N.E.

Aim. To study the possibility of the use of known medications used in cardiology - calcium channel blockers - derivatives of phenylalkilamine (verapamil), benzodiazepine (diltiazem), dihydropyridine (nifedipine) - for prevention of peritoneal adhesion formation.

Methods. The study of the effect of different concentrations of medications on nuclear translocation of NF-κB, proliferative and collagen-synthetic activity of fibroblasts was conducted in the primary culture of rats peritoneal fibroblasts with hemoperitoneum. Aseptic injury of peritoneum was caused by modeling of autohemoperitoneum according to original method.

Results. It was found that verapamil and diltiazem normalized nuclear translocation of NF-κB, processes of fibroblasts proliferation and their collagen synthesis by optimizing fibroblast functional activity during adhesion formation induction. Verapamil and diltiazem affected fibroblasts similarly but with different intensity. Verapamil in concentrations 0.05 and 0.1 mg/ml and diltiazem in concentration 0.1 mg/ml suppressed the excessive fibroblast activity by inhibiting their proliferative and collagen-synthetic activity, nuclear translocation of NF-κB. Verapamil demonstrated the most prominent pharmacological effect. Nifedepine did not reveal such effect. At the molecular level inhibiting effect of calcium channel blockers verapamil and diltiazem on the activation of apoptosis blocking nuclear transcription factor NF-κB was demonstrated.

Conclusion. Verapamil and diltiazem can be recommended for further detailed experimental and clinical studies focused on widening of biological activity spectrum of known medications and area of their clinical use.

Kazan medical journal. 2017;98(2):218-221
Cytokine status of patients with chronic obstructive pulmonary disease and type 2 diabetes mellitus
Nedomolkina S.A., Velikaya O.V., Zoloedov V.I.

The review article is devoted to an actual problem of modern medicine - combined pathology of chronic obstructive pulmonary disease and type 2 diabetes mellitus. These 2 diseases take the first place in the structure of people’s mortality. The rate of chronic obstructive pulmonary disease and type 2 diabetes mellitus increases annually along with life length and according to different data reaches 35.8%. In the article scientists’ modern perception and known facts from scientific literature are presented. Special attention is given to cytokine status in chronic obstructive pulmonary disease and type 2 diabetes mellitus. Cytokines classification based on mechanism of action and their role in pathogenesis is presented. Systemic inflammation characteristic for both diseases presents as the increase of pro-inflammatory cytokines level in the blood and decrease of anti-inflammatory cytokines. Determining cytokines in patients with chronic obstructive pulmonary disease and type 2 diabetes mellitus has prognostic value. Mutual negative influence of these two diseases is directly associated with the increase of pro-inflammatory cytokines which are considered the reason for insulin resistance and type 2 diabetes mellitus. Despite the attempts to study cytokine status in patients with chronic obstructive pulmonary disease and type 2 diabetes mellitus the issues of treatment of combined pathology, diagnostic concentration of pro-inflammatory and anti-inflammatory cytokines, their role in pathogenesis and clinical presentation are still an open question. Certainly it is necessary to continue studying the cytokine status in patients with chronic obstructive pulmonary disease and type 2 diabetes mellitus to answer those questions.

Kazan medical journal. 2017;98(2):222-226
Role of nitric oxide synthases polymorphism in the development of comorbidity of bronchial asthma and hypertension
Uryas’ev O.M., Shakhanov A.V.

Present literature review highlights the current views on the role of genetic factors in the development of bronchial asthma and hypertension, indicates their role in the formation of comorbid pathology, draws attention to the role of nitric oxide and nitric oxide synthase genes in the pathogenesis. In recent years there has been increasing interest of researchers to the problem of comorbidity, in particular to a combination of asthma and hypertension. Genetic factors play a great role in pathogenesis of these diseases. Among genes that play role in development of asthma there are genes encoding antigen recognition factors and humoral immune response factors, genes encoding mediators of inflammation, chemokines and intercellular adhesion molecules, genes of receptors performing fixation of external ligand molecules on the target cell, genes of intracellular signaling molecules and transcription factors and a number of other genes. The pathogenesis of essential hypertension is associated with the genes of renin-angiotensin-aldosterone system and genes regulating endothelial status. The link between asthma and hypertension is nitric oxide, which is involved in many physiological processes, in particular, regulates vascular and respiratory tone. Polymorphism of nitric oxide synthases genes is able to violate its production in the organism and thus lead to the development of bronchial asthma and hypertension. Polymorphisms Glu298Asp, eNOS4a/b, and 786C/T of NOS3 gene are associated with development of hypertension. Polymorphisms of this gene had been studied in patients with bronchial asthma, and they have demonstrated their influence on the level of nitric oxide in patients. Thus, the NOS gene polymorphisms may participate in the formation of comorbidity of bronchial asthma and hypertension.

Kazan medical journal. 2017;98(2):226-232
Social hygiene and healthcare management
Impact of resource provision for the regional infection services on public infectious morbidity
Galieva A.M., Vafin A.Y., Kravchenko I.I.

Aim. To study the impact of resource provision for the regional infection services on public infectious morbidity rate and determine priority ways of the service development.

Methods. The analysis of infectious diseases statistics by the Federal Service for Supervision of Consumer Rights Protection and Human Well-Being office in the Republic of Tatarstan as well as 2005-2015 annual reports of infection service of the Ministry of Health Care of the Republic of Tatarstan was carried out using statistical methods.

Results. Public infectious morbidity in the Republic of Tatarstan increased by 11.7% during the period of 2005-2015, which indicates low growth rate. The average level of infectious morbidity variation was revealed (the coefficient of variation - 11.24%). During the analyzed period (2005-2015) in order to optimize infection service of the Republic of Tatarstan resource provision of the infection service (number of infectiologists, bed capacity, offices of infectious diseases) was cut. A significant correlation between infectious morbidity and resource provision for the service at the level of municipal districts was found. Priority ways of Tatarstan service development are creation of the Center for Infectious Pathology and introduction of new forms of examination and treatment. Low growth rate and average level of infectious morbidity variation in the Republic of Tatrstan during the period of 2005-2015 were revealed. A significant correlation between infectious morbidity and resource provision of the service was found. The highest infectious morbidity rate was registered in large cities of the Republic with high availability of human resources, bed capacity and specialized laboratories, while low morbidity rate was registered at municipal level with lack of infectiologists, subdivisions of infection service and specialized laboratories.

Conclusion. Reduction of material and technical resources and human resources of infection service of the Republic of Tatarstan had an impact on infectious morbidity rate in the region associated with decreased level of diagnosis of infectious diseases at certain territories.

Kazan medical journal. 2017;98(2):233-238
Epidemiological analysis of neonatal infectious morbidity associated with health care
Zaripova A.Z., Badamshina G.G., Ziatdinov V.B., Isaeva G.S.

Aim. Investigation of the features of epidemiological characteristics of infectious morbidity associated with medical care registered in newborns in maternity care facilities of the Republic of Tatarstan.

Methods. Retrospective epidemiological study of the morbidity of infections associated with medical care registered in newborns in the Republic of Tatarstan was performed. Epidemiological analysis was carried out using the forms of Federal statistical observation №2 of the Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing «The information about the infectious and parasitic diseases» (section «Hospital-acquired infections»).

Results. Based on the received materials epidemiological analysis of the dynamics of hospital-acquired infectious morbidity in newborns for the period from 2009 to 2015 was performed. Unidirectional trend of infectious morbidity associated with medical care and of various nosological forms was revealed. Downward trend with a negative morbidity growth rate was identified for neonatal pneumonia, osteomyelitis, pyoderma, impetigo, mastitis, panaritium and paronychia of newborns, omphalitis, phlebitis of the umbilical vein and neonatal conjunctivitis. Neonatal morbidity of hospital-acquired otitis media did not changed from the baseline. Prevalent nosological forms of infections associated with medical care among newborns were pyoderma, impetigo, mastitis, panaritium, paronychia (33.6%) and pneumonia (29.5%).

Conclusion. The average morbidity of infections associated with medical care in newborns in the Republic of Tatarstan for the period from 2009 to 2015 was 13.0 per 1000 newborns; negative dynamics of the morbidity with negative morbidity growth rate in newborns during this period was revealed (-42.3%).

Kazan medical journal. 2017;98(2):238-243
Alcohol intoxication: evaluation of the population appealability and emergency medical care in Kazan
Paykov V.L., Zamaleeva E.I., Zhukov D.A., Chernova O.L.

Aim. To study population appealability for emergency medical care with alcohol intoxication as well as the features of medical care service for them in Kazan at modern stage.

Methods. The data from emergency call cards from 2015 with the diagnosis «alcohol intoxication» (form No.11/u) were studied. A survey of 271 responders (medical personnel of mobile teams of emergency care and admission departments of the hospitals) of medical care service for people with alcohol intoxication in the streets was performed.

Results. In the structure of performed calls for adult popultion the ratio of patients who called an ambulance because of alcohol intoxication was 2.1% and because of the need for urgent care - 5.7%. Males were more prevalent than females: 82.1 and 17.9% respectively. Predominantly people younger than 60 years appealed: among males 82.7%, among females - 79%. Maximum appealability was registered in July (7.4 calls per 10 000 adults); during the week - on Saturday (11.9 per 10 000 adults), and during the day - during the period from 5 to 6 pm. The survey of the teams of ambulances and admission departments demonstrated the need for re-establishment of medical sobering-up stations (83.5 and 80% respectively) and more rarely the responders suggested development of specialized medical departments and active delivery of people with alcohol intoxication to specialized institutions involving law enforcement officials and personnel of specialized sobering-up stations (13 and 14.3% respectively).

Conclusion. In the structure of the calls performed by emergency care stations the ratio of patients who called an ambulance because of alcohol intoxication among adults was 2.1% and because of the need for urgent care - 5.7%; the appealability was affected by sex, age and calendar time; analysis of the survey results demonstrated the need for re-establishment of recently closed medical sobering-up stations and for development of specialized medical departments.

Kazan medical journal. 2017;98(2):243-247
Prevalence of eye traumas in Baku
Ismailov G.M., Rzaeva A.D.

Aim. To study the prevalence of injuries of the eye and its appendages in Baku depending on the age and gender of the population.

Methods. The study was conducted by continuous monitoring method. Data were collected about all cases of appealing to prevention and treatment facilities of Baku related to injuries of the eye and its appendages during 2014-2015, the structure of traumas was analysed. The patients were divided by gender (3067 females and 8754 males) and age. Frequency of all cases was determined by appealability, and frequency of trauma cases was determined by admission records according to average annual data.

Results. Among all cases of eye traumas during 2014-2015 (11 821 cases) 2.7% (322) of patients were hospitalized. Prevalence of eye and appendages injuries reached 2.68±0.04 per 1000 population. Prevalence of eye and appendages injuries among males and females was 4.00±0.06 and 1.38± 0.04 per 1000, respectively (р=0.001), relative risk of injuries in males compared to females was 2.9.

Conclusion. Prevalence of injuries of eye and appendages of the population of Baku city is relatively low; eye injuries occur 3 times more often in males and are most frequent at the age of 40-49 years in males and 10-19 years in female population; the ratio of admitted eye injury cases among all cases of traumas of eye and its appendages is highest at the age of 0-9 years.

Kazan medical journal. 2017;98(2):248-250
Satisfaction with medical services as a factor of competitiveness of regional health care institutions
Gudimenko G.V., Kondrashova R.A.

Aim. To conduct comparative analysis of patients’ satisfaction with medical services in private and public health care institutions, considering satisfaction as a factor of improving competitiveness.

Methods. Analysis of satisfaction with medical services in two medical institutions in Orel was performed by means of survey of 300 patients and analysis of web-based feedbacks. The obtained quantitative data were processed, grouped and presented as a result of statistical observation.

Results. According to the results of the survey of clients of the medical center «Sakara» it was found that almost 100% of patients were satisfied with medical services, and according to the web-based feedbacks 59.1% of patients were not satisfied with the services and stuff attitude. In polyclinic №2 according to the results of the survey about 70% of the visitors were satisfied, and according to web-based feedbacks 78.8% are completely unsatisfied. It was revealed that over time consumers marked down their assessment and sometimes they even became reverse. In this regard we identified the primary level of satisfaction - satisfaction, and secondary level - contentment (discontent). Primary satisfaction and subsequent contentment of consumers with medical services do not coincide and are not consistent. The explanation of this result lies in specificity of medical services, their duration and uncertainty of outcome. In the market of medical services in Russia satisfaction doesn’t often transform into customer loyalty, and therefore is not a source of profit. Between the parameters of satisfaction and customer contentment there is a gap due to the current efficiency of services and customer expectations.

Conclusion. Medical institutions should constantly analyze satisfaction and contentment of consumers for wider and more justified understanding of their behavior, preferences and expectations; identification of medical instituion problems and their timely correction is one of the most effective mechanisms to improve competitiveness.

Kazan medical journal. 2017;98(2):251-256
On the problem of improving dental care for professional athletes
Gadzhiev D.G.

Aim. Assessment of organs and tissues of oral cavity of professional athletes who use protective mouth guards.

Methods. Dental examination of 340 professional athletes of Olympic reserve at the age of 18 to 32 years with a duration of sport experience of 9-13 years was performed. We investigated the effect of mouth guards on the condition of the marginal periodontium and microbial contamination. Changes in periodontal tissues were diagnosed by means of traditional methods of inspection, probing of the periodontal grooves, recesses, as well as determining tooth mobility. The control group included 20 athletes not using athletic mouth guards during training.

Results. High prevalence of caries (in average, in all examined athletes the rate of carious teeth reaches 32.90%) and fairly high prevalence of severe forms of periodontal diseases in those patients were revealed. Evaluation of the structure of the index of teeth with decay and fillings and removed teeth showed major defects in timely dental care organization for professional boxers: their ratio of filled teeth does not exceed 40.36% in average. A significant number of extracted teeth (more than 23%) indicates that the examined patients require dental orthopaedic care. 30 examined athletes wearing protective mouth guards had the strains of P. gingivalis, A. Actinomycetemcomitans and P. oralis revealed.

Conclusion. The study of dental status of professional athletes using protective mouth guards, showed high prevalence of inflammatory periodontal diseases and low level of hygienic state of oral cavity.

Kazan medical journal. 2017;98(2):256-260
Clinical observations
A clinical case of pulmonary and hepatic echinococcosis
Gorbunova M.L., Volkova S.N., Shestakova G.V., Spiridonova E.L.

The article presents а description of our personal case of pulmonary and hepatic echinococcosis in a 38-years-old patient. Literature data on clinical presentation, laboratory and instrumental diagnostic methods of the disease are presented. Different variants of clinical presentation of pulmonary echinococcosis and its possible complications are described. The problems of differential diagnosis, surgical and conventional methods of treatment are analyzed. The presented clinical case confirms the wide spread opinion that the diagnosis of pulmonary echinococcosis based on only the results of chest X-ray is extremely challenging. Frequent diagnostic mistakes are associated with the primary diagnosis of pneumonia based on chest X-ray. Use of high-pitch spiral computed tomography implemented recently into clinical practice provides early differential diagnosis of pulmonary lesions with parasitic diseases, in particular, with echinococcosis. The final diagnosis is confirmed by serologic methods of echinococcosis diagnosis with the use of enzyme immunoassays.

Kazan medical journal. 2017;98(2):261-266
Dermatomyositis in the practice of a neurologist of the department of emergency neurology
Matveeva T.V., Egorova K.E., Mullayanova R.F.

Dermatomyositis is a disease from the group of diffuse connective tissue diseases mainly affecting the cross-striated and smooth muscles. The leading disorders in the clinical picture of dermatomyositis are movement disorders, which are often regarded to as a manifestation of acute inflammatory demyelinating polyneuropathy. Also skin lesions in the form of erythema and edema are characteristic, in the absence of these manifestations the term «polymyositis» is used. The disease proceeds with the development of severe neurological symptoms, and is dangerous because of complications which can lead to patient’s death. The article contains a description of cases of two female patients with the initial diagnosis of «Guillain-Barre syndrome». The analysis of the clinical picture, paraclinical studies, features of the disease course in patients was performed, and it enables differential diagnosis between acute/chronic inflammatory demyelinating polyneuropathy and dermatomyositiss at early stages of the disease.

Kazan medical journal. 2017;98(2):267-271
Clinical experiences
Technology of liquid chromatographic serum spectral images fixation in the diagnosis of colonic mucosal dysplasia
Alekseeva O.P., Kolodey E.N.

Aim. To demonstrate the possibility of use of technology of liquid chromatographic serum spectral images fixing for the diagnosis of colonic epithelial dysplasia in patients with ulcerative colitis.

Methods. 49 patients with ulcerative colitis were examined. Colonoscopy with Mayo index evaluation and biopsy of the intestinal mucosa were carried out using OLYMPUS CV-170 device (Japan). Biopsies were taken from the most affected areas of the colonic mucosa (from 3 to 10 biopsies). Morphological study included an assessment of histological activity of ulcerative colitis and colonic mucosal dysplasia. The results of histological studies were evaluated by two experts. High performance liquid chromatography of serum was performed by a standard technique in the chromatograph «Milichrom A-02» (CJSC «EcoNova», Novosibirsk). Statistical analysis of serum chromatograms was performed with the use of chromatograph combined with a PC, the end result was construction of spectral images of the disease.

Results. In 13 patients with ulcerative colitis the results of histological examination revealed various degrees of dysplasia. The set of spectral images of different patients, obtained in the processing of chromatograms, composed the diagnostic cloud of a pathological condition. The study revealed complete differentiation of liquid-chromatographic spectral images of serum of patients with ulcerative colitis with and without colonic mucosal dysplasia according to the results of multivariate cluster analysis. The diagnostic accuracy of the method was 88%.

Conclusion. The possibility of using the technology of construction and analysis of liquid-chromatographic spectral images of serum for the diagnosis of colonic epithelial dysplasia in patients with ulcerative colitis was demonstrated.

Kazan medical journal. 2017;98(2):272-277
Evaluation of the efficacy of respiratory gymnastics in patients with panic attacks
Yakupov E.Z., Shikov A.S.

Aim. Study of the efficacy of respiratory gymnastics in the treatment of panic attacks.

Methods. The study included 28 patients with the diagnosis of «panic attacks»: 22 females and 6 males. All participants followed the specially developed respiratory gymnastics program twice a day daily for 2 months. In each patient neurological status was checked before and after the study, and cardiovascular parameters (heart rate, blood pressure), respiration rate, severity and frequency of panic attacks were registered. For the evaluation of anxiety Spielberger scale for anxiety was used. The level of depression was assessed according to Hamilton rating scale for depression. For identification of hyperventilation syndrome hyperventilation provocation test was performed and Nijmegen questionnaire was used.

Results. After respiratory gymnastics for 2 months the frequency of panic attacks decreased by 66%, the number of symptoms during panic attacks decreased by 50%. Respiratory rate decreased by 18%, Nijmegen questionnaire score - by 28%. The level of situational anxiety and depression decreased by 15 and 14%, respectively, and degree of personal anxiety decreased by 5%. Cardiovascular parameters decreased nonsignificantly: pulse - by 3%, systolic and diastolic BP - by 1 and 2%, respectively.

Conclusion. Respiratory gymnastics effectively decreases the frequency and severity of panic attacks and can be effectively used in the complex treatment of panic attacks as a safe and effective non-drug method of treatment.

Kazan medical journal. 2017;98(2):277-281
Experience of applying phoneme perception test to the process of hearing aid selection and fitting
Tufatulin G.S.

Aim. To study the effectiveness of phoneme perception test for evaluation of different hearing aids’ types performance

Methods. Hearing aid was provided to 100 patients aged 45-59 years with bilateral chronic sensorineural moderate and moderate-to-severe hearing loss. 4 equal groups were formed depending on the type of a hearing aid - behind-the-ear with standard (BTE) and slim (BTEslim) tubes, receiver-in-the-canal (RIC), and completely-in-the-canal (CIC). All devices had comparable characteristics and were fitted monaurally. The efficacy was evaluated by phoneme perceprion test, which was performed before and 12 weeks after the correction (with and without the hearing aid).

Results. The detection test before correction revealed 38 deviations from the expected numbers, after 3-month adaptation - 28 without the device and 23 with it reflecting the significant dynamics compared to baseline parameters in CIC group (p <0.05). Grade of distinction before correction was 4.3 in average (σ=1.2) without significant intergroup difference, after 3-month adaptation - 4.9 (σ=1.0) without the device with significantly higher numbers in RIC group (p <0.05). In hearing aid the average result was 5.04 (σ=1.0) with significantly higher numbers in RIC (p <0.01) and CIC (p <0.05) groups. The recognition test before correction revealed 35 deviations, after it - 24 without the hearing aid and 25 with it without significant intergroup difference and dynamics (p >0.05). There was significant correlation between all tests’ results.

Conclusion. In comparison of the types of hearing aid the recognition test is the most informative and its results demonstrate advantages of RIC and CIC for such patient cohort.

Kazan medical journal. 2017;98(2):281-288
Complex ultrasound with strain elastography in the diagnosis of local recurrence of breast cancer
Savel’eva N.A.

Aim. To evaluate the capacities of complex ultrasound with the use of gray scale and color coded Doppler and strain elastography in the diagnosis of local recurrence of breast cancer and to determine the position of each method in the diagnostic algorithm.

Methods. Complex ultrasound of 76 female patients with suspected local recurrence of breast cancer was performed. The study included 83 masses. Ultrasound of preserved part of the breast, postoperative scar and soft tissues of the patient’s chest was performed with the use of high frequency linear 5-12 MHz transducer of Accuvix XG scanner (Samsung Medison, South Korea). The mass was considered malignant if it had 3 and more suspicious ultrasound features in gray scale regimen or 2 and more suspicious features in gray scale regimen combined with 3 or more color stains in color coded Doppler or with elastograms types 4 and 5. According to morphologic results the masses were divided into 2 groups. The first group included 48 masses in which according to cytologic and histologic studies recurrence of breast cancer was found, the second group included 35 masses in which tumor growth was not revealed morphologically.

Results. Complex ultrasound was accurate in 90.4%. Sensitivity and specificity were 89.6 and 91.4%, respectively.

Conclusion. Complex ultrasound with the use of strain elastography is a highly informative method that in most cases allows diagnosing local recurrence of breast cancer.

Kazan medical journal. 2017;98(2):288-293
First experience of lymphoscintigraphy use in early stages of breast cancer
Vatankha S.S., Aliev F.Y.

Aim. To evaluate efficacy of radioisotopic methods in detection of metastatic involvement of sentinel lymph nodes for choosing further theurapeutic tactics.

Methods. The study group included 23 females with confirmed breast cancer. Sentinel lymph nodes were detected by isotope 99mTc Nanocolloid and blue dye in General Electric gamma camera (USA).

Results. In all cases patients’ age was 45 to 60 years. In 16 (69.5%) cases the tumor size was below 5 cm which corresponded to clinical stage 2, in other 7 (30.5%) patients the tumor size was below 2 cm. Positive results with the use of lymphoscintigraphy were revealed in 6 (26%) cases, all results were morphologically confirmed straight after lymph node removal. In 5 (83%) cases metastatic involvement of the node was observed in stage 2 cancer. Such patients were immediately referred to radical mastectomy with radical lymph node dissection. In other cases pathological accumulation of a radiopharmaceutical was not observed. Only in one case after removal of such node its metastatic involvement was confirmed histologically. So the frequency of false negative results was 4.3%. Respectively, status of sentinel lymph nodes in breast cancer reflects the status of lymphatic collector with 95.7% accuracy.

Conclusion. The biopsy results demonstrated high diagnostic value of lymphoscintigraphy for detection of breast cancer metastases to sentinel lymph nodes (sensitivity 86%, specificity 100%): the method can be successfully used in early stages of breast cancer and also in case of negative results of conventional diagnostic methods (ultrasound, roentgen mammography).

Kazan medical journal. 2017;98(2):293-295
Modern capacities of surgical mallet toe deformity correction
Privalov A.M.

Aim. Analysis of gathered experience of surgical treatment of severe mallet toe deformity which is an actual problem of modern foot and ankle surgery.

Methods. The results of 23 arthrodeses with IPP-ON interphalangeal implant in the treatment of mallet toe deformity in 14 patients. The period of observation was from January 2015 to March 2016. All patients were operated on and subsequently were observed in International Clinic «MEDEM».

Results. All operated patients were females at the age of 27 to 65 years. All of them had confirmed stage III mallet toe deformity (according to M.I. Kuslik’s classification). In 64.3% of cases the surgeries were performed on both feet, in 35.7% - on one foot. All surgical interventions were combined with respective metatrsal Weil-osteotomy. Follow up period was 8 to 20 months. Evaluation of the results was performed by means of AOFAS scale (American Orthopaedic Foot and Ankle Society). An average score before the surgery was 46, after the surgery it reached 90. Foot function improved from 18 to 40 points. Toe deformity improved from 2.8 before the surgery to 11.6 in postoperative period.

Conclusion. Arthrodesis with IPP-ON interphalangeal implant is effective in surgical treatment of severe mallet toe deformity; use of the implant allows ro achieve good functional and cosmetic effect in postoperative period.

Kazan medical journal. 2017;98(2):296-299
Medical education
Development of a distance learning system in dermatovenerology
Kupeeva I.A., Ravodin R.A., Raznatovskiy K.I.

Цель. Разработать систему дистанционного обучения в дерматовенерологии и оценить её эффективность.

Методы. Работа выполнена на базе кафедры дерматовенерологии Северо-Западного государственного медицинского университета им. И.И. Мечникова (г. Санкт-Петербург). На основе лицензионной версии программы 1С-Битрикс разработана система дистанционного обучения для врачей-дерматовенерологов в составе модуля «Школа врача». В оценке сравнительной эффективности обучения приняли участие 23 ординатора 1-го года подготовки и 16 ординаторов 2-го года обучения кафедры дерматовенерологии. Врачи-ординаторы каждого года подготовки были разделены на две приблизительно равные группы: контрольную и исследуемую. Контрольная группа в отличие от опытной в процессе подготовки не пользовалась системой дистанционного обучения. Для оценки межгрупповых различий использовали Т-критерий Уилкоксона парных сравнений и U-критерий Манна-Уитни.

Результаты. Различия между результатами контрольного тестирования врачей-ординаторов 1-го года обучения из исследуемой и контрольной групп оказались статистически значимы (р <0,05). При оценке значимости различий между результатами первичного и контрольного (итогового) тестирования ординаторов 2-го года обучения в рамках исследуемой и контрольной групп мы получили значимые различия между исходным и конечным уровнями знаний врачей из опытной группы после проведённого курса дистанционного обучения (р <0,05), в контрольной группе различия были незначимы (р0 >0,05).

Вывод. Курс дистанционного обучения за счёт визуализации клинических симптомов и нового способа подачи информации позволяет оптимизировать и персонализировать учебный процесс, повышая эффективность обучения, и способствует уменьшению затраченного времени и количества используемой литературы для подготовки к занятиям; разработанная система дистанционного обучения может быть рекомендована для непрерывного образования врачей-дерматовенерологов.

Kazan medical journal. 2017;98(2):300-305
4th All-Russian scientific-practical conference «Acute care in modern multidisciplinary medical institution, problems, objectives, and perspectives of development»
Kazan medical journal. 2017;98(2):306-308
Professor Luiza Kiramovna Fazleeva is 80 years old
Kazan medical journal. 2017;98(2):309-310
Professor Georgiy Mikhaylovich Kharin is 70 years old
Kazan medical journal. 2017;98(2):310-311
Professor Lyudmila Aleksandrovna Potselueva
Kazan medical journal. 2017;98(2):312

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