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Vol 102, No 3 (2021)

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Theoretical and clinical medicine
Study of the antioxidant status in patients with secondary lymphedema of the lower extremities under conservative treatment
Kalinin R.E., Suchkov I.A., Maksaev D.A., Abalenikhina Y.V.

Aim. To assess the antioxidant status in patients with secondary lymphedema of the lower extremities who undergo different types of conservative treatment.

Methods. The study included 90 patients with secondary lymphedema of the lower extremities and 30 healthy volunteers. Group 1 participants (n=30) received compression therapy and Vitamin E at a dose of 400 IU/day, group 2 participants (n=30) compression therapy and a micronized purified flavonoid fraction 1000 mg/day, group 3 (n=30) compression therapy alone. Group 4 (n=30) comprised healthy volunteers. The level of malondialdehyde, the activity of superoxide dismutase, glutathione peroxidase, catalase, and the level of non-protein thiols (SH-groups) were determined at inclusion in the study and then after 1 and 3 months.

Results. In patients with secondary lymphedema, the initial level of glutathione peroxidase was higher by 768.22%, catalase — by 420.5%, malondialdehyde — by 60%, and the level of SH-groups was lower by 65,71% compared with the group of volunteers. In the first group, there was a significant decrease of 36.1% in the level of superoxide dismutase and a significant increase of 89.9% in the level of glutathione peroxidase at the end of therapy when compared with the level after 1 month. In the second group, catalase level significantly increased — by 33.3%, superoxide dismutase by 17.6%, and glutathione peroxidase by 61.3% compared to baseline values. The biochemical indicators of the endothelium significantly increased when using a combination of micronized purified flavonoid fraction and elastic compression in comparison with elastic compression alone and a combination with Vitamin E. In the third group, there were no significant differences in the levels of biochemical indicators of endothelial function.

Conclusion. Increased formation of lipid peroxidation products along with a decrease in the activity of antioxidant systems was revealed in patients with lower extremity secondary lymphedema compared with healthy volunteers; the most effective therapy aimed at correcting endothelial cell dysfunction is the use of micronized purified flavonoid fraction and elastic compression.

Kazan medical journal. 2021;102(3):277-283
Comprehensive assessment of certain trace elements, hormones and enzymes in patients with exogenous-constitutional obesity in predicting transition to metabolic syndrome
Nikishova T.V., Kurnikova I.A.

Aim. To study the relationship between the trace element status (chromium, zinc and copper) and hormonal activity (insulin, leptin) in women with metabolically healthy and unhealthy obesity phenotypes, depending on the type and severity of obesity.

Methods. A cross-sectional study was conducted to compare 288 women with exogenous-constitutional obesity aged 25–45 years and healthy women of similar age (n=38). The comparative analysis was carried out in groups of patients with android and gynoid ECO types and varying degrees of obesity. The study was conducted in the NUZ “Department Clinical Hospital of the Kazan station of JSC Russian Railways” between 2016 and 2020. Along with clinical laboratory tests, the indicators of carbohydrate and lipid metabolism (including the determination of hormones), the activity of enzyme systems and trace element content were determined. The statistical significance of the differences was assessed by using the non-parametric Spearman's rank correlation test.

Results. It was revealed that the type of obesity associated with the indicators of lipid and carbohydrate metabolism, the activities of catalase and peroxidase, and trace element content. In patients with abdominal obesity, the concentration of copper was higher than in the comparison group, and chromium and zinc — lower than in patients with gynoid obesity and in the control group. In patients with android obesity, a high correlation was found between the serum copper level (r=0.98) and body fat percentage (r=0.74) compared with patients with gynoid type obesity. The correlation of chromium level with the level of blood glucose (r=0.58), triglycerides (r=0.66), cholesterol (r=0.60) and catalase enzyme activity (r=0.54) as well as correlation of zinc level with the level of blood glucose (r=0.74), cholesterol (r=0.77), triglycerides (r=0.90), catalase (r=0.57), and peroxidase (r=0.59) were revealed. Also, significant differences in the level of trace elements in patients with varying degrees of obesity were found.

Conclusion. An increase in copper concentration and a decrease in the concentration of chromium and zinc are unfavorable signs in obese patients associated with the activation of oxidative stress, hyperplastic processes and a high risk of developing a metabolic syndrome.

Kazan medical journal. 2021;102(3):284-292
Heart failure patients with mid-range ejection fraction: clinical features and prognosis
Bulashova O.V., Nasybullina A.A., Khazova E.V., Gazizyanova V.M., Oslopov V.N.

Aim. To analyze clinical and echocardiographic characteristics and prognosis in patients with heart failure mid-range ejection fraction.

Methods. The study included 76 patients with stable heart failure I–IV functional class, with a mean age of 66.1±10.4 years. All patients were divided into 3 subgroups based on the left ventricular ejection fraction: the first group — heart failure patients with reduced ejection fraction (below 40%), 21.1%; the second group — patients with mid-range ejection fraction (from 40 to 49%), 23.7%; the third group — patients with preserved ejection fraction (>50%), 55.3%. The clinical characteristics of all groups were compared. The quality of life was assessed by the Minnesota Satisfaction Questionnaire (MSQ), the clinical condition was determined by using the clinical condition assessment scale (Russian “Shocks”). The prognosis was studied according to the onset of cardiovascular events one year after enrollment in the study. The endpoints were cardiovascular mortality, myocardial infarction (MI), stroke, hospitalization for acutely decompensated heart failure, thrombotic complications. Statistical analysis was performed by using IBM SPSS Statistics 20 software. Normal distribution of the data was determined by the Shapiro–Wilk test, nominal indicators were compared between groups by using chi-square tests, normally distributed quantitative indicators — by ANOVA. The Kruskal–Wallis test was performed to comparing data with non-normal distribution.

Results. Analysis showed that the most of clinical characteristics (etiological structure, age, gender, quality of life, results on the clinical condition assessment scale for patients with chronic heart failure and a 6-minute walk test, distribution by functional classes of heart failure) in patients with mid-range ejection fraction (HFmrEF) were similar to those in patients with reduced ejection fraction (HFrEF). At the same time, they significantly differed from the characteristics of patients with preserved ejection fraction (HFpEF). Echocardiographic data from patients with mid-range ejection fraction ranks in the middle compared to patients with reduced and preserved ejection fraction. In heart failure patients with mid-range ejection fraction, the incidence of adverse outcomes during the 1st year also was intermediate between heart failure patients with preserved ejection fraction and patients with reduced ejection fraction: for all cardiovascular events in the absence of significant differences (17.6; 10.8 and 18.8%, respectively), myocardial infarction (5,9; 0 and 6.2%), thrombotic complications (5.9; 5.4 and 6.2%). Heart failure patients with mid-range ejection fraction in comparison to patients with preserved ejection fraction and reduced ejection fraction had significantly lower cardiovascular mortality (0; 2.7 and 12.5%, p >0.05) and the number of hospitalization for acutely decompensated heart failure (0; 2,7 and 6.2%).

Conclusion. Clinical characteristics of heart failure patients with mid-range and heart failure patients with reduced ejection fraction are similar but significantly different from those in the group of patients with preserved ejection fraction; echocardiographic data in heart failure patients with mid-range ejection fraction is intermediate between those in patients with reduced ejection fraction and patients with preserved ejection fraction; the prognosis for all cardiovascular events did not differ significantly in the groups depending on the left ventricular ejection fraction.

Kazan medical journal. 2021;102(3):293-301
Screening methods for autism spectrum disorders in the study of neuropsychological development of preschool children
Tkachuk E.A., Martynovich N.N., Rychkova L.V.

Aim. To assess the effectiveness of screening methods for diagnosing autism spectrum disorders available to the pediatric service; to prove in practice impossibilities to identify signs of autism spectrum disorders by using the existed pediatric methods.

Methods. The neuropsychological development of 187 preschool children (5–6 years old) was investigated. The neurological status, anxiety according to A.M. Parishioners, level of intelligence using Raven's Progressive Matrices, the presence of hyperactivity according to the method of V.R. Kuchma, mental performance according to V.Ya. Anfimov, screening diagnostics of autism spectrum disorders were studied.

Results. Assessment of the neurological status showed an increase in tendon reflexes in 10.2±2.2% of children, a decrease in 12.3±2.4%. The study of the intelligence levels in the Ravenna test showed that the average intelligence level was in 47.1±3.7% of the studied children, the intelligence was below the average in 52.9±3.7% of children. Screening diagnostics of autism spectrum disorders did not reveal abnormalities, however, 5.3±1.6% of children had signs of predisposition to the autism spectrum disorder (decreased adaptation to changes, nervousness and fears, verbal and non-verbal communication, level of activity and consistency of intellectual response). The indicator of the productivity of mental performance of preschool children was 5.4±0.5. Attention deficit was detected in 5.9±1.7% of children (according to the parent's questionnaire) and 8.6±2.0% children (according to the teachers' questionnaire). The level of anxiety was 9.6±0.3 points.

Conclusion. The currently known screening methods for detecting autism spectrum disorders, available to the pediatric service, in our opinion, are uninformative; the search for the most sensitive markers of autism should be based on an understanding of the epigenetic mechanisms of autism spectrum disorders.

Kazan medical journal. 2021;102(3):302-306
Predicting the development of complications in patients with rhinosinusitis by cytokine profile indicators
Baranova N.I., Aschina L.A., Fedin A.V., Shkurova N.A., Sergeev S.V.

Aim. To develop a method for predicting the development of complications in rhinosinusitis patients based on the cytokine profile study.

Methods. We examined 110 patients with rhinosinusitis and 30 healthy donors (control group). The patients were divided into the group without a complicated course of rhinosinusitis (first group, n=65) and the group with a complicated course of rhinosinusitis (second group, n=45). The blood serum levels of interleukin (IL)-1β, IL-4, IL-8, IL-10, IL-17, IL-18, interferon (IFN)-γ were determined by enzyme immunoassay. Statistical analysis of the results was performed by using Microsoft Excel 2013 and Statistica 12.0 software. Statistically significant differences between the compared groups were determined by using the Mann–Whitney U-test, and p <0.05 was considered significant. Multivariate analysis included correlation analysis and stepwise regression analysis. The mathematical model consistency was determined by using Fisher's F-test, and p <0.05 was considered significant.

Results. Changes in cytokine profile manifested by a decrease in the level of interleukin-1β (p=0.00001), interleukin-4 (p=0.045) and an increase in the level of interleukin-18 (p=0.00001) were revealed in patients with uncomplicated course of rhinosinusitis. The complicated course of rhinosinusitis was characterized by a decrease in the level of interleukin-1β (p=0.00002), interleukin-4 (p=0.049) and an increase in the level of interleukin-8 (p=0.023), interleukin-17 (p=0.00015) and interleukin-18 (p=0.0002). Comparative analysis of the first and the second groups of patients showed an increased level of interleukin-8 (p=0.00001), interleukin-17 (p=0.0001) and reduced levels of interleukin-18 (p=0.00045) in the group of patients with complicated course of rhinosinusitis. Based on interleukin-17, interleukin-8 and interleukin-18 levels, the mathematical model for predicting the development of complications in patients with rhinosinusitis was developed.

Conclusion. The complicated course of rhinosinusitis was characterized by decreased levels of interleukin-1β, interleukin-4 and increased levels of interleukin-17, interleukin-8 and interleukin-18, indicating a more pronounced inflammatory process; for personalized therapy, an approach based on interleukin-17, interleukin-8 and interleukin-18 levels was developed on which the development of a complicated course in patients with rhinosinusitis can be predicted.

Kazan medical journal. 2021;102(3):307-312
Low-molecular-weight fibroblast growth factor-2 — a viable prognostic factor for gastric gastrointestinal stromal tumors
Mikheeva E.G., Aukhadieva A.M., Sabirov A.G., Boichuk S.V.

Aim. To examine the expression of fibroblast growth factor-2 and its isoforms in gastrointestinal stromal tumors and assess the prognostic value of this marker.

Methods. The study included 44 patients with gastric gastrointestinal stromal tumors of the stomach who were prescribed surgical or combined treatment with the targeted drug imatinib (imatinib mesylate). Immunohistochemistry (IHC)-staining and immunoblotting with monoclonal antibodies were used to assess the expression of FGF-2. Statistical analysis for differences in clinical and morphological parameters was performed by using Student’s, Mann–Whitney–Wilcoxon and Fisher’s tests. Differences were considered significant at p < 0.05.

Results. Fibroblast growth factor-2 expression was assessed in tumor tissues in 39 out of 44 analyzed patients. The frequency of fibroblast growth factor-2 expression in the observed patients was 84.6% (33/39). The moderate and strong fibroblast growth factor-2 expression was detected in 21 (53.8%) patients with gastric gastrointestinal stromal tumors. High expression of low-molecular weight (18 kDa) fibroblast growth factor-2 isoform was found in all tumor samples from patients with high-risk gastrointestinal stromal tumor (prognostic group 6) (p=0.039), which indicated the active secretion of this ligand by its signalling pathway in the cancer cells. Patients with high levels of low‐molecular‐weight fibroblast growth factor-2 showed a higher level of Ki-67 proliferative activity (р=0.013) and tumor size (р=0.0017). Patients with increased expression of the low molecular weight isoform of fibroblast growth factor-2 in gastric gastrointestinal stromal tumor had a higher risk of recurrence, as well as larger tumor size and proliferative activity compared with patients without expression of this isoform. The level of fibroblast growth factor-2 expression in tumor samples, determined by immunohistochemistry-staining, increases after initiation of imatinib to based therapy, which may indicate the formation of resistance to this targeted drug and the progression of the disease.

Conclusion. The results of the study suggest that FGF-2 might be an independent prognostic marker of gastric gastrointestinal stromal tumor and a viable therapeutic target.

Kazan medical journal. 2021;102(3):313-321
Dynamics of clinical and immunological parameters in the integrated management of endo-­periodontal lesions, including laser therapy
Blashkova S.L., Krikun E.V., Mustafin I.G., Valeeva I.K., Blashkova J.V.

Aim. To determine the dynamics of clinical changes and indicators of local immunity in integrating the diode laser into the treatment of the endo-periodontal lesion.

Methods. We performed a prospective study of 110 patients of both sexes aged 25–55 years with endo-periodontal lesions. The patients were randomized into two groups — the main group (n=54), whose received root canal treatment and periodontal pockets with a diode laser in addition to standard therapy, which included endodontic and periodontal treatment, and control group (n=56), whose patients received only standard treatment. The Green–Vermillion oral hygiene index and Russell’s periodontal index, as well as the levels of immunoglobulin (Ig) A, tumor necrosis factor-alpha (TNF-alpha) and cytokine interleukin-10 (IL-10) in the mixed saliva of patients, were determined during the study. Quantitative data were described using median, lower and upper quartiles. These data were visualized using boxplots. The Mann–Whitney U test was used to compare differences between an independent set of quantitative data. Differences were considered significant at a confidence level of p <0.05.

Results. The median oral hygiene index decreased from 2.9 to 1.0 (p <0.001) in the main group and from 2.9 to 1.6 (p <0.001) in the control group. The median Russell's periodontal index decreased from 3.38 to 1.3 (p <0.001) in the main group and from 3.95 to 2.0 (p <0.001) in the control group. The median immunoglobulin A content decreased from 5.25 to 3.13 mg/L (p <0.001) in the main group and from 5.23 to 4.21 mg/L (p <0.001) in the control group. The tumor necrosis factor-alpha level decreased from 16.65 pg/ml in the main group and 18.28 pg/ml in the control group to 3.96 and 8.44 pg/ml (p <0.001), respectively. The median cytokine interleukin-10 levels increased from 0.83 to 2.94 pg/ml (p <0.001) in the main group and from 1.29 to 2.13 pg/ml (p <0.001) in the control group.

Conclusion. The use of a diode laser in the treatment of endo-periodontal lesions has a positive effect on the dynamics of clinical and immunological parameters, as evidenced by a statistically significant decrease in clinical indices, as well as the normalization of the immunoglobulin A and cytokine levels in mixed saliva.

Kazan medical journal. 2021;102(3):322-328
Experimental medicine
Contractions dynamic of “fast” and “slow” rat muscle under spinal shock and modulators of contraction
Valiullin V.V., Khairullin A.E., Eremeev A.A., Teplov A.Y., Shaikhutdinova A.R., Kashtanov N.M., Grishin S.N.

Aim. To study the dynamics of neuromotor regulation of the contractile function of “fast” and “slow” muscles in rodents during spinal shock by spinal cord transection at the level Тh11–Тh12.

Methods. The experiments were carried out on laboratory rats weighing 140–180 g. The animals were divided into two groups: “Control” (8 rats) and “Spinal shock” (6 rats). The lower leg muscles, m. soleus and m. extensor digitorum longus (m. EDL), were dissected by partially isolating without disrupting the connection with the body's circulatory system. The sciatic nerve was stimulated with single electrical impulses (10 V, 0.5 ms). Contractions of both muscles caused by electrical stimulation of the sciatic nerve before and after the injection of the substances into the femoral artery — tubocurarine (1 mM) or norepinephrine (10 mM) — were recorded in animals of both groups. After spinalization, muscle contractions were re-recorded during electrical stimulation of the sciatic nerve before and 10 minutes after the injection of tubocurarine or noradrenaline into the femoral artery in the same concentrations.

Results. After spinalization of the animal, the contraction force of the muscle m. EDL fibers increased to 0.43±0.03 g (p=0.040), but the temporal parameters remained unchanged. M. soleus, on the contrary, showed a decrease in the contraction time to 0.053±0.005 s (p=0.045), and no change in the contraction force was observed under these conditions. Intra-arterial administration of norepinephrine in the control group resulted in an increase of m. soleus contractions up to 1.21±0.17 g (p=0.048), and m. EDL — up to 0.57±0.07 g (p=0.043). The administration of norepinephrine in spinalized animals caused an increase in the contraction of m. soleus up to 1.21±0.09 g (p=0.047), and m. EDL up to 0.66±0.05 g (p=0.043). The blocker of postsynaptic cholinergic receptors tubocurarine administration reduced the force of contraction of both muscle types in both control [m. soleus up to 0.39±0.03 g (p=0.039), m. EDL up to 0.11±0.02 g (p=0.042)] and spinalized [m. soleus up to 0.34±0.05 g (p=0.039), m. EDL up to 0.15±0.04 g (p=0.040)] animals.

Conclusion. The data obtained demonstrate the presence of significant differences in the mechanisms of control of contractile activity in the “fast” and “slow” skeletal muscles of warm-blooded animals; the persistence of the similar effect of the basic modulators on the contraction of both muscles with such a striking reaction to spinalization highlights the contribution of neurotrophic control to the functioning of “fast” and “slow” motor units.

Kazan medical journal. 2021;102(3):329-334
The role of transanal drainage tube in low anterior resection for rectal cancer
Akhmetzyanov F.S., Egorov V.I., Ruvinskiy D.M., Lûtikovа O.V.

Total mesorectal excision with low anterior resection has significantly improved the long-term outcomes of surgical treatment for rectal cancer, decreasing the local recurrence rate and increasing survival. However, total mesorectal excision is becoming one of the main factors for the development of colorectal anastomosis leakage, the rate of which reaches 20% in these operations. To minimize the complications associated with the inconsistency of the colorectal anastomotic suture, preventive intestinal stoma is formed when performing low anterior resections. That significantly worsen the quality of life of patients, their elimination requires re-hospitalization, and surgical interventions are accompanied by a high incidence of postoperative complications, reaching a rate of 20%, which has a significant impact on the cost of treatment for this category of patients. Transanal drainage is an alternative to the formation of preventive intestinal stoma and is devoid of its shortcomings. This literature review is devoted to an analysis of the effectiveness of transanal drainage in low anterior rectal resection. Until recently, transanal drainage has not yet gained popularity among surgeons due to the lack of evidence of its safety and effectiveness, and many studies are retrospective, including small samples. The review considered single-center, multicenter, randomized trials and a meta-analysis of the use of transanal drainage. Transanal drainage is an effective method for preven­ting the inconsistency of colorectal anastomotic suture, it is safe, and it surpasses the preventive intestinal stoma in a number of indicators.

Kazan medical journal. 2021;102(3):335-341
Heart damage in patients with cirrhosis of the liver
Chistyakova M.V., Govorin A.V., Kalinkina T.V.

The review outlines the current understanding of the clinical syndrome of heart disease in patients with liver cirrhosis and the development of cirrhotic cardiomyopathy. Patients with cirrhosis of the liver often notice chest pain, palpitations, complaints of arterial hypotension and rapid fatigue. Echocardiography shows that the left ventricular ejection fraction in cirrhosis is preserved at rest and decreases under stress. In some patients with viral liver cirrhosis, there is a decrease in global myocardial deformation (the presence of latent systolic dysfunction). More pronounced impairment of left ventricular diastolic function is recorded in patients with ascites and patients with Child–Pugh class B and C. In patients with ascites, unfavorable left ventricular remodeling, left heart cavities enlargement, dilatation of the pulmonary artery and its branches are more common. There is an increase in pulmonary artery pressure, the development of portopulmonary hypertension and hepatopulmonary syndrome in patients with liver cirrhosis. Тhe development of these syndromes leads to a sharp decrease in the quality of life of patients with relatively preserved liver function and a worsening of the prognosis for orthotopic liver transplantation. Аpproximately half of patients with liver cirrhosis have electrophysiological disorders: prolongation of the QT interval, tachycardia, supraventricular and ventricular extrasystoles. To date, there are no clinical guidelines for the management of cirrhotic cardiomyopathy. If a patient with liver cirrhosis develops clinically significant heart failure, then general principles of management of such patients are necessary. It is necessary to limit the use of angiotensin-converting enzyme inhibitors and cardiac glycosides. The combined use of nonselective beta-blockers and nitrates reduce cardiac output and QT interval. The use of potassium canrenoate, lisinopril helps reverse the development of structural and functional changes in left ventricle. The positive effect of antiviral therapy on cardiac hemodynamics in patients with viral cirrhosis was noted. Liver transplantation is known to be an effective treatment for cirrhotic cardiomyopathy, but this treatment may worsen latent heart failure. Thus, in patients with liver cirrhosis, heart damage occurs with the development of cirrhotic cardiomyopathy, while the mechanisms of the development of myocardial dysfunction are not fully understood. Further studies of the development of the syndrome are required for timely diagnosis and clinical intervention to improve the survival of patients.

Kazan medical journal. 2021;102(3):342-346
Modern concepts of low birth weight and fetal growth restriction
Yakovleva O.V., Rogozhina I.E., Glukhova T.N.

The aim of this work is to study the state of the problem of the development of small-for-gestational-age fetus and fetal growth restriction over the past 5 years. A review of randomized trials of the PubMed database for the period of 2015 to 2020 was carried out. Experts reached an agreement on the definition of diagnostic criteria for small-for-gestational-age fetus and fetal growth restriction, a clinically valid classification was created, and the main monitoring strategies were developed. Due to the different pathogenesis, fetal growth restriction is divided into early and late. The observation algorithm includes tests that have shown higher sensitivity and specificity. There is no single standard for the median weight and abdominal circumference of a fetus, indicators of the reference range for fetal Doppler. Smoking cessation and taking acetylsalicylic acid at a dose of 150 mg at high risk of preeclampsia is recommended to prevent the small-for-gestational-age fetus and fetal growth restriction. The pregnancy management algorithm includes Doppler ultrasound examination of the umbilical artery, cardiotocography. If this pathology occurs before 32 weeks of pregnancy, the blood flow in ductus venosus is additionally examined, and after 32 weeks of pregnancy, the middle cerebral artery blood velocities and cerebroplacental ratio are assessed. Indicators of Doppler velocimetry and cardiotocography, which serve as criteria for early termination of pregnancy, are developed, measures are proposed to improve neonatal outcomes — prevention of respiratory distress syndrome at 24–34 weeks of gestation, as well as magnesium therapy for fetal neuroprotection. The problems of preventing fetal growth restriction and the algorithm for monitoring pregnant women who do not have risk factors for small-for-gestational-age fetus, management tactics and indications for delivery while slowing fetal weight gain remain unresolved.

Kazan medical journal. 2021;102(3):347-354
Social hygiene and healthcare management
The relationship between breastfeeding and maternal education and family income
Bezrukova A.A., Yarmolinskaya M.I., Sazonova O.V., Spiridonova N.V., Komarova M.N.

Aim. To assess the relationship between breastfeeding and maternal education and family income in Samara.

Methods. A survey was conducted among 174 mothers in the children's outpatient clinic, in which their children were assigned at the place of residence. Information on breastfeeding and its duration, mother's education, and family income were obtained by questionnaire and copying data from outpatient records. Pearson's chi-square, Mann–Whitney U test and logistic regression were used in the statistical processing of the data.

Results. There was a positive association of maternal education (χ2=11.25; p=0.024) and income (χ2=11.5; p=0.022) with breastfeeding practices. Higher education, compared with specialized secondary or secondary education, increased the likelihood of breastfeeding for more than 6 months with an odds ratio of 2.6 (95% confidence interval 1.18–5.73; p=0.018). The median (and its Q1–Q3 quartiles) breastfeeding duration was 4.0 months (Q1–Q3 2.0–14.0 months) for mothers with secondary or specialized secondary education and 12.0 months (Q1–Q3 4.0–18.0 months; p=0.012) for mothers with higher education. It was found that 67.7% of women with incomes above the subsistence level per family member ($150) breastfed for more than 7 months and only 43.9% of women with incomes below the subsistence level (p=0.011). The likelihood of breastfeeding for more than 6 months in household income above one minimum wage per family member compared with household income below increases with an odds ratio of 2.18 (95% confidence interval 1.03–4.60; p=0.041). There was no relationship between lactation cessation and maternal education or family income.

Conclusion. There is a positive relationship between mother's education and family income and the practice of breastfeeding.

Kazan medical journal. 2021;102(3):355-361
Clinical experiences
A new look at the correction of COVID-19-mediated pulmonary gas exchange disorders
Simutis I.S., Boyarinov G.A., Yuriev M.Y., Petrovsky D.S., Kovalenko A.I., Sapozhnikov K.V.

Aim. To assess the effect of meglumine sodium succinate on the effectiveness of basic therapy in correcting gas exchange abnormalities in patients with severe COVID-19 infection complicated by bilateral community-acquired pneumonia.

Methods. The analysis of the effectiveness of therapy of 12 patients with a diagnosis of “New coronavirus infection COVID-19 (confirmed), severe form U07.1. Complication: bilateral multifocal pneumonia” was carried out. The patients were divided into two groups: 7 received, as part of standard therapy, a solution of meglumine sodium succinate in a daily dose of 5 ml/kg during stay in the intensive care unit; 5 patients received a similar volume of Ringer's solution and formed the control group. In the arterial and venous blood of all patients, the indicators of acid-base state and water-electrolyte balance, glycemia and lactatemia were measured at several stages: (1) at admission to the intensive care unit, (2) 2–4 hours after the start of intensive therapy, (3) after 8–12 hours, (4) after 24 hours. On the 28th day of observation, mortality, the duration of treatment in the intensive care unit and the incidence of thrombotic complications in the groups were assessed. The Friedman nonparametric hypothesis test was used to assess intragroup dynamics, and the nonparametric Mann–hitney U test for intergroup comparisons.

Results. In the group of patients who received meglumine sodium succinate, there was a significant decrease in the incidence of thromboembolic events during 28 days of treatment: myocardial ischemia event rate ratio from 0.89 [95% confidence interval (CI) 0.19–1.16] in the control group to 0.55 (95% CI 0.06–0.81) in the study group at p=0.043; pulmonary embolism event from 0.50 (95% CI 0–1.0) in the control group to 0.28 (95% CI 0–1.0) in the study group at p=0.041. There was also a decrease in the duration of intensive care unit length of stay to 6.1±1.1 days in the study group versus 8.9±1.3 days in the control group.

Conclusion. Compared with standard infusion therapy, the use of meglumine sodium succinate leads to a faster normalization of ventilation-perfusion ratios in patients with severe coronavirus infection.

Kazan medical journal. 2021;102(3):362-372
Inclusion of the prepared patient relatives in the process of early rehabilitation of onco-surgical patients in the department of anesthesiology and intensive care
Saetgaraev A.K., Maximov I.L., Zakirov I.I., Shaymardanov I.V., Grigoreva I.A., Guryleva M.E.

Aim. To study the influence of the trained environment of geriatric onco-surgical patients on the quality of the interventions in the complex of early postoperative rehabilitation in the Intensive Care Unit (ICU).

Methods. The 96 patients aged 73.3±7.1 years operated on in the emergency onco-surgery clinic of the Tatarstan Cancer Center of the Ministry of Health of the Republic of Tatarstan between 2016 and 2020. Patients, similar in age and condition (American Society of Anaesthesiologists’ Physical Status category IIIE) were divided into three equal groups: the first group — generally accepted measures for early rehabilitation were carried out by medical staff; the second group — the prepared relatives of the patient was additionally involved in rehabilitation; the control group — early rehabilitation was not carried out. The quality of nutritional support and measures to prevent pressure ulcers, cognitive function were assessed. Statistical processing was performed by using Microsoft Excel 2007 and IBM SPSS Statistics version 20 software. The statistical significance of data was determined by using the chi-square test at p <0.05.

Results. The involvement of previously trained relatives made it possible to reduce the incidence of pressure ulcers grade IV to 0%. There was a significant difference in the volume of assimilated enteral oral feeding (180.6±20.8; 240.6±20.8; 80.5±10.2; p <0.05) and the serum albumin level by 11 days after surgery (26.8±1.5; 28.9±1.2; 24.2±1.1 g/L, respectively; p <0.05). Assimilation of enteral oral feeding improved 3 times compared with the control group and 1.5 times compared with the first group (p <0.05). Indicators of cognitive status by the Mini Mental State Examination (MMSE) on the 6th day were 23.3±1.1; 25.3±1.1; 21.2±1.2 (p <0.05), respectively.

Conclusion. A rationally organized preparation of the patient's environment for the implementation of care, parti­cipation in rehabilitation measures and the prevention of complications can improve outcomes of medical intervention and reduce the incidence of postoperative complications.

Kazan medical journal. 2021;102(3):373-380
Cervical tracheal resection without intubation
Akopov A.A., Kovalev M.G.

Aim. To present the experience in a new approach for the surgical treatment of cicatricial cervical tracheal stenosis — tracheal resection without using an endotracheal tube.

Methods. The technique includes preliminary metal stent placement instead of bougienage in the stenosis zone; introduction of the supraglottic airway device I-Gel instead of the endotracheal tube and; jet ventilation through the supraglottic airway device. The stent is removed together with the resected trachea. The technique of cervical tracheal resection using the supraglottic airway device was implemented in 22 patients with cicatricial tracheal stenosis.

Results. The resection length ranged from 15 to 45 mm (on average, 27±3 mm). The duration of surgical interventions ranged from 65 to 180 minutes (on average, 109±9 minutes). Preliminary stenting excluded preoperative bougienage of the trachea and facilitated intraoperative assessment of the extent of the stenosis. The absence of an endotracheal tube facilitated the formation of anastomosis of the trachea, eliminated the risk of trauma to the anastomosis during tube removal. There were no complications in the early postoperative period. The length of postoperative hospital stay ranged from10 to 14 days (on average, 12±2 days). No restenosis was detected at long term follow-up.

Conclusion. Performing tracheal resection without intubation allows the surgeon to work comfortably, observing the safety conditions for ensuring airway patency throughout the operation by installing a supraglottic airway device.

Kazan medical journal. 2021;102(3):381-388
Medical and economic efficiency of dental caries prevention through the use of fluoride sealant in schoolchildren
Shaymieva N.I., Khasanov R.S., Olesova V.N.

Aim. To study the medical and economic efficiency of the program for the prevention of dental caries using UltraSeal XT among schoolchildren of Kazan.

Methods. In 2013, 200 schoolchildren from Kazan seen in the Republican Dental Clinic of the Ministry of Health of the Republic of Tatarstan (100 boys and girls aged 7–8) were selected. All patients were divided into two groups with similar distributions of sex and age: the test (main) group and control group. In the test group “Sealants”, the fissures of the first permanent molars were sealed with a composite fluorine-containing sealant according to the manufacturer's instructions. The control group was formed from children without dental sealants. The oral health assessment of children is reflected in the Examination Cards. Average indices of the severity of dental caries were determined (the number of decayed, filled and missing primary/permanent teeth — dmft/DMFT). Re-examination of children was carried out in 2016 with the determination of the same indicators. The economic analysis was carried out using the method of mathematical modeling. Statistical processing was performed in Microsoft Office Excel 2017.

Results. The use of sealants at the age of 7–8 years provided a lower level of caries severity in deciduous teeth (4.09±3.0; p <0.01). There was no statistically significant difference between the DMFT score of permanent teeth in children aged 7–8 years in the test group and the dmft score of deciduous teeth of children in the control group (p >0.05). The DMFT score in the permanent teeth of children in the test group of this age cohort (7–8 years old) was 0.66±0.95. The mean severity of dental caries DMFT index of 12-year-olds children with permanent dentition in the test group was 0.77±1.07, which is 1.52 more healthy teeth than in the control group — DMFT score 2.29±1.59 (t=4.01; p <0.01). The medical and economic efficiency of the fluoride prevention of dental caries in 12-year-olds schoolchildren through the use of a composite fluorine-containing sealant is expressed in the eradication of caries (less than 1 affected tooth according to the World Health Organization classification) and amounts to 437.38 rubles of notional saved costs per child for sealing versus dental treatment.

Conclusion. The use of a fluoride composite material reduces the severity of dental caries in children and the ­notional saved costs for sealing teeth.

Kazan medical journal. 2021;102(3):389-394
History of medicine
The role of Kazan therapists in the development of the direction of Botkin's scientific research and clinical practice in the first half of the twentieth century
Borodulin V.I., Albitsky V.Y.

The article highlights the formation of scientific therapeutic schools in Kazan using the comparative-historical method from the position of the modern concept of “scientific school”. Founded by the first of Botkin's student N.A. Vinogradov, the “affiliate” Botkin's scientific school initiated the creation of therapeutic schools at Kazan University in the first half of the XX century, originating in the second or third generation directly from S.P. Botkin. The activities of prominent Kazan therapists and their role in the formation of scientific schools are considered based on the approach of the social history of medicine — the impact of the social changes in Russia in 1917 and the beginning of the Civil War. Having established a center for the development of the scientific heritage of the great Russian clinician in Kazan, the clinical schools of A.N. Kazem-Bek, S.S. Zimnitsky, M.N. Cheboksarov, and N.K. Goryaev played a huge role in the development of Botkin’s direction of domestic internal medicine.

Kazan medical journal. 2021;102(3):395-399
The role of the Kazan surgical school in better understanding of sepsis
Volkov V.E., Volkov S.V.

The work aims to give a clinical assessment of the scientific research of representatives of the Kazan surgical school in the 40–60s of the last century on the problem of sepsis and to consider the practical significance of the results obtained in the light of modern concepts about the purulent-septic disease, as well as to study the effectiveness of the methods used to reduce mortality in wound sepsis. The representatives of the Kazan surgical school were among the first physicians in the national medical society to substantiate the key role of the local focus/foci and generalization of infection in the development of sepsis. They first laid the foundations for the prevention of generalization of infection from the primary focus — as the main factor for developing sepsis. Their data on the role of bacteremia in the etiology of sepsis and the prevention of fulminant sepsis are still relevant. These achievements remain priorities for the domestic surgical school and have become part and parcel of the international guidelines 2016 on sepsis (“Sepsis-3”).

Kazan medical journal. 2021;102(3):400-405
Cochrane Review Summaries
Negative pressure wound therapy for treating foot wounds in people with dia­betes ­mellitus

Мы рассмотрели данные о том, является ли терапия ран отрицательным давлением (ТРОД) эффективной при лечении ран стопы у людей с диабетом. Исследователи Кокрейн собрали и проанализировали все соответствующие исследования (рандомизированные контролируемые исследования; клинические исследования, в которых людей случайным образом определяют в одну из двух или более лечебных групп) для ответа на этот вопрос, и обнаружили 11 соответствующих исследований.

Kazan medical journal. 2021;102(3):406-407
Psychological interventions for treating foot ulcers, and preventing their recurrence, in people with diabetes

Люди с язвами, обусловленными синдромом диабетической стопы, могут испытывать стресс от полученных ран и от того влияния, которое они оказывают на их жизнь. В результате этого снижается вероятность заживления язв и повышается вероятность их повторного возникновения. Психологические методы лечения могут способствовать заживлению язв и предотвратить их повторное появление, позволяя людям почувствовать, что они могут справиться с диабетом и язвами, обусловленными синдромом диабетической стопы.

Мы хотели выяснить, улучшают ли психологические методы лечения заживление язв, обусловленных синдромом диабетической стопы, и предотвращают ли их повторное появление. Мы также хотели узнать, влияют ли они на число ампутаций, качество жизни, стоимость лечения и веру людей в то, что они могут справиться с этим состоянием, а также сравнить эффективность различных вариантов психологической терапии.

Kazan medical journal. 2021;102(3):407-408
Metformin monotherapy for adults with type 2 diabetes mellitus

Мы хотели выяснить, является ли метформин эффективным средством лечения сахарного диабета 2-го типа и не вызывает ли он какие-либо нежелательные эффекты. Мы также хотели сравнить его действие с другими противодиабетическими лекарствами, а также с диетами, упражнениями или и тем, и другим. Нас особенно интересовали такие исходы, как смерть, серьёзные нежелательные явления, качество жизни, связанное со здоровьем, смерть от сердечно-сосудистых заболеваний и несмертельные осложнения диабета (например, сердечные приступы, инсульты или почечная недостаточность).

Kazan medical journal. 2021;102(3):408-409
Insulin monotherapy compared with the addition of oral glucose-lowering agents to insulin for people with type 2 diabetes already on insulin therapy and inadequate glycaemic control

Неясно, следует ли людям с сахарным диабетом 2-го типа, принимающим инсулин в монотерапии, но не достигающим хороших уровней глюкозы, продолжить принимать инсулин в монотерапии, или им может быть полезно добавить пероральное антидиабетическое средство к их инсулинотерапии.

Kazan medical journal. 2021;102(3):409-410
XII Russian scientific practical conference with international participation “Human health in 21st century”
Ksembaev S.S., Torgashova O.E.

Продолжая славные научные традиции Казанской медицинской школы и учитывая сложную эпидемиологическую ситуацию мире, 28–29 октября 2020 г. в г. Казани прошла ХII Всероссийская научно-практическая конференция с международным участием «Здоровье человека в ХХI веке» в онлайн формате с использованием дистанционных технологий.

Kazan medical journal. 2021;102(3):411-412
Letters to the Editor
Science and art — a unified whole in the formation of a doctor (to the 100th anniversary of Professor A.G. Korotkov)

Каждому врачу, окончившему Казанский медицинский институт/университет, хорошо известно внутреннее оснащение анатомического театра, основу которого составляет богатейшая коллекция анатомических препаратов. Они хорошо многократно описаны в специальных трудах, и сегодня речь пойдёт не о них, а о другом уникальном экспонате. В 1978 г. на торцевой стене секционной аудитории кафедры появилась картина «Диспут анатомов», или «Зарождение современной анатомии» (рис. 1), на которой представлены связанные единой композицией учёные от Гиппократа до В.Н. Тонкова. Об этой картине и поговорим дальше.

Kazan medical journal. 2021;102(3):413-415

На странице 228 вместо Алексей Юрьевич Расчёсков следует читать Александр Юрьевич Расчёсков.

Kazan medical journal. 2021;102(3):416

На странице 9 вместо рис. 1 правильным считать приведённый ниже.

Kazan medical journal. 2021;102(3):416

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