Vol 102, No 4 (2021)

Aim. To identify the most important risk factors affecting the development of epilepsy in children with cerebral palsy.

Methods. The study included 160 cerebral palsy patients with and without epilepsy who received treatment at the Baku Children's Neurological Hospital. The patients were divided into 2 groups. The first group consisted of 110 (68.7%) patients with cerebral palsy and epilepsy, and the second group consisted of 50 (31.3%) patients with cerebral palsy. The age of children ranged from 1 to 14 years. Statistical data processing was performed by using the SPSS software version 16.0. The Chi-square test was used to compare categorical measurements. T-test for independent groups was used for comparison between groups of continuous measurements. Binary logistic regression was used for determining the risk factors. In all tests, the level of statistical significance was set at p <0.05.

Results. There was no significant difference in age and gender distribution between groups (p=0.492 and p=0.818, respectively). 10 (9.1%) children in the main group had a positive family history of epilepsy (odds ratio 8.08, p=0.028). Neonatal seizures were observed in 25 (22.7%) children in the main group and 3 (6%) children in the control group (odds ratio 4.4, p=0.010). The presence of infection during pregnancy in the mother was found in both the main (39.1%) and control (20%) groups (odds ratio 2.6, p=0.018). Level IV of the Gross Motor Function Classification System (GMFCS) was the most frequent among patients with epilepsy (odds ratio 12.8; p=0.035). The incidence rate of epilepsy among cerebral palsy patients was 68.7%. The mean age of onset of seizures was 19.2±26.6 months. The most frequent epileptic seizures (55.5%) occurred in spastic quadriplegic cerebral palsy.

Conclusion. The presence of a positive family history of epilepsy, neonatal seizures, maternal infection during pregnancy and severe GMFCS level were identified as factors for the development of epilepsy in patients with cerebral palsy; premature birth, presence of hypoxic-ischemic injury, low birth weight, consanguineous marriage, multiple pregnancies, or gender were not identified as risk factors for the development of epilepsy in children.

Aim. To analyze anticoagulant therapy in elderly patients with non-valvular atrial fibrillation and ways to increase adherence in the work of a specialized team.

Methods. The study followed 250 patients with non-valvular atrial fibrillation aged 65 to 74 years (mean age 70.7±4.39 years). The patients were divided into three groups: the first group included 105 people, who were prescribed warfarin in a retrospective study; the second group — 57 people treated with rivaroxaban, and the third group — 88 people treated with warfarin. The second and third groups were prospective study groups which were supervised by a specialized team of physicians. The groups were matched on sex and age, comorbidities. Statistical data analysis and mathematical processing were performed by using the methods of descriptive and variational statistics. Most parameters reported as absolute values and percentages, while quantitative data — the 25th and 75th percentiles.

Results. All patients included in the study had a high risk of developing thromboembolic complications by their CHA2DS2-VASc score (≥2) and a low risk of developing hemorrhagic complications on the HAS-BLED scale (average score 1.49±0.04). They were prescribed anticoagulant therapy. By the end of the year follow-up from the start of anticoagulant therapy, only 9.5% of patients were treatment adherent, in the second group — 43.8%, in the third group — 70.5% of patients. The reason for refusing to take warfarin in the vast majority of cases was the inability to control the international normalized ratio, medical contraindications, and the high cost of the drug in prescribing rivaroxaban. The results showed that the majority of patients with atrial fibrillation (90.5%) receive inadequate antithrombotic therapy in routine outpatient clinical practice. At the same time, in a very small number of patients (9.5%) receiving warfarin, this type of therapy can be considered adequate (60% or more of the stay time in the therapeutic range of international normalized ratio of 2.0 to 3.0).

Conclusion. Anticoagulant therapy prescription under the supervision of a specialized team contributes to a significant improvement in treatment adherence (from 43.8 to 70.5%); promising in the future is the use of drugs from the group of new oral anticoagulants that do not require routine monitoring of coagulogram.

Aim. To assess the number of markers of apoptosis and cell proliferation, as well as their relationships in the area of restenosis of arterial reconstructions.

Methods. The study included 14 patients with a diagnosis of “arteriosclerosis obliterans of the lower extremities. Post-thrombotic occlusion of femoropopliteal bypass”. All patients were males with stage III disease according to the Fontaine classification modified by A.V. Pokrovsky. The average age of the patients was 65±3.4 years. The mean disease duration was 9±2.5 months after the initial intervention. Intraoperative material — distal anastomosis of femoropopliteal bypass — was taken from patients during arterial reconstructions. As a control, we used arterial wall samples obtained at organ procurement from postmortem donors without arteriosclerosis obliterans of the lower extremities. The number of samples is 8. The site of their collection is the popliteal artery. After sampling, they were crushed, and a homogenate was prepared, followed by the determination of the amount of p53, PDGF BB, Bcl2, and Bax proteins using the enzyme immunoassay. Statistical analysis was performed using the Statistica 10.0 software. Group differences were assessed by using the Mann–Whitney test. Correlation coefficients were determined using the Spearman test. Data are presented as medians and interquartile ranges.

Results. In tissue samples of restenosis, the amount of p53 protein was 0.07 units/mg and was significantly reduced compared with the control samples — 0.14 units/mg (р=0,015). The amount of platelet-derived growth factor PDGF BB was 0.17 ng/mg (р=0.05), Bcl2 — 1.61 ng/mg (р=0.008), Bax — 6.0 ng/mg (р=0.25) in the restenosis area and was increased in comparison with the control samples (0.04 ng/mg, 0.9 ng/mg, 4.4 ng/mg, respectively). A relationship between p53 and platelet-derived growth factor BB (r=–0.724, p=0.002), platelet-derived growth factor BB and Bcl2 (r=0.672, p=0.003) was revealed in samples from restenosis tissue obtained during arterial reconstructions.

Conclusion. The decreased apoptosis, expressed in a low level of p53 protein, with an increased Bax/Bcl-2 ratio is associated with an increase in the proliferative response of vascular wall cells in the area of restenosis of arterial reconstruction.

Aim. To study the nature and extent of the effects of long-term sleep and wake phase disorders (working at night for more than 10 years) on the characteristics of microcirculation in men.

Methods. Laser Doppler flowmetry and spectophotometry, optical tissue oximetry, and laser-induced fluorescence spectroscopy were performed in 34 male patients with a mean age of 40.3±0.9 years and more than 10 years’ experience of night work to assess the effectiveness of microcirculation. 25 men with a mean age of 40.2±1.2 without night work experience were used as a control group. Microcirculation was studied on the laser diagnostic complex LAKK-M (LAZMA, Russian Federation). The measurement was carried out on the skin of the palmar surface of the terminal phalanx of the second finger of the hand. The following indicators were analyzed in automatic mode: the mean perfusion value, the index of specific oxygen consumption in the tissue, capillary blood saturation, the relative volume of the red blood cell fraction, arterial blood oxygen saturation, the index of perfusion oxygen saturation in the microcirculation, the efficiency of oxygen exchange and the fluorescent indicator of oxygen consumption. Statistical processing of the results was carried out using the Student's t-test for independent samples.

Results. In patients working at night for more than 10 years, a decrease in microcirculation efficiency was revealed. The index of specific oxygen consumption in the tissue was lower than that of healthy volunteers by 34.1% (p=0.000255), and the index of oxygen exchange efficiency by 56.3% (p <0.001). Long-term night work (>10 years) can lead to violations of microcirculation parameters and an irreversible decrease in the efficiency of oxygen exchange compared with the control group by an average of 56.3% (18.0±0.5 for the group with night work experience, 41.2±0.6 for the group of healthy volunteers, p <0.001), the index of specific oxygen consumption in the tissue by an average of 34.1% (1.53±0.03 for the group with night work experience, 2.32±0.2 for the group of healthy volunteers, p=0.000255) and an increase in the index of perfusion oxygen saturation in the microcirculation by 2 times compared with the control group (6.2±0.05 for the group with night work experience, 3.67±0.09 for the group of healthy volunteers, p <0.001), which is accompanied by an increase in the saturation of mixed (and venous) blood.

Conclusion. The nature of the revealed violations of microcirculatory parameters in the long-term night work suggests their significance in the development of diseases that are currently attributable to the so-called group of “diseases of civilization”.

Aim. To study the effect of substance P on the blood serum glycoproteins in experimental animals with different stress-resistance profiles under technogenic rotating electric field.

Methods. The level of sialic acids, mucoproteins, fucose, and α-L-fucosidase was determined in the blood serum of 72 noninbred white male rats before (control) and on the 10th and 20th day of exposure to a technogenic rotating electric field (REF), as well as under the combination of technogenic rotating electric field and substance P injection at the same time. To determine the stress resistance, the animals were tested using the “open field” method. Animals were divided into groups based on the tests’ data obtained: stress-resistant, not stress-resistant and ambivalent.

Results. On the 10th day of technogenic rotating electric field action, the level of sialic acids, fucose, and α-L-fucosidase activity increased in all animals. The concentration of mucoproteins tended to decrease. On the 20th day, the sialic acids content remained elevated compared with the control in all groups. The content of mucoproteins decreased in stress-resistant, not stress-resistant and restored to the control level in ambivalent compared with those on the 10th day. On the 20th day, fucose concentration reached control values in stress-resistant and ambivalent animals and decreased in not stress-resistant. On the 10th day of the combined exposure, the concentration of sialic acids, mucoproteins, fucose, α-L-fucosidase was reduced in all animals compared with the 10th day of technogenic rotating electric field action. On the 20th day of the combined exposure, the values of the studied parameters remained reduced in all groups of animals compared with those on the 20th day of isolated technogenic rotating electric field action.

Conclusion. The substance P injection limits the effects of technogenic rotating electric field on the metabolism of carbohydrate-containing biopolymers in blood serum in all groups of animals, as can be seen by a decrease in the level of sialic acids, fucose, and low enzymatic activity of α-L-fucosidase under combined exposure.

Aim. Comparative assessment of the effect of fibrous materials on cell cultures RAW264.7 and BEAS-2B.

Methods. The effects of various fibrous materials — single-walled carbon nanotubes of two types (SWCNT-1 and SWCNT-2), differing in morphological characteristics, and chrysotile asbestos as a positive control — was assessed on two cell lines macrophages RAW 264.7 and human bronchial epithelium BEAS-2B cells. The studied materials’ concentration range for experiments on cells was selected taking into account the SWCNT content in the air of the working area and the subsequent modeling of SWCNT deposition in the human respiratory tract. Suspensions of the studied materials were prepared based on cell culture media by ultrasonication. Cytotoxicity assessment after 48 hours of incubation was performed by using the MTS colorimetric assay. The expression level of apoptosis mar¬kers was assessed by immunoblotting using the corresponding monoclonal antibodies. Visualization of SWCNT-1, SWCNT-2 and chrysotile asbestos in BEAS-2B cell cultures was carried out by improved dark-field microscopy.

Results. According to dark-field microscopy, all the studied fibrous materials were found on the surface or cytoplasm of the cells. SWCNT and chrysotile asbestos did not have a direct cytotoxic effect in the MTS assay and did not induce apoptosis according to the results of Western blotting in cell cultures of RAW264.7 macrophages and BEAS-2B bronchial epithelium. In the cells of the bronchial epithelium (BEAS-2B) that showed greater sensitivity, a slight increase in the expression of pro-apoptotic protein PARP, which was more pronounced for shorter SWCNT-2, was revealed.

Conclusion. Both types of SWCNTs, despite the differences in morphological characteristics, demonstrated similar effects in in vitro experiments; this result, with its further verification, can have an important practical application in justifying approaches to determining the safety criteria for single-walled carbon nanotubes as a class of nanomaterials of the same type.

The discussion continues about the role of systemic inflammation in the pathogenesis of cardiovascular diseases of ischemic etiology. This article reviews the information on the role of C-reactive protein in patients with atherosclerosis and heart failure in risk stratification for adverse cardiovascular events, including assessment of factors affecting the basal level of highly sensitive C-reactive protein. Research data (MRFIT, MONICA) have demonstrated a relationship between an increased level of C-reactive protein and the development of coronary heart disease. An increase in the serum level of highly sensitive C-reactive protein is observed in arterial hypertension, dyslipidemia, type 2 diabetes mellitus and insulin resistance, which indicates the involvement of systemic inflammation in these disorders. Currently, the assessment of highly sensitive C-reactive protein is used to determine the risk of developing myocardial infarction and stroke. It has been proven that heart failure patients have a high level of highly sensitive C-reactive protein compared with patients without heart failure. The level of C-reactive protein is referred to as modifiable risk factors for cardiovascular diseases of ischemic origin, since lifestyle changes or taking drugs such as statins, non-steroidal anti-inflammatory drugs, glucocorticoids, etc. reduce the level of highly sensitive C-reactive protein. In patients with heart failure with different left ventricular ejection fraction values, it was found that the regression of the inflammatory response is accompanied by an improvement in prognosis, which confirms the hypothesis of inflammation as a response to stress, which has negative consequences for the cardiovascular system.

Chronic pancreatitis remains an unsolved problem for clinicians. One of the biggest dilemmas is to establish a clear diagnosis. Diagnosis can be particularly elusive in patients with early chronic pancreatitis. Many studies have been undertaken to improve diagnostics in chronic pancreatitis, but this has been significantly limited by the lack of a “gold standard”. The evaluation of patients with suspected chronic pancreatitis should follow a progressively non-invasive to more invasive approach. Computed tomography is the best primary imaging modality to obtain as it has good sensitivity for severe chronic pancreatitis and may exclude the need for other diagnostic tests. When ambiguous results are obtained, a magnetic resonance cholangiopancreatography may require for a more detailed evaluation of both the pancreatic parenchyma and ducts. If the diagnosis remains in doubt, endoscopic ultrasound with or without pancreas function testing becomes the preferred method. Endoscopic retrograde cholangiopancreatography remains a last line diagnostic test and generally should be used only for diagnostic purposes. Future researches in the field of diagnosis of early-stage chronic pancreatitis should purpose optimizing current diagnostic tools. A definitive diagnosis of chronic pancreatitis may not be made simply by clinical history, imaging or function testing alone, but rather by the data gathered by a combination of these diagnostic tools.

Aim. To conduct a clinical and economic analysis of the effectiveness of the program fissure sealing of first permanent molars with fluorine-containing sealants among schoolchildren of 7–8 years old in six cities of the Republic of Tatarstan.

Methods. Between 2007 and 2011, dentists of six cities of the Republic of Tatarstan performed fissure sealing of permanent first molars using a fluorine-containing sealant in 24,394 schoolchildren aged 7–8 years according to the manufacturer's instruction. A clinical assessment of fluorine-containing sealant retention during tooth eruption was carried out annually, the results were submitted to the organizational and methodological office of the Republican Dental Clinic. The analysis of the complex of signs that have a normal distribution and characterize four degrees of sealant retention on the occlusal surfaces of teeth in children from several cities was carried out by using one-way ANOVA (analysis of variance) with the calculation of a p-value and F-test (according to Ronald Fischer). Statistical data processing was performed using the Microsoft Office Excel 2017 software. The economic analysis was performed by using mathematical modelling.

Results. The use of sealants at the age of 7–8 years ensured the complete safety of the sealant in 80% of children; the development of dental caries in 1.7%; complete and partial loss — 14.3%; disturbance of fit without the development of caries — in 4.1% of cases [р=0.0095 (<0.01); f-test 3.09839]. Clinical and economic analysis using a mathematical hypothesis in sealing with a fluorine-containing composite sealant determined the preservation of the conditionally spent funds for the treatment of 80% of healthy teeth for 4 years of the project in the amount of 6,001,177 rubles. Notional saved costs for the treatment of one tooth with a sealant amounted to 23.7 rubles.

Conclusion. Implementation of the program fissure sealing of first permanent molars with fluorine-containing sealants among schoolchildren of 7–8 years old allows a total of 98.3% of healthy teeth to be preserved and notionally saved costs of sealing fissures to be reduced.

We report a clinical case of exfoliative dermatitis associated with a novel coronavirus disease. A patient with moderate COVID-19 and decompensation of insulin-dependent diabetes mellitus, hypertension and obesity developed a generalized drug eruption. Treatment of coronavirus infection included drugs associated with the frequent development of skin allergic reactions: third-generation cephalosporin and hydroxychloroquine. In this clinical case, the patient had a generalized form of exfoliative dermatitis with moderate COVID-19. Thus, the generalization of drug eruption occurred with a decrease in the viral pneumonia foci area and was accompanied by repeated deterioration of general condition of the patient. Skin rashes resolved in the correction of concomitant pathology. Erythroderma has a benign course in hemostatic disorders and the use of systemic glucocorticosteroids, hyperglycemia therapy. For managing such patients, it is important to use an integrated approach, providing both the treatment of the underlying disease and the correction of comorbidity and complications. This is relevant for both dermatologist-venereologist and specialists involved in the treatment of COVID-19.

We analyzed a forensic case related to an unfavorable outcome of medical care by a pediatrician. One of the reasons for the unfavorable outcome of medical care was the combination of pediatric and pediatric neurology specialties by the doctor, which, according to experts, contributed to an incorrect assessment of the severity of the child’s condition and incorrect assessment of general cerebral symptoms and neurological disorders, without proper differentiation. As a result, the diagnostic was not fully provided, and more serious diseases at the time were not excluded. We determined the objective and subjective aspects of liability for combination several specialties. A medical-legal and forensic assessment of a specific unfavorable outcome of medical practice is given. It is concluded that any combination of different specialties by a doctor not only requires additional professional duties but, at the same time, creates additional legal risks in term of criminal law, which should be taken into account by each specialist who has assumed additional obligations.

The introduction of the new University Charter and the era of large-scale reforms in the middle of the XIX century, the emergence of experimental methods of research, and at the same time, the remaining urgent issues of the spread of epidemic diseases made the opening of departments of hygiene acutely necessary. The process of formation and subsequent institutionalization of hygiene teaching as a discipline has not previously been comprehensively covered by researchers in Russian historiography. The possibility of identifying a number of unresolved systemically important tasks allowing to synthesize the main directions of the scientific study of the process of hygiene development in the historical and medical knowledge from an institutional perspective was realized in this article. The history of the organization of hygiene departments in Russia is the subject of many studies. And the publications of general historical medical monographs and textbooks often contain contradictory information that does not reflect some important details and peculiarities of the formation of the traditions of teaching this discipline, which were established in the second half of the XIX century. The result of the study was clarification of data on medical workers who became the first hygiene educators in Russia. It was determined that the regular teaching of hygiene as a separate discipline began in the second semester of the 1864–1865 academic year at the medical faculty of the Imperial Kazan University. The first teacher of hygiene in Russia was Professor of Kazan University Arkady Ivanovich Yakobii. It was also clarified that regular hygiene teaching at the Saint Petersburg Imperial Medico-Surgical Academy was established in November 1865. Ivan Maksimovich Sorokin was the first hygiene teacher at the Academy and the first head of the hygiene department. Alexey Petrovich Dobroslavin, who was previously considered the first head of the hygiene department, actually became the second head of the corresponding department, starting teaching only in 1872.

Выдающемуся детскому врачу, учёному, педагогу и крупному организатору здравоохранения России Александру Александровичу Баранову исполнилось 80 лет. Это юбилей не только учёного-педиатра, но и общественного деятеля государственного масштаба в сфере охраны материнства и детства. Его лозунг «Сохраним здоровье детей — сохраним Россию» стал по существу программой деятельности педиатрического сообщества в условиях тяжелейшего социально-экономического кризиса 90-х годов прошлого века и продолжает оставаться таковым в условиях новых вызов современной ­России.

COVID-19 поражает многие органы организма, поэтому у людей с COVID-19 может быть широкий спектр симптомов. Симптомы и признаки болезни могут быть важны для того, чтобы помочь им и медицинскому персоналу, с которым они вступают в контакт, узнать, есть ли у них эта болезнь.

Мы хотели узнать, насколько точна диагностика COVID-19 в условиях первичной помощи или больницы (стационара), основываясь на симптомах и признаках, полученных в результате клинического обследования.