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Vol 102, No 4 (2021)

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Theoretical and clinical medicine

Risk factors for developing epilepsy in children with cerebral pals

Mammadbayli A.K., Taghiyeva M.R.


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.

Kazan medical journal. 2021;102(4):421-427
pages 421-427 views

Perioperative antibiotic prophylaxis for abdominal delivery at the regional perinatal center

Tashtanbekova C.B., Evstratov A.A., Chuenkova E.A., Ziganshina L.E.


Aim. To conduct a comparative pharmacoepidemiological study and assess the rational use of antibiotics in wo­men undergoing caesarean section.

Methods. A retrospective analysis of 1,025 birth histories of women after planned and emergency cesarean section was carried out with a detailed assessment of the use of antibiotics in 2007–2009 (523) and 2016–2017 (502) — with an interval of 10 years for which new clinical guidelines, principles of rational pharmacotherapy and evidence-based medicine were introduced. The time of administration of the first dose, duration of administration, consumption of antibiotics were assessed. The significance of differences in relative indicators was assessed according to Pearson (χ2).

Results. Antibiotics were prescribed to women with planned and emergency caesarean section in 100% of cases in the first period of the study (2007–2009) and prescribed in 98% of women with planned caesarean section and 96% with emergency caesarean section in the second period (2016–2017). In the first period, the first dose of antibiotic was administered: in 110 (44%) cases during surgery and 139 (56%) cases after surgery in planned caesarean section; in 139 (51%) cases during surgery and 135 (49%) cases after surgery in emergency caesarean section. In the second period, antibiotics were administered 30–60 minutes before the operation in 263 (96%) cases in the planned caesarean section and 218 (95%) cases in the emergency; postoperative antibiotics were administered in 7 (2%) women in the planned caesarean section and 2 (1%) women in the emergency (p <0.05). Greater than 5–6 days of antibiotics were used: in 166 (67%) women in the planned operation and 166 (61%) in the emergency for the first period; in 43 (16%) women with the planned operation, and 38 (17%, p <0.05) women with an emergency for the second period. In the first period, 13 antibiotics from 8 pharmacotherapeutic groups were used and in the second period, 7 out of 5 were used.

Conclusion. From 2007 to 2017, the use of antibiotics has become to comply with the implemented clinical guidelines for abdominal delivery: the duration of antibiotic use has decreased, the time of administration of the first dose and the range of antibiotics used changed.

Kazan medical journal. 2021;102(4):428-438
pages 428-438 views

Analysis of antithrombotic therapy in elderly patients with nonvalvular atrial fibrillation in the Kyrgyz Republic and ways to increase treatment adherencе

Kinderbaeva N.K., Bazira K., Karabekova N.M., Mamatova R.M., Asel Z., Nartaeva A.K., Mamatov S.M.


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.

Kazan medical journal. 2021;102(4):439-445
pages 439-445 views

Systemic inflammation and nutritional insufficiency in palliative cancer patients

Kurchenkova O.V., Kharlamova U.V., Vazhenin A.V., Abdalov A.O.


Aim. To study the relationship between the symptoms of nutritional insufficiency and systemic inflammation in cancer palliative patients.

Methods. 106 palliative cancer patients were examined at Chelyabinsk Regional Clinical Center of Oncology and Nuclear Medicine: 54 (50.9%) men and 52 (49.1%) women aged 61 [54; 67] years. All patients underwent laboratory and instrumental examination within the approved standards of specialized medical care. Systemic inflammation was assessed by the levels of acute phase proteins (C-reactive protein, fibrinogen). The study of integrated clinical and laboratory, somatometric parameters was carried out. The nutritional risk index was assessed.

Results. Palliative cancer patients showed a statistically significant decrease in the concentration of hemoglobin, lymphocytes, and albumin. The activation of systemic inflammation that manifested by hyperfibrinogenemia and an increase in the level of C-reactive protein was revealed. The study of somatometric parameters revealed a statistically significant decrease in body mass index, shoulder circumference, subscapular skinfold thickness, and a tendency to reduce lean body mass. The nutritional risk index assessment showed mild nutritional insufficiency in 22 (20.8%) of the examined patients and severe nutritional insufficiency in 28 (26.4%) patients. The maximum diagnostic significance of the level of C-reactive protein for prediction the nutritional insufficiency was achieved at 80.4% sensitivity and 52.7% specificity (AUC=0.671, 95% confidence interval [0.573; 0.759], p=0.001), which corresponded to a C-reactive protein threshold of 31 mg/l.

Conclusion. 50 (47.2%) of the examined patients showed signs of nutritional insufficiency, a statistically significant decrease in hemoglobin and albumin concentration, as well as lymphocyte count, activation of systemic inflammation, manifested by hyperfibrinogenemia, and an increase in the level of C-reactive protein; it was revealed a statistically significant relationship between C-reactive protein level and malnutrition.

Kazan medical journal. 2021;102(4):446-452
pages 446-452 views

The level of markers of apoptosis and cell proliferation in the area of restenosis after lower extremity arterial reconstruction

Kalinin R.E., Suchkov I.A., Klimentova E.A., Shchulkin A.V., Gerasimov A.A., Povarov V.O.


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.

Kazan medical journal. 2021;102(4):453-458
pages 453-458 views

Improving the Russian-language Wikipedia articles on medicines using new knowledge Cochrane

Potapov A.S., Alexandrova E.G., Yudina E.V., Ziganshina L.E.


Aim. To evaluate the effectiveness of the Cochrane Russia Initiative to improve the articles of the Russian-language Wikipedia by including information from Cochrane Systematic Reviews (CSR) to ensure the accuracy and impartiality of their content as an information basis for the quality use of medicines by doctors and the public.

Methods. Wikipedia articles on selected drugs were improved by introducing evidence from Cochrane Systematic Reviews — “Cochrenized”. A parallel open-label non-randomized controlled intervention study was conducted. We assigned 2 groups of drugs and Wikipedia articles about them: the intervention group (“Cochrenization”) and the control group (36 articles each). Control group articles were not edited. The change in the number of visits to Wikipedia pages for the year (2018–2019) was measured, the statistical significance of the differences was assessed by using the Wilcoxon signed-rank test.

Results. We edited 36 Wikipedia articles, including 13 articles on migraine treatment, 9 diabetes mellitus, 14 pain and inflammation articles. These articles constituted the intervention group. The control group consisted of articles on cardiovascular (11), gastrointestinal (14) and dermatological agents (11). We used the Cochrane Russia Initiative dashboard on Wikipedia to compare the number of article views before and after the intervention and Cochrane analytics on demand for translations of Cochrane systematic reviews summaries. After “Cochrenization”, the number of Wikipedia article views (2018–2019) increased in total/average article views for treatments: migraines by 18%/47%, pain and inflammation — 16%/43%, diabetes mellitus — 18%/0%. Analysis of Cochrane reports showed an increase in the number of views of Cochrane systematic reviews summaries on the website in general by 9 times and from Russian-speaking browsers by 11 times. Improvement of medicine-related articles of the Russian-language Wikipedia by the introduction of information from Cochrane systematic reviews was accompanied by an increase in their demand in terms of the number of views in general by 34%, with a similar increase in control (without intervention) (p-value of the experimental group — 0.002, control — 0.000). The Wikipedia articles on medicines, which belonged to the Russian Vital and Essential Drugs List or the World Health Organization Model List of Essential Medicines, got more views.

Conclusion. The role of confounding factors justifies the feasibility of developing a methodology for studying the usefulness of improving Wikipedia articles, different from controlled trial research methodology; further inclusion of Cochrane knowledge into Wikipedia is needed.

Kazan medical journal. 2021;102(4):459-473
pages 459-473 views

Analysis of microcirculatory disorders in men with more than 10 years’ experience on night work

Gribanov I.A., Zarubina E.G.


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”.

Kazan medical journal. 2021;102(4):474-478
pages 474-478 views

Surgical component of lateral and central breast cancer treatment

Abdurakhmanova Z.M., Ramazanov M.R., Sigal E.I.


Aim. To improve the results of the surgical component in the treatment of a nodular form of breast cancer with lateral and central localization by analyzing hemoglobin oxygen saturation of arterial blood in the foci of breast cancer, regional lymph nodes and resection line of the breast.

Methods. The study involved 175 patients with a nodular form of breast cancer with lateral and central localization (T2–3N1–2M0), including 86 in the main group and 89 in the comparison group. In the main group, hemoglobin oxygen saturation in arterial blood of the foci of breast cancer, parenchyma, pectoral muscles and regional lymph nodes was examined for spread of cancer during surgery for nodular breast cancer by using a device developed by us (patent RU 2581266). This examination was not performed in the comparison group. Histopathological examination of resection specimens revealed confirmation of the main foci of breast cancer and the presence of metastases in the regional lymph nodes and pectoral muscles of the breast. Statistical analysis of the data was performed by using the Statistica 10 software. The arithmetic mean, the standard error of the mean and the standard deviation were calculated for the quantitative indicators.

Results. In the main group, 86 patients had no recurrence and metastases in the follow-up, while in the comparison group, cancer recurrence was identified in 89 patients and metastases was found during cytological and histological studies in 9 patients.

Conclusion. Determination of hemoglobin oxygen saturation of arterial blood during surgery in the subclavian, axillary and subscapular lymph nodes as well as in the pectoralis major and minor muscles allows clarifying the distribution of breast cancer, specifying the scope of the operation and improving the results of the surgical component of breast cancer treatment (T2–3N1–2M0).

Kazan medical journal. 2021;102(4):479-485
pages 479-485 views

Experimental medicine

The effect of substance P on blood serum glycoproteins under technogenic rotating electric fields in animals with different stress resistance profiles

Vorontsova T.S., Vasileva N.N., Isakova L.S.


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.

Kazan medical journal. 2021;102(4):486-493
pages 486-493 views

Efficacy of Leu-Ile-Lys tripeptide in the correction of experimental urate nephrolithiasis

Zharikov A.Y., Mazko O.N., Makarova O.G., Bobrov I.P., Kalnitsky A.S., Zharikova G.V., Yakushev N.N., Gossen I.E.


Aim. To study the effect of the Leu-Ile-Lys (leucine-isoleucine-lysine) tripeptide on the course of experimental urate nephrolithiasis.

Methods. The experiment was carried out on 23 male Wistar rats weighing 200–220 grams that were divided into a control (n=8, modeling of urate nephrolithiasis) and an experimental (n=15, modeling of urate nephrolithiasis + ¬administration of Leu-Ile-Lys tripeptide) groups. The tripeptide was administered intragastrically through a tube at a dose of 11.5 mg/kg. Daily urine was collected on a weekly basis, and the activity of lactate dehydrogenase and gamma-glutamyl transpeptidase was determined. After three weeks of the experiment, the animals were euthanized, and kidneys were removed to determine the parameters of free radical oxidation [concentration of thiobarbituric acid reactive substances (TARS), total pro-oxidant and total antioxidant activity, the activities of catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GPX)] and conduct a morphological study in which the number and area of calculi and the condition of the renal tissues were determined. Statistical data processing was performed using the Statistica 12.0 software. We used the Mann–Whitney U test, the Wilcoxon signed rank test. The results are presented as median with the 25th and 75th percentiles. The differences were considered significant at p <0.05.

Results. In the kidneys of the rats of the experimental group, the number of deposits decreased twofold, as compared with the control group (1.6±0.2 and 3.2±0.4, respectively, p=0.001). Lactate dehydrogenase activity in the urine of rats increased from 0.10 (0.06; 0.21) units/mg of creatinine per day initially to 0.75 (0.44; 1.07) units/mg creatinine per day on day 21 (p=0.012) in the control group, and from 0.10 (0.06; 0.12) units/mg creatinine per day to 0.45 (0.34; 0.71) units/mg creatinine per day on 21st day (p=0.003) in the experimental group. The concentration of thiobarbituric acid reactive substances in the experimental group was 1.2 times lower than that of the control group: 4.2 (3.9; 4.6) μmol and 5.1 (4.7; 5.5) μmol, respectively (p <0.001). In addition, in the kidneys of the rats of the experimental group, the total antioxidant activity was 1.3 times higher than in control: 70.4 (65.4; 74.1)% and 53.8 (33.3; 62.2)% respectively (p <0.001). Superoxide dismutase activity in the experimental group was 1.5 times higher than in the control group: 12.4 (11.0; 13.2)% against 8.1 (6.4; 13.1)% (p=0.016). Catalase activity in the experimental group was 1.2 times higher than in the control group: 31.1 (26.4; 36.1)% against 25.1 (20.3; 27.1)% (p=0.005).

Conclusion. The Leu-Ile-Lys tripeptide has a litholytic effect, manifested in a statistically significant decrease in the activity of oxidative stress markers (p <0,001) and a twofold decrease in the average amount of uric acid kidney stones (p <0,001).

Kazan medical journal. 2021;102(4):494-500
pages 494-500 views

Comparative characteristics of various fibrous materials in in vitro experiments

Timerbulatova G.A., Dunaev P.D., Dimiev A.M., Gabidinova G.F., Khaertdinov N.N., Fakhrullin R.F., Boichuk S.V., Fatkhutdinova L.M.


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.

Kazan medical journal. 2021;102(4):501-509
pages 501-509 views


The role of systemic inflammation in heart failure

Khazova E.V., Bulashova O.V.


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.

Kazan medical journal. 2021;102(4):510-517
pages 510-517 views

Coronavirus infection and gut microbiota

Safina D.D., Abdulkhakov S.R.


At present time, a number of questions regarding the pathophysiological characteristics and therapeutic approa¬ches to the treatment of the new coronavirus infection COVID-19 remain unresolved. In some cases, patients with COVID-19 may experience symptoms of gastrointestinal tract disorder. According to the literature, the new SARS-CoV-2 coronavirus can replicate in the gastrointestinal tract and may affect the gut microbiota. The article aims to review studies about the possible relationship between the gut microbiota condition and the course of COVID-19 infection, as well as to consider the gut microbiota as a potential therapeutic target and probiotic drugs as possible therapeutic agents in the treatment of viral infections, including COVID-19 infection. It is known that gut microbiota condition is one of the factors determining the susceptibility and features of the body’s response to various infectious agents, possibly including the COVID-19 infection. Currently published studies demonstrate a possible relationship between the gut microbiota condition and the course of COVID-19 infection, however, to confirm this hypothesis, additional studies are required, which will allow to make more unambiguous conclusions with subsequent development of new approaches to the prevention and treatment of infection. Potentially a lot of hope in this direction is inspired by the results of probiotics studies, which showed that their use may reduce the frequency and severity of viral infections of the upper respiratory tract. However, currently, there is insufficient data to extrapolate the results of these studies to COVID-19 patients.

Kazan medical journal. 2021;102(4):518-527
pages 518-527 views

Diagnostic value of research methods in diagnostics of chronic pancreatitis

Aliyeva G.R.


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.

Kazan medical journal. 2021;102(4):528-536
pages 528-536 views

The role of risk factors in the development of speech and language disorders in preschool children

Volgina S.Y., Ahmetova A.R., Shaidukova L.K., Zhurkova N.V., Kulakova G.A.


The article provides an overview of modern literature on the risk factors for the development of speech and language, which can be taken into account by pediatricians when forming a high-risk group of the corresponding contingent of preschool children. The leading risk factor for the development of speech/language disorders in children is childhood developmental brain disorders that arose in the prenatal, intrapartum and postnatal period of a child's life, which is often found in children with cerebral palsy, epilepsy, and after head injuries. The occurrence of disorders is greatly influenced by anatomical defects in the speech apparatus, requiring timely surgical correction, and hearing loss. Impairment or absence of speech/language in children is common causes for visiting a psychiatrist, which is observed in autistic spectrum disorders (including autism), elective mutism, mental retardation, attention deficit hyperactivity disorder. Many genetic factors which are often found in patients with other hereditary diseases (chromosome disorders, monogenic hereditary diseases, inherited metabolic diseases, genetic speech disorders) play a special role in the development of speech/language and are associated with developmental disorders, intellectual disability and behavioral deviations. Finally, social factors such as socioeconomic status and social structure of the family, family conflict, pedagogical neglect, child abuse and prolonged use of modern digital devices throughout the day contribute to speech/language development disorders in preschool children. Analysis of the causes of speech/language pathology is of great practical importance for improving the management strategy aimed at preventing the manifestation of the disorders in children.

Kazan medical journal. 2021;102(4):537-544
pages 537-544 views

Social hygiene and healthcare management

Clinical and economic analysis of dental caries prevention using fluorine-containing sealants

Shaymieva N.I., Khasanov R.S., Olesova V.N.


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.

Kazan medical journal. 2021;102(4):545-550
pages 545-550 views

Clinical observations

Exfoliative dermatitis as a complication of drug eruption associated with COVID-19

Faizullina E.V., Khismatulina I.M., Abdrakhmanov R.M., Usmanov V.V.


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.

Kazan medical journal. 2021;102(4):551-556
pages 551-556 views

Clinical experiences

Clinical case of special legal liability which is the result of a doctor when combination of specialties

Spiridonov V.A., Alexandrova L.G., Anisimov A.A., Latfullina R.R., Kulakova E.V.


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.

Kazan medical journal. 2021;102(4):557-562
pages 557-562 views

Evaluation of the effectiveness of methods of transurethral electroresection of bladder cancer

Zubkov A.Y., Nuriev I.R., Sitdykova M.E.


Aim. To evaluate the treatment outcomes of patients with non-muscle invasive bladder cancer by using transurethral resection alone, transurethral resection combined with electrovaporization and transurethral resection with preliminary tumor fulguration.

Methods. The analysis of the treatment outcomes of 81 patients with non-muscle invasive bladder cancer (¬Ta–T1N0M0) in the urological clinic of Kazan State Medical University between the period 2000 and 2016 was carried out. The mean age was 63±10.8 years. The patients were divided into 3 groups. The first group included 28 patients who underwent transurethral resection as monotherapy, the second group — 26 patients underwent transurethral resection combined with electrovaporization, and the third group — 27 patients underwent transurethral resection with preliminary tumor fulguration.

Results. In the group of patients who underwent transurethral resection only, recurrences outside the resection zone occurred in 8 (28.57%) patients, recurrences in the resection zone were detected in 6 (21.43%) patients, and tumor progression was diagnosed in 3 (10.71%) patients. In the group of patients who underwent transurethral resection combined with vaporization, recurrences outside the resection zone were diagnosed in 6 (23.08%) patients, recurrences in the resection zone were detected in 4 (15.38%) cases, and tumor progression was detected in 2 (7.69%) patients. In the group of patients who underwent transurethral resection with preliminary tumor fulguration, recurrences outside the resection zone were diagnosed in 4 (14.81%) patients, in the resection zone — in 6 (22.22%) patients, tumor progression in 2 (7.41%) cases.

Conclusion. Transurethral resection alone is not a radical treatment of non-muscle-invasive bladder cancer; transurethral resection combined with vaporization slightly increases the radicality of treatment; transurethral resection with preliminary fulguration reduces the recurrence rate, ensuring the prevention of implant recurrence.

Kazan medical journal. 2021;102(4):563-569
pages 563-569 views

History of medicine

Formation of hygiene and institutionalization of its teaching as an independent discipline of ­higher medical school in Russia

Shulaev A.V., Ivanov A.Y., Ivanova R.G., Shikaleva A.A.


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.

Kazan medical journal. 2021;102(4):570-580
pages 570-580 views

Modern aspects of morphology of endometrial cancer and neuroendocrine tumors (to the 100th anniversary of the birth of O.K. Khmelnitsky)

Nepomnyashchaya E.M., Moiseenko T.I., Trifanov V.S.


November 4, 2020, marks the 100th anniversary of the birth of Oleg Konstantinovich Khmelnitskiy, an outstanding Russian pathologist, Corresponding Member of the Russian Academy of Medical Sciences (04.11.1920–08.02.2004). The creative legacy of O.K. Khmelnitskiy has a large number of works devoted to endometrial cancer and neuroendocrine tumors. Modern concepts of these tumors take a lot from the scientist’s ideas. The development of the classification of endometrioid carcinomas is determined by new data in molecular genetic research. The most common genetic changes in endometrioid adenocarcinomas involve mutations in the PTEN, KRAS, CTNNB1, PIK3CA, and MS1 genes. Serous carcinomas are characterized by TP53 mutations and HER2-neu gene amplification. The immunohistochemical panel allows differentiation of endometrioid and serous carcinomas. There is evidence of the role of the POLE gene mutation. Various advantages of the introduction of molecular genetic classification are presented, which allow changing approaches to the treatment of endometrial cancer depending on the risk of its development. The 2019 neuroendocrine tumors (NETs) classification allows interpreting morphological characteristics of these tumors in a new way.

Kazan medical journal. 2021;102(4):581-586
pages 581-586 views


80 years to Academician Alexander Alexandrovich Baranov


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.

Kazan medical journal. 2021;102(4):587-588
pages 587-588 views

Cochrane Review Summaries

Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19


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.

Kazan medical journal. 2021;102(4):589-590
pages 589-590 views

Rapid, point-of-care antigen and molecular-based tests for diagnosis of SARS-CoV-2 infection


Люди с подозрением на COVID-19 должны быстро узнать, инфицированы ли они, чтобы они могли самоизолироваться, получить лечение и информировать находившихся в близком контакте. В настоящее время инфекцию COVID-19 подтверждают лабораторным тестом под названием RT-PCR, для проведения которого используют специальное оборудование, а для получения результата часто требуется не менее 24 часов.

Экспресс-тесты в пунктах оказания медицинской помощи могут открыть доступ к тестированию для гораздо большего числа людей, как с симптомами, так и без них, возможно, в местах, отличных от медицинских учреждений. Если они будут точными, то более быстрая диагностика позволит людям быстрее принять необходимые меры, что может снизить распространение COVID-19.

Мы хотели узнать, достаточно ли точны коммерчески доступные быстрые тесты на антигены и молекулярные тесты в точках оказания помощи, чтобы надёжно диагностировать инфекцию COVID-19, а также выяснить, отличается ли точность у людей с симптомами и без симптомов.

Kazan medical journal. 2021;102(4):590-592
pages 590-592 views

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