Vol 98, No 5 (2017)

Theoretical and clinical medicine
Association of FGB, LPL, GPIIIA and TGFB gene polymorphisms with variants of atherosclerosis severity
Garaeva L.A., Mayanskaya S.D.
Abstract

Aim. To estimate the effect of transforming growth factor в, lipoprotein lipase, fibrinogen в and glycoprotein 3б gene polymorphisms on different variants of atherosclerosis severity.

Methods. The study included 319 patients with angiografically verified atherosclerosis. In all patients FGB (rs1800788), LPL (rs328), GpIIIa (rs5918) and TGFВ (rs1800469) polymorphism genotyping was performed. In all patients we evaluated the influence of the studied gene polymorphisms on parameters of atherosclerosis severity such as occlusion and presence and severity of stenosis. Presence of occlusion, occlusion and/or two and more stenoses over 70%, occlusion and multiple critical stenoses were considered the severity criteria.

Results. The studied gene polymorphisms were shown to be associated with severe course of atherosclerosis. GPIIIa polymorphism was commonly determined in patients with more severe course regardless of occlusion and number and severity of stenoses. FGB gene influenced the rate of occlusion development, TGF gene was expressed only in the group with occlusion and/or two and more stenoses over 70%, and LPL gene proved to be significant for the development of occlusion associated with critical stenosis.

Conclusion. The frequency of rare alleles of polymorphic regions is significantly associated with different variants of severe atherosclerosis course; this could suggest unequal influence of gene polymorphisms as well as their proteins on different stages of atherogenesis and requires further investigation.

Kazan medical journal. 2017;98(5):669-674
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Features of lymphatic metastasis of proximal gastric cancer
Akhmetzyanov F.S., Kaulgud K.A., Ruvinskiy D.M., Akhmetzyanova F.F.
Abstract

Aim. To study lymphatic metastasis of proximal gastric cancer to determine the extent of surgical intervention both on the stomach wall and lymphatic pathways.

Methods. The data on lymphatic metastasis were analyzed in 185 patients with proximal gastric cancer not extending to the esophagus who underwent gastrosplenectomy with extended lymphodissection D2 in 2 surgical departments of the Republican clinical oncology center (Kazan) in 1982-2014. All patients were morphologically verified prior to surgery. 105 out of 185 patients (56.7%) had metastases to lymph nodes.

Results. In proximal gastric cancer (within IV and V angiological segments) lymph node involvement in cancer metastases occurs in all sub-segments of the lymphatic system of the stomach. There is a fairly clear pattern: involvement of lymph nodes in metastases mainly occurs in groups №3a, 3b, and 4d, along the common hepatic artery and its branches, around the celiac trunk, along the splenic artery and in splenic hilum. In case of cancer localization in segment IV metastases were observed in 46.7%, in segment V - in 66.7% and in case of involvement of both segments IV and V - in 53.3% of patients. In gastric cancer located within segments IV and V, starting with the involvement of muscular tunic, lymph nodes of perigastric groups (№3b - in 37.1%, 4d - in 11.4%) are often affected as well as parietal lymph nodes of groups 7-12.

Conclusion. In cancer located within gastric segments IV and V gastrosplenectomy with extended lymphodissection D2 should be performed to remove lymph node groups along the splenic artery and in splenic hilum.

Kazan medical journal. 2017;98(5):674-680
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Analysis of the frequency of radiation therapy complications in patients with prostate cancer
Isaev I.G., Guliev F.A., Akperov K.S., Alieva N.R.
Abstract

Aim. Study of the frequency of radiation therapy complications in patients with prostate cancer.

Methods. The study included 142 patients who underwent radiation therapy combined with hormonal therapy in 2001-2015. Average age of patients was 68 years. All of them received 3D-conformal radiotherapy by linear accelerators with 6 to 15 MV photon beams. Single boost dose was 2 Gy, total boost dose was 75 Gy. We studied frequency and severity of acute hematological toxicity and early and late gastroenterological and urological complications of the treatment. Treatment-related toxicity was assessed by RTOG/ EORTC and CTCAE v. 4.0 scales.

Results. Early radiation-induced proctitis of I, II and III degree were registered in 95 (66.9%), 32 (22.5%) and 8 (5.6%) patients, respectively. Acute cystitis of I, II and III degree were noted in 22 (15.5%), 87 (61.3%) and 16 (11.3%) patients, respectively. Signs of late radiation-induced proctitis of I degree was diagnosed in 21 (14.8%) cases. Late radiation-induced cystitis of I degree was diagnoswed in 37 (26.1%) patients. No late complications of higher severity occurred.

Conclusion. The results of the conducted study showed that use of high-tech precision external-beam radiotherapy techniques in the treatment of prostate cancer along with high efficacy allows to reduce the number of early and late complications.

Kazan medical journal. 2017;98(5):680-686
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Features of disorders of the system of cytokines and lipid peroxidation in acute ulcerative gastroduodenal hemorrhages
Gadzhiev D.N., Allakhverdiev V.A., Gadzhiev N.D.
Abstract

Aim. Investigation of the local and systemic levels of some pro- and anti-inflammatory cytokines as well as the system of lipid peroxidation - antioxidant defense of the organism in acute ulcerative gastroduodenal hemorrhages, taking into account the severity of the blood loss.

Methods. We performed the investigation of cytokines in the blood (tumor necrosis factor α, interferon γ, interleukin-1, -2, -4, -6, -8, -10) and parameters of lipoperoxidation (in plasma - diene conjugates, malonic dialdehyde, catalase; in erythrocytes - reduced glutathione, glutathione peroxidase, total antioxidant activity), interleukin-6 in gastric content and urine, diene conjugates and malonic dialdehyde in biopsy samples from the ulcer edges from patients with acute ulcerative gastroduodenal bleeding. The blood serum of 156 patients with mild (54), moderate (51) and severe (51) bleeding was studied. Interleukin-6 in gastric contents was determined in 37 patients, diene conjugates and malonic dialdehyde in biopsy samples taken from periulcerous zone - in 20 patients.

Results. Patients had a statistically significant increase of serum levels of tumor necrosis factor α, interferon γ, interleukins-1, -2, -4, -6, -8, and decrease of interleukin-10 concentration in comparison with the control group. The level of interleukin-6 in gastric juice was 37.5% lower, and in urine - 8.2 times higher than the control value. In plasma and biopsy samples, the content of diene conjugates and malonic dialdehyde was statistically significantly higher, in erythrocytes the level of reduced glutathione was lower than the control value. The depth of imbalance in the system of cytokines and lipid peroxidation - antioxidant defense increased with increasing of blood loss severity.

Conclusion. The relationship between cytokine production and lipid peroxidation indices is established, which confirms the role of local and systemic disorders of cytokine and antioxidant status in the occurrence of ulcer bleeding.

Kazan medical journal. 2017;98(5):686-691
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Health features of newborns depending on vitamin D level of their mothers during pregnancy
Vasil’eva E.N., Mal’tseva L.I., Denisova T.G., Gerasimova L.I.
Abstract

Aim. Evaluation of health state in newborns whose mothers were at risk of pre-eclampsia, depending on vitamin D level.

Methods. Study materials included peripheral blood from pregnant women and umbilical cord blood of newborns. Vitamin D level was measured by enzyme-linked immunoassay kits of BIOMEDICAGRUPPE company (Germany). Intrauterine fetal state was studied with the use of ultrasonography.

Results. Analysis of the study proved that vitamin D level in the umbilical cord blood correlates with its concentration in the mother’s blood. In women at pre-eclampsia risk decreased calcium level and vitamin D deficiency in the blood were detected. Administration of 2,000 IU of vitamin D and 1.5 g of calcium from the beginning of 2nd trimester of pregnancy resulted in reduction of frequency and severity of pre-eclampsia and its complications, including intrauterine growth retardation. Use of vitamin D in combination with calcium supplementation was shown to significantly improve unfavorable perinatal outcomes in women at high risk of pre-eclampsia, reducing by 3 times hypoxia and cerebral fetal lesions frequency that proves the vitamin D importance for functioning of mother-placenta-fetus system.

Conclusion. Children of patients at risk of pre-eclampsia not taking vitamin D and calcium supplementation have lower birth weight and Apgar score, they have more frequent perinatal complications.

Kazan medical journal. 2017;98(5):691-696
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Menopausal disorders in obese women
Idrisova M.A., Esedova A.E.
Abstract

Aim. To study menopausal disorders in women suffering from obesity.

Methods. The study included 165 women in physiological postmenopausal state. Women were divided into two groups: group 1 (study group) included 87 women with obesity, group 2 (control group) consisted of 78 women without obesity. With the use of modified menopausal index (the Kupperman index) the severity of climacteric disorders was assessed. Severity of neurovegetative, metabolic-endocrine and psychoemotional symptoms was assessed according to 4-point scale (from 0 to 3 points). The number of points in each group was summarized and a modified menopausal index was obtained.

Results. It was revealed that in women with obesity severe (in 24 females, 27.5%) and moderate (in 39 patients, 44.5%) climacteric syndrome was prevalent, in patients from the control group such forms were 1.5-2 times less frequent - in 11 (14.2%) and 28 (36.2%) patients, respectively. A deeper analysis of the entire symptom complex of climacteric syndrome revealed that severe and moderate forms of neurovegetative manifestations were 2 times more common in patients with obesity, in contrast to healthy women (in 7.8% and 4.5%, 21.5% and 12.3%, respectively). Severe forms of psychoemotional manifestations were also observed 2.6 times more often in women with obesity.

Conclusion. Severity of menopausal disorders depends on obesity presence, the data obtained demonstrated that, against the background of obesity, climacteric syndrome tends to have prolonged course with predominance of severe and moderate forms.

Kazan medical journal. 2017;98(5):696-701
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Evaluation of attributable risk of dentoalveolar and facial anomalies prevalence among children depending on the features of family history
Aliev Z.U.
Abstract

Aim. To assess the attributable risk of dentoalveolar and facial anomalies prevalence among children depending on the features of family history.

Methods. A sample of 2000 children was selected (250 boys and 250 girls from 4 age groups: 3-5, 6-9, 10-12 and 13-15 years). Characteristics of the family history was obtained by parents’ survey. The risk of dentoalveolar and facial anomalies was determined by comparing their frequency between groups with compromised and normal family history. Attributable risk was defined as the difference in the frequency of dentoalveolar and facial anomalies.

Results. The number of teeth with abnormal position per 100 examined patients ranged widely: from 72.3±1.1 to 105.4±5.3. Depending on various characteristics of the family history, the attributable risk of anomalous tooth position varied in the range from 3.0 to 33.1 per 100 children. The highest attributable risk of anomalies of the tooth position in children was revealed in cases when their parents had a history of dentoalveolar and facial anomalies (33.1%). In the presence of close relatives’ history of dentoalveolar and facial anomalies (except grandparents) attributable risk of anomalies of the tooth position in children was 11.4-14.8%. In the groups of children, whose grandparents had a history of dentoalveolar and facial anomalies, the prevalence of anomalies of the tooth position (80.9±2.0 per 100 children) was not significantly different from that in the control group (77.9±1.0). It can be explained by the fact that during the parents’ survey they were not able to state with certainty grandparents’ history of dentoalveolar and facial anomalies.

Conclusion. Compromised family history in children is associated with high attributable risk of anomalies of occlusion and tooth position.

Kazan medical journal. 2017;98(5):701-703
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Comparative analysis of DQB1 и DQA1 class II genes of human leukocyte antigen system in the population of Azerbaijan
Akhmedov G.A.
Abstract

Aim. To perform comparative analysis of DQB1 and DQA1 class II genes of the human leukocyte antigen (HLA) system in the population of Azerbaijan.

Methods. We studied the alleles of HLA DQ gene and subtypes of HLA DRB1*04 in 160 children with diabetes mellitus and in 271 healthy children from the population of Azerbaijan. Out of 160 patients, 50.6% (n=81) were boys, 49.4% (n=79) were girls. All patients with diabetes were under the age of 18 years. As a control group, 271 students of the Medical College No. 1 were involved: 79 (29.1%) boys, 192 (70.9%) girls. The collected blood samples were sent for further investigation to the medical genetic laboratory where polymerase chain reaction-based genotyping of the samples was performed.

Results. For the first time, the relationship of diabetes with class II genes of the HLA system was studied. The Azerbaijani were found to have higher risk associated with HLA DQ2 molecule. The molecule HLA DQ8 also increases risk, although it is lower in comparison with HLA DQ2 molecule. What is unusual is that for this population the allele HLA DQB1*0304 was also associated with the risk of diabetes.

Conclusion. The haplotype DQB1*0302-DQA1*03/DQB1*02-DQA1*05 (DQ8/DQ2.5) associated with high risk of diabetes is found in 3% of the representatives of the population of Azerbaijan, which is estimated as the average prevalence of diabetes.

Kazan medical journal. 2017;98(5):704-708
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Assessment of quality of life of patients operated for chronic pancreatitis
Tarasenko S.V., Natal’skiy A.A., Zaytsev O.V., Sokolova S.N., Bogomolov A.Y., Rakhmaev T.S., Bakonina I.V., Kadykova O.A.
Abstract

Aim. Comparative analysis of the long-term results of surgical treatment of patients with chronic pancreatitis.

Methods. The study included patients with complicated clinical forms of chronic pancreatitis including: ductal pancreatic hypertension, main pancreatic duct concrements, marked fibrous restructuring of the pancreatic parenchyma and presence of calcifications, presence of biliary hypertension, portal hypertension syndrome, duodenostasis syndrome, chronic abdominal pain syndrome, retention and post-necrotic cysts. Patients were divided into 3 groups: group 1 included patients with chronic pancreatitis receiving conservative treatment (n=32), group 2 - patients who underwent the Frey pancreatic resection (n=24) and group 3 - Beger pancreatic resection (n=9). The assessment was performed according to the most spread specific questionnaire in gastroenterology GSRS (Gastrointestinal Symptom Rating Scale).

Results. The quality of life of patients who underwent both Frey and Beger pancreatic resection was significantly higher than the quality of life of patients in whom chronic pancreatitis was treated conservatively. Quality of life of patients who underwent Frey or Beger pancreatic resection did not differ significantly. Malabsorption syndrome has a significant effect on the quality of life of patients who underwent surgical treatment of chronic pancreatitis. The GSRS questionnaire demonstrated low sensitivity in detecting malabsorption syndrome.

Conclusion. Quality of life of patients who underwent surgical treatment of chronic pancreatitis is statistically significantly higher than in patients receiving conservative treatment; correction of existing quality of life questionnaires is required in order to identify malabsorption syndrome.

Kazan medical journal. 2017;98(5):709-713
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Comparative characteristic of consumption of psychoactive substances by adolescent students of initial vocational education in Kazan and the Russian Federation
Skvortsova E.S., Postnikova L.K.
Abstract

Aim. To identify the patterns of psychoactive substances consumption among adolescent students of initial vocational educational institutions of Kazan compared to equivalent parameters among their peers in the whole across Russia.

Methods. Anonymous survey of adolescent students of initial vocational education in randomly chosen institutions (in Kazan and the Russian Federation - 17 cities from 5 federal districts).

Results. Analysis of prevalence, age-specific structure of initiation and reasons for consumption of psychoactive substances among teenagers aged 15 to 17, students of initial vocational educational institutions of Kazan, revealed that these parameters outnumber similar indicators in the Russian Federation. Prevalence of alcohol consumption among students of initial vocational educational institutions of Kazan was 81.3 per 100 boys and 75.0 per 100 girls, and in the Russian Federation - 59.7 per 100 boys and 63.1 per 100 girls, respectively (p <0.001). Also, the number of boys consuming alcohol in Kazan was significantly higher than the number of girls consuming alcohol. In the Russian Federation, on the contrary, the number of girls consuming alcohol is higher than boys (p <0.05). The reasons for initiation of alcohol consumption among male adolescents in Kazan are different from those among their peers in the whole across Russia. In Kazan the reason for alcohol consumption initiation for boys is «curiosity» (33.7%), and in Russia - «holidays and family celebration» (44.2%). Among adolescents in Kazan prevalence of tobacco use is also higher both among boys (72.8 per 100) and girls (52.9 per 100; p <0.001).

Conclusion. High level of alcohol and tobacco consumption among adolescent students of initial vocational educational institutions of Kazan requires additional special investigation of the reasons for and factors predisposing to this fact.

Kazan medical journal. 2017;98(5):713-719
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Oral diseases prevalence among mariners of the Black sea fleet of the Russian Federation
Nikitenko V.V., Grebnev G.A., Kovalevskiy A.M., Iordanishvili A.K., Chernysh V.F., Murynin V.A., Teplov E.V., Vasil’eva L.V., Kovalevskiy V.A., Vasil’eva M.I.
Abstract

Aim. Investigation of the prevalence and severity of dental diseases of seafarers of the Black Sea Russian Fleet, as well as the need for various types of dental care.

Methods. Thorough dental examination of 785 mariners aged 18 to 40 years was performed. Group 1 consisted of 510 conscripts aged 18-27 years, group 2 - 275 military contract personnel aged 18-40 years. A thorough dental examination was performed using mouth mirror and probe, as well as the graduated periodontal probe. Dental caries extension and DMF (decayed-missing-filled) index were determined. Evaluation of periodontium was carried out according to the CPITN index (Community Periodontal Index of Treatment Needs), hygiene indices (Fedorov, Y.A., Volodkina V.V., 1971) and Sulcus Bleeding Index (SBI, Мuhlemann, Son, 1971).

Results. Investigation of oral disease prevalence among seafarers of the Black Sea Russian Fleet showed its increase during the last twenty years. Particularly, dental caries prevalence among conscripts and military contract personnel of Black Sea Fleet reached 97.64±0.36% and 99.63±0.36%, respectively (DMF 8.85±1.25 and 13.30±2.05, respectively), and prevalence of chronic generalized periodontitis was 10.70±1.37% and 18.30±2.33%, respectively (p <0.005). Periodontal pockets deeper than 5 mm were found in military contract personnel in 4.90±1.30% cases whereas were not found in conscripts.

Conclusion. Prevalence and severity of oral diseases among mariners of the Black Sea Fleet during a twenty year period increased in comparison with the results of studies by G.N. Varavva, A.V. Bazhan (1995) and V.F. Chernysh (1996).

Kazan medical journal. 2017;98(5):719-722
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Prevalence of Helicobacter pylori genotypes in patients with gastroduodenal pathology in Kazan
Akhtereeva A.R., Davidyuk Y.N., Faizullina R.A., Ivanovskaya K.A., Safin A.G., Safina D.D., Abdulkhakov S.R.
Abstract

Aim. Investigation of the prevalence of various H. pylori genotypes among children and adult population of Kazan with chronic gastroduodenal pathology.

Methods. The study included 107 patients (49 children and 58 adults) with chronic gastritis/gastroduodenitis and gastric and duodenal ulcer who had H. pylori infection confirmed by molecular genetic method. All patients underwent biospy from antral mucosa during endoscopy for H. pylori verification by polymerase chain reaction and genotyping for сagA and babA genes and iceA and vacA allels.

Results. CagA gene was found in 19 (32.8%) out of 58 adults and 13 (26.5%) out of 49 children. VacA gene was detected in all patients (100%). VacAs2 genotype in children was nearly 1.6 times as frequent as the vacAs1 genotype (61.2 and 36.7% respectively). In adult patients vacAs2 genotype was detected 2.5 times less frequently than vacAs1 (27.6 and 70.7%, respectively). VacAm2 genotype was revealed in 71.4% (35/49) of children and 77.6% (45/58) of adults. IceA2 genotype was identified in 46.9% (23/49) of children and 44.8% (26/58) of adult patients, iceA1 gene - in 20.4% of children and 55.2% of adult patients.

Conclusion. The strains with vacAs2m2 genotype are prevailing in children (42.9%) and determine low toxigenicity of H. pylori strains; vacAs1m2 genotype is predominant among adult patients (53.4%); high prevalence of cagA-negative strains of H. pylori was found both in children and adults (73.5 and 67.2%, respectively).

Kazan medical journal. 2017;98(5):723-728
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The peculiarities of focal epilepsy in pregnant women
Melikova S.Y.
Abstract

Aim. To investigate the peculiarities of focal epilepsy in pregnant women.

Methods. 70 pregnant women with symptomatic focal epilepsy during the period from 2013 to 2017 were studied.

Results. The average age at the onset of epilepsy was 18.2±0.6 years. The average duration of epilepsy by the time of pregnancy was 6.6±0.7 years. 15 (21.4±4.9%) women remained seizure-free during pregnancy. Seizures during pregnancy were observed in 55 (78.6±4.9%) women: seizure frequency increased in 22 (31.4±5.5%) cases, decreased in 17 (24.3±5.1%), remained unchanged in 8 (11.4±3.8%), in 8 (11.4±3.8%) women the onset of epilepsy occurred during pregnancy. 72.7% of women who were seizure-free for 1 year prior to pregnancy remained seizure-free during pregnancy. In 21 (40.4%) of 52 women with epilepsy diagnosed prior to pregnancy and treated with antiepileptic drugs, the increase of seizure frequency was observed, which can be explained by non-compliance with the regimen and therapy and sleep deprivation in 15 (71.4%) of them. Generalized convulsive status epilepticus during pregnancy was observed in 1 (1.4±1.4%) woman after a sudden withdrawal of the antiepileptic drug.

Conclusion. The risk of seizures during pregnancy is lower in women who were seziure-free for 1 year prior to pregnancy; non-compliance with the regimen and therapy and sleep deprivation may lead to worsening of epilepsy during pregnancy.

Kazan medical journal. 2017;98(5):729-732
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Electromyographic study in spondylogenic monocorditis
Alimetov K.A., Rodnyakova E.B.
Abstract

Aim. To reveal relation between neuromascular disorders of the larynx and cervical spine pathology and to assess extrinsic laryngeal muscular tension in digital format.

Methods. The article contains clinical experience of the survey of 130 patients, 110 of whom were included into the study group with diagnosed spondylogenic monocorditis, and 20 healthy subjects were included into control group. All patients underwent electromyographic study using the patented Kh.A. Alimetov аnd D.D. Jabarov’s technique with the use of 4-channel electromyograph Neuro-MEP (Neurosoft) with the frequency range from 5 Hz to 20 kHz. The used method of interference (global) electromyography allowed obtaining information on laryngeal muscular tension in norm and spondylogenic pathology.

Results. In patients with spondylogenic monocorditis, the upper and lower muscle group tension was increased approximately by 1.2 times on the affected side in contrast to the opposite side. The received results confirm clinical trial data - on the affected side the vocal fold is visually thinner than the opposite fold, lags behind it during phonation and has decreased tension, and the increased tension of anterior laryngeal muscles on the right or left side, revealed during examination and palpation of the larynx, indicates neuromuscular disorder in cervical osteochondrosis on the affected side and involvement of certain laryngeal regions in the process of myofixation.

Conclusion. Electromyographic study provides quantitative assessment of laryngeal muscular tension imbalance, allows to correctly prescribe treatment and to control it.

Kazan medical journal. 2017;98(5):733-736
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Efficacy of Sodium deoxyribonucleate in community-acquired pneumonia in children of school age
Pikuza O.I., Fayzullina R.A., Suleymanova Z.Y., Zakirova A.M., Serdinskaya I.N.
Abstract

Aim. To study efficacy of sodium deoxyribonucleate use for the treatment of community-acquired pneumonia in children of school age.

Methods. 102 children aged 7 to 17 years were observed: 25 relatively healthy children (control group), 39 children with community-acquired pneumonia, who received only conventional treatment (comparison group) and 38 patients with community-acquired pneumonia receiving complex treatment with additional sodium deoxyribonucleate (study group). All patients underwent clinical and instrumental and laboratory examination. Cytomorphologic features of neutrophils and epithelial cells, cytokine concentration (interleukin-8, -10 and -17, tumor necrosis factor α) were examined in nasal secret of patients with community-acquired pneumonia dynamically on different therapy regimens. Evaluation of dynamics of clinical signs was performed in the studied groups.

Results. In the study clinical efficacy of the medication was discovered and caused decreased disease duration, acceleration of inflammatory changes reparation in the lungs in rhinocytogram, decreased level of neutrophils and their destructive forms, decreased levels of pro-inflammatory cytokines - interleukin-8 and tumor necrosis factor α.

Conclusion. Sodium deoxyribonucleate enhances adaptive resources of mucosal immunity, leads to restoration of epithelium lining the upper respiratory airways and therefore potentiates local immunity.

Kazan medical journal. 2017;98(5):736-742
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Determining the efficacy of complex conservative treatment of chronic constipation in children
Polukhov R.S.
Abstract

Aim. Evaluation of the effectiveness of complex conservative treatment of chronic constipation in children of different age groups.

Methods. Results of conservative treatment for chronic constipation in 574 children in different age groups are presented in the article. 321 of those were assigned to traditional treatment (group 1), while 248 were assigned consecutively to metronidazole, intesti-bacteriofague, probiotics along with traditional treatment for more adequate therapy; to magnesium orotate - to correct microcirculatory disorders and tissue dysplasia; to prevent and treat endogenic intoxication and secondary hepatic disease - to glutathione (group 2). The treatment was conducted for a year by courses in months 1, 2, 3, 6, 9 and 12 (total of 6 courses). If ineffective, follow-up treatment was provided: within 2 years - quarterly (4 courses) and during the third year - once in 6 months (2 courses).

Results. Compared to traditional treatment the results of the suggested complex treatment were sifgnificantly better; the best results were achieved in age group 3-7 years; stable and positive result was achieved already by the end of the first year of suggested complex treatment, and with traditional approach the duration of treatment was up to 3 years.

Kazan medical journal. 2017;98(5):742-746
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Experimental medicine
Histologic investigation of cytotoxicity of nanocomposite particles used for direct restorations in dentistry in rat models
Gimaletdinova A.M., Saleeva G.T., Boychuk N.V., Abdul’yanov V.A., Saleev R.A.
Abstract

Aim. To study cytotoxicity of glass-ionomer cement 3MTMESPETMVitremer, nanocomposite for direct restorations 3MTMESPETMFiltekTMUltimate and nanocomposite particles 3MTMESPETMFiltekTMUltimate in the experiment with laboratory male Wistar rats.

Methods. The experimental animals in precervical region of the first left superior molar had a cavity formed with the use of dental drill, which was filled with glass-ionomer cement 3MTMESPETMVitremer, nanocomposite for direct restorations 3MTMESPETMFiltekTMUltimate or nanocomposite particles 3MTMESPETMFiltekTMUltimate. On day 14 the animals were removed from the experiment, and sample of gingiva adjucent to the formed tooth cavity and sample of gingiva from the opposite side of dental arch were taken. Paraffin sections of the samples were prepared and were straightaway placed on a glass slide. For histologic study deparaffinized sections were stained with hematoxylin and eosin and immunohistochemical test with the use of primary antibodies to macrophage marker CD68, marker of cell proliferative activity Ki-67, mesenchymal marker vimentin, endothelial cell membrane antigen CD34 and cytokeratin CKP-PAN.

Results. The results proving cytotoxic effect of nanocomposite particles 3MTMESPETMFiltekTMUltimate on the tissues surrounding teeth, were received. On the operated and contralateral sides morphologic changes of mucosa were found including the signs of inflammation, hyperkeratosis, and cell proliferative activity. Changes of gingival mucosa are mostly pronounced in animals whose tooth cavity was filled with nanocomposite particles.

Conclusion. Taking into account the negative effect of nanocomposite particles discharging at erosion on gingival mucosa, we consider it reasonable to limit the use of the studied materials on occlusal surfaces exposed to heavy mechanical load leading to intensive erosion.

Kazan medical journal. 2017;98(5):747-752
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Prospects for the use of direct antioxidant ionol (2,6-di-tert-butyl-4-methylphenol) for conservative treatment of cataract
Kolesnikov A.V.
Abstract

Aim. To estimate the effect of ionol (2,6-di-teRt-butyl-4-methylphenol) on the dynamics of lens opacities and its free-radical status in experimental cataract.

Methods. Cataract was induced by a single injection of diquat dibromide solution into the vitreous body of 80 rabbits (160 eyes) at a dose of 600 nmol, 5 rabbits were included into the control intact group. Animals with induced cataract were divided into 4 groups each including 20 animals (40 eyes) who were treated with TID instillation in conjunctival cavity of: olive oil (control), «Oftan Catachrom», solution of α-tocopherol acetate, 2.2% ionol oil solution. Treatment was started on day 7. The duration of the experiment was 56 days. Dynamics of lens opacities was assessed by the following criteria: progress, stabilization and regression. In the lens homogenate the concentration of malonic dialdehyde, level of non-protein thiol (SH) groups, activity of glutathione peroxidase and glutathione transferase were determined. The results were analyzed by ANOVA, paired comparison was performed by the Newman-Keysl criterion.

Results. Application of ionol reduced malonic dialdehyde concentration in the lens compared to the series without treatment on days 14, 28, 42 and 56 (by 74.3, 90.0, 89.3, and 80.2%, p <0.05). Use of ionol prevented the depletion of antioxidant enzymes. On day 56, glutathione peroxidase activity exceeded control by more than 400%, and glutathione transferase - by 983.4% (p <0.05). The content of SH-groups by day 56 exceeded the control by 5 times. «Oftan Catachrom» and tocopherol showed no significant effect on free-radical status of the lens. With ionol, marked anti-cataract effect was registered. By day 28, stabilization of the process was noted in 44.3% of cases, and in 11.3% of cases the regression of lens opacities started. Further on, this trend persisted and by the end of the study, in half of the cases regression of lens opacities was noted, and in one third - their stabilization. «Oftan Catachrom» treatment stabilized the process of cataract formation only in 33%, and regression was not observed. Tocopherol did not have a significant effect on the cataractogenesis process.

Conclusion. The received results testify to the pathogenetic validity of the use of the direct antioxidant ionol for the treatment of cataract.

Kazan medical journal. 2017;98(5):753-758
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Blood coagulation system in chronic benzene poisoning via inhalation
Oruzhov R.A., Zhafarova R.A.
Abstract

Aim. To experimentally study the changes occurring in blood coagulation system in exposure to low-dose benzene.

Methods. The experiment was performed on 36 rabbits by chronic exposure of the animals to benzene during 4 months on a daily basis 4 hours a day with 1 non-exposure day a week and a one-month recovery period after the end of exposure. The average poisoning concentration of benzene in the chambers was between 1240±82 mg/m3. The animals were divided into three groups: group 1 was exposed to gradually increasing concentration of benzene, group 2 - to fluctuating (intermittent) concentrations of benzene, group 3 included unexposed to benzene animals and was used as the control group. Overall blood clotting activity, blood clotting time, blood clot retraction, plasma recalcification time, plasma tolerance to heparin, prothrombin index, fibrinogen concentration, blood fibrinolytic activity were determined.

Results. In a month after exposure blood clot retraction rates in groups 1 and 2 increased by 79.8 and 23.1% respectively. Plasma tolerance to heparin most significantly changed in animals from group 2 (by 15.4%). Prothrombin time increased by 11.4% in group 1 while in group 3 this parameter decreased by 0.4%. Prothrombin index in group 1 decreased by 4.3%, and in group 2 the changes were not statistically significant. Concentration of fibrinogen in the blood in group 1 had no significant changes and decreased by 4.2% while in group 2 it decreased by 10.4%. Fibrinolytic activity in group 1 and 2 decreased by 47.5 and 5.8% respectively.

Conclusion. The studied benzene concentrations impair blood coagulation and anti-coagulation systems including two stages of hemostasis: 1st stage - from factor XII activation, 2nd stage - from prothrombin (factor II) activation.

Kazan medical journal. 2017;98(5):758-763
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Experimental validation of gene therapy for ischemic stroke
Sokolov M.E., Bashirov F.V., Safiullov Z.Z.
Abstract

Aim. To develop a protocol of direct and cell-mediated gene therapy for ischemic stroke.

Methods. Viral vector carrying green fluorescent protein (GFP) reporter gene was created on the basis of human adenovirus serotype 5 (Ad5). The umbilical blood supply was preserved according to instructions of Kazan State Medical Uuniversity Stem cell bank. Umbilical cord blood mononuclear cells were isolated in a ficoll density gradient by standard procedure and transduced with Ad5-GFP. Ischemic cerebral stroke in rats was caused by distal occlusion of the middle cerebral artery through trephination hole in a temporal bone under surgical microscope. Within four hours after modeling stroke in the anesthetized animals laminectomy was performed at the L4-L5 level, and (1) 0.9% sodium chloride solution, (2) Ad5-GFP and (3) umbilical cord blood mononuclear cells + Ad5-GFP were inserted intrathecally. Survival, targeted migration to the focus of neurodegeneration, the ability to synthesize recombinant protein and the effect of umbilical cord blood mononuclear cells on the infarction area were assessed using luminescent microscopy and morphometric analysis.

Results. GFP expression in the area of the stroke was established 3 weeks after stroke modeling, both after intrathecal insertion of Ad5-GFP and after xenotransplantation of umbilical cord blood mononuclear cells Ad5-GFP transduced ex vivo. When comparing the areas of cerebral infarction 3 weeks after modeling the stroke, in animals from umbilical cord blood mononuclear cells + Ad5-GFP group the median of the infarction area was 47.4% less than in animals receiving isotonic saline solution.

Conclusion. Umbilical cord blood mononuclear cells + Ad5-GFP after intrathecal insertion to animals with ischemic stroke, are capable of targeted migration to the neurodegeneration site as well as of recombinant protein synthesis; the results suggest the expediency of delivering therapeutic genes to ischemic zone via umbilical cord blood mononuclear cells overexpressing neurotrophic factors.

Kazan medical journal. 2017;98(5):763-769
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Reviews
Modern aspects of the treatment and prevention of diabetes type 2 in patients with metabolic syndrome
Uryas’ev O.M., Morgunova Z.A., Gorbunova D.Y., Shcherbakova O.N., Pyko A.A.
Abstract

Literature review is devoted to the most important medical-social problems of the XXI century - metabolic syndrome and diabetes mellitus type 2. Dirung the last decades prevalence of this pathology is steadily growing worldwide. Metabolic syndrome is associated with high risk of developing diabetes type 2, which is associated with early disability and high mortality from vascular complications. The wide spread of undiagnosed diabetes among persons of working age results in the need for early active detection of the disease in this group. Prophylaxis plays a huge role in the prevention of negative effects of diabetes. Since the major modifiable risk factors of its development are visceral obesity and a complex of its associated states (metabolic syndrome components), normalization of body weight preserves its significance as a measure of primary, secondary and tertiary prevention. In patients with diabetes not only carbohydrate metabolism requires correction, but also body mass, lipid profile, blood pressure, and hemostasis system, that should be considered when choosing a glucose-lowering drug. The article presents the results of nationwide epidemiological studies devoted to the evaluation of prevalence of metabolic syndrome and diabetes type 2 among the adult population. Current understanding of pathogenesis of metabolic syndrome and diabetes is discussed. Attention is paid to 2017 guidelines of the American diabetes Association for obesity management in terms of diabetes prevention, as well as medications that can be used for weight loss in metabolic syndrome. The new criteria for screening for diabetes type 2 are described, the main results of recent studies on cardiovascular safety of glucose-lowering drugs are presented.

Kazan medical journal. 2017;98(5):770-774
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Сorrection of patients’ immune status with human intravenous immunoglobulin
Romanenko N.A., Bessmel’tsev S.S., Chechetkin A.V.
Abstract

The article is dedicated to administration of human intravenous immunoglobulin for patients with different pathology accompanied by immunity disorders. Pharmacokinetics of human intravenous immunoglobulin and mechanisms of its action are presented in detail. Capabilities for its use as replacement (in immunodeficiencies, agammaglobulinemia) and immunomodulatory therapy (in autoimmune disorders) are discussed. We present algorithms for correction treatment with intravenous immunoglobulin of lymphoproliferative diseases (such as chronic lymphocytic leukemia, non-Hodgkin lymphoma, multiple myeloma), patients after hematopoietic stem cell transplantation with recurrent infections, patients with different autoimmune diseases including systemic collagenosis (systemic lupus erythematosus, systemic vasculitis, systemic sclerosis), autoimmune agranulocytosis, immune thrombocytopenia. Capability for the use of intravenous immunoglobulin is considered for treatment of different septic, septicotoxemic complications, herpetic infections (cytomegalovirus infection, infection caused by Epstein-Barr virus) occuring in oncology, surgical and obstetric practice as well as for complex treatment of sepsis including in neonates. The article presents in detail the used doses of intravenous immunoglobulin and methods of its infusion for different groups of diseases. Timely administration of intravenous immunoglobulin in optimal doses allows reducing the duration of treatment of active infection in patients with immunosuppresion of different causes, bleeding in immune thrombocytopenia, intensity of autoimmune disease manifestation as well as reducing the risk of severe infection in innate and acquired agammaglobulinemia without serious adverse effects.

Kazan medical journal. 2017;98(5):775-783
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Modern classification, progression factors, treatment and outcomes of primary mesangial proliferative glomerulonephritis
Sigitova O.N., Kim T.Y., Sharipova R.R.
Abstract

The choice of treatment of mesangial proliferative glomerulonephritis (post-infection, immunoglobulin A, G and M nephritis) is performed taking into account the remission achievement, slowing of progression and reduction of the risk of recurrences of glomerulonephritis. The efficiency of etiologic factor removing is debatable: glomerulonephritis associated with infections usually resolves after their elimination; individual patients achieve immunoglobulin A nephritis remission with persistent antimicrobial treatment of focal infection, but surgical removal of the focus (tonsillectomy) does not affect the long-term prognosis, therefore it is not recommended. Treatment of immunoglobulin A nephritis with oral prednisone for up to 4 months, sometimes in combination with cyclophosphamide (cyclophosphane), reduces the likelihood of its relapse. At low risk of progression of immunoglobulin A nephritis with proteinuria less than 1 g/day, long-term therapy with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers is indicated with administration of maximum tolerated doses for proteinuria more than 1 g/day. Also fish oil 3 g/day is administered for up to 2 years. If proteinuria more than 1 g/day persists for 3-6 months, corticosteroids are recommended for 6 months. With mild renal dysfunction, corticosteroids are prescribed orally or in pulse-therapy with high doses intravenously and maintenance therapy with low doses orally. Immunosuppressive therapy - cyclophosphamide, cyclosporine, azathioprine, mycophenolate mofetil - in combination with corticosteroids is indicated in rapid loss of renal function or massive/moderate proteinuria. In minimal proteinuria immunosuppressive therapy is considered to be unreasonable. Use of intravenous immunoglobulin for immunoglobulin A nephritis from the point of view of lesser toxic effect is possible only as the induction therapy. Currently, there are no clinical recommendations for the treatment of immunoglobulin M nephritis, in case of nephrotic syndrome, corticosteroids are the drugs of the 1st line. There are isolated studies of the use of cyclophosphamide, mycophenolate mofetil, and cyclosporine, with the achievement of remission in frequent relapses of nephrotic syndrome or steroid drug resistance. The cases of immunoglobulin M nephritis treates with retuximab with a positive effect are described. The effectiveness of immunoglobulin G nephritis treatment is less studied, the choice of treatment is similar to that of immunoglobulin A and M nephritis.

Kazan medical journal. 2017;98(5):784-791
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Current conception of carotid chemodectoma and efficiency of its treatment methods
Alferova J.S., Surina V.D., Karpov N.V.
Abstract

The review presents current data from foreign studies of a rare tumor — carotid chemodectoma, particularly, about its prevalence, classification, clinical presentation, applicability of different diagnostics methods, and also on efficiency of treatment of this disease and complications developing after it in terms of described clinical cases. Search for relevant sources was carried out in Medline, US National Library of Medicine, Elibrary systems, in Cochrane Library and peer-reviewed scientific journals. A total of 26 studies were found, 22 of them were included in the review. Carotid chemodectoma is most often characterized by benign course, but, because of its scarce clinical presentation, specific examination methods are required for its accurate diagnosis. Surgical resection is usually used for the treatment of carotid chemodectoma, and in case of contraindications for the surgery, radiotherapy is applied (as a palliative method). The most widespread complications after surgical treatment are cranial nerve damage, intraoperative bleeding and ischemic stroke. Several cases were described in literature, when scientists from different countries (USA, Korea) attempted to decrease risk of complications by use of preoperational embolization, but that led to new complications, particularly, to migration of embolic material. At the same time, scientists from Netherlands noted some decrease of the number of postoperative complications when craniocaudal method was used. To date the only effective method of treatment of carotid chemodectoma is still surgical resection, but it cannot be used in a broad variety of cases. Moreover, the world surgical practice has no effective techniques for prevention of different complications occurring in postoperative period, that reduces possibilities of successful patients’ recovery. Therefore, to decrease the rate of postoperative complications and to increase patients survival rate further studies are required.

Kazan medical journal. 2017;98(5):792-796
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Surgical site infections in spinal neurosurgery
Byval’tsev V.A., Stepanov I.A., Borisov V.E., Kalinin A.A., Pleshko I.V., Belykh E.G., Aliev M.A.
Abstract

The review presents current data on the problem of surgical site infections in spinal neurosurgery. Infectious complications are the most common cause of unsatisfactory results of surgical treatment and prolonged hospital stay of patients after spinal surgery. Clinical and economic analysis shows that each case of infection at the site of surgical intervention causes additional 7.3 days of hospital stay in the postoperative period and $3152 extra costs per patient. According to the world literature, the incidence of wound infection in spinal neurosurgery varies from 0.7 to 11.9%. The main risk factors for this complication are long period from the moment of hospitalization to the operation, significant blood loss and long duration of surgical intervention. In the article, special role in the development of wound infection is given to the malnutrition syndrome. Patients suffering from this syndrome are considered to be at high risk of surgical site infections developing. Insufficient amounts of protein and energy substances are the cause of disturbed reparative processes in the wound and decreased level of immune defense. Diagnosis of wound infection is based on a comprehensive analysis of clinical and laboratory-instrumental research methods. The review presents current data on the pathogens of surgical site infections, regimens of antibiotic prophylaxis and effective methods of treatment (local and systemic antibiotic therapy, vacuum-assisted closure, flow-washing drainage, hyperbaric oxygenation). Undoubtedly, early diagnosis and correctly chosen management of a patient allows to reverse signs of wound infection and to avoid unfavorable clinical outcomes after surgical interventions on the spine.

Kazan medical journal. 2017;98(5):796-803
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Role of lipid peroxidation and antioxidant defense destabilization in the pathogenesis of hypoxia in premature infants
Loskutova E.V., Vorontsova I.A., Vakhitov K.M., Safiullin T.R.
Abstract

The presented literature review describes current views on the problem of preventive diagnosis of hypoxic states in premature infants. To date it is one of the most actual directions in neonatology as according to World Health Organization data, the number of premature births in the world grows annually, and children born earlier than 37 weeks of gestation are at the highest risk for perinatal losses and disability. Special role among disturbing factors is given to conditions related to oxygenation violation in different tissues and organs of a premature infant. Thus, the article deals with lipid peroxidation and antioxidant defense destabilization and degree of their influence on the course of hypoxia. Special attention is paid to cytokine regulation of metabolic processes in a pregnant woman and an infant’s organism. Their role in the course of hypoxic states is emphasized, characteristic changes of some cytokine concentration in this pathology is described and also current views on the possibility of recombinant cytokines use as correction factors are presented. Literature analysis showed that despite significant success in the field of research of cytokine control of hemostasis of the human organism, the issue of pro- and anti-inflammatory interleukins’ role in oxidative stress in premature infants is still open. The authors consider that joint study of lipid peroxidation and cytokine profile may form extended viewpoint on hypoxia pathogenesis that will allow to prognose its severe and complicated course and to develop relevant correction methods.

Kazan medical journal. 2017;98(5):803-808
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Immunoglobulin A and its selective deficiency
Moskalets O.V.
Abstract

Immunoglobulin A plays a key role in local immunity preventing microorganism adhesion and its activity. Besides, it participates in virus and antigenes neutralizing. In the blood Immunoglobulin A circulates predominantly as a monomer, and at secretion as dimer in complex with S-component. Transitory decrease of Immunoglobulin A develops in different states: infectious and inflammatory processes, allergies, tumors. Specific disease is selective Immunoglobulin A deficiency which is a primary immunodeficiency. It is considered the most prevalent primary immunodeficiency but its true prevalence is unknown as in most cases it is asymptomatic and is revealed accidentally at laboratory testing. No specific methods of treatment of selective Immunoglobulin A deficiency exist. The literature review contains data on the character of the pathology, clinical presentation and tactics of patient management.

Kazan medical journal. 2017;98(5):809-813
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The role of amylin in the development of diabetic osteopathy
Safarova S.S.
Abstract

Diabetes mellitus adversely affects the bone. Basically, it is related to weakening of the anabolic effect of insulin and other pancreatic hormones. Mechanisms underlying the decrease in bone density are not fully understood. However, many of the systemic changes related to metabolic abnormalities in diabetes have a damaging effect on the bone tissue. Inadequate compensation of glycemic profile in this disease, both directly (non-enzymatic glycosylation of proteins, activation of polyol pathway of glucose metabolism, oxidative stress) and indirectly (violation of gene expression), damages the bone structure. Another anabolic hormone produced by β-cells of the pancreas is amylin. It is a potent hypoglycemic and antiresorptive hormone affecting calcium homeostasis and influencing the preservation of bone density. The studies have shown that amylin, on the one hand, stimulates osteoblast proliferation, and on the other hand, inhibits osteoclast motility, thus acting similar to calcitonin. Inefficient redistribution of bone mass occurs. This may explain the increased incidence of fractures in patients with type 2 diabetes on the background of high bone density according to densitometry. In this regard, further studies are required to clarify the effect of amylin deficiency on the development of osteoporosis.

Kazan medical journal. 2017;98(5):813-816
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Social hygiene and healthcare management
Some aspects of realizing the order for ophtalmologic service as exemplified by Irkutsk oblast
Zapevalin P.V., Taevsky B.V.
Abstract

Aim. Evaluation of the state of ophthalmologic service in Irkutsk oblast, as well as its compliance with the requirements of new legislative and regulatory documents of the federal level, development of a draft program for the development of ophthalmic care for the adult population of Irkutsk oblast.

Methods. To achieve the goal, two types of special process chart («Personnel» and «Equipment») were developed, based on the technology of a fact-potential method for assessing the performance of health facilities. Information capabilities of these methods were demonstrated. Assessment of comliance of the human resources and material and technical equipment of the ophthalmologic service of Irkutsk oblast with the order for medical care was performed.

Results. A serious staff shortage was reveled, as well as unsatisfactory material and technical equipment of institutions providing ophthalmologic service to the adult population. This problem is especially acute in the regions of Irkutsk oblast. To bring the material and technical base of the ophthalmologic service of Irkutsk oblast into compliance with the requirements of the Law №323 FZ and the approved Order for medical care to the adult population in case of eye diseases, 169.3 million rubles are required, of which 145 million rubles are required for «priority expenses». Measures aimed at improving the state of the ophthalmologic service in the region were suggested. The need to develop and implement a perspective regional targeted program for the development of ophthalmologic service of the Irkutsk oblast for a long-term period was shown.

Conclusion. Human resources and material and technical equipment of medical institutions providing ophthalmologic service to the population of Irkutsk oblast do not comply with the standards; one of the solutions to the problem is the development and implementation of the regional targeted program for the development of ophthalmologic service.

Kazan medical journal. 2017;98(5):817-821
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Change in affordability of medications in Kazan in 2011 and 2015 as a reflection of state initiatives to regulate drug prices
Razzakova C.M., Ziganshina L.E.
Abstract

Aim. Performing comparative analysis of drug prices in 2011 and 2015 in Kazan to assess the effectiveness of state initiatives to ensure the affordability of medicines.

Methods. The collection and processing of data was performed according to methodology developed by Health Action International and World Health Organization (WHO/HAI). We studied the availability and prices of 30 medicines in public and private pharmacies in Kazan in 2011 and 2015 and analyzed the procurement prices of the same medicines in inpatient hospitals. Recording and analysis were performed using standardized MS Excel WHO/HAI Workbook. Medicine prices were compared with international reference prices and were expressed as median price ratio.

Results. The analysis showed a decrease in medicine prices in 2015 compared to 2011. In public and private sectors median price ratio of the originator brands reduced by about 3 times, and of the lowest price generics reduced by 1.5 times. A decrease in procurement prices by more than 2 times for generics and more than 6 times for the original brands was also revealed in 2015 in comparison with 2011.

Conclusion. State initiatives to regulate drug prices contributed to the price reduction by 1.5-3 times in 2015 compared to 2011; changes in the procedures for the medicines procurement at the legislative level resulted in reduction of procurement prices by more than 2 times for generic drugs in 2015 compared to 2011.

Kazan medical journal. 2017;98(5):822-826
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Occupational allergic diseases in the Samara region: features and problems
Nikiforova G.A., Spiridonov A.M., Gavryushin M.Y.
Abstract

Aim. Improving the system of identifying occupational allergic diseases based on the anaysis of the features of occupational allergic morbidity in the Samara region for the period from 2005 to 2014.

Methods. Comprehensive retrospective study of occupational allergic morbidity in the Samara region was carried out on the data from 3229 occupational diseases (poisoning) registry cards including 278 occupational allergic diseases registry cards, as well as 262 acts on cases of occupational diseases. Obtained data were compared to the official data of the Federal budgetary healthcare institution «Federal center of hygiene and epidemiology» of Rospotrebnadzor and the reports of the Office of Rospotrebnadzor in the Samara region «On the sanitary-epidemiological welfare of population» for the relevant years.

Results. The proportion of occupational allergic diseases in the Samara region is in average 7.68±1.03% of all newly diagnosed cases of occupational diseases varying from 12.25% in 2005 to 3.22% in 2013, exceeding the same indicator across Russia. In the structure of occupational allergic diseases the most common nosological forms were revealed: bronchial asthma - 37.86%, allergic rhinitis - 25.07%, allergic (atopic) dermatitis - 7.93%, eczema - 7.68%. In 78.38% of cases the priority allergens in the region were chemical allergens: formaldehyde, chromium, nickel, molybdenum and other metals compounds, antibiotics, disinfectants, chlorine and synthetic detergents and others. 38.07% of cases of occupational allergic diseases were found to be registered in Samara, 26.15% of cases - in Tolyatti, and 5.50% of cases - in Otradnoye in the Samara region. The proportion of occupational allergic diseases found at periodic medical examinations was in average 29.31±4.5%.

Conclusion. The identified features of occupational allergic morbidity in the Samara region show the necessity to improve the organization and conduct of preventive measures, periodic medical examinations as well as further development of the regulatory framework.

Kazan medical journal. 2017;98(5):827-832
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Gender aspects of work motivation among oncologists
Gataullin I.G., Zabirova L.M., Gataullin I.I.
Abstract

Aim. Study of work motivation and job satisfaction factors among oncologists from a gender perspective.

Methods. The survey involved 102 physicians-oncologists of the Republic of Tatarstan - 47% men and 53% women. The study included the following methods: observation, questionnaire, interview.

Results. Among all corporate factors, the work content (the functions performed, complexity, diversity, responsibility) was highly evaluated by men - 8.26 points (on a 10-point scale), the style and methods of leadership in the unit - 7.24 points. The highest score (above 8 points) among female doctors was given to organizational culture, training, labor peer review by colleagues, the style and methods of leadership in the unit, as well as standards, rules, regulations, and their implementation. Job satisfaction indicators among male doctors were generally lower than among women in all 16 occupational characteristics. Among the leading motivators oncologists place work content, positive attitude towards their profession, mission and goals of the clinic. They oppose demotivators such as pay rate, moral motivation, career opportunities and provide an acceptable level of work motivation for doctors. Compensation in the form of an award came out on top among the forms of stimulation both in men and in women. Forms of non-cash stimulation are also quite popular with doctors and are approximately equal in men and women: advanced training in the leading domestic and foreign clinics, payment of sports occupations, days off. Women prefer additional vacation, a praise, acknowledgement from the executive management of the clinic. Men appreciate more position increase, awarding of honorary title and especially provision of larger freedom and powers at work.

Conclusion. Gender studies of motivation demonstrated the differences in the attitude towards work, in its most important characteristics, labor values among male and female oncologists.

Kazan medical journal. 2017;98(5):832-837
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Clinical observations
Case of atypical retroperitoneal suppurative complication of acute appendicitis
Shaymardanov R.S., Gubaev R.F., Sharafiev S.Z., Nuriev I.I., Gafurov K.D.
Abstract

The article presents a case of an occasional extraperitoneal suppurative complication of acute appendicitis due to atypical clinical manifestation and diagnostic complexity. A 56-year-old male was hospitalized to the urological emergency department of Emergency Hospital №2 in December, 2014, with low back pain suggestive of renal colic. Renal ultrasound revealed cavitary lesion with liquid content in right lumbar region. Pus was drawn off by tapping. Further on, the abcess was opened 6 times during 2 following years. X-ray computed tomography of abdomen showed that the apex of appendix was located in lumbar (Petit) hernia and communicated with purulent cavity. Planned appendectomy was performed on January, 10, 2017. Convalescence. Histological finding (11.01.2017) was simple appendicitis. The reported case is of clinical interest as a rare compication of acute appendicitis developed in appendix located in lumbar (Petit) hernia; X-ray computed tomography of the abdomen is the most informative instrumental method for the diagnosis of acute appendicitis and its complications.

Kazan medical journal. 2017;98(5):838-840
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Case of periodic disease with recurrent interstitial lung disease
Shestakova A.V., Volkova S.N., Shestakova G.V., Gorbunova M.L., D’yachkova I.V., Radovskaya E.V.
Abstract

Periodic disease or Familial Mediterranean fever is an inherited monogenic disease widespread among the ancient peoples of the countries of Mediterranean region: Armenians, Jews, Turks, Arabs. MEFV gene (Familian Mediterranean Fever Gene) located on chromosome 16 in the region 16р13.3, is responsible for the development of the disease. MEFV gene encodes marenostrin protein (Pirin) involved in the regulation of inflammatory processes. Typical manifestations of the disease are recurrent fever, peritonitis, synovitis, pleuritis, and rarely pericarditis, meningitis, erysipeloid skin lesions, development of amyloidosis, mainly kidneys, is also characteristic. In the described clinical case the disease has manifested as recurrent interstitial lung disease and morphea-like skin lesion. Over 5 years the lung pathology was considered as cryptogenic organizing pneumonia, so the patient was administered corticosteroids (with no effect). In 2013, molecular genetic study detected mutations V726A and A744S in compaud-heterozygous state, the diagnosis of periodic disease was confirmed. Receiving colchicine for over 3.5 years induced remission of the disease: there were no episodes of febrile fever and exacerbations of pneumonia, radiologic regression of lung lesions and elimination of morphea-like skin lesion was observed. Clinical symptoms of periodic disease in this case are rarely encountered.

Kazan medical journal. 2017;98(5):840-845
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Clinical experiences
A method of treatment of knee hemosynovitis after arthroscopic meniscal resection
Vasil’ev V.N., Novikov A.V.
Abstract

Aim. Optimization of the treatment of patients with knee hemosynovitis after arthroscopic meniscal resection in early postoperative period.

Methods. The results of treatment of 79 patients aged 18 to 60 years, who underwent arthroscopic meniscal resection complicated by knee hemosynovitis, were analyzed. Out of them, 38 patients underwent the treatment according to authors’ method (group 1) which included joint drainage with +5 °С isotonic solution of Sodium hydrocarbonate until the solution ran clear, and intraarticular administration of a cocktail of 5% Ascorbic acid solution for injections, 5% Sodium dimercaptopropansulfonate (unithiol) and 0.5% procaine (novocaine) in a ratio 1:1:1. 41 patients (group 2) received traditional treatment - only tapping and intraarticular administration of 3 ml of 0.5% procaine (novocaine). To assess the efficacy of treatment, severity of edema and pain syndrome, results of MRI on days 3 and 7 after arthroscopy, hydrogen ion concentration, relative density, lipid hydroperoxide level, total SH-groups, cytosis and synovial cytogram of hemosynovial fluid were measured, as well as the number of punctures, hospital stay and survey results of 45 patients.

Results. Surgical intervention was found to lead to inflammation, decreased hydrogen ion concentration, increased lipid peroxidation and decreased thiol antioxidants concentration. The severity of these changes correlates with severity of clinical manifistations. In the early postoperative period inflammatory processes develop in the knee, which clinically manifest as hemosynovitis, occurrence of which after arthroscopic meniscal resection is 16%.

Conclusion. The developed method of the treatment of postoperative hemosynovitis leads to faster decrease of severity of lipid peroxidation, pain syndrome and inflammatory reaction as opposed to traditional treatment.

Kazan medical journal. 2017;98(5):846-851
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The experience of minimally invasive restoration of acromioclavicular joint anatomy from mini-approach
Kogan P.G., Chugaev D.M., Sudyakova M.Y., Lasunskiy S.A., Sorokin E.P., Stafeev D.V.
Abstract

Aim. To develop a method of acromioclavicular joint stabilization with the TightRope system using «mini-open» technique and to evaluate effectiveness and safety of this surgery.

Methods. The study involved 11 patients with Rockwood type III, IV and V acromioclavicular joint dislocation, who underwent «mini-open» surgery of acromioclavicular joint stabilization using the TightRope device. The results were evaluated clinically using the Constant scale and radiologically 3, 6, and 12 months after the treatment. The results obtained were statistically processed and compared to the results of the treatment of patients with the same pathology published in the foreign literature.

Results. In the early postoperative period (up to 3 months after the surgery) functional result according to Constant scale in the studied patients varied in the score range of 67.5±16.2. In the period of up to 12 months all patients had 82.5±11.5 score, which corresponds to good and excellent results and does not show significant difference compared to the arthroscopic technique (according to literature data). Complications among observed patients occurred in 18% and were identified in 2 patients (1 case of fixation loss, 1 local skin inflammation in the area of the wound).

Conclusion. New surgical techniques allow achieving good and excellent functional results and to improve patient satisfaction.

Kazan medical journal. 2017;98(5):851-857
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The role of antibiotic therapy and hysteroscopy technique in the prevention of infectious and inflammatory complications
Klyucharov I.V., Morozov V.V., Khasanov A.A., Ampilova E.A., Yusupov K.F.
Abstract

Inflammatory complications are relatively frequent in the hierarchy of complications of hysteroscopy. The article describes two clinical case scenarios of hysteroscopic procedures complicated by pelvioperitonitis. The analysis of contemporary local and international literature is presented, and shows different attitude towards the antibiotic prophylaxis of inflammatory complications related to hysteroscopy. Taking into account that potential spread of infected material from the uterine cavity through the tubes into Douglas space plays role in the pathogenesis of inflammatory complications, it is advisable to consider the value of intra-uterine pressure as one of the main factors responsible for the development of inflammatory complications. It is also prudent to use the technique and values of in-office hysteroscopy to prevent tubal reflux and thus reduce the chance of infectious complications. The possibility of complete abandonment of antibiotic prophylaxis requires additional research and confirmation with clinical studies.

Kazan medical journal. 2017;98(5):857-861
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Buccal mucosal urethroplasty, first experience in the Samara region
Nizamova R.S., Bayrikov I.M., Gubanov E.S., Stolyarenko P.Y., Boryaev E.A., Soltanov A.D., Evstigneeva T.M.
Abstract

The incidence of urethral strictures in the structure of genitourinary diseases is about 6%. Treatment effectiveness, according to the literature, accounts for only 30%. The article describes the authors’ early experience of urethroplasty with free flaps of oral mucosa. Similar operations were performed for the first time in the Samara region. The stages of the surgery are described, images of surgical stages and pre- and post-operative urethrography results are presented. From the oral cavity a full-thickness mucosal flap 4×1.5 cm in size was taken. Wounds in the oral cavity were sutured, whereby uniform epithelialization without forming rough scars occurred. Through perineal access bulbar urethra with cicatricial changes was approached and mobilized. Buccal flaps were separated from underlying fatty tissue and sequentially fixed to the cavernous bodies with the separate sutures. Dorsal wall of the mobilized urethra was incised along the stricture. Bladder was drained through silicone catheter 14 Ch, above which the edges of incised urethra were sutured with the edges of transplanted mucosa. Surgical wound was sutured in layers tightly. In the late postoperative period, patients underwent urethrocopy and uroflowmetry. Good functional results were achieved.

Kazan medical journal. 2017;98(5):861-864
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Pneumatic induction of the posterior vitreous detachment - a minimally invasive method of treating vitreomacular traction syndrome
Petrachkov D.V., Zolotarev A.V., Zamytskiy P.A., Karlova E.V., Podsevakina T.A.
Abstract

To study the efficacy of pneumatic induction of posterior vitreous detachment for the treatment of vitreomacular traction syndrome, the analysis of the results of surgical treatment of 10 patients (10 eyes) with vitreomacular traction syndrome was performed, among them 8 patients (8 eyes) had an accompanied immature age-related cataract and 2 patients (2 eyes) - pseudophakia. The average age of the patients was 64.1±4.6 years, among them 8 women and 2 men. The mean best corrected visual acuity on admission was 0.31±0.15, the average length of vitreomacular adhesion and retina thickness in the fovea by optical coherence tomography were 289.3±75.4 and 367.5±50.3 μm, respectively. Patients with pseudophakia underwent pneumatic induction of the posterior vitreous detachment, and patients with cataract underwent the same surgery in combination with phacoemulsification of the cataract and intraocular lens implantation. Within 1 month of follow-up, all patients had a complete posterior vitreous detachment and increased best corrected visual acuity. Intraocular pressure remained normal throughout the follow-up period in 9 out of 10 patients, 1 patient experienced hypertension on day 1 after the surgery, which required decompression during the gas expansion period. Further on, intraocular pressure was normalized and did not require therapy. Pneumatic induction of posterior vitreous detachment is an effective method of treatment of vitreomacular traction syndrome, which allows eliminating vitreomacular traction; the combination of pneumatic induction of the posterior vitreous detachment with phacoemulsification of cataract allows avoiding hypertension during and after operation and avoiding performing vitrectomy.

Kazan medical journal. 2017;98(5):865-868
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Jubilees
Professor Lidiya Ivanovna Anchikova is 80 years old
 
Abstract
Становление и развитие современной школы эндокринологии в Республике Татарстан (РТ) невозможно без основателя кафедры клинической эндокринологии Казанской государственной медицинской академии доктора медицинских наук, профессора, заслуженного врача РТ, председателя общества эндокринологов РТ, директора клиники «Авиценна-эндокринология» Лидии Ивановны Анчиковой. 20 августа 2016 г. Лидии Ивановне исполнилось 80 лет.
Kazan medical journal. 2017;98(5):869-870
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Obituary
Gennadiy Alekseevich Izmaylov
 
Abstract
6 августа 2017 г. на 86-м году жизни скоропостижно скончался преподаватель кафедры общей хирургии (1966-2001) Казанского государственного медицинского университета, кандидат медицинских наук, изобретатель СССР, лауреат ВДНХ СССР (1989) Геннадий Алексеевич Измайлов, научные разработки которого нашли заслуженное признание в нашей стране и за рубежом.
Kazan medical journal. 2017;98(5):871-872
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Retraction: "Experience of cooperation in the creation of hematopoietic stem cells donors registry" by Murzabekova M.A., Neredko J.S., Marchenko Y.M.
 
Abstract
Отзыв из печати статьи Мурзабекова М.А., Нередько Ю.С., Марченко Я.М. Опыт сотрудничества по созданию регистра доноров гемопоэтических стволовых клеток. Казанский мед. ж. 2016; (5): 777-780. DOI: 10.17750/KMJ2016-777. Изъятие (ретракция) публикации обусловлено выявлением неправомерного заимствования авторами результатов интеллектуальной собственности ФГБУ РМНПЦ «Росплазма» ФМБА России (г. Киров) и материалов презентации на тему «Возможности поиска неродственного донора костного мозга в России» И.В. Парамонова (г. Кисловодск, 2015 г.). Протокол заседания редакционной коллегии «Казанского медицинского журнала» №3 от 28.06.2017.
Kazan medical journal. 2017;98(5):872
views


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