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Vol 103, No 1 (2022)

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Theoretical and clinical medicine

Effect of preoperative platelet alpha-granules secretion on hemostasis and blood loss in large joint arthroplasty

Antropova I.P., Yushkov B.G., Kutepov S.M.

Abstract

Background. Currently, it was proven that the role of platelets is not limited to the formation of a clot that stops blood loss and provides vascular wall repair. The importance of determining the functional characteristics of platelets in patients who underwent traumatic surgery is beyond doubt. However, there are few studies on this subject.

Aim. To determine the effect of the preoperative platelet α-granules secretory activity on the coagulation parameters and blood loss in total hip arthroplasty (THA).Material and methods. The study included 58 patients admitted to the hospital for primary total hip arthroplasty. All patients were divided into 2 groups according to the preoperative plasma level of the specific platelet α-granules protein β-thromboglobulin (β-TG). The group with a low plasma level of β-thromboglobulin (<30 IU/ml) consisted of 30 patients, the group with a high level (≥30 IU/ml) — 28 patients. Blood sampling was carried out 1 day before the operation, 30 minutes after surgery, on the 1st, 3rd, 7th 14th days after the total hip arthroplasty. The platelet count, β-thromboglobulin, and D-dimer levels were determined. The plasma coagulation was examined by using thromboelastography. The volume of intraoperative blood loss was estimated by the gravimetric method, postoperative blood loss — by drainage volume. Statistical analysis was carried out by using the Friedman, Wilcoxon, Mann–Whitney tests, calculating Spearman's rank correlation coefficient. All calculations were performed using the Statistica 8.0 software.

Results. Before surgery, the group with a high level of β-thromboglobulin showed significantly higher levels of D-dimer than the group with low levels: 132 [73; 191] ng/ml and 79 [37; 123] ng/ml (p=0.024); and shorter R times (time to onset of clotting): 13.7 [11.5; 15.3] min and 15.5 [13.0; 18.1] min (p=0.048), respectively. The maximum β-thromboglobulin was observed at the end of the operation. The release of β-thromboglobulin was significantly more intense in the group with low levels of β-thromboglobulin than in the group with high levels: 35.6 [10.5; 78.0] IU/ml and 19.0 [0; 41.3] IU/ml, respectively (p=0.027). A relationship was found between β-thromboglobulin levels and D-dimer concentration early after surgery (30 minutes), Spearman's correlation coefficients for groups with low and high levels of β-thromboglobulin: r=0.57 and r=0.48, respectively (p <0.05 for both). Blood loss in the group with low β-thromboglobulin levels was significantly higher than in the group with high levels: 850 [550; 1050] ml and 600 [500; 850] ml, respectively (p <0.05).

Conclusion. In patients requiring total hip arthroplasty, an increase in the activity of platelet α-granules secretion is associated with an increase in the activity of fibrin formation and a shortening of reaction time to onset of clotting; during surgery, the secretory activity of platelets is directly related to the activity of coagulation and affects blood loss volume.

Kazan medical journal. 2022;103(1):5-13
pages 5-13 views

Features of the anti-erythrocyte antibodies screening results interpretation in patients with ­hematological diseases

Krobinets I.I., Mineeva N.V., Bodrova N. ., Sisoeva E.A., Gavrovskaya S.V., Sidorkevich S.V., Bessmeltsev S.S.

Abstract

Background. Screening for anti-erythrocyte alloantibodies is a mandatory pre-transfusion test. The correct interpretation of the screening results plays a key role in ensuring the immunological safety of hemotransfusion therapy.

Aim. To study the features of anti-erythrocyte antibodies detection in patients with hematological diseases.

Material and methods. The study was performed with blood samples of 1269 patients with hematological diseases (569 male and 700 female patients aged 18–85 with a median of 63 years). Screening and identification were carried out in indirect antiglobulin test using ID Coombs Anti-IgG gel cards with 4 and 15 samples of test erythrocytes as well as the salt agglutination method. The results were evaluated visually. The Pearson chi-squared test was used to check the statistical significance of differences in the alloimmune anti-erythrocyte antibodies frequency detection. The differences were considered statistically significant at p ≤0.05.

Results. Interpretation of the anti-erythrocyte alloantibodies screening results was difficult in 6.55% of cases and was associated with the presence of autoantibodies in plasma (0.6%) and cross-reactive antibodies (5.9%). Аnti-erythrocyte alloantibodies were detected in 2.05% of cases which required further identification of antibody specificity. Antibodies to Rh system antigens were detected in 68.2% of cases, to antigens of other erythrocyte systems — in 31.8% of cases. In Rh-negative patients only anti-D or anti-DC antibodies were detected. Rh-positive patients were more likely to have anti-K antibodies (30%). Anti-E antibodies were discovered in 20% of cases, anti-Cw and anti-Fya — in 10% each. Alloantibodies were detected most frequently in patients with β-thalassemia (20%), aplastic anemia (13%), hemophilia (9.2%) and thrombophilia (6.9%) and less frequently in patients with hemoblastosis and hematopoiesis depression (0.3–2.4%). Cross-reacting antibodies were detected more frequently in patients with multiple myeloma (74.7%; p ≤0.05) than in patients with chronic lymphocytic leukemia (17.3%), myelodysplastic syndrome (5.3%), and acute leukemia (2.7%).

Conclusion. The reasons for the difficulties in interpreting the alloantibody screening results in hematological patients were the presence of autoantibodies (0.6%), alloantibodies (2.05%) and cross-reacting antibodies (5.9%).

Kazan medical journal. 2022;103(1):14-22
pages 14-22 views

Evaluation of long-term treatment results of patients with critical limb ischemia and diabetes mellitus with different management approaches

Kalinin R.E., Suchkov I.A., Krylov A.A., Mzhavanadze N.D., Pshennikov A. ., Vinogradov S.A., Solyanik N.A., Karpov V.V.

Abstract

Background. In all cases of critical lower limb ischemia revascularization should be performed. However, the overlay of diabetic angiopathy significantly worsens the prognosis of the surgery, and the conservative therapy also frequently turns out to be ineffective even in the nearest future. Therapeutic stimulation of angiogenesis in this group of patients is an additional application point for the possible improvement of treatment results.

Aim. Evaluating treatment results of patients with critical ischemia and underlying diabetes after 5 years from the beginning of supervising, as well as assessing the benefits of additional angiogenesis as a part of treatment.

Material and methods. The study included data from 140 patients with critical ischemia and diabetes mellitus, divided into 4 groups, who received surgical [groups IA (n=45) and IB (n=30)] or therapeutic [groups IIA (n=40) and IIB (n=25)] treatment. Additional angiogenic therapy was also carried out in two groups (groups IB and IIB). Treatment outcomes were assessed over a 5-year period. Efficacy criteria were evaluated in the form of limb preservation and patient survival. The results were studied using descriptive statistics methods. Qualitative data were analyzed by constructing 2×2 contingency tables and using the xi-square method.

Results. The best indices of limb preservation and the lowest mortality of patients were obtained in the group after revascularization with additional angiogenic therapy. Gene therapy induction significantly improved the course of disease in limb preservation for periods from 6 months to 2 years (30% amputations by 2 years of follow-up, p=0.045). Angiogenic induction of angiogenesis also made it possible to improve the treatment results in the groups of conservative therapy but reliably better indicators of limb preservation were obtained in two groups with surgical interventions.

Conclusion. The optimal management tactic for patients with critical lower limb ischemia and underlying diabetes mellitus is direct revascularizing intervention on the lower limb arteries with additional angiogenic therapy in the postoperative period. Additional gene therapy induction of angiogenesis makes it possible to reduce the number of amputations both as part of combined surgical or therapeutic treatment , but it cannot be an alternative to surgery.

Kazan medical journal. 2022;103(1):23-34
pages 23-34 views

Research on adherence of elder patients with cardiovascular diseases to surgical treatment and assessment of the endovascular treatment clinical efficacy

Goloshchapov-Aksenov R.S., Rukodaynyy O.V., Volkov P.S.

Abstract

Background. Patients with cardiovascular diseases (CVD) older than 70 years have low adherence to surgical treatment.

Aim. To investigate the adherence of elder patients with CVD to surgical treatment and evaluate the effectiveness of endovascular care.

Material and methods. In 2016–2020 on the basis of the vascular surgery department of the Central Clinical Hospital “Russian Railways-Medicine” (Moscow) and the Peoples' Friendship University of Russia standardized clinical interviewing of patients with surgical CVD (n=422, average age 76.11±7.2 years) was conducted. Patients were considered adherent to surgical treatment if more than in 90% of cases they agreed to undergo cardiovascular surgery. Endovascular operations were performed (100%). Evaluation of the endovascular treatment effectiveness was carried out according to the following criteria: reducing the degree of ischemia, the duration of hospital treatment, the frequency of hospitalizations during the year caused by the CVD progression, and two-year survival. The duration of patients’ supervision was 24 months. We compared the results of the years 2016–2017 (the period of mainly conservative treatment, group A, n=106) and the years 2018–2019 (the period of high surgical activity for CVD, group B, n=422 which included 106 patients from group A). Differences between the compared indicators were considered significant at p <0.05.

Results. The adherence of patients over 70 years old to surgical CVD treatment was 99.5% if endovascular techno­logy was suggested. The priority usage of endovascular care contributed to the growth of surgical activity in the vascular surgery department from 7 to 98.9% (p=0.0015), as well as high immediate and long-term (24 months) clinical efficiency (100 and 88%), and two-year survival of patients up to 100% (group B). The average duration of hospita­lization for endovascular treatment was 5.1±0.11 days, for conservative treatment it was 8.4±3.6 days (p=0.02). The average number of hospitalizations per year for patients in group A was 3.1 times, in group B — 1.6 times (p=0.0028).

Conclusion. Endovascular care for CVD curing is an effective method of surgical treatment and promotes adherence of elder patients to surgical treatment.

Kazan medical journal. 2022;103(1):35-43
pages 35-43 views

Structure of the drug treatment adherence in elderly patients with mild cognitive impairment and psychopathological symptoms

Kovtun O.P., Sidenkova A.P., Izmozherova N.V., Serdyuk O.V., Vikhareva A.A., Melnik A.A., Rezaikin A.V.

Abstract

Background. The high prevalence of pre-dementia cognitive impairment in the elderly, their poor prognosis with a frequent transition to dementia, polymorbidity with somatic pathology determine the need for adequate correction of all somatic diseases. This increases the importance of treatment adherence.

Aim. To assess the structure of drug treatment adherence in elderly patients with mild cognitive impairment (MCI) and psychopathological symptoms.

Material and methods. An observational study of 264 patients diagnosed with mild cognitive impairment was conducted. The average age was 68.5±1.4 years. Of these, 17.6% were men, and 83.3% were women. The patients were divided into two groups: with psychopathological symptoms (main group, n=189) and without psychopathological symptoms (comparison group, n=75). Research methods used: clinical-psychopathological, psychometric, statistical by using Statistica 7 software for Windows OS. The Pearson's chi-squared test, the nonparametric Mann–Whitney U test, and the correlation analysis with calculation of Spearman’s rank correlation coefficient (r) were used.

Results. The adherence (compliance) of the study participants in relation to general therapeutic recommendations is represented by social, emotional and behavioural compliance. The total score of general compliance in the main study group was 45.42±29.7, in the comparison group — 51.09±32.3 points (p=0.031). In the main group, half of the participants (49.7%) had a low total score of general compliance, less than half of the participants had an average total score, only 4.8% of the participants showed high compliance with therapeutic recommendations. Increased depression correlates with low overall, social and emotional competence (r=0.512). Severe agitation and aggression correlate with low behavioural and emotional competence (r=0.589). Statistically significant correlations were found between psychotic symptoms and low behavioural compliance (r=0.151 and r=0.145).

Conclusion. The overall medication compliance rates are lower in patients with affective and psychotic symptoms; an increase in the number of affective, psychotic, behavioural disorders in patients with mild cognitive impairment correlates with low overall, social, emotional and behavioural compliance.

Kazan medical journal. 2022;103(1):44-53
pages 44-53 views

Dynamic assessment of the enzyme immunoassay composition of the oral fluid in children with physiological occlusion and anomalies of the dentition

Kosolapova I.V., Dorohov E.V., Lesnikov R.V.

Abstract

Background. Understanding the dynamics of changes in the immunoenzyme composition of the oral fluid at various stages of treatment will allow the doctor to correctly draw up a treatment plan, predict its timing, and prevent the development of complications.

Aim. Dynamic assessment of the enzyme immunoassay composition of the oral fluid in children with physiological occlusion and anomalies of the dentoalveolar system.

Material and methods. The study groups consisted of 125 children aged 6–12 years with anomalies of the dentoalveolar system receiving treatment with plate and mouth guard orthodontic appliances, and 42 children with physiological occlusion of the dentition. Quantitative determination of total immunoglobulins G, A, M and secretory immunoglobulin A of the oral fluid was carried out before the start of treatment, after 3 and 6 months. Statistical analysis was carried out using IBM SPSS Statistics 20, StatTech v. 1.2.0. Shapiro–Wilk, Kolmogorov–Smirnov, Kruskal–Wallis, Dunn with Holm correction, Friedman, Wilcoxon with Holm correction were used.

Results. In patients with anomalies of the dentoalveolar system, a pronounced increase in the content of secretory immunoglobulin A, total immunoglobulin A in the oral fluid during treatment with a kappa apparatus and a pronounced increase in the content of total immunoglobulin M during therapy with a plate apparatus were found. In children with physiological occlusion, there is a dynamic decrease in the content of secretory immunoglobulin A 6 months after the start of observation. These changes indicate the development of a protective mechanism of a specific immune response of the oral cavity when using orthodontic appliances.

Conclusion. As a result of a dynamic assessment of the enzyme immunoassay composition of the oral fluid in children with physiological occlusion, there was a decrease in the content of secretory immunoglobulin A; in children with anomalies of the dentition, a change in the content of secretory immunoglobulin A, total immunoglobulins A and M was found.

Kazan medical journal. 2022;103(1):63-68
pages 63-68 views

Features of sinus rhythm restoration in patients with paroxysmal and persistent non-valvular atrial fibrillation and previous COVID-19 infection in iron-deficiency anaemia

Valeev M.K., Khasanov N.R.

Abstract

Background. Currently, there are conclusive data in the literature on the effect of reduced haemoglobin concentration on sinus rhythm restoration in patients with nonvalvular atrial fibrillation. It is relevant to study the features of rhythm restoration in patients with anaemia and atrial fibrillation in COVID-19 infection.

Aim. To study the effects of iron-deficiency anaemia on sinus rhythm restoration rate and the dose of amiodarone required for this in patients with paroxysmal and persistent non-valvular atrial fibrillation and previous COVID-19 infection.

Material and methods. The study included 63 patients aged between 53 and 94 years (mean age 60.8±10.9 years): 26 men (41.3%) and 37 women (58.7%). The patients were divided into groups according to the presence of anaemia and computed tomography staging (CT severity score) of lung damage. Criteria for inclusion: paroxysmal or persistent non-valvular atrial fibrillation; previous COVID-infection (according to the documents, medical records). We took into account medical histories, laboratory and instrumental findings, as well as treatment. The statistical analysis was performed by using the Statistica 13.3 software. The obtained data were presented as M±σ or Me [Q1; Q3]. The differences between the indicators were assessed using Student’s t test, the Mann–Whitney U test and the Kruskal–Wallis H test. Nominal variables were compared by using Pearson’s χ2 test with Yates correction or Fisher’s criterion. The relationship between the parameters was assessed using the Pearson’s or Spearman’s correlation coefficient. A p <0.05 was considered statistically significant.

Results. The patients with normal haemoglobin concentration restored sinus rhythm for 10 [4; 13] hours and the patients with iron-deficiency anaemia — for 5.5 [2; 10] hours (p=0.044). In patients with COVID-19 pneumonia, we found a direct correlation between the degree of lung damage and the dose of amiodarone (r=0.33, p <0.05), as well as the time of sinus rhythm restoration (r=0.48, p <0.05).

Conclusion. The presence of iron-deficiency anaemia in patients with previous COVID-19 infection and paroxysmal and persistent non-valvular atrial fibrillation is associated with a shorter time and a lower dose of amiodarone required for successful sinus rhythm restoration in comparison to patients with normal haemoglobin concentration; in patients with more severe lung damage caused by COVID-19 pneumonia, it takes more time and a large dose of amiodarone for sinus rhythm restoration.

Kazan medical journal. 2022;103(1):54-62
pages 54-62 views

Experimental medicine

Anatomical and morphometric variation of the orifice of the left atrial appendage

Iakimov A.A., Gaponov A.A.

Abstract

Background. Knowledge of the anatomical variations of the shape and size of the left atrial appendage orifice, along with the relationship of its size with the number of left atrial appendage lobes, the size of its neck, the left atrioventricular orifice, the left atrioventricular fibrous ring and the distance to it, as well as with the overall dimensions of the heart is important in personalized surgical planning for the installation of occluder device and left atrial appendage clipping to prevent thromboembolic complications.

Aim. To identify anatomical variations in the shape and size of the left atrial appendage orifice and analyze the dependence of these parameters on the number of left atrial appendage lobes, cardiac dimensions, mitral orifice area and the distance from the orifice to the left atrioventricular fibrous ring.

Material and methods. We studied 37 heart specimens fixed in 10% formalin in adults who died of non-cardiac causes. Morphometry was performed by an ShTsTs-1-200 digital calliper, drawing needle calliper and 4UM goniometer. We used nonparametric analysis of variance, Spearman correlation coefficient (Rs), univariate regression analysis, cross-tabulation analysis. The results are presented as the mean and standard deviation. The significance of differences was assessed by using the Mann–Whitney U-test.

Results. The left atrial appendage was single-lobed in 16.2% of cases, two-lobed in 62.2%, and three-lobed in 18.9%. The length of the orifice was 12.7±4.03 mm, and the width was 9.5±3.62 mm. The elliptical shaped orifices were 3.1 times more common than round ones (28/37 and 9/37, p=0.0027). In 17 of 28, oval orifices were located predominantly horizontally, in nine predominantly vertical, in one case obliquely. Vertically oriented orifices were significantly longer and slightly wider compared with others. The number of the left atrial appendage lobes was not a reliable predictor for the orifice shape (p=0.055). The size of the appendage orifice, variants of its shape and the distance to the left atrioventricular opening were unrelated to each other. The length and width of the orifice were correlated with each other (Rs 0.68) and correlated with the diameters of the left atrioventricular fibrous ring size. The orifice length correlated with the length of the ventricular complex (Rs 0.47) and heart width (Rs 0.53). The orifice width correlated only with the heart width (Rs 0.4) but not with other dimensions. As the length and width of the ventricular complex increased, the orifice length increased exponentially. The distance from the left atrial appendage orifice to the left atrioventricular opening did not depend on either the orifice shape or its orientation.

Conclusion. In a normal human adult heart, the shape of the left atrial appendage orifice was oval, less often round, and the size of the orifice depends on the length and the width of the ventricles.

Kazan medical journal. 2022;103(1):69-78
pages 69-78 views

Reviews

High-density lipoprotein cholesterol — friend or enemy?

Murzakhanova A.F., Oslopov V.N., Sergienko K. ., Khazova E.V., Oslopova J.V.

Abstract

The article provides a review of the literature on the effect of excess and deficiency of high-density lipoprotein cholesterol on the prevention and treatment of cardiovascular pathology. Information about high-density lipoproteins structure, function, antiatherogenic role and the prospect of using various high-density lipoproteins subclasses in the pharmacotherapy of dyslipidemic conditions are also described. It is proven that a lowered level of such cholesterol is a predictor of cardiovascular disease. At the same time, many observations confirm the correlation between elevated high-density lipoprotein levels and mortality from myocardial infarction and other acute cardiovascular conditions. In large studies, the use of cholesterol ester transfer protein inhibitors and other drugs increased the level of high-density lipoprotein, but the unreduced risk of cardiovascular disease confirms the lack of positive results from the use as a therapeutic target. In addition, it was found that the composition of high-density lipoprotein cholesterol protein differs in healthy and diseased people: it becomes “dysfunctional”, losing its antioxidant and anti-inflammatory properties in diseased individuals. The atheroprotective activity of properly functioning high-density lipoprotein cholesterol is often impaired in clinical situations associated with oxidative stress. In these cases, high-density lipoproteins can have some changes, and even if the quantity is within the normal range, the quality is no longer the same. Thus, it is necessary to identify a better therapeutic target than high-density lipoprotein cholesterol levels, as there is currently insufficient clinical trial data to recommend targeted high-density lipoprotein therapy.

Kazan medical journal. 2022;103(1):79-88
pages 79-88 views

Compensation of acetabular defects in hip arthroplasty

Udintseva M.Y., Volokitina E.A., Kutepov S.M.

Abstract

Acetabular reconstruction is a necessary condition for improving the survival rate and proper functioning of the implant. The issue of compensation for bone loss remains one of the most difficult and controversial in orthopaedics. The article aimed to analyze approaches to the problem of management of acetabular defects in hip replacement. The paper presents the key features of the anatomy and radiological anatomy of the acetabulum. Modern modifications of acetabular components of an endoprosthesis, their advantages and disadvantages, as well as ways to compensate for acetabular bone loss with bone substitute materials are considered. The review highlights the use of 3D printing technologies, the interaction between physicians and other experts in this field. Currently, an active search for materials, alternatives to autogenous bone, as well as ways to facilitate the design and reduce the negative impact of the implant on the patient's bone tissue continues. The use of additive technologies seems to be the most promising direction that allows applying an individual approach to each clinical case, but it is available only in specialized centres and is associated with significant material, technical and legal difficulties. Stable fixation of the acetabular component, according to the literature, is achieved under the condition of restoration of hip rotation centre in the native acetabulum area, restoration of normal anatomical relations in the hip joint and adequate replacement of bone loss.

Kazan medical journal. 2022;103(1):89-99
pages 89-99 views

Modern vision of pathogene­sis, clinical and immunological features and new methods of atopic dermatitis treatment

Makeev O.G., Antonova S.B., Ufimtseva M.A., Efimova M.S., Mylnikova E.S., Korotkov A.V., Shuman E.A., Sichkar D.A., Desyatova M.A.

Abstract

The article provides a literature review of one of the modern medical social problems in the world — atopic dermatitis. Epidemiological data, current view on the pathogenesis of this disease, the role of genetic factors and epigenetic mechanisms in the development of dermatosis and modern treatment approaches are highlighted. Atopic dermatitis is a chronic inflammatory skin disease which common for children and adolescents, as well as for adults. Epidemiological studies conducted in different countries reveal the high prevalence and increased incidence of atopic dermatitis over the past three decades. Atopic dermatitis significantly affects the quality of patients’ and their relatives’ lives and also results in considerable social and economic burdens. Atopic dermatitis is a heterogeneous disease which pathogenesis is associated with mutations in genes encoding epidermal structural proteins, as well as genes that regulate innate and adaptive immune responses to environmental factors. In addition, the review reflects studies on the mechanisms of epigenetic regulation underlying the development of atopic dermatitis: Deoxyribonucleic acid (DNA) methylation, histone modification, and micro ribonucleic acid (microRNA)-mediated mechanisms of gene expression regulation. Epigenetic modifications in parents are realized in offspring in several generations, causing a wide range of clinical differences in the course of the disease in different age and gender groups. Currently available treatments for atopic dermatitis achieve remission but not a cure. The study of the disease pathogenesis, combined with the continuation of research on finding effective drugs, determines the prospects for developing prevention and treatment of atopic dermatitis.

Kazan medical journal. 2022;103(1):100-109
pages 100-109 views

Modern approaches to the surgical treatment of large full-thickness macular holes

Samoylov A. ., Khaibrakhmanov T.R., Khaibrakhmanova G.A., Samoylova P.A.

Abstract

Vitreoretinal surgery is an actively developing area of modern ophthalmic surgery. Intravitreal interventions in the central retina with large full-thickness macular holes deserve special attention. This article provides an overview of the scientific literature published in journals recommended by the Higher Attestation Commission, also presented in the scientific databases Scopus, PubMed, dedicated to modern techniques to the surgical treatment of large full-thickness macular holes. The main methods for closing defects in the macular area today are the use of various modifications of the inverted internal limiting membrane flap technique and the application of autologous platelet rich plasma in a macular hole. These techniques provide high anatomical and functional outcomes. Modifications of the inverted internal limiting membrane flap technique demonstrated effectiveness in such complex clinical situations as recurrent macular holes, concomitant high myopia, retinal detachment. Over the past 10 years, data on the use of autologous platelet-rich plasma for this group of patients appeared in the scientific literature. More accurate surgical procedures are required for the use of this technique compared with the standard methods, but this technique is applicable in all patients, does not require additional manipulations (blood sampling and centrifugation), additional equipment. Vitreoretinal interventions with the use of platelet-rich plasma are characterized by relative simplicity and ease of carrying out surgical procedures. However, it is important to consider the possibility of pseudouveitis development, the need for additional equipment. Since both of these methods demonstrate good anatomical results, the problem of choosing a technique in a particular clinical case remains. It was clear that the method of surgical intervention should be chosen, taking into account possible disadvantages and limitations to the method, as well as the skills of an ophthalmic surgeon. The lack of a unified approach to macular hole surgery encourages researchers to improve surgical techniques, develop and implement new modifications of surgical approaches.

Kazan medical journal. 2022;103(1):119-125
pages 119-125 views

Asymptomatic bacteriuria in young pregnant women in modern society

Sitdikova D.G., Fatkullina I.B., Lazareva A.Y., Fatkullina Y.N., Galiullina L.A., Fayzullina L.A., Galeeva S.A.

Abstract

The article provides an overview of the literature and existing international and national Guidelines on the etiology and main pathogens’ characteristics of asymptomatic bacteriuria, diagnostic criteria, management of young pregnant women with asymptomatic bacteriuria and antibacterial therapy regimens. Young pregnant women are a significant part of the society structure that requires protection. Young women in the age category of 15–17 years are identified as a group with a high risk of complications during pregnancy, delivery and the postpartum period, as well as perinatal pathologies. Women of this age group are characterized by a high risk of complications: the threatened miscarriage, premature birth as well as young pregnancies usually accompanied by sexually transmitted infections. It is important for this group of patients to be more carefully monitored by doctors in the hospitals, maternity welfare centers, during delivery and postpartum period. The main causative agents of asymptomatic bacteriuria in pregnant women are representatives of the Enterobacteriaceae family (88.0%). E. coli, Klebsiella spp., Staphilococcus spp. cause asymptomatic bacteriuria only in 3–10% of cases. The diagnosis is based on the Russian Clinical Guidelines for Urology and the Federal Clinical Guidelines 2020, as well as on the European Guidelines of the Urologists Association 2020. The National Guidelines indicate the main principles of asymptomatic bacteriuria treatment in high risk patients (pregnant and young). Despite the progress made in the urinary tract infections study, especially asymptomatic bacteriuria in pregnant women, and the development of practical Guidelines for the management of these patients, this issue remains important in modern society.

Kazan medical journal. 2022;103(1):110-118
pages 110-118 views

Clinical observations

Postinfectious autoimmune encephalitis with opsoclonus-myoclonus syndrome

Gaifutdinov R.T., Matveeva T.V., Zalyalova Z.A.

Abstract

Opsoclonus is irregular chaotic eye movements, accompanied by impaired gaze fixation, oscillopsia and associated visual impairment. It is combined with myoclonus of the extremities, trunk, change in gait. It occurs in many pathological conditions, most often in oncological and post-infectious diseases. The rarity and uncommonness of the clinical manifestations of the opsoclonus-myoclonus syndrome, as well as the poor awareness of doctors about this pathology, cause diagnostic difficulties and errors. This report presents the case of a 49-year-old patient, who developed unsteadiness when walking, opsoclonus, myoclonus, startle syndrome, exaggerated startle response 3 weeks after an acute intestinal infection. The diagnostic errors made were analyzed. The diagnosis “Post-infection autoimmune encephalitis” was proposed and substantiated. Paraneoplastic opsoclonus-myoclonus syndrome was excluded by prospective observation of the patient for 6 years. High efficiency of glucocorticoid treatment was noted.

Kazan medical journal. 2022;103(1):126-132
pages 126-132 views

Two-stage orthodontic treatment outcomes of children with dentoalveolar class II malocclusion

Ayupova F.S., Khotko R.A.

Abstract

Background. During the rehabilitation of children with distal occlusion, it is not always possible to achieve the desired outcomes. In this context, the factors influencing the outcomes of treatment for class II malocclusions in children at different stages of occlusion development.

Aim. To study two-stage orthodontic treatment outcomes in children with dentoalveolar class II malocclusion by the clinical case.

Material and methods. We analyzed the physical examination results of the patient within the treatment from 6 to 17 years. Facial proportion symmetry, aesthetic, type of face, plaster dental models were determined by using the photographs. Orthopantomography was used to analyze the condition of temporary and permanent teeth, jaw bone tissue and to assess functional disorders. Orthodontic treatment in a mixed dentition period was carried out using removable devices, including those improved by the authors. In the permanent dentition, orthodontic brackets with power elements were used.

Results. Untimely contacting the doctor, an insufficient level of motivation to implement recommendations for improving posture and dental care contributed to an increase in treatment duration. Keeping excessive cervical spine flexion and head tilted back, the “bad habit” of placing (pressure) the hand on the chin, and the rejection of a myo-gymnastic exercise (physical therapy) interfered with the synchronous (normal) development of the jaws. Premature loss of a temporary molar on one side led to dentoalveolar asymmetry and disruption of occlusal contacts. Additional orthodontic appliances were used to correct these deformities. Over-retained deciduous teeth led to the delayed eruption of permanent teeth and, presumably, to the curvature of their roots. Violation of the tooth’s root shape and asymmetry in permanent teeth crown size prevented the full correction of their position using highly effective modern non-removable orthodontic equipment. The anomalous position of the rudiment of the third molar, the refusal for timely tooth extraction further led to the increasing complexity of the surgical technique.

Conclusion. The timing and effectiveness of orthodontic treatment of a patient with dentoalveolar class II malocclusion were influenced by a poor body posture, extraction of a primary molar, the delayed eruption and crown size asymmetry of permanent teeth, the presence of “bad” habits and minimal cooperation of the patient with the orthodontist.

Kazan medical journal. 2022;103(1):133-142
pages 133-142 views

Clinical experiences

Assessment of the acute bronchodilator test and the efficacy of the course of treatment with Glycopyrronium bromide in patients with pulmonary tuberculosis associated with chronic obstructive pulmonary disease

Yaushev M.F., Alexeev A.P.

Abstract

Background. Despite significant progress in the fight against tuberculosis, the number of new cases in the world remains relatively stable, and amounts are more than 10 million annually. Chronic obstructive pulmonary disease (COPD) negatively affects the quality of life in patients with pulmonary tuberculosis and reduces the effectiveness of chemotherapy. Correction of bronchial obstruction in pulmonary tuberculosis remains an actual problem.

Aim. To assess the acute bronchodilator test with glycopyrronium bromide, pulmonary function test parameters changing within 24 hours after inhalation, as well as the effect of a 2–3-month course of treatment with glycopyrronium bromide on the same parameters and the quality of life in patients with pulmonary tuberculosis associated with chronic obstructive pulmonary disease.

Material and methods. A prospective cohort study of 38 patients with active pulmonary tuberculosis associated with the chronic obstructive pulmonary disease treated with anti-tuberculosis chemotherapy was carried out. The pulmonary function test parameters were assessed before inhalation, 15, 30, 120 min, 23 h 45 min after a single inhalation of glycopyrronium bromide, as well as after 1, 2 and 3 months of treatment. Quality of life was assessed by using CAT (COPD Assessment Test), SF-36 (Short Form-36 Health Survey Questionnaire), SGRQ (St. Georges Respiratory questionnaire).

Results. A single inhalation of 50 μg glycopyrronium bromide led to a significant increase in forced expiratory volume in 1 second by +15.2%, +18.3%, +22.8% and +11.2% after 15, 30, 120 minutes and 23 h 45 min, respectively. The change in forced expiratory volume in 1 second after 1, 2 and 3 months of treatment was +13.1%, +9.3% and +11.7%, respectively. The overall CAT score after 3 months decreased by 7. The mental health index SF-36 increased by 9.2 points. A decrease in SGRQ parameters was revealed: symptoms — by 21.7 points, physical activity — by 14.8 points, impact — by 18.2 points.

Conclusion. Inhaled glycopyrronium bromide 50 μg once daily can be recommended for the treatment of patients with active pulmonary tuberculosis associated with chronic obstructive pulmonary disease.

Kazan medical journal. 2022;103(1):143-152
pages 143-152 views

The effectiveness of three-step treatment for keratoconus with correction of associated ametropia

Maharramov P.M.

Abstract

Background. Keratoconus is a progressive ectatic disease with thinning and bulging of the cornea structure. It is characterized by a bilateral and usually asymmetric course, which is manifested by the formation of irregular astigmatism. Several different combinations of treatments are currently being used to stop the progression of keratoconus and increase visual acuity.

Aim. To assess the effectiveness of three-step treatment for progressive keratoconus to stabilize the cornea, eliminate its irregularity and achieve maximum visual acuity.

Material and methods. A triple combined treatment was applied to 48 patients (24 women and 24 men) with stage 2–3 keratoconus (67 eyes) aged 16–31 years (mean age 24.4±0.21 years) at the National Center of Ophthalmology named after Academician Zarifa Aliyeva between 2017 and 2019. It consisted of intrastromal corneal ring implantation, corneal crosslinking after 24 hours, and topography-guided transepithelial photorefractive keratectomy (PRK) after 8 months. All patients underwent complex examinations: uncorrected visual acuity and best spectacle-corrected visual acuity, autorefractometry, non-contact tonometry, corneal topography, tomography, optical coherence tomography of the anterior segment, ultrasound pachymetry. The statistical significance of the difference between the data before and after treatment was assessed by using analysis of variance in the “data analysis” package of the Microsoft Excel software.

Results. Uncorrected visual acuity before surgery was 0.2±0.041 and ranged between 0.04 and 0.3. Twelve months after surgery, uncorrected visual acuity significantly improved in all patients; its average value was 0.5±0.048 and ranged between 0.2 and 0.7. An improvement was observed in best spectacle-corrected visual acuity, which ranged between 0.2–0.5 before surgery and 0.4–0.8 after surgery. After intrastromal corneal ring implantation + corneal crosslinking + topography-guided transepithelial-PRK, residual refractive errors of the cornea were eliminated. The maximum keratometry (Kmax) decreased from 46.1–57.3 D to 42.1–49.9 D (M and SD before surgery 50.0±1.5 and after surgery 45.2±1.4, p=0.009), astigmatism also decreased from 5.25–9.25 to 0.5–3.25 cyl (M and SD before surgery 4.61±0.50 and after surgery 4.18±0.48, p=0.025). No complications were observed during and in the postoperative period.

Conclusion. The three-step treatment of progressive keratoconus will avoid the need for keratoplasty and achieve maximum visual acuity, minimize the number of aberrations and halts the progression of keratoconus.

Kazan medical journal. 2022;103(1):153-159
pages 153-159 views

Cochrane Review Summaries

Recall intervals for oral health in primary care patients (Russian Translation of Cochrane Plain Language Summary)

Abstract

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Fee PA, Riley P, Worthington HV, Clarkson JE, Boyers D, Beirne PV. Recall intervals for oral health in primary care patients. Cochrane Database of Systematic Reviews 2020, Issue 10. Art. No.: CD004346. DOI: 10.1002/14651858.CD004346.pub5.

Kazan medical journal. 2022;103(1):160-161
pages 160-161 views

Routine scale and polish for periodontal health in adults (Russian Translation of Cochrane Plain Language Summary)

Abstract

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Lamont T, Worthington HV, Clarkson JE, Beirne PV. Routine scale and polish for periodontal health in adults. ­Cochrane Database of Systematic Reviews. 2018, Issue 12. Art. No.: CD004625. DOI: 10.1002/14651858.CD004625.pub5

Kazan medical journal. 2022;103(1):162-163
pages 162-163 views

Through the pages of the “Kazan Medical Journal”

pages 164-173 views

Acknowledgements to reviewers

Thank you to all our reviewers in 2021

Abstract

The editorial board of the “Kazan Medical Journal” expresses its sincere gratitude to the reviewers for their fruitful cooperation in the preparation of articles.

Kazan medical journal. 2022;103(1):174-176
pages 174-176 views


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