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Vol 103, No 2 (2022)

Theoretical and clinical medicine

Prospective 5-year follow-up of patients with acute coronary syndrome and percutaneous coronary intervention

Musikhina N.A., Teploukhova A.I., Petelina T.I., Gorbatenko E.A., Bessonov I.S., Gapon L.I.

Abstract

Background. The study of predictors that negatively affect the long-term prognosis of patients with an increased risk of coronary syndrome can improve the effectiveness of measures for the secondary prevention of cardiovas­cular events.

Aim. To determine the factors that have a negative impact on 5-year survival in patients with acute coronary syndrome and percutaneous coronary intervention.

Material and methods. 135 patients with acute coronary syndrome enrolled in the “Register of percutaneous coronary interventions” in 2012–2013 at the Tyumen Cardiology Center, a branch of the Tomsk Research Institute of Cardiology of the Russian Academy of Sciences, were included in the study. After 12 and 60 months, the clinical status of patients and ongoing drug therapy were evaluated, and an examination including echocardiography with an ultrasound scanner, daily monitoring of the electrocardiogram and standard blood pressure measuring was performed. Laboratory studies included general and biochemical blood tests. To calculate the factors associated with poor prognosis, a Cox proportional hazards regression model with stepwise inclusion was used. Survival was assessed by the Kaplan–Meier method using the Log-rank test (logarithmic test).

Results. After 1 year, only three-quarters of patients continued the recommended drug therapy, a similar trend continued after 5 years of follow-up. The number of patients without any antiplatelet therapy increased from 19.9% after 12 months to 29.7% after 60 months. Overall survival after 1 year was 97.1%, after 5 years — 86.7%. The risk of death increased in the presence of chronic kidney disease (risk ratio 15.1; 95% confidence interval 4.30–52.93; p=0.001); type 2 diabetes mellitus (risk ratio 3.67; 95% confidence interval 1.18–11.43; p=0.025), history of stroke (risk ratio 9.07; 95% confidence interval 1.85–44.60; p=0.007), in patients with a heart rate >80 beats per minute [risk ratio 4.3; (95% confidence interval 1.51–12.26; p=0.006) and at pulse pressure ≥60 mm Hg (risk ratio 4.68; 95% confidence interval 1.60–13.72; p=0.005)].

Conclusion. The predictors that influenced the 5-year survival of patients after acute coronary syndrome and percutaneous coronary intervention were chronic kidney disease, diabetes mellitus, a history of stroke, high pulse pressure, and increased heart rate of more than 80 beats per minute.

Kazan medical journal. 2022;103(2):181-187
pages 181-187 views

Prediction of the development of inflammatory complications in the postpartum period

Gadzhievа F.R.

Abstract

Background. The main etiological reasons for the still high level of serious postpartum complications are frequent isolation of aggressive pathogenic microorganism associations, an increase in their virulence and antibiotic resistance, and an increase in the frequency of surgical methods of delivery.

Aim. Assessment of the significance of clinical, instrumental and laboratory parameters in the diagnosis of early inflammatory complications of the postpartum period.

Material and methods. To study the risk factors for the development of the inflammatory process, they were registered in the postpartum period during the examination of 150 patients who underwent inpatient treatment at the Scientific Research Institute of Obstetrics and Gynecology in Baku for the period 2017–2020. Depending on the presence or absence of the studied pathology, the patients were divided into two groups: the main group included puerperas with developed postpartum complications (n=100), the comparison group included puerperas with a physiological course of the postpartum period (n=50). The average age of puerperas in groups was 29.9±0.64 and 30.3±0.86 years, respectively (p=0.679). Complications were diagnosed based on the analysis of the results of clinical and laboratory studies, the study of anamnestic data and the results of ultrasound examination. The information content of the obtained data was determined by the Kullback method.

Results. In the course of research, it was found that an important reason for the development of postpartum complications of an inflammatory nature is the long-term use of contraception. Women of the main group more often use means for intrauterine contraception and barrier contraceptives — 24 and 29%, and in the comparison group — 6 and 12% (p=0.006; p=0.024). When studying the structure of clinical manifestations of complications of the early postpartum period, pain in the lower abdominal cavity was most often recorded — 89.0±3.13%, and in the comparison group — 6.0±3.36% (p <0.0001). Among the studied ultrasound diagnostic criteria for inflammatory complications in the postpartum period, cases of an increase in the size of the uterus and thickening of the endometrium were detected in 98 and 97 out of 100 people in the main group and only in 1 case out of 50 patients in the comparison group (p <0.0001). The absolute number of T-lymphocytes, hemoglobin, the concentration of the pro-inflammatory cytokine interleukin-6, and the erythrocyte sedimentation rate are recognized as the most informative diagnostic indicators of biochemical studies in patients with postpartum complications.

Conclusion. The reasons for the development of inflammatory complications in the postpartum period are the presence of a history of spontaneous abortions, intrauterine contraception and the use of barrier contraceptives.

Kazan medical journal. 2022;103(2):188-194
pages 188-194 views

The association of stress level with the central serous chorioretinopathy development

Khasanova G.R., Agliullin D.R., Abdulaeva E.A., Kuzmin N.D., Karimov A.U., Agliullina S.T.

Abstract

Background. The impact of stress on the central serous chorioretinopathy development has been studied in a small number of studies, and the results are conflicting.

Aim. To assess the association of the level of individual stress with the central serous chorioretinopathy development.

Material and methods. A cross-sectional study based on a survey of 110 patients with central serous chorioretino­pathy (the main group) and 110 individuals without central serous chorioretinopathy was conducted. The stress level was assessed on the Perceived Stress Scale. Quantitative and categorical data between the groups were compared. Comparison of groups by quantitative indicator was performed using the Mann–Whitney U-test, and by categorical indicator — using the odds ratio and its 95% confidence intervals.

Results. The groups of respondents were comparable according to the main demographic indicators. The median total score for the “Overstrain” subscale in the central serous chorioretinopathy group was 12 points (Q25%–Q75% 9.25–14 points), in the control group — 10 points (Q25%–Q75% 7–12 points; p=0.0002). The median total score for the “Stress Response” subscale in the central serous chorioretinopathy group was 7 points (Q25%–Q75% 5–8 points), in the control group it was 4 points (Q25%–Q75% 3–7 points; p=0.000003). In the group with central serous chorioretinopathy, compared with the control group, the proportion of people with moderate stress level was higher (74.5% vs. 53.6%; odds ratio 2.53, 95% confidence interval 1.43÷4.48) and the proportion of people with low stress level was lower (19.1% vs. 45.5%; odds ratio 0.28, 95% confidence interval 0.15÷0.52).

Conclusion. The study demonstrated the association of stress with the development of central serous chorioretinopathy.

Kazan medical journal. 2022;103(2):195-201
pages 195-201 views

Significance of diagnostic transcranial magnetic stimulation during radiotherapy

Kartashev A.V., Chirkin V.Y., Il’in N.V., Voitenkov V.B., Vinogradova Y.N.

Abstract

Background. Transcranial magnetic stimulation is a non-invasive, painless method that stimulates the cerebral cortex using short magnetic pulses. The information obtained as a result of the research can be further used for an objective assessment of the therapy.

Aim. Evaluation the reliability of transcranial magnetic stimulation technique as a neurophysiological monitoring tool in patients with malignant brain tumors.

Material and methods. There were two groups as a study objects: patients with large-focal solitary lesions of the central nervous system (glioma) who underwent radiotherapy (n=20), median age 49.5±5.3 (39; 60) years, and a comparison group of neurologically healthy individuals (n=16), median age 48.5±6.3 (43.0; 58.8) years. There were no statistically significant age differences between the studied groups. All patients underwent diagnostic transcranial magnetic stimulation before and after therapy. The Mann–Whitney test was used to make comparisons between the two groups. A p value <0.05 was considered statistically significant.

Results. During transcranial magnetic stimulation in patients with malignant brain neoplasms, signs of impaired conduction along the central motor pathways were recorded in 50% of cases, and in total, signs of impaired conduction of all degrees of severity along the central motor pathway were detected in 90% of cases. Carrying out diagnostic transcranial magnetic stimulation according to a single-pulse protocol makes it possible to predict the further course of the recovery period. The use of transcranial magnetic stimulation in dynamics revealed an improvement in conduction along the central motor pathways in patients with malignant brain neoplasms. The obtained statistically significant differences allow us to conclude that transcranial magnetic stimulation can be used for an objective assessment of the state of the motor pathways in patients with neurooncological diseases.

Conclusion. Diagnostic transcranial magnetic stimulation is applicable in large-focal solitary lesions of the central nervous system, since it allows assessing the state of the motor pathways and the functional activity of the brain at different stages of this condition.

Kazan medical journal. 2022;103(2):202-210
pages 202-210 views

Biochemical markers of the severity and emergence of non-smooth progression of pseudotuberculosis in children

Nosareva O.L., Pomogaeva A.P., Stepovaya E.A., Shakhristova E.V., Karpov R.M.

Abstract

Background. Currently, pseudotuberculosis is characterized by a high incidence in children and it is the second acute intestinal infection by frequency after shigellosis. The search for relationships between early changes in cell metabolism, dysfunctions of some organs and body systems under the pathogenic effect of an infectious agent and the severity, the occurrence of a non-smooth course of pseudotuberculosis in children is relevant.

Aim. Search for biochemical markers to predict the severity and occurrence of a non-smooth variant of the course of pseudotuberculosis in children.

Material and methods. A prospective study was performed in 125 patients with pseudotuberculosis during pe­riods of the disease height, early convalescence and recovery: 17 patients with mild severity and a smooth course of the disease; 64 — with moderate severity and smooth course of the disease; 28 — with moderate severity and non-smooth course, 16 — with high severity and non-smooth course of the disease. The comparison group consisted of 45 children from the IIA health group. The distribution of the examined children by sex was equal, the age ranged from 9 to 13 years. The spectrophotometric method determined the following: in blood plasma — the content of malondialdehyde; in erythrocytes — the concentration of reduced glutathione, the activity of glutathione reductase, glutathione peroxidase, glutathione-S-transferase and catalase. The following ratios were calculated: reduced glutathione/malondialdehyde, reduced glutathione/glutathione reductase, reduced glutathione/glutathione peroxidase, reduced glutathione/glutathione S-transferase, glutathione peroxidase/catalase. Normality of the obtained data distribution was checked using the Shapiro–Wilk test, and the statistical hypotheses about the difference between the studied groups were checked using the nonparametric Mann–Whitney test at a significance level of p <0.05.

Results. In the acute period of the disease, based on the analysis, a statistically significant decrease in the ratios of reduced glutathione/malonic dialdehyde, reduced glutathione/glutathione reductase, reduced glutathione/glutathione peroxidase by 3.0, 3.5 and 3.1 times, respectively, was established (p <0.05) in patients with mild severity and smooth course; 5.3, 5.1 and 3.8 times (p <0.05) — with moderate severity and smooth course; 5.8, 4.0 and 3.0 times (p <0.05) — with moderate severity and non-smooth course; by 8.1 and 6.1 times (p <0.05) — with heavy severity and non-smooth course relative to control values. However, during the period of early convalescence of a non-smooth course, these indicators significantly decreased by 2.2, 4.4 and 1.8 times (p <0.05) in patients with moderate severity and by 3.4, 6.8 and 2.2 times ( p <0.05) — with heavy severity relative to control values.

Conclusion. Prognostically significant criteria for an increase in the severity and occurrence of a non-smooth course of pseudotuberculosis in children in the acute period of the disease are a decrease in the ratios of reduced glutathione/malonic dialdehyde less than 17.0, reduced glutathione/glutathione reductase below 38.0 and reduced glutathione/glutathione peroxidase less than 12.0.

Kazan medical journal. 2022;103(2):211-220
pages 211-220 views

Reviews

Epidemiological surveillance of surgical site infections in large joint replacement

Bulycheva I.A., Kondratieva K.A., Yakupova G.R., Lokotkova A.I., Mamkeev E.K., Mazitov M.R.

Abstract

Joint replacement is a reliable and effective surgery that allows profound pain relief and restores joint function in patients. Despite the progress made and the experience gained in joint replacement, surgical site infection is one of the leading postoperative complications. It can proceed as a periprosthetic joint infection, osteomyelitis, sepsis and lead to disabled or dead outcomes. Systematization of risk factors for infectious complications plays an important role as an element of epidemiological surveillance system optimization. Age, the presence of concomitant diseases (for example, diabetes mellitus, cancer, arthritis and systemic collagenosis), carriage of antimicrobial-resistant microorganisms, infectious and inflammation both outside and in the area of surgery, and external factors (surgery duration, correct antibiotic prophylaxis and surgeon's experience) are the most significant risk factors for periprosthetic joint infection. In world practice, the National Nosocomial Infections Surveillance System surgical site infection risk index is used. This criterion does not consider all potential risk factors. It is important to analyze and rank the identified risk factors according to the impact on the development of infectious complications in organizing an epidemiological surveillance system process in a medical organization. Risk factors analysis will identify the most significant modifiable factors for the development, implementation and execution of organizational, preventive measures and epidemic control. The creation and implementation of a standardized preoperative protocol based on a risk factors assessment will allow predicting the surgery outcome and arguing the strategy and tactic of preventive measures.

Kazan medical journal. 2022;103(2):221-229
pages 221-229 views

Capabilities of transesophageal echocardiography in patients with atrial fibrillation

Galyautdinov G.S., Ibragimova K.R., Galeeva S.S.

Abstract

Transesophageal echocardiography is widely used in clinical practice in patients with atrial fibrillation and it is mainly applied to determine the morphology of the heart, the presence of intracardiac thrombi, quantify the structures of the heart, as well as to determine the tactics for surgical interventions. Transesophageal echocardiography has an advantage over transthoracic echocardiography in visualizing the left atrium and left atrial appendage, common sites of thrombus formation in patients with atrial fibrillation. Due to the anatomical proximity of the esophagus to the heart, the transesophageal access avoids signal fading and incorrect interpretation of the study results. The possibilities of transesophageal echocardiography in patients with atrial fibrillation have expanded with the development of medical technology, and three-dimensional transesophageal echocardiography has become widespread. In recent years, the studies on the use of the transesophageal echocardiography in patients with atrial fibrillation during the coronavirus pandemic have been published. The review presents the results of studies, meta-analyzes of pooled samples, as well as clinical cases, demonstrating capabilities of transesophageal echocardiography in patients with atrial fibrillation. A brief history of the development of the method, work on the study of the technology features and capabilities of transesophageal echocardiography for pulmonary vein ablation, cardioversion, occlusion of the left atrial appendage in patients with atrial fibrillation, as well as studies on disadvantages of the transesophageal echocardiography and possible options for their elimination are presented. Comparison of the transesophageal echocardiography with transthoracic and intracardial echocardiography is also highlighted. In preparing the review, the literature search method in PubMed databases for the period 2012–2021 was used, as well as data from an earlier period to indicate the history of the method development.

Kazan medical journal. 2022;103(2):230-240
pages 230-240 views

Spondyloptosis in children, adolescents and youth age patients

Skryabin E.G.

Abstract

The study aimed to analyze scientific publications on “Spondyloptosis in children, adolescents and youth age patients”. The article analyzes 77 literary sources for the period from 1995 to 2021, presented in modern electronic databases of medical information: PubMed, CyberLeninka, eLibrary, Google Scholar. The analysis of scientific articles showed that many important issues related to spondyloptosis in children have not yet been resolved. For example, the disease incidence rate in children and adolescents is unknown. To date, an algorithm for choosing a method for surgical treatment in this category of patients has not been defined, the need and methods for reduction of a displaced LV vertebra remain debatable, the spinal fusion length is not scientifically justified, measures to prevent the appearance or exacerbation of neurological disorders have not been developed, there are no generally accepted clinical and radiation criteria for evaluating treatment outcomes. It is recognized that the severity of clinical manifestations of spondyloptosis is associated with the degree of spinal-pelvic imbalance. The range of surgical interventions is wide: from “in situ” fusion at the LV–SI motion segment to 360° reconstruction with a change in the parameters of the lumbo-pelvic balance. Successful attempts are being made to introduce into clinical practice composite models of metal structures individually made on a 3D printer, specific to the spinal-pelvic balance of a particular patient. Many authors in their publications expressed that various aspects of LV spondyloptosis in children and adolescents require further study.

Kazan medical journal. 2022;103(2):241-249
pages 241-249 views

Possible pathophysiological mechanisms of cardiac troponin level elevations in blood serum and urine in arterial hypertension

Chaulin A.M.

Abstract

The review aimed to discuss and detail the main mechanisms of myocardial cell injury and increased concentrations of cardiac specific troponin isoforms (cTnI and cTnT) in blood serum and urine in hypertension. The search and analysis of foreign and domestic literature were carried out using the MedLine, EMBASE, Scopus and eLibrary databases to achieve this goal. According to recent experimental and clinical researches using high and ultra-sensitive methods for determining cTnI and cTnT, cardiomyocytes are extremely sensitive to many damaging factors in a number of physiological and pathological conditions. The serum concentrations of cTnI and cTnT can increase at the earliest stages of cardiovascular diseases (for example, in prehypertension, latent forms of coronary heart disease, arterial hypertension) and are important for predicting subsequent complications in the form of acute and life-threatening cardiovascular diseases (myocardial infarction, stroke, heart failure, and others). Moreover, troponin molecules can be detected not only in blood serum but also in non-invasively obtained biological fluids, including urine and oral fluid, which in the future can be used as new methods for the non-invasive diagnosis of many cardiovascular diseases. Although elevated levels of cTnI and cTnT in blood serum and urine in hypertension have a fairly high diagnostic and prognostic value, the pathophysiological mechanisms of cardiac troponins level elevations in human biological fluids in this pathological condition remain unclear.

Kazan medical journal. 2022;103(2):250-258
pages 250-258 views

Metal-ligand forms of iron and zinc in the human body

Notova S.V., Kazakova T.V., Marshinskaya O.V., Shoshina O.V.

Abstract

Metals have a wide range of effects on biological processes, playing an important role in maintaining the functioning of the human body. However, many metals, including essential elements, can have a toxic effect on the body, leading to pathological processes. The biological role of an element depends on a number of physicochemical facts, such as the oxidation degree and the formation of metal-ligand organic and inorganic complexes. For example, most of the iron binds to transferrin and ferritin ensuring the safe transportation of the fenton-active trivalent metal ions in the bloodstream. Free Fe3+ ions lead to the formation of reactive oxygen species and further damage of cell structures. Thus, the chemical form of the element determines the toxicokinetics and toxicodynamics of metals. Knowledge in total exposure of elements in biological fluids is not enough to understand the complex mechanism of biological and abnormal reactions. It is necessary to study the interaction of metal elements with various ligands such as high- and low-molecular compounds (proteins, polysaccharides, nucleic acids, citrates, amino acids). In this regard, the application of modern analytical methods is becoming increasingly important to obtain qualitative and quantitative data on elements, ionic forms, speciation and functions in biological systems. The combination of these methods is called “speciation analysis”, which is a well-established way to study the biological role and metabolism of trace ­elements. This article reviews the main metal-ligand forms of iron (transferrin, albumin, ferritin and citrate) and zinc (albumin, α2-macroglobulin, IgG, transcuprein, metallothioneins, ZIP and ZnT transporters). This information can be useful both in fundamental and applied researches in the biology and medicine.

Kazan medical journal. 2022;103(2):259-268
pages 259-268 views

Social hygiene and healthcare management

The effectiveness of regular medical check-up for ovarian cancer patients

Maystrenko D.N., Manikhas A.G., Chernobrovkina A.E., Tsivyan B.L., Gladyshev D.V.

Abstract

Background. With the widespread prevalence of oncogynecological diseases, measures for their early detection and timely treatment, including the systematic implementation of all necessary medical and diagnostic measures within the framework of regular medical check-up, become more important.

Aim. Evaluation of the effectiveness of regular medical check-up of patients with ovarian cancer.

Material and methods. Information was collected by copying data from the primary medical documentation of patients with ovarian cancer who were under regular medical check-up in 2020 in all 4 outpatient cancer care centers in St. Petersburg (392 observation units, complete study). The average age of the patients was 59.7±3.8 years. The data were statistically processed, extensive coefficients and average values with standard deviation (δ) were calculated. The initial data had a normal distribution. The effectiveness of regular medical check-up and the achievement of its completeness was assessed by comparing the actual volumes of medical care provided to patients as part of regular medical check-up with the volumes of medical care established by the Standard of Medical Care for Adults with Ovarian cancer, Fallopian Tube Cancer and primary peritoneal cancer, approved by Order of the Ministry of Health of the Russian Federation dated April 13, 2021, as well as by assessing the compliance of the actual terms of medical care with the terms established by the program of state guarantees.

Results. Non-compliance with the timing of the regular medical check-up start from the moment of establishing diagnosis was revealed, as well as limited compliance with the requirements of the industry standard for the frequency and multiplicity of therapeutic and diagnostic procedures: the three-time visit to the oncologist established by the standard was performed only in 45.5%, the determination of the level of the CA125 adenogenic cancer antigen in blood — in 68.8%, ultrasound examination of the abdominal organs — in 36.6%, of the true pelvis — in 82.2%, magnetic resonance imaging of the true pelvis — in 36.6% of cases.

Conclusion. Evaluation of compliance with the completeness of regular medical check-up of patients with ovarian cancer showed a discrepancy between the volume of its performance to the industry standard and other regulatory documents in the field of healthcare, which indicates the failure to achieve its effectiveness and the unsatisfactory quality of medical care for patients in this group.

Kazan medical journal. 2022;103(2):269-277
pages 269-277 views

On the issue of improving the organization of medical and social support for the elderly and ­senile people

Linnichenko Y.V., Shulaev A.V., Konovalov O.E.

Abstract

Background. In the context of a pronounced aging of the population, one of the priority areas of social policy in the country is the improvement of the organization and provision of medical and social assistance to people of elderly and senile age.

Aim. Substantiation and development of a structural and functional model of a regional (provincial or interregional) geriatric center for further improvement of medical and social care for the elderly and senile.

Material and methods. Using a specially designed questionnaire, we analyzed the opinion about the medical and social assistance received by 456 residents of the Moscow Region of elderly and senile age, who were patients of the Moscow Regional Hospital for War Veterans at the time of the survey.

Results. Only 47.5% of the respondents of elderly and senile age gave a positive assessment of the received medical care and 50.4% — of social assistance. In 83.7% of cases, respondents reported that some social infrastructure facilities are difficult or inaccessible to them, including medical organizations in 16.3% of cases. The survey also made it possible to identify problem areas in the medical and social support of the elderly and senile people associated with the implementation of individual rehabilitation programs, obtaining legal and psychological assistance. The organization of regional geriatric centers is proposed to solve the problems identified in the course of the study and to improve the medical and social support of the elderly and senile. The article describes the tasks of each structural and functional unit of these centers. The available information resources, including those using an interactive mode of communication, are considered to increase the level of information support for the elderly and senile population.

Conclusion. The proposed structural and functional model of the regional geriatric center in conditions of implementation of the three-level system for providing geriatric care makes it possible to most effectively use the existing resources of the healthcare system and the social sphere of the region (province), to set and improve organizational, methodological and interdepartmental interaction aimed at increasing the availability and quality of medical and social care for the elderly and senile population.

Kazan medical journal. 2022;103(2):278-284
pages 278-284 views

Features of the population immunity to SARS-CoV-2 development in staff members of medical organizations during the spread of COVID-19

Sadykov M.N., Ziatdinov V.B., Reshetnikova I.D., Khakimov N.M., Lopushov D.V., Isaeva G.S.

Abstract

Background. The ongoing COVID-19 pandemic generates the urgent need of monitoring the herd immunity among healthcare workers as a high-risk group for infection.

Aim. Determining the level and structure of population immunity to SARS-CoV-2 in the medical workers during the second peak of COVID-19 from August to November 2020.

Material and methods. The study involved 15,158 medical workers from 91 medical organizations of the Republic of Tatarstan. The age of the examined stuff members varied from 18 to 74 years, the average age was 45.48±0.1016 years, most of them were women (13 627, 89.87±0.258%). Testing for the presence of total antibodies (immunoglobulin classes G, A and M) to SARS- CoV-2 was performed once by the enhanced chemiluminescence method. Statistical processing was carried out by methods of variation statistics and correlation analysis according to the Pearson method using MS Excel and WinPepi.

Results. Seroprevalence to SARS-CoV-2 in medical workers was 35.23±0.388%. An increase in seropositive individuals level from 27.44±0.265% in August to 57.91±0.499% in November and an increase in the average geometric mean titer of total antibodies (immunoglobulin classes A, M, G) from 84.43 in August to 101.09 in November 2020 were detected. The level of individuals with antibodies increased with age from 18 to 59 years and decreased in group of 60–70 years. The largest proportion of seropositive to SARS-CoV-2 individuals was found among junior (42.01±1.384%) and middle grade (37.5±0.527%) medical staff of hospitals for patients with COVID-19, ambulance and emergency stations. Among the seropositive to the SARS-CoV-2 workers the proportion of asymptomatic forms of infection was 84.97±0.498%. According to the level of seroprevalence, municipal districts of the Republic of Tatarstan were divided into three groups: moderate — 8.9–39.0; average — 42.9–49.6, high level — 53.1–64.4.

Сonclusion. An increase in seroprevalence to SARS-CoV-2 was revealed among medical workers of the Republic of Tatarstan from August to November 2020 during the second peak of COVID-19.

Kazan medical journal. 2022;103(2):285-295
pages 285-295 views

Clinical observations

The experience of critical burn injury treatment in pediatric practice

Gostev V.N., Bogdanov S.B., Harina J.N., Arefyev I.Y.

Abstract

Patients with severe burn injuries require specialized medical care. For many decades, burn injury in children remains an important issue both in medical and social-economic aspects. It is explained by the high frequency of this pathology, prevalence among all age groups of the population, severe clinical course accompanied by the multiple organ failure development. About 400 thousand burns per year occur in Russia, 35–40% of them affect children. A burn injury often leads to fatal outcome, disability and reduce of the quality of life. Wound infection associated with the burn injury in children remains a topical problem of modern combustiology. The authors present the clinical case of successful treatment of Patient M., born in 2005. The patient was transferred from the city M. to the burn center of University Clinic of the Privolzhsky Research Medical University in Nizhny Novgorod on the third day after getting the injury. During the hospitalization period in the burn center, the patient underwent complex treatment: infusion-transfusion therapy under the hemodynamic and laboratory indicators control, antibacterial and anticoagulant therapy, nutritional support by a combined method, symptomatic treatment, active surgical tactics (necrectomy by bordering incisions using modern wound hydrocolloid coatings, autologous skin grafting). In skin grafting operations, a high perforation coefficient of split grafts was used (1:6, 1:3). The success of treatment was determined by the creation of an optimal wound environment for the autografts’ engraftment, the absence of regression, which made it possible to restore the skin integrity in a short time, and to avoid complications of the burn disease course. Thus, the early transfer of a child with a severe injury into a specialized burn center, intensive therapy, active surgical tactics, the use of modern wound coatings in the treatment of a patient with a critical area of deep burn injury made it possible to successfully restore the skin in a short time of hospitalization.

Kazan medical journal. 2022;103(2):296-301
pages 296-301 views

Clinical experiences

Analysis of own observations of visceral syphilis lethal outcomes

Nadeev A.P., Krivosheev A.B., Pakhomova A.E., Travin M.A., Pakhomova E.E.

Abstract

The epidemiological situation of the syphilis incidence in the modern world is characterized as a “hidden” epidemic, which manifests itself in latent and late forms of the disease. Despite the general trend towards a decrease in the incidence of syphilis, there are some specific features in many regions of Russia. Deaths from visceral syphilis are now rare. The article presents data on the epidemiology, nosological forms of visceral syphilis, and describes two lethal outcomes. In observations, late syphilis was characterized by damage to several organs (liver, lungs, heart, brain), but the leading clinical manifestations were neurosyphilis (syphilitic meningoencephalitis) and cardiovascular syphilis (syphilitic mesaortitis, interstitial myocarditis). Damage of the respiratory and digestive organs (stomach, liver) are rare forms of visceral syphilis. In the presented observations, gummas in the lungs and liver, which were not clinically diagnosed, were detected. In all cases, the diagnosis of visceral syphilis was established at autopsy on the basis of a characteristic morphological picture (detection of gummas) and positive results of the Wassermann reaction.

Kazan medical journal. 2022;103(2):302-308
pages 302-308 views

Differentiated approach to the surgical tactics choice in the treatment of patients with bite wounds

Izmailov S.G., Leontiev A.E., Izmailov A.G., Lukoyanychev E.E., Rotkov A.I., Kuranov A.A., Koloshein N.A., Mezinov A.V., Simonov A.S., Samarin E.V.

Abstract

Background. Wounds inflicted by the teeth of animals and humans take a special place and have a number of characteristic features. There is still no generally accepted surgical tactics for the bite wounds treatment, and the issues of choosing the timing of wound closure, depending on their localization, remain unresolved.

Aim. To analyze the clinical experience of bite wounds surgical treatment by applying primary and secondary sutures.

Material and methods. From 2008 to 2018 409 patients with bite wounds of various localizations (289 female and 120 male) aged 16 to 84 years were under our supervision. The average age of the victims was 52.5±10.17 years. All patients were prescribed combined therapy, which was based on an urgent surgical care, since we attach a decisive role in the prevention and local treatment of wound infection to full primary or secondary surgical treatment. The analysis of the obtained data was performed using the statistical calculations in R 3.6.3 (R Foundation for Statistical Computing). To compare the average treatment time for primary and secondary sutures nonparametric Mann–Whitney test was used.

Results. Analysis of the obtained clinical data showed that the largest number of bite wounds were dog bites (95%), which occured most often in spring (38%) and summer (38.1%), and, as a rule, at home (68%), these results were comparable with statistical data from other sources. The average duration of patients’ treatment with a primary suture was 13.2 days, and with a secondary suture — 19.3 days. The authors proposed a differentiated approach to the choice of surgical tactics in the treatment of patients with bite wounds, depending on the timing of their admission to the hospital and the local status of the wound defect.

Conclusion. The primary or primary delayed blind suturing should be used in the early stages (not later than in 12 hours after getting a bite), and secondary sutures are shown in late stages (more than 12 hours).

Kazan medical journal. 2022;103(2):309-316
pages 309-316 views

A complex approach to the chronic recurrent cystitis treatment

Sayapova D.R., Zubkov A.Y., Ibragimov T.M.

Abstract

Background. Chronic cystitis is the dominating urinary tract disease. Due to its high prevalence among women, this issue remains topical in medicine.

Aim. To evaluate the effectiveness of the sodium hyaluronate in the complex treatment of chronic recurrent cystitis.

Material and methods. The research included 60 patients with a confirmed clinical diagnosis of “chronic recurrent cystitis” in the clinic of Kazan State Medical University for the period from July 2020 to July 2021. To evaluate the effectiveness of treatment, the patients were divided into groups using the copy-pair method. The first (main) group included 30 women receiving anti-inflammatory therapy and local treatment with collargol instillations. After that, the patients were prescribed the topical use of sodium hyaluronate: 40 mg (50 ml) once a week for 1 month. The second (control) group also included 30 patients who received only anti-inflammatory therapy and local treatment with collargol. The average age of the observed patients was 30.5±1.5 years: in the first group — 31.1±1.5 years, in the second group — 31.9±1.3 years. All patients underwent control cystoscopy, ultrasound and urodynamic examinations on the 15th and 30th day of treatment. The Welch's t-test, Fisher's test, analysis of variance with repeated observations were used as statistical data analysis methods.

Results. Treatment was completed by all patients in both groups. The patients’ management showed a significant decrease in the number of urination (up to 6 times a day), and urgent uriesthesia was recorded in 86.6% of women in the main group compared to 60% in the control group (p <0.05). The control cystoscopy performed on the planned 15th day of treatment showed positive dynamics in the bladder mucosa recovery under the collargol influence. All patients of the first group had no changes in the mucous membrane of the bladder. There was a positive dynamics of urodynamic parameters in the first group compared to the control group.

Conclusion. The sodium hyaluronate, which was included in the complex therapy of chronic recurrent cystitis, accelerates the process of the bladder mucosa regeneration after local treatment with collargol and reduces the time of its recovery.

Kazan medical journal. 2022;103(2):317-323
pages 317-323 views

History of medicine

The history of the appointment of V.M. Bekhterev to the Imperial Kazan University

Sozinov A.S., Mendelevich V.D., Mitrofanov I.A.

Abstract

In this article, based on archival data and literary sources, the history and reasons for the appointment of V.M. Bekhterev to the Imperial Kazan University are described. Since the sixties of the 19th century, anatomy and physiology professors, as well as clinicians and psychologists of Kazan University, started comprehensive studies of the nervous system within the framework of a specially created psychophysiological department of the Society of Naturalists. Kazan scientific community was familiar with the experimental work of V.M. Bekhterev, the assistant of the Imperial Military Medical Academy, and considered him capable of continuing research on nervous system, which was actively carried out in Kazan. The professors of the medical faculty needed a like-minded person like V.M. Bekhterev at the university to support their scientific views on the role of the nervous system physiology in human mental phenomena formation, as well as to continue the nervous system complex studies, which were started in the framework of the psychophysiological department of the Society of Naturalists. The initiator of the invitation of V.M. Bekhterev as a physiology professor was N.O. Kovalevskiy, who was actively studying the nervous system physiology and supporting the young professor in his scientific and organizational activities for almost the entire period of his work in Kazan. Vladimir Mikhailovich was unanimously elected by the Council of the Faculty of Medicine, and despite being sent on a business trip abroad, he became a head of the Department of Psychiatry at Kazan University from August 1, 1885.

Kazan medical journal. 2022;103(2):324-333
pages 324-333 views

Conferences

Interregional scientific and practical online conference “Dentoalveolar training in dental practice: results and prospects”

Abstract

On October 8, 2021, the Interregional Scientific and Practical Online Conference “Dentoalveolar Training in Dental Practice: Results and Prospects” was held. The main topic was the use of Dentoalveolar training. The conference aroused great interest among the participants, many questions were asked, to which the speakers gave exhaustive answers.

Kazan medical journal. 2022;103(2):334-337
pages 334-337 views

Cochrane Review Summaries

Oral antihistamine-decongestant-analgesic combinations for the common cold

Abstract

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: De Sutter AIM, Eriksson L, van Driel ML. Oral antihistamine-decongestant-analgesic combinations for the common cold. Cochrane Database of Systematic Reviews. 2022, Issue 1. Art. No.: CD004976. DOI: 10.1002/14651858.CD004976.pub4.

Kazan medical journal. 2022;103(2):338-339
pages 338-339 views

Low-carbohydrate versus balanced-carbohydrate diets for reducing weight and cardiovascular risk

Abstract

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Naude CE, Brand A, Schoonees A, Nguyen KA, Chaplin M, Volmink J. Low-carbohydrate versus ba­lanced-carbohydrate diets for reducing weight and cardiovascular risk. Cochrane Database of Systematic Reviews. 2022, Issue 1. Art. No.: CD013334. DOI: 10.1002/14651858.CD013334.pub2.

Kazan medical journal. 2022;103(2):340-341
pages 340-341 views

Through the pages of the “Kazan Medical Journal”

Reprint of an article by V.E. Adamyuk, published in the Kazan Medical Journal 100 years ago

Abstract

This publication is a reprint of an article by Prof. V.E. Adamyuk “Streptotrichosis of the eyelid”, Published in the Kazan Medical Journal in 1921. Reprinting is carried out in preparation for the celebration of the 150th anniversary of the first issue of the Kazan Doctors' Society Diaries, the assignee of which is the Kazan Medical Journal. Original publication: Adamyuk VE. Streptotrichosis of the eyelid. Kazan Medical Journal. 1921;17(3):404–412.

Kazan medical journal. 2022;103(2):342-352
pages 342-352 views


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