Vol 99, No 3 (2018)

Theoretical and clinical medicine
Features of dental diseases in children with albinism
Saleev R.A., Abdrashitova A.B., Makhmutova A.I., Mayanskaya N.N.
Abstract

Aim. To comparatively characterize the state of local and general immunity in patients with the primary diagnosis of albinism and oral mucosal diseases.

Methods. In the dental clinic of FSBEI HE «Kazan SMU MOH Russia» 4 patients aged 16 to 17 years are observed with the primary diagnosis of albinism and comorbid oral mucosal diseases. On initial examination 2 patients from group 1 were diagnosed with chronic recurrent aphthous stomatitis, Sutton’s disease. K12.1. The control group (group 2) included 5 children aged 12 to 15 years diagnosed with chronic recurrent aphthous stomatitis. The state of local immunity was assessed by the level of lysozyme of the oral fluid before and after the treatment. Lysozyme activity in the oral fluid was evaluated and calculated by our newly developed method. The state of local immunity was assessed by immunograms. Patients’ microbiologic status was evaluated by microscopic and bacteriological methods.

Results. Among the patients from group 1 with the diagnosis of chronic recurrent aphthous stomatitis, Sutton’s disease, the analysis of immunograms prior to the study revealed severe neutropenia (5.4±0.4×109/l), lymphocytosis (Т-lymphocytes 85±3.5%), leukopenia (2.2±0.1×109/l), increased level of immunoglobulin A (2.69±0.1 g/l), decreased number of phagocytes (2.6) and circulating immune complexes (22±1.48). In patients from the control group leukopenia (2.89±0.23×109/l), lymphocytosis (Т-lymphocytes 74.3±1.32%), insignificant increase of immunoglobulin G level (14.5±0.59 g/l), decreased number of phagocytes (4.5±0.5) and circulating immune complexes (38.67±1.23), and neutropenia (25.5±0.1×109/l) were revealed.

Conclusion. Cellular component of the general immunity in albinos insignificantly differs from the patients of the control group but no restoration of the cellular immunity occurs even in long-term remission; to choose the method of treatment for patients diagnosed with chronic recurrent aphthous stomatitis it is necessary to determine the etiology of the disease, particularly, immunologic status of patients before and after the treatment.

Kazan medical journal. 2018;99(3):357-362
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Features of clinical course and treatment principles of endodontic-periodontal lesions
Moroz P.I., Iordanishvili A.K., Prohodnaya V.A., Maxyukov S.Y., Safronenko A.V., Gulyaeva E.S.
Abstract

Aim. To study the characteristic differences in the clinical course of chronic generalized periodontitis in the presence of periapical infection focus and the principles of combined treatment of endodontium and periodontium.

Methods. A clinical and X-ray examination of 1525 patients of different age groups was performed. As a result, a clinical group of 68 patients with chronic generalized moderate and severe periodontitis was formed, who were divided into two groups depending on the presence or absence of periapical destruction. In group 1, 32 patients with the presence of chronic generalized periodontitis and signs of chronic apical periodontitis were united. Group 2 included 36 patients with chronic generalized periodontitis and no periapical infection and damage. The index estimation of the periodontal tissues state in the dynamics of combined endodontic and periodontal treatment was performed.

Results. The initial task of treating endodontic periodontal lesions, regardless of the localization of the primary lesion focus, is the elimination or reversal of chronic periapical inflammatory processes of the teeth. The proposed monitoring system in the course of treatment and dynamic follow-up for 18 months for patients suffering from endodontic periodontal lesions using clinical and radiological methods of examination involves: (1) interim epicrisis or conclusion about negative or positive compliance 1-2 months after the completion of endodontic treatment and hygiene procedures; (2) periodontal treatment (according to indications) with the assessment of clinical efficacy 6 and 12 months after the start of treatment; (3) epicrisis after 18 months.

Conclusion. The use of proposed concept of complex treatment of endodontic-periodontal lesions, monitoring system in the course of dental therapeutic and preventive measures and dynamic follow-up for 18 months allows achieving positive compliance in 85% of patients according to the clinical examination and in 80% of patients according to radiologic examination.

Kazan medical journal. 2018;99(3):362-368
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Features of cellular mechanisms affecting the pathogenesis and course of chronic catarrhal gingivitis
Mayanskaya N.N., Vanyunina V.V.
Abstract

Aim. To investigate the cellular mechanisms of chronic catarrhal gingivitis to develop the appropriate treatment schemes based on the analysis of obtained data.

Methods. 57 patients aged 16 to 22 years were observed and divided into the control group (18 subjects with the intact periodontium with no orthopedic constructions) and the study group of patients with chronic catarrhal gingivitis (39 subjects, group 1). The degree of gingival inflammation was evaluated by papillo-marginal alveolar index as well as by gingival bleeding index. In addition, laboratory parameters were measured: spontaneous nitroblue tetrazolium test and zymosan-stimulated nitroblue tetrazolium test. Leukocyte-modulating activity of oral fluid was determined by measurement of luminol-dependent chemiluminescence. The activity of lysosomal enzymes - acid deoxyribonuclease and acid phosphatase - was determined in whole oral fluid, supernatant fraction of oral fluid and in sediment, obtained by centrifugation. Antioxidant activity was determined in whole oral fluid by biochemiluminescent method with hydrogen peroxide.

Results. The performed investigations demonstrated that the development of chronic catarrhal gingivitis is accompanied by a sharp increase of the number of neutrophils and macrophages with a significant increase of their functional activity. At the same time, more than two-fold increase of the activity of lysosomal enzymes, lysosomal membrane labilization and release of enzymes outside the organelles and cells were observed, that indicated the increase of destructive potential in chronic catarrhal gingivitis. Use of indometacin in the complex treatment of chronic catarrhal gingivitis contributed to normalization of clinical parameters, increased neutrophil functional activity and enhanced their functional reserve, reduced the activity of phlogogenic factors and normalized the antioxidant activity of oral fluid. Pro- and anti-inflammatory factors secreted into the oral cavity during inflammatory periodontal diseases collectively have leukocyte-modulating activity.

Conclusion. The obtained data indicate the important role of both high oxygen-dependent and oxygen-independent biocidal activity of neutrophils and macrophages in the pathogenesis and clinical course of chronic catarrhal gingivitis.

Kazan medical journal. 2018;99(3):368-374
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Improving the efficiency of treatment of inflammatory periodontal diseases in professional athletes
Safaraliev F.R.
Abstract

Aim. Evaluation of the effectiveness of the medication «Pomegranate balm» in the treatment of inflammatory periodontal diseases in professional athletes.

Methods. Among 475 professional athletes the prevalence of periodontal diseases was studied using the Community Periodontal Index of Treatment Needs. Silness-Löe plaque index, periodontal index, Muhlemann sulcus bleeding index modified by I. Cowell and biochemical analyses were determined in 51 freestyle and classical style wrestlers divided into three groups: group 1 - 20 athletes with intact periodontium, group 2 - 16 athletes with chronic catarrhal gingivitis, group 3 - 15 wrestlers with the signs of mild periodontitis. Sialometry was performed, the concentration of secretory immunoglobulin A and interleukin-8 in oral fluid was measured by the method of enzyme linked immunosorbant assay (ELISA).

Results. The maximum values of gingival bleeding were recorded in groups 1 and 2 of the examined athletes - 20.9±3.79 and 34.5±3.21%, respectively. The incidence of moderate and severe periodontal diseases in the age group of 24-32 years was in average 14.1±2.35 and 5.5±1.53%, respectively. Use of the drug sharply increased the rate of basic salivation (from 1.98±0.031 to 2.23±0.023 ml/min, p <0.001), and by the end of the investigation, in most of the athletes the earlier observed signs of hyposalivation resolved, and the analysis of laboratory data revealed markedly increased level of secretory immunoglobulin A from 260.2±1.47 to 544.0±6.33 mg×mg-1 protein and decreased levels of interleukin-8 from 2829.6±15.8 to 1224.2±18.0 pg×mg-1 protein (p <0.001).

Conclusion. Effective and biologically active preparation based on propolis «Pomegranate balm» can significantly improve the dental status of professional athletes against the background of improving the state of factors of local oral immunity.

Kazan medical journal. 2018;99(3):374-380
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Analysis of the causes of postfilling pain in the treatment of uncomplicated caries
Yurkevich A.V., Suvyrina M.B., Chaban A.V., Kruglov T.E.
Abstract

Aim. To analyze the incidence of postfilling pain in the treatment of uncomplicated caries with filling materials approved by the program of compulsory medical insurance (CMI).

Methods. Retrospective analysis of medical records of patients of dental clinic of Far Eastern state medical university «Uni-Stom» treated for uncomplicated caries according to the program of compulsory medical insurance.

Results. In patients’ group 1 where cementation was performed with zinc-phosphate cement, the average duration of postfilling pain was statistically calculated to be 13 days (M±0.8). In group 2 of patients seeking dental care who had permanent filling performed with composite material without cementation, significant decrease (t=9.4; p <0.001) of time course of postfilling pain relief to 4 days (M±0.6) was revealed. In group 3 compomer material was used as cement, postfilling pain relief occurred significantly earlier (t=11.6; p <0.001) by 2.5 days (M±0.4). The best measures were observed in the group where chemically cured glass ionomer cement was used as cement; postfilling pain was controlled in 1.5 day (M±1.2), being statistically significant (t=8.3; p <0.001). The dependence of postfilling pain on the selected filling material is observed after the treatment of uncomplicated caries; when using zinc-phosphate cement «Uniphase», a complete postfilling pain relief occurs on average on day 14, when using a light-curing composite «Charisma» - on day 4, «Isolain» - on days 2-3 and «Tsemion» - on day 1-2.

Conclusion. Given the clinical results, positive qualities and low cost of glass-ionomer cement «Tsemion», its use is recommended for the treatment of uncomplicated caries in public dental practice.

Kazan medical journal. 2018;99(3):380-385
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Capabilities of gravitational surgery for improvement of treatment results in patients with diabetic foot syndrome
Akhmedov M.B., Abushov N.S., Zakirdzaev E.D., Kosaev D.V., Babaev N.I., Kuliev R.A., Tagizade G.T.
Abstract

Aim. Improvement of complex treatment results in patients with diabetic foot syndrome by introducing methods of gravitational surgery and α-lipoic acid.

Methods. The results of treatment were analyzed for 558 patients with diabetic foot syndrome treated in Scientific Centre of Surgery named after M.A. Topchubashov (Baku, Azerbaijan) from 1988 to 2015. The age varied from 28 to 83 years. The patients included 416 men and 142 women. The control group included 90 patients who at the perioperative period underwent basic therapy including antibiotics, anticoagulants, antiaggregants, dextrans, angioprotectors, spasmolytics, corticosteroids, narcotic and non-narcotic analgesics. The study group included 468 patients, along with traditional therapy receiving efferent methods (plasmapheresis, ultraviolet blood irradiation, ozone therapy) and α-lipoic acid. 282 patients of the study group received outpatient treatment and 186 - complex inpatient surgical treatment. A comparative evaluation of the results was performed separately in three groups: angiopathy, neuropathy, angioneuropathy. The results were evaluated by clinical and instrumental examinations before and after treatment (6, 12, 60 months and more).

Results. In the study group a satisfactory result of treatment was registered in 85.5% of patients, in the control group - in 62.2%, unsatisfactory in 14.5 and 37.8% of patients, respectively (p=0.046).

Conclusion. The use of efferent methods and α-lipoic acid provided prompt elimination of numerous pathogenetic disorders observed in diabetes mellitus, decrease of amputation frequency and improvement of complex surgical treatment results in patients with diabetic foot syndrome.

Kazan medical journal. 2018;99(3):385-391
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Comparative study of different methods of anesthesia with transrectal resection of the large bowel in Hirschsprung's disease in young children
Nasibova E.M., Polukhov R.S.
Abstract

Aim. Improvement of the safety of patients and of effectiveness of anesthetic protection for young children with Hirschsprung's disease during transrectal resection of the large bowel by comparative study of various methods of anesthesia and creating an effective and safe anesthesia regimen.

Methods. The study included 25 children with Hirschsprung's disease who underwent transrectal resection of the large intestine. All examined patients were divided into two groups depending on the chosen method of anesthesia. In clinical group 1 (n=13) multicomponent endotracheal anesthesia with high doses of fentanyl were selected for anesthesia, in clinical group 2 (n=12), surgical interventions were performed under general anesthesia combined with caudal block.

Results. The level of cortisol in patients from group 2 at the 2nd stage of the study significantly decreased by 22%, which indicated the adequacy of this technique of anesthesia. Also, in patients of this group at the 4th stage of the study the level of cortisol and glucose did not change. In patients from group 1 who underwent multicomponent general anesthesia with high doses of fentanyl, at the 4th stage of the study a significant increase occurred in the level of cortisol and glucose by 48.6 and 93.6%, respectively. This indicates the appearance of severe pain 24 hours after the surgery.

Conclusion. Caudal anesthesia combined with general anesthesia provides a reliable analgesic effect and miorelaxation in transrectal resection of the colon in Hirschsprung's disease in young children; the combined administration of trimeperidine (promedol) with ropivacain (naropine) into the caudal canal prolongs the analgesic effect up to 24 hours.

Kazan medical journal. 2018;99(3):392-396
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Fetal growth restriction: features of somatomental development in infancy
Dolgova N.S., Yavorskaya S.D.
Abstract

Aim. To determine the features of physical and somatic health of full-term infants with fetal growth restriction during the first year.

Methods. A retrospective analysis of 100 neonatal medical records of full-term infants was performed. All children were divided into 2 groups: group 1 - full-term infants, who were diagnosed with fetal growth restriction at birth (n=50), group 2 - full term infants born with normal body weight (n=50). Control points of comparison were neonatal period, months of life 1, 3, 6 and 12. Overall anthropometric data (length, weight, head and chest circumference), incidence and structure of morbidity and child's key system involvement were assessed.

Results. Full-term newborns with fetal growth restriction present a risk group of growth and weight gain retardation during infancy, perinatal disorders of central nervous system persistent in 28±12% of cases by year 1 and, consequently, restriction of psychomotor (16±10%) and pre-verbal development (16±10%). Full-term low birth-weight newborns are characterized by short period of breast feeding and are included into the group of frequently ill children. The most vulnerable system, except for central nervous system, is the respiratory system.

Conclusion. Children born with fetal growth restriction by the full term of gestation require special approach: diagnosis of and degree of central nervous system perinatal disorders at the first minutes of life, dynamic monitoring and personalized rehabilitation and preventive measures during the first year of life.v

Kazan medical journal. 2018;99(3):397-401
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Microbial landscape of the intestine in outpatients with acute enteric infections
Kulieva Z.M., Gasanov A.I., Rustamova L.I., Israfilbekova I.B., Mukhtarov M.M., Mamedova M.N.
Abstract

Aim. Study of the state of intestinal microflora in young children seen in an outpatient setting with acute enteric infections.

Methods. The state of microflora of 156 children was examined. All children underwent bacteriological study. Children were divided into following groups by age: 0-6 months - 59 (37.8%) patients; 6-12 months - 32 (20.5%) and 1-3 years - 65 (41.7%) subjects. Among them, 33 (21.1%) received breast milk, 46 (29.5%) received artificial feeding and 77 (49.4%) - mixed feeding.

Results. Conditionally pathogenic bacteria were revealed in 114 (73.08%) patients, mainly (92.98% of cases) Candida alone or in combination with other conditionally pathogenic microorganisms were detected in 57 (50.0%) children: Candida + St. aureus - in 32 (28.1%) patients, Candida + P. vulgaris - in 9 (7.9%), Candida + P. vulgaris + St. aureus - in 12 (10.5%), Candida + St. aureus + Ps. aeroginosa - in 4 (3.5%) subjects. In 42 (26.92%) children conditionally pathogenic flora was not detected. As a result of the study of intestinal microflora structure of outpatients, decreased number of E. coli and B. bifidum by 67.3 and 36.5%, respectively, was revealed. The leading place was taken by Candida albicans identified in more than 50% of outpatients.

Conclusion. Young children with acute enteric infections had mainly conditionally pathogenic and pathogenic microorganisms isolated in different associations.

Kazan medical journal. 2018;99(3):401-404
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Investigation of the correlation of allele polymorphism of renin-angiotensin system genes, nitric oxide synthase and folate cycle with the severity of ischemic stroke
Levashova O.A., Baranova N.I., Zolkornyaev I.G.
Abstract

Aim. To study the frequency of polymorphic gene variants encoding proteins of renin-angiotensin system [AGT Thr174Met (rs 4762), AGT Met235Thr (rs699), AGTR1 A1166C (rs5186)], endothelial factors [NOS3 C786T (rs2070744)], and folate cycle enzymes [MTHFR C677T (rs1801133)] in patients with various ischemic stroke severity.

Methods. 98 patients with ischemic stroke verified by magnetic resonance imaging and computed tomography scan of the brain, were examined. The severity of stroke was assessed by National Institutes of Health Stroke Scale. The allelic variants of genes were typified by polymerase chain reaction with the detection of amplification products in the «real time» mode.

Results. The analysis of genetic polymorphism frequency of renin-angiotensin system did not reveal statistically significant differences in the study groups. The polymorphism of NOSC786T gene in the study was also not associated with the severity of ischemic stroke. Among the studied polymorphic variants, only the C677T polymorphism of MTHFR gene was revealed to be reliably associated with severe course of acute cerebral ischemia.

Conclusion. C677T polymorphism of MTHFR gene is reliably associated with severe course of acute cerebral ischemia; carriage of 677T allele of MTHFR gene in the studied category of patients can cause an increased level of homocysteine and have an adverse effect on the course of acute cerebral ischemia.

Kazan medical journal. 2018;99(3):404-408
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Modification of biochemical recurrence risk in patients with localized prostate cancer after radical prostatectomy with combined histomorphological changes in the peritumoral zone
Bova F.S., Kit O.I., Maksimov A.Y., Karnaukhov N.S.
Abstract

Aim. To assess the prognostic significance of histopathological processes in the peritumoral zone with respect to the risk of biochemical recurrence in patients with localized prostate cancer after radical prostatectomy.

Methods. Histomorphological studies were conducted in the perifocal area of surgical tissue samples from 309 patients with localized prostate cancer (T1c-2cN0M0) after a radical surgery using light microscopy. Four groups of patients were identified depending on the risk of recurrence. Enzyme immunoassay was used to determine the concentration of prostate-specific antigen in the serum at baseline and every 3 months for two years after the surgery to detect biochemical recurrence.

Results. Histomorphological examination of the peritumoral zone made it possible to identify histopathological processes associated with adenocarcinoma in 257 out of 309 (83.2%) patients with localized prostate cancer. The risk of biochemical recurrence of a combination of prostatic adenocarcinoma and prostatic intraepithelial neoplasia-2 increased by 3.3 (p=0.02), and of a combination of adenocarcinoma, neoplasia and chronic inflammation in the perifocal zone increased by 4.5 times (p=0.005) compared to patients without histopathological changes of the peritumoral zone. In combination of prostate adenocarcinoma with neoplasia and chronic inflammation in the peritumoral zone, the number of patients with an intermediate risk of cancer recurrence after surgical treatment increased due to decrease of the proportion of patients with very low and low risk of recurrence of the oncologic disease.

Conclusion. The combination of prostate cancer with high-grade prostatic intraepithelial neoplasia and chronic inflammation in the peritumoral zone modifies the risk of biochemical recurrence of cancer after radical prostatectomy.

Kazan medical journal. 2018;99(3):408-415
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DNA-cytometric characteristics of recurrent soft tissue sarcomas
Nepomnyashchaya E.M., Ul'yanova E.P., Novikova I.A., Selyutina O.N., Zlatnik E.Y., Aliev T.A., Vashchenko L.N., Ausheva T.V., Andreyko E.A., Zolotareva E.I., Bondarenko E.S.
Abstract

Aim. To determine the content of deoxyribonucleic acid (DNA) and distribution of cells in mitotic phases in patients with recurrent soft tissue sarcomas for the assessment of malignancy of the process.

Methods. Tumor tissues of patients with recurrent soft tissue sarcomas were studied. Research methods included histological, DNA-cytometric and statistical methods.

Results. Proliferative activity and proliferative index of recurrent sarcomas differed depending on the tumor grade and stage. Differences in the number of diploid, aneuploid and polyploid cells were determined in each group and between the groups depending on the cell cycle phases. Cell cycle parameters were as following: 100% of G1 (well-differentiated) cancer were diploid, as well as 33.3% of G2 (moderately differentiated) and 15% of G3 (poorly differentiated) tumors. Aneuploid tumors prevailed in G2 and G3, the ratio of which was 66.7 and 85%, respectively. The analysis of kinetic parameters of the cell cycle allowed establishing a decrease in the number of cells in G1/G0 phase of the cell cycle from G1 to G3, which was accompanied by a statistically significant increase in the proportion of cells in S-phase (p ˂0.05).

Conclusion. The DNA-cytometric study of cell cycle parameters showed high biological potential of recurrent soft tissue sarcomas, which was determined by two indices - the proportion of cells in G2+M-phase and the cell loss factor; 100% of well-differentiated (G1) tumors, 33.3% of moderately differentiated (G2) and 15% of poorly differentiated (G3) tumors were diploid; aneuploid tumors prevailed in G2 and G3.

Kazan medical journal. 2018;99(3):415-420
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Estimation of serological landscape of nazofaringeal strains of Streptococcus pneumoniae circulating in the territory of Barnaul
Kozyanova Y.A., Safyanova T.V.
Abstract

Aim. To study the prevalence of S. pneumoniae serotypes in nasopharyngeal carriage among different age groups in organized groups to optimize the information and analytical system of epidemiological surveillance of pneumococcal infection.

Methods. By classical bacteriological method 75 nasopharyngeal isolates of pneumococcus, which later were serotyped, were identified in 319 subjects of different age from children's and adults' organized groups in Barnaul.

Results. In 2017 the epidemiological screening was used to evaluate the prevalence of S. pneumoniae carriage. After identification, nasopharyngeal pneumococcal strains underwent serotyping. The greatest proportion of serological landscape of the studied strains was 3 and 19F serotypes, the total proportion of which was 75±9.7%. 13-valent pneumococcal conjugated vaccine had the maximum coverage of local strains - 62.5%. Based on the data on community-acquired pneumonia caused most often by pneumococcus, from information and analytical system received from the territories of the region, the database «Community-acquired pneumonia of the Altai Krai» was created. However, for an adequate assessment of the epidemiological situation regarding pneumococcal infection in the region, incoming information was not enough. The analysis of information from the territories on community-acquired pneumonia allowed identifying disadvantages of epidemiological surveillance of this nosology and inability to adequately assess the epidemiological situation with regard to pneumococcal infection in the region.

Conclusion. The results of serotyping allowed determining further tactics of immunization in the Altai Krai; information and analytical system requires supplementing microbiological monitoring data regarding antibiotic susceptibility and resistance to disinfectants of the etiological agent.

Kazan medical journal. 2018;99(3):421-426
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Effect of modified twin block appliance used for distoclusion treatment on stomatognathic system
Novruzov Z.G., Alieva R.K., Garaev Z.I., Kulieva S.K.
Abstract

Aim. Study of the effect of modified twin block activator used for distoclusion treatment on stomatognathic system and its improvement.

Methods. 55 patients with skeletal distoclusion were examined. Out of them 28 patients treated orthodontically comprised the study group and 27 non-treated patients were included into the control group. The patients' age was 10-14 years (mean age 11.78±0.91), the duration of treatment was 1.5-2 years (mean duration 1.82±0.43). To avaluate the changes in stomatognathic system, cephalometric analysis was performed before and after treatment, and in the control group cephalometric analysis was performed with a 2-year interval.

Results. During treatment with modified twin block appliance, SNB angle reached norm (80°). This is an important positive result in the treatment of distoclusion. ANB angle reflecting sagittal relationship between the upper and lower jaws and WITS decreased and reached normal size. Overjet normalized due to upper incisors retrusion and repositioning of the mandible forward in patients of the study group. In this group due to changes in soft tissues, in-profile esthetic and harmonious appearance of lips and chin was restored. In case of relative physiological rest the opened lips became closer and provided esthetic optimum of the face.

Conclusion. Use of modified twin block appliance for the treatment of patients with distoclusion due to repositioning of the mandible forward allows improving sagittal relationship between the upper and lower jaws as well as overjet correction without increasing face height; use of modified twin block appliance allows normalizing sagittal occlusion and protrusion of upper incisors and upper lip.

Kazan medical journal. 2018;99(3):426-432
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Assessment of the risk of cardiovascular diseases among the staff members of law enforcement body who work in counter-terrorist operation mode and live in the Republic of Dagestan
Omarova A.K., Arkad'eva G.V.
Abstract

Aim. Early identification of risk factors of cardiovascular diseases in staff members of law enforcement body working in counter-terrorist operation mode in the Republic of Dagestan and evaluation of their overall cardiovascular risk.

Methods. 62 employees (males, average age 35.2±4.1 years) were the object of study. The follow-up period was 3.7±0.7 years. The examination included laboratory studies, electrocardiography, echocardiography, 24-hour blood pressure monitoring, duplex study of brachiocephalic arteries, examination of the vessels of the fundus.

Results. The following risk factors were identified: arterial hypertension, dyslipidemia, excess body weight, smoking.

Conclusion. Law enforcement officers are exposed to a range of unfavorable work-related factors (severity and labor intensity) in the course of labor activity, which are associated with operational activity of the Ministry of Internal Affairs employees and enable formation of risk factors of cardiovascular pathology (such as arterial hypertension, overweight, smoking).

Kazan medical journal. 2018;99(3):432-438
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Application of fuzzy mathematical model of decision-making for the selection of optimal surgical tactics in patients with non-tumor obstructive jaundice
Gadzhiev D.N., Tagiev E.G., Gadzhiev N.D., Shikhlinskaya R.Y.
Abstract

Aim. Creation of a model of fuzzy logic for predicting the risk of postoperative complications and the choice of individual optimal surgical tactics in obstructive jaundice caused by choledocholithiasis. Methods. At the first stage, we determined the most prognostically significant factors affecting the risk of postoperative complications. In accordance with these factors, linguistic variables were introduced: X1 - patient’s age; X2 - duration of jaundice; X3 - temperature; X4 - comorbidities; X5 - the level of liver dysfunction; X6 - CD4+ in the blood; X7 - interleukin-2 in the serum; Y - level of risk. The intervals of their changes were determined. Fuzzi Logic Toolbox Matlab soft was used to achieve the determined aim. The values of input variables were introduced into the model, transformed in the «Phaser» block and then the rule base of the fuzzy inference system was formed by the expert method. As a result, the level of risk is determined and the choice of surgical tactics is made: (1) risk is absent or low (A); (2) doubtful risk (B) - if the risk assessment in the dynamics after preoperative therapy decreases, then tactics A, if the score does not decrease or increases, then tactics C; (3) high and very high risk (C) - an unequivocal choice of stage tactics. Results. According to the defined level of risk, in 92 patients a one-stage procedure was used, while 58 underwent a two-stage intervention. Due to the developed fuzzy mathematical model, forecasting of the optimal choice of surgical tactics is achieved, which significantly improves the results of treatment. Conclusion. The developed fuzzy mathematical model makes it possible to differentiate the choice of surgical tactics for a particular patient and thereby reduce the incidence of postoperative complications from 29.0 to 4.7% and mortality from 11.0 to 1.3%.

Kazan medical journal. 2018;99(3):439-445
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Experimental medicine
Neurological status and ethanol preference in rats during alcohol addiction formation
Tarasov A.S., Knyshova L.P., Morkovin E.I., Yakovlev A.T., Poroyskiy S.V.
Abstract

Aim. To estimate the features of neurological status and drinking behaviour in rats during 20 days of chronic alcohol intake.

Methods. The current study was performed on 40 male Wistar rats (170-300 g). The animals from the study group were administered 15% solution of ethanol used as the only fluid source. On day 20 of the experiment the alcohol preference test and evaluation of neurological status were performed: tail-suspension (to determine paresis and paralysis), home cage motion activity (to determine gait disorders and stereotypic movements) and features of horizontal beam-walking (evaluation of movement coordination) were assessed, presence of the basic reflexes (startle reflex, external auditory canal reflex, corneal reflex) was controlled.

Results. The main neurological signs were presented as ataxic form, in which unsteady gait in beam-walking test was predominant. In the experimental groups, the signs of ataxic form of neurological deficit were demonstrated, when animals slipped off and fell off the beam within 40 s from the beginning of the test. This was associated with the significant increase of discrimination ratio in alcohol preference test.

Conclusion. In rat models of chronic alcohol intake, significant changes in drinking behavior and alcohol preference test were found on day 20 of the experiment, reflecting formation of alcohol addiction; changes in drinking behavior were associated with mild and moderate neurological deficit, primarily including movement coordination disorders that illustrates the malfunction of peripheral nervous system.

Kazan medical journal. 2018;99(3):446-449
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Some features of musclemetabolic processes changes with prolonged use of simvastatin and thioctic acid in the experiment
Semenets I.A.
Abstract

Aim. To identify biochemical changes in the muscle tissue of rats in long-term comprehensive administration of simvastatin and thioctic acid (lipoic acid).

Methods. The study was conducted on 120 male outbred rats. The animals were divided into 2 groups: group 1 - intact animals fed common vivarium diet, group 2 - with induced essential hypercholesterolemia. The animals of the experimental group were divided into three subgroups: subgroup 1 - animals that received a diet without the additional drugs; subgroup 2 - those who received simvastatin, and subgroup 3 - those who received simvastatin in combination with thioctic (lipoic) acid. At the end of experiment the concentrations of pyruvic acid, lactate, and reduced glutathione, activity of glutathione reductase, glutathione peroxidase, succinate dehydrogenase and cytochrome oxidase were determined in the muscle of experimental animals.

Results. The development of hypercholesterolemia was found to be characterized by the accumulation of pyruvic acid and lactate in the muscles of rats, which may indicate metabolic acidosis formation. The activity of antioxidant enzymes was multidirectional, indicating disorganization of the main mechanisms of antioxidant defense. The dynamics of antioxidant enzymes activity in animal muscles after the administration of simvastatin indicates aggravation of antioxidant defense disorders. The decrease of the concentration of pyruvic acid and lactate indicates a decrease of the severity of hypoxia. At the same time, decrease of the activity of cytochrome oxidase and succinate dehydrogenase indicates the prevalence of anaerobic bioenergetic mechanisms. After administration of simvastatin in combination with thioctic (lipoic) acid, a decrease of the level of pyruvic acid and lactate to the levels in the control group, an increase of the activity of succinate dehydrogenase and cytochrome oxidase, and increase of the reduced activity of glutathione peroxidase and the concentration of reduced glutathione were detected.

Conclusion. Analyzing the data obtained, thioctic (lipoic) acid with the concomitant use of a statin can be assumed to provide reduction of the severity of hypoxia, stabilization of the bioenergetic and antioxidant processes that can be used for targeted impact on certain pathobiochemical violations in muscle tissue with chronic administration of statins.

Kazan medical journal. 2018;99(3):450-455
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Reviews
Arterial blood supply of the umbilical region in newborns
Kivva A.N., Leiga A.V.
Abstract

The review of national and foreign literature sources presents information on arterial blood supply of the umbilical region in newborns having relevant practical significance due to the development of new surgical approaches in that part of the anterior abdominal wall. Scientific data on the course and location of arteries participating in the blood supply of the umbilical region are summarized. Particular attention is devoted to the description of superficial, superior and inferior epigastric arteries and umbilical arteries. The issues of intervascular connections between the named arteries and other blood vessels are discussed including information on various anastomosis variations and their extent. Various existing viewpoints regarding the location and depth of anastomoses between the vessels essential for blood supply of the umbilical region are presented as well as the layers, through which the main arteries pass, and the character and level of their branching. Features of arterial blood supply of the umbilical region in newborns are also noted. The paper contains data on the role of umbilical arteries in the umbilical region supply in children of that age. It is demonstrated that blood supply of the umbilical region in newborns still poses issues that are insufficiently researched and solved, such as assessing functional capacity of the umbilical arteries, revealing histotopographic peculiarities in the location of blood vessels within the layers and various segments of the umbilical region, topographic and anatomic identification of the segments that are most and least supplied with arterial vessels in that part of the abdominal wall.

Kazan medical journal. 2018;99(3):456-461
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P2-receptors of the urinary bladder as potential targets for novel drugs
Ziganshin A.U., Bedova D.V., Zubkov E.A., Sitdykova M.E.
Abstract

Purinergic P2 receptors, the basic endogenous agonist of which is adenosine triphosphoric acid (ATP), are widely spread in the organs and tissues of human and animals including urogenitary system. Physiologically, in the peripheral nervous system the role of P2 receptors in most cases is not leading, they only complement or modulate the action of main neuromediators (acetylcholine, norepinephrine). But in pathology the role of P2 receptors significantly increases and often takes the lead in the pathogenesis of one or another disease. In particular, it was determined that purinergic component of contractile bladder response increases from 2-5% in normal state to 40% in some pathological processes (such as interstitial cystitis, neurogenic bladder, urinary obstruction). In the bladder of experimental animals different subtypes of P2 receptors were revealed, their functional role was established in normal conditions and models of pathological processes. Certain subtypes of P2 receptors were also detected in the human bladder, including in some urinary tract diseases. The level of ATP in patients’ urine was established to significantly increase in lower urinary tract obstruction that holds certain promise for the diagnosis of these diseases. Variety and large representation of P2 receptors in lower urinary tract make them attractive as potential targets for novel drugs. On this evidence, evaluation of effect of P2 receptor agonists and antagonists as well as medications affecting the metabolism of endogenous nucleotides and nucleosides, is one of promising direction for the search for new urological drugs.

Kazan medical journal. 2018;99(3):462-466
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Social hygiene and healthcare management
Study of medico-biological, medico-social and organizational factors influencing the morbidity of school-age children
Khuzikhanov F.V., Mukhametdinova A.A.
Abstract

Aim. The study of the incidence among school-age children, and development of a complex of medico-biological, medico-social and organizational measures for improving health status of schoolchildren.

Methods. Statistical, mathematical, sociological.

Results. Morbidity among children in Kazan in 2015-2017 increased to 20.4%, incidence during this period increased by 38.6%. The conducted examination of physical development of schoolchildren revealed significant decrease of the ratio of students with normal physical development. While in primary school this parameter was 85.3±2.17%, in grades 8 to 11 it decreased to 77.8±1.98% (p <0.01). The social and hygienic health characteristics of schoolchildren's health include the following: 25% of surveyed students live in families with a low subsistence level; 30% of schoolchildren are brought up in single-parent families; in 10% of cases parents do not allocate money for child nutrition at school; 30.5% of schoolchildren of grades 8 to 11 smoke; 35.9% of students of grades 8 to 11 drink alcohol; 34.9% of schoolchildren have conflicts with their classmates; 17.1% of schoolchildren of grades 8 to 11 do not eat hot meals at school; 28% of students consider themselves not informed about the issues of proper nutrition, etc. The conducted study of the schedule at schools demonstrated that the workload of the junior schoolchildren exceeds the age standards by 5-7 hours, and in the middle and senior classes the load turned out to be higher than the age standards by 5-10 hours.

Conclusion. One-way ANOVA reflected that medico-biological, medico-social and organizational factors significantly influence the occurrence of diseases in school-age children; based on the data on the influence of unfavorable risk factors on the development of diseases in school-age children we will develop measures for medical and social prevention.

Kazan medical journal. 2018;99(3):467-471
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Incidence of thyroid malignancies in Baku
Mardanly F.A., Guliev N.A., Alieva I.D., Alieva F.K., Dzhafarova S.I., Dzhafarova E.R., Burdzhueva A.I.
Abstract

Aim. To study the epidemiological situation of the incidence of thyroid cancer in Baku during the period 2012-2016.

Methods. The basis for conducting the present study was statistical reporting form No. 7 of the Ministry of Health of the Republic of Azerbaijan for the period 2012-2016. 355 patients were examined who were further divided into 2 age groups: 0-17 years (children) and 18 years and older (adults). To assess the epidemiological situation, extensive parameter (disease distribution), intensive (incidence), prevalence of thyroid malignancies, overall mortality rate and lethality, 5-year survival and cancer aggressiveness were used.

Results. Analysis of the incidence of thyroid malignancies in Baku during the period 2012-2016, revealed an increase in incidence, especially in female patients. During the study period, incidence of thyroid cancer among males was 1.5-1.6 per 100 000, and among females - 2.5-4.2 per 100 000. Prevalence during the study period among males increased by 1.7 times and by 2.3 times among females. The peak morbidity of thyroid cancer among females was in the age group of 30-39 years (1.8 per 100 000) and 50-59 years (2.2 per 100 000), and among males the standardized index for all age groups was relatively stable (0.3 per 100 000).

Conclusion. The assessment of incidence of thyroid malignancies among the population of Baku during the period 2012-2016 revealed its increase, especially among the female population.

Kazan medical journal. 2018;99(3):472-475
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Complicated abdominal delivery in females of the Kyrgyz Republic: a retrospective study
Samigullina A.E., Vybornykh V.A.
Abstract

Aim. The study of the dynamics of the rate of complicated abdominal delivery in the Kyrgyz Republic.

Methods. A retrospective cohort study was conducted on the basis of the Kyrgyz state medical institute of retraining and advanced training of the Ministry of Health of the Kyrgyz Republic. The data of consolidated annual reports (form No. 14 «The hospital services report») of the Republican medical information center of the Ministry of Health of the Kyrgyz Republic on the number of abdominal deliveries and complicated abdominal deliveries in women of the Kyrgyz Republic in 2005-2016 were used. For the analysis of time series reflecting the change of the rate and dynamics of complicated abdominal delivery, the developmental cycle of 12 years was chosen. Medium-term prognosis of dynamics of complicated abdominal delivery was calculated till 2021 using the pair-wise linear regression equation, the equation parameters were calculated using the method of least squares.

Results. The study showed the increase in the number of abdominal deliveries in the Kyrgyz Republic during 12 years by 3.2 times and the increase of complicated surgical deliveries by 11.2 times and revealed negative, strong and reliable correlation between maternal and perinatal mortality and the number of abdominal deliveries. A two-fold increase of the rate of complicated caesarean sections in 2010 compared to 2009 (p <0.001), a decrease of this parameter in 2011-2012 by 1.8 times (p <0.001) and subsequent increase by 3.1 times from 2013 to 2016 (p <0.001) were revealed. The leading place in the rate of complicated caesarean sections is taken by Bishkek and Osh region, where the institutions of tertiary medical care are located and severe obstetric and extragenital pathology is concentrated. The medium-term prognosis for the dynamics of complicated abdominal deliveries calculated till 2021 indicates the continued increase of this parameter.

Conduction. The obtained results demonstrate the need for thorough study of this problem with revision and organization of information logistics to reveal a real state and determine cause-and-effect factors influencing these parameters.

Kazan medical journal. 2018;99(3):476-482
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Medical awareness of rural residents with arterial hypertension - the basis of disease prevention
Sadreeva S.K., Zinatullina D.S.
Abstract

Aim. Assessment of awareness of rural residents with arterial hypertension about the disease, risk factors for its development and prevention.

Methods. The study involved 585 patients with arterial hypertension, who are rural residents of Krasnoyarskiy, Volzhskiy and Elkhovskiy districts of the Samara region in 2012-2016: 221 (37.8%) men and 364 (62.2%) women aged 25-65 years (average age 52.5±11.9 years). The disease duration was in average 7.7±3.24 years. The level of medical awareness of arterial hypertension, its risk factors and awareness of individual health indicators were studied using a specially designed questionnaire.

Results. As a result of the survey, rural residents suffering from arterial hypertension had a low level of medical awareness: patients were aware of their disease and the main causes of its manifestations in 46.2%; of the main modifiable risk factors - in 17.6%. Of those who participated in the survey, women were more informed - 61.2% vs 38.8% of men (p=0.0431). 61.5% of all respondents had no blood pressure monitors and no skills of blood pressure measuring. The majority of rural residents (74.6%) are not aware of therapeutic training programs on arterial hypertension. Antihypertensive therapy in a significant portion of patients included two drugs, 73.8% of all respondents showed the desire and need for therapeutic training for secondary prevention of arterial hypertension and risk factors of its development, which involves the study and awareness of correction principles of modifiable risk factors of arterial hypertension, the principles of non-drug and drug treatment to reduce medical and social consequences of the disease - disability and mortality.

Conclusion. Total medical awareness of the disease was 11.4±3.1 points; awareness of the main causes and manifestations of arterial hypertension was 46.2%, awareness of the main modifiable risk factors was 17.6%, among them men are less informed (38.8%) than women (61.2%; p=0.0431); 74.6% of all respondents did not know about the existence of therapeutic educational schools, among them men are less informed (30.3%) than women (69.7%; p=0.0271).

Kazan medical journal. 2018;99(3):483-490
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Clinical experiences
The value of hysteroscopy for diagnosing pathology of the uterine cavity in the postpartum period
Ampilova E.A., Klyucharov I.V., Morozov V.V., Galimova I.R., Khasanov A.A.
Abstract

Although hysteroscopy is considered a gold standard of diagnosis and treatment of different pathologies of uterine cavity and the postpartum period is not considered to be a contraindication to hysteroscopy, the study of the state of the uterus after delivery with the use of hysteroscopy is not common. We propose that hysteroscopy is a valuable diagnostic method in the postpartum period, potentially reducing the risk of postpartum complications. The article presents a brief literature review regarding the role of hysteroscopy in the diagnosis of uterine pathology in the postpartum period. The following effects of hysteroscopy on the postpartum uterus are observed: mechanical effect of fluid flow on the wall of the uterus increases contractility, provides washing out of the uterine cavity (blood clots, decidual tissue) and reduction of the number of bacteria (bactericidal effect of antiseptics). Indications for hysteroscopy in the postpartum period are presented. Hysteroscopic picture in the normal course of the postpartum period is described, as well as in such pathological conditions as uterine subinvolution, endometritis (after vaginal delivery and delivery by cesarean section) and placentation abnormalities. The technique of hysteroscopy in the postpartum period is described, which has some significant differences from traditional hysteroscopy. Photos of the uterine cavity one month after cesarean section are presented. Pathologies of the uterine cavity in the postpartum period are a subject that require further investigations not only by traditional non-invasive visualization techniques, but also by modern minimally invasive endoscopic technologies. Hysteroscopic visualization of the uterine cavity allows confirming the diagnosis and, if needed, accurately performing of the necessary intervention with minimal risk of intra- and postoperative complications.

Kazan medical journal. 2018;99(3):491-495
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Significance of disorders of proteomic profile of follicular fluid for predicting the effectiveness of in vitro fertilisation in women with infertility
Zolotykh O.S., Lomteva S.V., Sagamonova K.Y.
Abstract

Aim. To study the proteomic profile of follicular fluid in patients with infertility in assisted reproductive technology programs.

Methods. The study included women with infertility included in assisted reproductive technology programs: 15 women who had in vitro fertilisation which resulted in pregnancy (group 1) and 16 women with a negative result of this program (group 2). Fractionation of the follicular fluid samples was performed using the sets of special magnetic beads. Proteomic profiling was performed by tandem MALDI-mass-spectrometry. The anti-Müllerian hormone level was measured by ELISA.

Results. The study revealed differences in the detectability of follicular fluid proteins with different regulatory properties in patients of groups 1 and 2. With the negative outcome of in vitro fertilisation, expression of a number of proteins involved in the processes of folliculogenesis, ovulation, selection of the dominant follicle, as well as proteins necessary for the development of the zygote and blastula was reduced in females' follicular fluid. Increased expression in women from group 2 was registered for proteins enhancing proteolytic reactions, cell apoptosis, including oocytes, which disrupt the positive action of activin and damage structural and functional state of mitochondria. A definite relationship was found between the level of anti-Müllerian hormone and rate of detection of a number of proteins, in particular protocadherin-2α, cystatin C, betaglycan, prostatic acid phosphatase, and dermicidin.

Conclusion. The revealed changes in proteomic profile of the follicular fluid obviously play an important role in the molecular mechanisms that determine the effectiveness of assisted reproductive technologies; the identified differentially expressed proteins can serve as objective markers for predicting the outcomes of in vitro fertilisation.

Kazan medical journal. 2018;99(3):496-503
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Analysis of the results of different treatment methods for patellar dislocation
Kotel'nikov G.P., Ryzhov P.V., Lartsev Y.V., Kudashev D.S., Zuev-Ratnikov S.D., Pirogova N.V., Shmel'kov A.V.
Abstract

The aim of the study was the analysis of domestic and foreign medical literature of different time periods, which describes the basic methods of surgical and conservative treatment of congenital or habitual dislocation of patella, as well as statistical analysis of the results of treatment. Due to the existence of a large number of options of surgical treatment for this pathology (more than 150 methods were developed) and high variability of its manifestations, it is necessary to know the basic methods and their results for planning tactics of treatment with individual approach to each patient. Based on this review, analysis was performed for the results of using different options for invasive treatment of congenital or habitual dislocation of patella. Also, the paper contains the indications and efficacy of conservative therapy for this disease. A comparative analysis was made on the results of surgical and conservative methods of treatment of patellar dislocation, which were used in different time periods, from the initial description of the first results of treatment of this pathology to modern surgical techniques that are currently used. It is shown that all methods of surgical treatment of the pathology are divided into three main groups: myofascioplastic surgeries, osteoplastic and combined surgical interventions. It is underlined that the diseases requires individual approach to the choice of correction method in each certain case to achieve positive outcomes.

Kazan medical journal. 2018;99(3):504-507
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Acute adhesive small-bowel obstruction: laparotomy or laparoscopy
Malkov I.S., Bagautdinov E.B., Sharafislamov I.F., Zogot S.R., Misiev D.K.
Abstract

Aim. To determine the capabilities of complex preoperative examination of patients with acute adhesive small-bowel obstruction for the choice of the method of surgical treatment.

Methods. The diagnostic significance was studied for clinical and radiological methods in assessment of the prevalence of adhesive process in the abdominal cavity in 354 patients with acute adhesive small-bowel obstruction. Patients were divided into two groups: (1) a comparison group of 204 subjects examined by the standard protocol without the use of computed tomography and ultrasound without mapping of adhesions operated by an open procedure, and (2) the study group of 150 patients who underwent the modified diagnostic algorithm and laparoscopic adhesiolysis. To clearly understand the spread of adhesive process, on ultrasound examination the anterior abdominal wall was divided into four sectors. The severity of pathological process was assessed by enteral index and intra-abdominal pressure reflecting the degree of morphofunctional disorders.

Results. The highest sensitivity (92%) among diagnostic methods was observed for X-ray contrast-enhanced computed tomography. The objective severity criteria for the patients with acute adhesive small-bowel obstruction are enteral index, intra-abdominal pressure, signs of diffuse peritonitis. The developed complex diagnostic program, presented in the form of an algorithm, was of decisive importance for the choice of the method of surgical intervention (laparotomy or laparoscopy).

Conclusion. The optimal treatment option for patients with acute adhesive small-bowel obstruction is laparoscopic adhesiolysis, which should be regulated by the severity of the patient's condition and spread of the adhesion process; to determine the spread of adhesive process, a complex diagnostic program should be used, in which radiological methods take the lead.

Kazan medical journal. 2018;99(3):508-514
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Capabilities of computed tomography angiography in the diagnosis of coronary artery calcifications in patients with rheumatoid arthritis
Sultanova M.D.
Abstract

The study was performed to identify the features of coronary artery calcifications with the use of coronary computed tomography angiography in patients suffering from rheumatoid arthritis. In the study, calcifications were found in one vessel in 5 (8.3%) patients, in two vessels - in 24 (40%) subjects, in three vessels - in 28 (46.7%), and in four vessels - in 3 (5%) patients. 100% of patients were diagnosed with calcifications in the left descending artery, 90.2% - in left circumflex artery, 56.9% - in right coronary artery, 9.8% - in the root of left coronary artery, 92.2% of patients were diagnosed with calcifications of the aortic arch. The highest calcium score was registered in left circumflex artery (343.5±10.0 HU), and the lowest one - in right coronary artery (262.1±17.7 HU). The study results demonstrated correlation between the stage of rheumatoid arthritis and coronary calcification. In 77.8% of patients with stage I of the disease and in all patients with stage II, III and IV, calcifications of various size and localization were revealed in coronary arteries and aortic arch. Also, the relationship between duration of the disease and calcinosis extent was revealed. The obtained results indicate the importance of coronary computed tomography angiography for the diagnosis of coronary atherosclerosis in patients with rheumatoid arthritis due to high risk of cardiovascular complications in these patients.

Kazan medical journal. 2018;99(3):515-520
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History of medicine
Russian school of bioethics: a quarter of a century of development
Nezhmetdinova F.T., Guryleva M.E.
Abstract

The article presents the reasons for the emergence and development of bioethics as a scientific direction in the world and in our country. In the end of 21st century, humanity faced the complex of global problems solving which affected its survival nowadays: these are the problems of peaceful coexistence of states and peoples, environmental security, demography, health and quality of life connected to health. The science of bioethics which appeared in 1970s started their discussion, understanding and finding solutions, using interdisciplinary approach, involving the general public and seeking political solutions. At the origins of bioethics stood the American biochemist V.R. Potter and doctor A. Hellegers, and a German pastor Fritz Jahr. Boris Grigorievich Yudin can be considered the founder of the Russian school of bioethics, who defined objectives, tasks, basic science perspective in the light of national and regional peculiarities and modalities and founded the platform for discussions. The development of bioethics in our country was multicentered: it is possible to distinguish Moscow, Volgograd and Kazan centers of science development, each of which has its own outstanding terms of reference. The article presents the authors' view of contribution of the brightest representatives developing bioethics in our country, and role of certain scientific and educational centers.

Kazan medical journal. 2018;99(3):521-527
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Some aspects of legal regulation of medical secrecy in the Russian Federation
Khamitova G.M., Khamitova D.V.
Abstract

<p><strong>Aim.</strong> To propose the development of a new form of informed voluntary consent, taking into account the legal regulation of medical secrecy. </p>
<p><strong>Methods.</strong> When performing the study, analytical method was used. The analysis of the mechanism of obtaining information about the patient was performed, including the study of a number of laws governing the transfer of information to the third parties without the patient's consent. </p>
<p><strong>Results.</strong> It was found that the patient's relatives can not be provided with information about the course of the disease and its treatment, unless the patient has previously signed a voluntary consent to transfer the information. The basis for such refusal is Article 13 of Federal Law No. 323-FZ issued on November 21, 2011 (as amended on July 29, 2017) «On the Fundamentals of Health protection of Citizens in the Russian Federation», which establishes the conditions under which information about patient's health can be transferred. This article examines the problem of violation in the field of disclosure of medical secrets, as well as the rights of patient's close relatives to obtain information about his or her state of health. The need to refine the mechanisms of obtaining information, which is a medical secret, is revealed and justified. </p>
<p><strong>Conclusion.</strong> Based on the review of laws regulating the procedure of information transfer, the authors propose the development of a new form of consent for disclosure of the patient's information about his state of health, which must necessarily be provided to the patient when contacting a medical organization, which in the future will significantly simplify the legal doctor-patient relationships.</p>

Kazan medical journal. 2018;99(3):527-530
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Ricardo Miledi - an outstanding neurophysiologist of 20th-21st centuries (1927-2017)
Bregestovski P.D.
Abstract

Ricardo Miledi (16.09.1927-18.12.2017) is an outstanding neurophysiologist and biophysicist who made a great contribution to the study of synaptic transmission functions. He proved the key role of сalcium ions in the release of neuromediators, developed methods of receptor expression and membrane fragments integration into large oocytes that provided huge possibilities for thousands of researchers to study subtle mechanisms of transmembrane proteins function in norm and pathology. Ricardo Miledi received his MD degree in the National Autonomous University of Mexico and in 1954 he defensed his dissertation on the study of electrical nature of cardiac fibrillation in the National Institute of Cardiology (Mexico). In 1956-1958 he underwent training in Canberra Health Research Institute (Australia) in the laboratory headed by John Eccles (Nobel Prize 1963). In 1958 R. Miledi was invited to the Department of biophysics of University College London where in cooperation with Bernard Katz (Nobel Prize 1970) made a number of important discoveries in the analysis of acetylcholine receptor expression in denervated mucle; determination of the role of calcium in neuromediators release; analysis of membrane noise on neuromediator application to neuromuscular synapses; study of the effect of antibodies from patients with myasthenia gravis on neuromuscular transmission. In the early 1980s Ricardo Miledi implemented the method of functional expression in Xenopus frog oocytes of receptors and ion channels from messenger ribonucleic acid (mRNA). His heritage running the gamut is presented in more than 500 articles.

Kazan medical journal. 2018;99(3):531-536
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Jubilees
Mikhaylov M.K. is 80 years old
 
Kazan medical journal. 2018;99(3):537-539
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Obituary
Academician Nikolay Alexeevich Mukhin
 
Kazan medical journal. 2018;99(3):540
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Cochrane Review Summaries
Vaccines for preventing influenza in healthy adults
 
Abstract

Инактивированные вакцины могут снизить долю здоровых взрослых (включая беременных), заболевших гриппом и ГПЗ, но их влияние умеренно. Мы не уверены во влиянии инактивированных вакцин на число пропущенных рабочих дней или серьёзные осложнения сезонного гриппа.

Kazan medical journal. 2018;99(3):541-542
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Vaccines for preventing influenza in healthy children
 
Abstract

Живые аттенуированные и инактивированные вакцины могут снизить долю детей, заболевших гриппом и ГПЗ. Вариабельность результатов исследований означает, что мы не уверены в эффектах этих вакцин в разные сезоны.

Kazan medical journal. 2018;99(3):542-543
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Vaccines for preventing influenza in the elderly
 
Abstract

Инактивированные вакцины могут снижать долю пожилых людей с гриппом и ГПЗ. Данные по смертности были немногочисленны, и мы не нашли данных по госпитализациям, связанным с осложнениями. Однако вариабельность результатов исследований означает, что мы не можем быть уверены в величине эффекта от вакцин в разные сезоны.

Kazan medical journal. 2018;99(3):543-544
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