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Vol 104, No 2 (2023)

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Theoretical and clinical medicine

The intensity of oxidative stress and systemic inflammation in patients with a combination of bronchial asthma and chronic obstructive pulmonary disease

Faletrova S.V., Uryasev O.M., Belskikh E.S., Berstneva S.V., Korshunova L.V.


Background. Chronic obstructive pulmonary disease and bronchial asthma, when combined in one patient, are characterized by a low level of control. Excess weight aggravates the course of obstructive diseases. The study of the features of this syntropy will improve the effectiveness of therapeutic measures.

Aim. The study of the level of cytokines and carbonylated proteins in patients with a combination of bronchial asthma and chronic obstructive pulmonary disease with overweight and normal weight during an exacerbation.

Material and methods. The study included 136 people: the first group — a combination of bronchial asthma and chronic obstructive pulmonary disease (n=30), the second — bronchial asthma (n=36), the third — chronic obstructive pulmonary disease (n=29), the fourth — volunteers without respiratory diseases (n=41). Each group was divided into two subgroups depending on the body mass index (less than 25 kg/m2 or 25 kg/m2 and more). The concentrations of interleukins-6 and -8, tumor necrosis factor α in blood plasma were determined by enzyme immunoassay. The level of carbonylated plasma proteins was assessed spectrophotometrically. Statistical processing was performed in the Statistica 10.0 program using nonparametric criteria. The correlation of the studied parameters was assessed using the Spearman coefficient.

Results. In patients with a combination of bronchial asthma and chronic obstructive pulmonary disease, statistically significant positive correlations between the levels of interleukins-6 and -8, tumor necrosis factor α and carbonylated proteins were found — 0.51, 0.59 and 0.55, respectively (p <0.05). Patients of the first group with overweight differed by 37.5% in higher levels of interleukin-6 compared with patients with body mass index <25 kg/m2.

Conclusion. The intensity of systemic inflammation in patients with a combination of bronchial asthma and chronic obstructive pulmonary disease during exacerbation correlates with the intensity of oxidative damage.

Kazan medical journal. 2023;104(2):165-175
pages 165-175 views

Assessment of the risks of cardiovascular system functional disorders developing in young people aged 18–25 years

Aminova O.S., Tyatenkova N.N., Melentev A.V.


Background. In recent years, the proportion of young people with functional disorders and diseases of the cardiovascular system has increased, in the formation of which behavioral risk factors play an important role.

Aim. To assess the risk of functional disorders developing in young people aged 18–25 depending on social status and lifestyle.

Material and methods. An observational one-stage uncontrolled study, the object of which was young people aged 18–25 years (1978 people), was conducted. The study sample was divided into four groups: working (n=200) and studying (n=313) males, working (n=526) and studying (n=939) females. To assess the relative cardiovascular risk, the groups were divided according to social status, to assess the impairment of adaptive capabilities — according to the presence of a behavioral risk factor. Comparison of independent groups was performed using the Mann–Whitney test. Testing null hypotheses about the absence of differences between the shares was carried out using the χ2 test and calculating the odds ratio.

Results. Relative cardiovascular risk was found in 21.8% of young people. The chances of risk occurrence were higher in males than in females (p <0.001), in working youth compared to students (p <0.001). The chances of reducing the adaptive capacity of the cardiovascular system were 2.1 times higher in smoking males (p <0.001) and 2.6 times higher in smoking females (p <0.001) compared to non-smoking respondents. In males with excessive alcohol consumption, in females with irregular meals and low physical activity, cases of tension in the mechanisms of adaptation of the cardiovascular system were more often noted (by 1.8; 1.4 and 1.7 times, respectively) compared with control groups.

Conclusion. The risk of functional disorders developing was more common in young males than in females, in workers in comparison with students; cigarette smoking in both sexes, alcohol consumption in males, irregular meals and low physical activity in females contributed to a decrease in the reserve capacity of the circulatory system.

Kazan medical journal. 2023;104(2):176-182
pages 176-182 views

Features of the immune and metabolomic profile in overweight children associated with polymorphic variants of the IL-1B and TP53 genes

Dolgikh O.V., Zaitseva N.V., Nikonoshina N.A., Alekseev V.B.


Background. The growing number of overweight children is an important problem of modern healthcare. Excess body weight causes the risk of severe metabolic disorders developing. Analysis of changes in the immune, metabolic, and genetic profile of overweight children as markers of the early development of metabolic disorders is an effective tool for the prevention, diagnosis, and treatment of these pathologies.

Aim. To identify the features of the immune and metabolomic profile in overweight children aged 7–11 years associated with polymorphic variants of the IL-1B (rs1143634) and TP53 (rs1042522) genes.

Material and methods. 132 children aged 7–11 years were examined: 54 children with overweight and 78 children with normal body weight. The lymphocytes subpopulation composition was analyzed by flow cytometry; the content of leptin, cortisol, superoxide dismutase, lipid hydroperoxide and interleukin-1β — using enzyme immunoassay, immunoglobulin G — using the method of radial immunodiffusion method by Mancini. Polymorphic variants of the IL-1B (rs1143634) and TP53 (rs1042522) genes were identified by real-time polymerase chain reaction. Statistical data processing was implemented in the Statistica 10, SNPStat and Gen-Expert programs.

Results. The immune profile of the examined children was characterized by an increased content of CD3+CD8+-, CD19+-lymphocytes and immunoglobulin G against the background of CD3+CD4+-lymphocytes, p53 deficiency and a decrease in the number of CD4+/CD8+. The metabolomic profile of children was characterized by an excess content of leptin, cortisol, lipid hydroperoxides, and superoxide dismutase. The identified changes in immune and metabolomic regulation in overweight children were significantly associated with the G allele and GG genotype of the IL-1B gene (rs1143634), as well as with the C allele and CC genotype of the TP53 gene (rs1042522), which cause the initiation of inflammation and inhibition of apoptosis.

Conclusion. The established features of immune and metabolomic regulation associated with the G allele and GG genotype of the IL-1B gene (rs1143634) and with the C allele and CC genotype of TP53 gene (rs1042522) represent a complex of markers of overweight formation in children aged 7–11 years.

Kazan medical journal. 2023;104(2):183-191
pages 183-191 views

Genetic polymorphism of some genes of toll-like receptors in patients with influenza A (H3N2)

Сhuprova G.A., Emelyanova A.N., Emelyanov A.S., Mudrov V.A., Vitkovsky Y.A.


Background. Among all infectious diseases that occur in the human population, only acute respiratory viral infections, including influenza, lead to massive outbreaks, often taking on the character of epidemics and pandemics. Polymorphism of cytokine genes can be both a factor of predisposition and resistance to infection, the development of the disease, and a long, complicated course of influenza.

Aim. Study of the genetic polymorphism of the genes of toll-like receptors rs5743708 (Arg753Gln, G2258A), TLR3 rs3775291 (Phe412Leu, C1234T), TLR4 rs4986790 (Asp299Gly, A896G), TLR4 rs4986791 (Thr399Ile, C1196T) in healthy individuals and in patients with influenza A(H3N2).

Material and methods. The study, using the continuous sampling method, included patients with influenza A (H3N2; 89 people) who were treated at the Regional Clinical Infectious Diseases Hospital in Chita during the epidemic seasons of 2016–2017 and 2017–2018. The control group consisted of 96 practically healthy donors. To analyze the polymorphism of the TLR2 rs5743708 (Arg753Gln, G2258A), TLR3 rs3775291 (Phe412Leu, C1234T), TLR4 rs4986790 (Asp299Gly, A896G), and TLR4 rs4986791 (Thr399Ile, C1196T) genes the method of polymerase chain reaction with electrophoretic detection using standard kits from Scientific and Production Company “Litekh” (Moscow) was applied. Statistical analysis was carried out in accordance with the principles of the International Committee of Medical Journal Editors and the “Statistical Analysis and Methods in the Published Literature” recommendations. Pearson's χ2 test was used for comparative evaluation of qualitative nominal data.

Results. Patients with influenza A (H3N2) more often had heterozygous TLR2 753Arg/Gln variants [χ2=8.26, p=0.02; odds ratio (OR) 3.00; 95% confidence interval (CI) 1.33–6.73], homozygous TLR3 412Leu/Leu variants (χ2=11.68, p=0.003; OR=2.39; 95% CI 1.04–3.61), heterozygous variants of TLR4 299Asp/Gly (χ2=6.97; p=0.03; OR=2.15; 95% CI 1.02–4.70) and 399Thr/Ile (χ2=8.39; p= 0.01; OR=2.30; 95% CI 1.06–4.88) compared with a group of healthy donors.

Conclusion. The genotypes 753Arg/Gln of the TLR2 gene, 412Leu/Leu of the TLR3 gene, 299Asp/Gly of the TLR4 gene, Thr399Ile of the TLR4 gene predispose to the development of influenza A (H3N2); carriage of genotypes 753Arg/Arg of the TLR2 gene, 412Phe/Phe of the TLR3 gene, 299Asp/Asp of the TLR4 gene, 399Thr/Thr of the TLR4 gene reduces the likelihood of the influenza A(H3N2) development.

Kazan medical journal. 2023;104(2):192-197
pages 192-197 views

Molecular genetic clusters of triple-negative breast cancer and their prognostic significance

Panchenko I.S., Rodionov V.V., Burmenskaya O.V., Kometova V.V., Bozhenko V.K.


Background. Triple-negative breast cancer is a group of tumors with different clinical and morphological features, prognosis, and response to therapy. There are from 4 to 6 molecular genetic varieties of this type of malignant neoplasm.

Aim. Identification of individual clusters of triple-negative breast cancer that differed in terms of overall and disease-free survival.

Material and methods. On the basis of the Regional Clinical Oncological Dispensary (Ulyanovsk) and “National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov” of the Ministry of Health of Russia (Moscow) in the period from 2017 to 2021, a molecular genetic analysis using a 45-gene signature in 246 patients with triple-negative breast cancer, confirmed by immunohistochemical method, was performed. Using the K-means clustering method, it was possible to form 4 molecular genetic clusters. When comparing clusters according to clinical and morphological features, the Student's t-test, Mann–Whitney U-test, Fisher's exact test, Pearson's χ2 test were used. Survival analysis was performed using the construction of Kaplan–Meier curves (the observation period was 3 years and 8 months). Comparison of clusters in terms of survival was carried out using a long-rank test. Multivariate analysis was used to determine the significance of variables affecting overall and disease-free survival. Differences between groups were considered statistically significant at p <0.05.

Results. Cluster 1 included patients with clinical stage IIA, invasive nonspecific subtype, G3, N0, Ki67 ≥31%, with hypoexpression of most genes, unstable prognostic outcome: high survival rate at stage IV (62%) and zero survival rate at stage IIIB. Patients of the 2nd cluster were associated with stage IIA, medullary histological subtype, G3, N0, Ki67 ≥31%, overexpression of genes for hormone receptors, growth factor receptors and transcription factors and a favorable prognosis: the best indicators of overall (100% in stage I, 66% in stage IV) and relapse-free (75% in stage I, 33% in stage IV) survival. Patients of the 3rd cluster more often had stage IA, invasive lobular and special histological tumor subtypes, N+, Ki67 ≤14%, high expression of genes responsible for the regulation of proliferation, mitosis, spindle formation and regulation of the cell cycle, genes that regulate cell transport, the processes of replication and repair of deoxyribonucleic acid, tumor cell differentiation markers, and genes that regulate immune processes, had a regular prognosis — with an increase in the clinical stage, a decrease in survival occurred. Cluster 4 patients correlated with stage IV, invasive non-specific subtype, G1–G2, N0, Ki67=15–30%, mean values of most genes, and worse overall and recurrence-free survival (64% in stage I, 0% in stage IV).

Conclusion. Based on the data of molecular genetic profiling of triple-negative breast cancer, it is possible to identify individual clusters that are statistically significantly different from each other in terms of survival rates.

Kazan medical journal. 2023;104(2):198-206
pages 198-206 views

Factors of the immune microenvironment and the state of the extracellular matrix in vulvar ­cancer

Zlatnik E.Y., Ulyanova E.P., Nepomnyashchaya E.M., Abdullaeva N.M., Verenikina .V.


Background. The progression of malignant tumors, including vulvar cancer, largely depends on the state of the extracellular matrix and immune microenvironment of the tumor, the study of which is an urgent problem of oncology to identify the most prognostically significant of them.

Aim. To evaluate the expression of extracellular matrix and local immunity factors, as well as their relationships in vulvar cancer with different prevalence.

Material and methods. A retrospective study on vulvar tumors in 56 patients with stage I (n=20), stage II (n=26) and relapses (n=10) was performed. The expression of markers of the extracellular matrix (matrix metalloproteinases MMP-2 and MMP-9, tissue inhibitor of metalloproteinase-2 TIMP-2) and local immunity (FOXP3, CD68, CD206) was determined by immunohistochemical method. Statistical processing was performed using the Mann–Whitney U-test and multiple correlation analysis with the calculation of paired and partial R coefficients.

Results. The depth of invasion proved to be more informative for detecting multidirectional differences in the expression of MMP-2 and TIMP-2 than the stage. Infiltration by CD68+-macrophages in the stroma increased in parallel with the stage and did not differ at different depths of invasion; infiltration by macrophages M2 (CD206+) increased at stage II compared with stage I (Me 13 and 5, respectively, p=0.03). Differences were noted only in the stroma of tumors, as well as an increase in T-regs (FOXP3) with an increase in the depth of invasion (Me 25 and 8, respectively, p=0.0359). As the prevalence of the tumor developed, the number of correlation relationships between the parameters of local immunity of the parenchyma and tumor stroma increased: 2 statistically significant correlations that do not depend on covariates, 7 that depend on the stage, and 6 that depend on the depth of invasion, were found. Correlations of factors of the immune microenvironment with the extracellular matrix weakened.

Conclusion. The levels of MMP-2, TIMP-2, CD68+, CD206+, FOXP3 reflect the progression of vulvar cancer and can be used to predict the course of the disease; infiltration of tumors by macrophages, T-regs characterizes the stage of the primary tumor rather than recurrence.

Kazan medical journal. 2023;104(2):207-215
pages 207-215 views

The content of chemical elements-antioxidants in the tissues of benign and malignant tumors

Lugovaya E.A., Ageenko K.I.


Background. Copper, zinc, manganese, and selenium play the role of cofactors in the enzymatic link of the antioxidant system and can be singled out as a special group of antioxidant elements. Reorganizations of the antioxidant system during carcinogenesis are reflected in the levels of these bioelements.

Aim. Analysis of the antioxidant element concentrations in benign and malignant tumor tissues and assessment of the possibility of their use as markers of neoplasms.

Material and methods. Using the methods of atomic emission and mass spectrometry with inductively coupled argon plasma, the concentrations of Cu, Zn, Mn and Se were measured in the tissues of benign and malignant neoplasms (surgical material) of 131 residents of Magadan. The objects of the study were benign neoplasia of the intestine, breast and ovary, as well as malignant neoplasia of the intestine, breast, uterus and lung. The Shapiro–Wilk test, the Mann–Whitney U test, and correlation analysis were used. Changes were considered significant at p <0.05.

Results. In a benign process, all antioxidant elements, in a malignant process, Cu and Zn turned out to be differentiating. The maximum levels of Cu, Zn, Mn and Se were recorded in benign and malignant tumors of the intestine (2.09 and 2.57; 62.99 and 22.22; 0.35 and 0.29; 0.33 and 0.30 µg/g, respectively), minimal — in benign and malignant breast tumors (0.58 and 0.88; 8.74 and 10.41; 0.08 and 0.19; 0.11 and 0.21 µg/g). The value of the Cu/Zn ratio corresponded to the range of 0.074–0.111 and significantly prevailed in cancer (p <0.05). Significant correlations (p <0.037) were recorded only in tumors of the intestine and breast and differed in multidirectional dynamics. Their number decreased in bowel cancer and increased in breast cancer.

Conclusion. Malignant neoplasms are distinguished by a higher level of antioxidant elements and atypism of the microelement profile.

Kazan medical journal. 2023;104(2):216-223
pages 216-223 views

Evaluation of the selenium deficiency impact on metabolic parameters of people of working age

Muhutdinova G.M., Imamov A.A., Gomsina E.G., Iskandarov I.R.


Background. Among the population living in Russia, the frequency of selenium deficiency in the body is more than 80%. An unbalanced diet in terms of the level of selenium supply to the body leads to metabolic disorders among the adult population.

Aim. Study of the relationship between the insufficient level of selenium supply of the body in different periods of the year and changes in body composition, basal metabolism among the adult population aged 25–50 years.

Material and methods. In the autumn, winter and spring periods, the adult population aged 25–50 years, living in the Leninogorsk district of the Republic of Tatarstan, of the 1st group of physical activity (n=143, of which 47% were men) was examined. The body composition was assessed using the ABC-01 “Medass” analyzer for bioimpedansometry. The content of selenium in the hair was studied using an atomic emission spectrometer. An assessment of the obesity and overweight prevalence in the adult population with selenium content below the reference values and the boundaries of the 95% confidence interval was made. Laboratory studies of dishes and foodstuffs for selenium content were carried out using an atomic absorption spectrometer. To assess the actual consumption of food products and dishes, the method of 24-hour (daily) reproduction of nutrition by questioning respondents on a 14-day menu was used. Statistical processing of the studied indicators was performed by the Spearman correlation method, mathematical and centile methods.

Results. In bioassays with a low level of selenium in the hair (<25 centile interval), the largest proportion of subjects with selenium deficiency was noted in autumn in more than 60% of cases, both among men with a 95% confidence interval Z-score=248, and among women with 95% confidence interval Z-score=240, while in spring — only 18% and 42% at 95% confidence interval Z-score=72 and 168, respectively. When studying the relationship of selenium content in hair with morphofunctional indicators, significant correlations were found using the Spearman method with body mass index (RNovember=–0.389), active cell mass (RFebruary=0.260; RMay=0.318), and basal metabolism (RMay=0.313; RNovember=0.294). Analysis of diets revealed a lack of selenium content in food products and ready-made meals in the autumn-winter period in both men (40–46%, n=67) and women (54–61%, n=76), in spring-summer period — in 35 and 42% of cases, respectively. The lower the level of selenium in the hair (in the body), the higher the body mass index, the lower the active cell mass and the basal metabolism. There is no correlation with fat and skeletal muscle mass. The basic exchange is reduced at an insufficient of selenium supply in the body.

Conclusion. The results indicate an insufficient intake of selenium in the body with a daily diet and the relationship of body mass index, basal metabolism with an insufficient level of selenium in the body.

Kazan medical journal. 2023;104(2):224-235
pages 224-235 views

Significance of insulin and insulin-like growth factor-1 in the pathogenesis of acne

Baytyakov V.V., Vlasova S.A.


Background. The potential involvement of insulin and insulin-like growth factor-1 in the pathogenesis of acne may be due to direct stimulation of sebaceous gland cells, an increase in androgen synthesis in the endocrine glands, activation of 5α-reductase, and an increase in the sensitivity of androgen receptors in tissues.

Aim. To study the level of insulin and insulin-like growth factor-1 in women of fertile age suffering from acne; to identify the dependence of these indicators on the clinical and anamnestic features of the disease and the nature of the nutrition of patients.

Material and methods. 60 patients suffering from acne (mean age 23.9±0.92 years) were examined. Clinical indices, reflecting the severity of the skin process and quality of life, were calculated, hormonal status indicators (insulin, insulin-like growth factor-1, total testosterone, estradiol, progesterone) and blood plasma glucose levels were studied. The blood of 30 healthy women (mean age 25.9±1.04 years) was examined as a control. Groups were compared using Student's t-test and odds ratio calculation, correlation analysis was performed using Spearman's rank correlation coefficient.

Results. Patients with acne showed a significant increase in the level of insulin-like growth factor-1 (p=0.0002) and total testosterone (p=0.005). The correlation of the insulin-like factor content with the indices that determine the severity of the skin process and the quality of life of patients was closer than that of the total testosterone. A lower concentration of insulin-like growth factor-1 was noted in the blood of acne patients who followed a diet with restriction of milk and dairy products, foods rich in easily digestible carbohydrates and saturated fats. The level of insulin in patients with acne did not differ from that in the control group.

Conclusion. In women suffering from acne, an increase in the content of insulin-like growth factor-1 in the blood plasma was revealed; at the same time, its level has a closer relationship with the severity of the course of dermatosis and the quality of life of patients in comparison with the indicator of total testosterone.

Kazan medical journal. 2023;104(2):236-241
pages 236-241 views

Experimental medicine

Model of small-focal ischemic cerebral infarction as a basis for the development of new methods of stroke therapy

Markosyan V.A., Izmailov A.A., Sokolov M.E., Valiullin V.V., Safiullov Z.Z.


Background. Among the existing experimental models of cerebral stroke in large animals, there is no possibility to create a focal brain infarction of limited volume, which would provide an opportunity to evaluate both the endogenous potential of neuroregeneration and to establish the effectiveness of new drugs on postischemic brain remodeling.

Aim. Development of a method for modeling small-focal ischemic infarction of the cerebral cortex in a mini-pig.

Material and methods. The study used mature female mini-pigs of the Vietnamese fold-bellied breed. Two-level occlusion of the great vessels was performed by ligation of the right common carotid artery and subsequent cauterization of the distal branches of the middle cerebral artery. In the postoperative period, the survival rate of animals and neurological deficit were assessed. On the 7th day, the animals were taken out of the experiment, the brain was isolated from the cranial box. Macroscopic and microscopic examinations included analysis of the localization and area of cerebral infarction, as well as morphological changes in the infarcted and peri-infarcted areas of the cerebral cortex.

Results. With a 100% survival rate of experimental animals on the 3rd day after the operation, a neurological examination revealed violations of skin sensitivity and muscle tone in the hind and fore limbs, which partially recovered a week after the onset of ischemic stroke. Macroscopic examination of the brain on the 7th day after the operation visually revealed a small-focal ischemic cerebral infarction in the parietal lobe of the left hemisphere. Histological analysis of the cerebral cortex revealed a wedge-shaped necrotic focus of ischemic injury. In the peri-infarction region of the brain, reactive tissue changes with preserved nerve cells, mostly without visible damage, were found.

Conclusion. The developed two-level method of stroke modeling in a mini pig induces ischemic cerebral infarction of limited volume in the parietal lobe; non-critical histological changes in the peri-infarct area and a slight neurological deficit suggest the possibility of using this model to develop new methods of stroke therapy.

Kazan medical journal. 2023;104(2):242-248
pages 242-248 views

Morphofunctional state of platelets in their concentrates depending on storage time

Khabirova A.I., Fatkhullina L.S., Andrianova I.A., Evtugina N.G., Litvinov R.I.


Background. Evaluation of the functional state of platelets in the composition of concentrates is necessary to improve the methods of their production, optimize storage conditions and terms, increase therapeutic efficacy, and reduce the risk of transfusion complications.

Aim. Comprehensive study of the morphofunctional state of platelets during the storage of their concentrates.

Material and methods. 202 samples of human platelet apheresis concentrates were studied for storage periods of up to 1–7 days at a temperature of 22–24 °C. The functional state of platelets was assessed using flow cytometry for the expression of P-selectin, active αIIbβ3 integrin, and phosphatidylserines before and after biochemical stimulation. In addition, the mitochondrial potential of platelets, the concentration of intracellular adenosine triphosphate, contractile properties, induced aggregation, and morphological characteristics were studied according to scanning electron microscopy. Statistical analysis was performed by analysis of variance (ANOVA or Kruskal–Wallis).

Results. In non-activated platelets during storage, the spontaneous expression of P-selectin increased by an average of 7 times, and phosphatidylserines — by 3 times. The induced expression of P-selectin, integrin αIIbβ3 and phosphatidylserines was the highest on the day of receiving the concentrate and gradually decreased during storage to 1/2 of the initial level. Platelet aggregation activity in response to collagen stimulation progressively decreased by an average of 100 times, in response to the TRAP peptide — by 1.5 times. In contrast to the expression of activation markers, the ability of platelets to compress plasma clots in most samples changed slightly, within a few percent; in single samples, the contractile function dropped to zero by 4–7 days of storage, which was combined with platelet hyperactivation and depletion. The mitochondrial potential of platelets and the content of adenosine triphosphate were relatively constant. Morphologically, discoid platelets predominated, however, starting from the 1st day of storage, spindle-shaped platelets, and from the 3rd day — spherical forms and microaggregates of platelets accumulated.

Conclusion. Platelets in the composition of concentrates initially have a high functional potential, which gradually decreases due to progressive spontaneous activation with a simultaneous decrease in reactivity and structural changes.

Kazan medical journal. 2023;104(2):249-260
pages 249-260 views


Efficacy and safety of allergen-specific immunotherapy in children

Delian V.Y.


Atopic diseases are one of the most common chronic diseases in children and adolescents. They lead to a significant deterioration in the quality of life of patients and their families. The only strategy for the treatment of atopic diseases that has a disease-modifying effect is allergen-specific immunotherapy. The purpose of this review is to summarize the literature data on the practical aspects of allergen-specific immunotherapy use in children and adolescents with allergic rhinoconjunctivitis and atopic bronchial asthma. An analysis of scientific articles has shown that allergen-specific immunotherapy can reduce the severity of symptoms of allergic rhinoconjunctivitis and/or atopic bronchial asthma and reduce the amount of pharmacotherapy, as well as reduce the risk of bronchial asthma developing in patients with allergic rhinoconjunctivitis. The current evidence of the preventive effect of allergen-specific immunotherapy in relation to the development of new sensitizations in monosensitized patients is unconvincing, and, according to many authors, new randomized clinical trials are needed. According to most experts, allergen-specific immunotherapy should be started in children from 5 years of age in the presence of proven immunoglobulin E-mediated sensitization to one or more allergens, carried out for at least 3 years, using preparations in which the presence of major allergens is documented. At the same time, both subcutaneous and sublingual administration of allergens has comparable effectiveness. Allergen-specific immunotherapy is a safe and well-tolerated treatment for children, but currently there is no generally accepted classification of possible adverse events, as well as a standardized and uniform system for assessing their severity.

Kazan medical journal. 2023;104(2):261-273
pages 261-273 views

Social hygiene and healthcare management

Medical and social criteria for predicting the employment of disabled people due to military trauma

Nurova A.A.


Background. Employment and occupation are important areas of social policy in the system of rehabilitation of the disabled people. Servicemen of working age are an active and able-bodied part of the population, however, when a disability is established, they develop problems associated with social maladaptation.

Aim. Development of criteria for assessing the social and labor prognosis of disabled military service due to “military injury”.

Material and methods. A cross-sectional study by the method of random non-repetitive selection was carried out. From a population of 1,618 disabled due to “military injury” who were re-examined at the Bureau of Medical and Social Expertise of the Republic of Dagestan in the period 2014–2019, a sample of military personnel with a disability due to the consequences of a military injury (n=90) was formed and divided into two groups. The criterion for dividing into groups was the motivation for labor activity. The first group included 28 disabled people who worked after their disability was established and were characterized by positive motivation to work. The second group included 62 disabled people who were not working at the time of the survey and were characterized by negative and indefinite motivation to work. Disabled people of both groups were subjected to a questionnaire survey based on the original questionnaire “Medical-expert indicators of the vital activity of disabled military service due to “military injury”, characterizing the state of life and the needs of disabled people due to military injury” developed by us. A comparative statistical analysis of the selected groups on a set of social and hygienic indicators of military personnel with disabilities due to “military injury” was carried out by testing statistical hypotheses using nonparametric Pearson’s χ2 test and Fisher’s exact test. The ranking of the studied indicators according to the degree of their influence on the result of employment was performed using the algorithm of classification trees. A set of 7 features that are most closely related to the result of employment were identified, which were used to calculate the indicator of social and labor forecast. The calculated threshold value of the indicator of social and labor prognosis made it possible to discriminate military personnel with disabilities due to “military injury” into two groups associated with high and low employment opportunities.

Results. The length of stay on disability from 1 to 4 years characterized more than half of working disabled people and only a quarter of non-working people (64.3 and 22.6%, respectively; χ2=14.64; p <0.001); 21.4% of working disabled people and 2 times more (45.2%) non-working people (χ2=4.62; p=0.032) were on disability from 5 to 10 years. In the working group, the overwhelming majority (92.9%) had clear ideas about the need for work to restore their health, which could not be said about the disabled from the group of non-working disabled (27.4%; χ2=33.1; р <0.001). A significant association of motivation to work with the age structure of disabled people due to military trauma has been established. The youngest age category (18–39 years) in 67.9% of cases was characteristic of disabled people with positive motivation to work, while in groups with uncertain and negative motivation it was statistically significantly less common — 26.7 and 6.5% (p=0.0017 and p <0.001, respectively). A relationship between the motivation to work and the assessment of one’s own labor opportunities was established: 67.9% with a positive attitude to work were characterized by adequate self-assessment, which distinguished this group from the other two (p <0.001). Significant differences in the structure of the severity of their psychoorganic syndrome were revealed. A pronounced degree of psychoorganic syndrome was determined in every fourth disabled person with negative motivation to work (25.0%), while in disabled people with positive and indefinite motivation it was absent (p <0.01).

Conclusion. The most priority indicators involved in the formation of a social and labor forecast were the duration of disability, motivation to work, age, the severity of the psychoorganic syndrome, self-assessment of professional abilities, timely career guidance and information work with disabled people, limiting the ability to self-service.

Kazan medical journal. 2023;104(2):274-282
pages 274-282 views

Factors limiting the motor rehabilitation of elderly disabled persons with lower limb loss

Kramer I.V., Khokhlova O.I., Vasilchenko E.M.


Background. Amputation of a limb leads to significant changes in a person's life, since mobility restrictions affect the ability to perform daily tasks and professional duties.

Aim. To identify factors that negatively affect the results of motor rehabilitation of elderly disabled people with lower limb loss.

Material and methods. Data on patients with postamputation lower limb defects, who were divided into two groups, were analyzed. The first group (comparison group) included patients aged 60 years and younger — 171 people, including 141 men and 30 women; the second group (main group) consisted of patients over 60 years of age — 260 people, including 207 men and 53 women. Patients of the second group with a satisfactory result of rehabilitation were included in subgroup 2A, with an unsatisfactory result — in subgroup 2B. The influence of gender, age, level of mobility, cognitive abilities, daily activity, level of amputation, presence of concomitant diseases, body mass index, duration of the post-amputation period on the result of rehabilitation in the second group were assessed. Statistical analysis used the χ2 test, the Mann–Whitney U test for independent groups, and binary logistic regression.

Results. The indicators of mobility before prosthetics in elderly people with disabilities did not differ significantly from those in people under the age of 60, however, by the end of the rehabilitation course, the optimal level of mobility in the room (without using a wheelchair) was reached by 75.4% of the comparison group and only by 52.7% of the main group (ꭓ2=22.59, р <0.001). Further analysis showed that at the age of over 66.5 years, the risk of obtaining an unsatisfactory result of motor rehabilitation is 2.3 times higher (p=0.006) than at the age of 60–66.5 years. In older women, this risk is 2.7 times higher than in men of the same age (p=0.014). With a body mass index of more than 28.5 kg/m2, the risk increases by 3.2 times (p=0.001), and with a duration of the post-amputation period at the time of primary prosthetics of more than 1 year, it increases by 2.6 times (p=0.008) compared with lower values of these indicators in elderly people with disabilities.

Conclusion. The factors associated with the unsatisfactory result of motor rehabilitation of elderly disabled people with lower limb loss are: age over 66.5 years, female sex, body mass index over 28.5 kg/m2, duration of the post-amputation period at the time of primary prosthesis over 1 year.

Kazan medical journal. 2023;104(2):283-292
pages 283-292 views

Hygienic education and training — the main direction of the implementation of health-saving measures in educational organizations

Valiev R.I., Radchenko O.R., Zhaboeva S.L.


Background. Hygienic education and the creation of conditions for motivating schoolchildren to health-saving behavior is the most important task of parents, teachers, the public, preventive medicine and the state.

Aim. Studying the advantages and disadvantages of educational technologies used in working with schoolchildren and their parents when conducting hygiene education in educational institutions.

Material and methods. The study consisted of four stages. At the first stage, a selective audit of information posted on 24 official websites of educational organizations in Kazan was carried out. At the second stage, 142 parents were surveyed. The third stage included work with 25 teachers in focus groups. At the fourth stage, a survey of 374 (192 girls and 182 boys) students in grades 7–10 was conducted. The results were processed using the methods of parametric and nonparametric statistics (mean value, error of the arithmetic mean, proportion of the feature, Kendal coefficient, χ2 at a significance level of α ≤0.05).

Results. Most (22 out of 24 analyzed) websites of educational organizations did not contain information on student health protection. The survey results of 142 parents showed low interest in the work carried out at the school. Evaluation of leaflets on healthy eating allowed us to choose the two most useful and informative ones: “For a teenager about nutrition. Food for the mind” (Xav=9.14 points) with consensus (W=0.744; α=0.0456) and “Healthy food for schoolchildren” (Xav=9.03 points; W=0.757; α=0.0398). The study of educational technologies used by teachers to instill in students the basic principles of health saving showed that teachers do not always use active forms. The result of a survey of 374 students was the identified need to improve knowledge in matters of self-regulation of the psychological state.

Conclusion. The study of the advantages and disadvantages of educational technologies used in the conduct of hygienic education and training of schoolchildren and their parents in the conditions of educational organizations requires further improvement and wider use of active forms of education that meet the needs of students.

Kazan medical journal. 2023;104(2):293-301
pages 293-301 views

Determining disease response patterns in patients with coronary heart disease

Zakharyan E.A., Ushakov A.V., Zyabkina I.V., Kubyshkin A.V., Ibragimova R.E.


Background. Attitude towards one's own illness significantly affects the course of the disease, the effectiveness of treatment and the possibility of rehabilitation. The formation of certain types of response to the disease determines adherence to treatment.

Aim. To study the types of attitude to the disease in patients with coronary heart disease, depending on the severity of coronary atherosclerosis and the planned treatment tactics.

Material and methods. To study the type of patient's response to the disease, a personal questionnaire of the Bekhterev Institute was used. The study included 240 patients with coronary heart disease (150 men and 90 women): the first group — 26 people without coronary artery disease; the second group — 41 people who were subject to conservative treatment, with hemodynamically unexpressed atherosclerosis of the coronary arteries; the third group — 84 patients with severe atherosclerotic lesions of the coronary arteries, who were candidates for surgical revascularization methods; the fourth group — 38 people hospitalized for coronary artery stenting; the fifth group — 51 people hospitalized for coronary artery bypass grafting. The sixth group was represented by healthy volunteers (40 people). To assess the statistical significance of the differences between the two groups in terms of any parameters with the non-normal distribution of features the Mann–Whitney test was used. To assess the relationship between two features, the Spearman rank correlation coefficient with an assessment of its significance was used. Differences were considered significant at p <0.05.

Results. Patients with ischemic heart disease chose statements characteristic of ergopathic and harmonious (p <0.05) types of attitude to the illness. In 56% (p <0.05) of the representatives of the control group, the anosognosic type prevailed. A higher frequency of the euphoric type of attitude towards the disease was found in patients of the second group in comparison with the third one (p=0.009). The fifth group was dominated by sensitive (42.5%) and paranoid (32.5%) types of response; less common were anxious (27.5%) and neurasthenic (30%) ones. A direct correlation was demonstrated between the age of patients and the detectability of hypochondriacal (p=0.027, r=0.15), apathetic (p=0.005, r=0.2) and paranoid (p=0.011, r=0.17) types of attitude towards illness.

Conclusion. Patients with coronary heart disease have predominantly ergopathic and harmonious types of response, which determine whether they have a sober assessment of their state of health, as well as the significance of work activity for the individual.

Kazan medical journal. 2023;104(2):302-310
pages 302-310 views

Clinical experiences

Predictors of lethal outcomes in severe cases of a new coronavirus infection COVID-19

Shapovalov K.G., Tsydenpilov G.A., Lozovsky E.V., Latyshov A.A., Petrova P.V.


Background. The spread of the new coronavirus infection COVID-19 has already become one of the main problems of national healthcare systems around the world. Until now, it has not been possible to find drugs with sufficient etiotropic activity for COVID-19, and therefore, it is important to determine new points of application for pathogenetic therapy in relation to this pathology.

Aim. To identify the predictors of an unfavorable outcome of a severe course of COVID-19 infection to determine the prognosis of the clinical course and optimize treatment tactics using succinates.

Material and methods. A retrospective observational study of 46 cases of treatment with a severe form of the disease on the basis of a monohospital for the treatment of patients with a new coronavirus infection was conducted. All patients had comobrid pathology (median Charlson index — 3 points). The most common ones were: encephalopathy of mixed genesis, diabetes mellitus, coronary heart disease, arterial hypertension, alimentary-constitutional obesity. We assessed the relationship between indicators of initial status and mortality in patients, and indicators with a statistically significant relationship were selected as predictors. Statistical processing of the results was carried out in the IBM SPSS v. 23.0, ROC analysis was used to find the relationship between quantitative predictors and lethal outcome.

Results. Among the treated parameters, the most significant influence on the risk of death was found in arterial anion gap (odds ratio 28.78; p <0.017) and fibrinogen level (odds ratio 22.20; p <0.01). To a lesser extent, the level of urea, aspartate aminotransferase, and the Charlson comorbidity index had an effect on the prognosis of a lethal outcome. The identified predictors of an unfavorable outcome of a severe course of COVID-19 infection can be used to predict the clinical course and build treatment tactics based on the received information.

Conclusion. Predictors of poor outcomes in severe COVID-19 infections include arterial anion gap and fibrinogen levels, and to a lesser extent, urea levels, aspartate aminotransferase levels, and the Charlson comorbidity index.

Kazan medical journal. 2023;104(2):311-318
pages 311-318 views

Cochrane Review Summaries

pages 319-320 views

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