Vol 104, No 4 (2023)

Background. For many years, nitroglycerin has been the primary treatment for coronary pain in patients with angina pectoris, but its effect on heart rate is not fully understood.

Aim. To study the change in heart rate under the influence of nitroglycerin in patients with stable angina pectoris of functional classes III and IV in combination with hypertension.

Material and methods. The study included 122 men aged 40 to 65 years (mean age 58.42±5.8 years) with stable exertional angina of functional classes III and IV in combination with hypertension. A rhythmocardiographic study was performed with simultaneous recording of an electrocardiogram initially and 5 minutes after sublingual administration of nitroglycerin. The number of ventricular and supraventricular extrasystoles was assessed in each vegetative test (background, Valsalva, Ashner, active orthostatic and with physical activity) initially and after taking nitroglycerin. To evaluate the compared values, the mean value, standard error of the mean, maximum, minimum, frequencies, Wilcoxon criteria, Pearson's χ2 were calculated.

Results. Under the influence of sublingual intake of nitroglycerin, the number of supraventricular extrasystoles decreased in approximately 7% of patients in the background sample, in the rest, an increase prevailed in 7.4–9.0% of patients, depending on vegetative test. At the same time, the number of ventricular extrasystoles decreased in the background (in 13.9% of patients) and orthostatic (in 9.8%) samples, in the rest, their growth prevailed in 9–17% of patients, depending on vegetative test.

Conclusion. Sublingual use of nitroglycerin leads to an increase in the number of supraventricular extrasystoles, as well as a variable effect on ventricular extrasystoles, depending on the vegetative test performed.

Background. The high prevalence of autoimmune thyroiditis and the insufficient effectiveness of hormone replacement therapy dictate the need to explore alternative methods of treating the disease. These methods include interval hypoxic therapy, but its effect on the cytokine profile in autoimmune thyroiditis has not been studied enough.

Aim. To study the effect of interval hypoxic therapy in combination with hormone replacement therapy on cytokine status in autoimmune thyroiditis and hypothyroidism.

Material and methods. 136 women with primary diagnosed autoimmune thyroiditis and hypothyroidism were examined. Half of them (n=68) received only hormone replacement therapy for 12 months. The rest of the women (n=68), along with sodium levothyroxine, underwent sessions of interval hypoxic therapy (every 3 months for 10 days according to the formula 5–5–5). The concentrations of interleukins-4, -6, -8, -10 and tumor necrosis factor α in blood serum were determined. To compare the results in groups, Kruskal–Wallis rank univariate analysis and Dunn's test were used. The Wilcoxon t-test was used to compare two related samples.

Results. Both isolated hormone therapy and its combination with hypoxic therapy did not affect the concentrations of interleukins-4, -8, -10 and tumor necrosis factor α in the blood serum of women with initially diagnosed autoimmune thyroiditis and hypothyroidism. However, hypoxic therapy caused a decrease (p=0.0001) in the initially elevated concentration of interleukin-6 to the level of the control group, which did not happen with the isolated intake of levothyroxine sodium.

Conclusion. The combination of sodium levothyroxine with hypoxic therapy causes a decrease in the level of interleukin-6, which is elevated in women with newly diagnosed autoimmune thyroiditis and hypothyroidism.

Background. It is known that the number of polymorphonuclear leukocytes increases with the development of periodontitis. However, their role in the pathogenesis of chronic periodontitis has not been fully defined.

Aim. To study the pathogenetic role of polymorphonuclear leukocytes in the development of chronic periodontitis, realized by microvesicles and aggression factors (metalloproteinases, myeloperoxidase, calprotectin, lipocaine 2).

Material and methods. 30 patients aged 30 to 50 years with a diagnosis of “chronic generalized periodontitis of moderate severity (K05.3)” and no severe somatic pathology were under observation. The comparison group included 20 people with no inflammatory diseases in the oral cavity, comparable with the main group in terms of gender, age, nationality, and the presence of bad habits. Using a standard set of indices, the state of periodontal tissues was assessed, and all examined patients underwent X-ray examination. In the oral fluid of the examined, the total number of microvesicles and their phenotype, the concentration of matrix metalloproteinases-2 and -9, myeloperoxidase, calprotectin, lipocaine 2 were determined. The parameters were determined using a flow cytometer. Descriptive statistics are represented by the median and interquartile range (25th and 75th percentiles). Two independent sample sets were compared using the Mann–Whitney test. Correlation analysis was carried out according to the Spearman method.

Results. The total number of microvesicles in the oral fluid in patients with chronic periodontitis was 11 times higher than in healthy volunteers (p=0.00001). More than a third of them had neutrophil markers. The levels of neutrophil aggression factors were also higher in patients with periodontitis and correlated with the value of the periodontal index, the depth of the periodontal pocket, bleeding index, indicators of periodontal health. Thus, a strong positive relationship was found between the total number of microvesicles and the value of the periodontal index (r=0.675), the depth of the periodontal pocket (r=0.763), the bleeding index (r=0.704); the number of neutrophilic microvesicles and indicators of periodontal health — r=0.816, r=0.837 and r=0.776, respectively. The content of metalloproteinase-2 correlated with the depth of the periodontal pocket (r=0.754), bleeding index (r=0.811), papillary-marginal-alveolar index (r=0.675).

Conclusion. Neutrophils contribute to the pathogenesis of chronic periodontitis through the secretion of aggression factors: metalloproteinases, myeloperoxidase, calprotectin, lipocaine 2, and microvesicles.

Background. Disturbances in the body associated with bone marrow failure caused by the administration of lethal doses of cyclophosphan to animals make it possible to use this experimental model to solve important pathophysiological problems.

Aim. To reveal hematological changes and structural morphological changes in the liver and spleen in mice against the background of acute toxic effects of lethal doses of.cyclophosphan.

Material and methods. The studies were performed on 200 outbred male mice weighing 27–29 g. Acute cytotoxic syndrome was modeled by a single intraperitoneal injection of a solution of cyclophosphan at doses of 500 and 750 mg/kg of body weight. Blood sampling for hematological studies was carried out on the 3rd, 6th, 10th and 15th days of intoxication, and the removal of the liver and spleen for morphological studies was performed on the 6th and 15th days. Statistical analysis was performed using Statistica 10 and MS Excel. Results were presented as mean (M) ± standard error of the mean (mx). To determine the significance of differences between groups with a significance level of p <0.05, Fisher's test and Mann–Whitney U-test were used.

Results. Mortality against the background of acute cytotoxic action of cyclophosphan at doses of 500 and 750 mg/kg reached 83.3 and 100%. The initial content of leukocytes in the peripheral blood of mice was (8.6±2.3)×109/l, and on the 6th day of intoxication it decreased to (1.0±0.3)×109/l and (0.6±0.1)×109/l (p=0.01). Blast cells of all hematopoietic lineages were present in blood smears. In the morphological picture of the spleen, the connective tissue stroma was sharply distinguished, and the white and red pulps were almost completely absent. Signs of acute toxic effects of cyclophosphan were found in the liver tissue.

Conclusion. The course of acute cytotoxic syndrome caused by cyclophosphan is accompanied by high mortality, the development of pancytopenia, pronounced destructive changes in the spleen tissue and toxic changes in the liver tissue.

The research highlights the fundamental concepts of microRNA, the mechanisms of RNA interference, the importance of microRNA in the development of diseases. Combining the experience of domestic and foreign researchers, the authors identified the main miRNAs involved in the development of gastric and duodenal ulcers. The article also describes the main mechanisms of regulation of the inflammatory process in gastric and duodenal ulcers associated with Helicobacter pylori, the influence of microorganisms on the expression of various microRNA types and the control of the cellular immune response. In addition, the review presents the latest research on methods for diagnosing Helicobacter pylori-associated peptic ulcer based on the determination of circulating microRNAs. The results of an experimental model of treatment of patients infected with Helicobacter pylori with drugs that act on non-coding RNA are presented.

The review article is devoted to one of the new topical problems in medicine — necrosis of the organs of the cranio-maxillofacial region in patients with coronavirus infection, which was first discussed at the end of 2020. Later, doctors of various specialties (otolaryngologists, ophthalmologists, maxillofacial surgeons, neurosurgeons, dentists) from many countries of the world met in their practice with inflammatory-necrotic lesions of the mucous membrane of the nasal cavity and paranasal sinuses, facial skeleton and skull, eyeball, brain. The article highlights the main points of view of scientists about the etiology and pathogenesis of the studied pathology. Summarized data from the largest studies on the epidemiology, risk factors, and symptoms of post-covid necrosis of the cranio-maxillofacial region are presented. The results of various methods for diagnosing this complication — multislice computed tomography, magnetic resonance imaging, angiography, are described in detail. Due to the fact that today the role of fungal flora is recognized as the leading one in the etiology of post-covid necrosis of the cranio-maxillofacial region, much attention is paid to cytological, microbiological and pathohistological research methods, which should be aimed at the search for mycelium. The main approaches to the treatment of patients with this pathology are formulated. The article highlights issues important for practical healthcare: interpretation of national clinical guidelines for coronavirus infection in terms of post-covid necrosis of the cranio-maxillofacial region, classification options according to the International Classification of Diseases of the 10th revision, the procedure for providing medical care to this category of patients, the economic consequences of the lack of active prevention methods of the presented complication in patients with COVID-19.

Transitional lumbosacral vertebrae in the form of SI lumbarization and LV sacralization are classified as spinal anomalies. In the domestic medical literature, there are few publications devoted to these pathological conditions. In the course of a study of the available literature on the problem of transitional lumbosacral vertebrae, it was found that the frequency of cases of transitional lumbosacral vertebrae diagnosis ranges from 4 to 30% of clinical cases. The share of patients with lumbar vertebrae accounts for an average of 40% of cases, the share of patients with sacralization of the vertebrae is 60% of clinical observations. Mutations in the Hox gene are considered to be the trigger for the development of pathology, and pain is usually the leading clinical symptom. Plain radiography, computed tomography and magnetic resonance imaging are used to diagnose the pathology. Radiation imaging of the entire spine is required to eliminate errors in vertebrae counting. The type of pathology is determined using various classifications. As conservative therapeutic agents, drug blockades applying anesthetics and hormonal drugs are used. The arsenal of surgical interventions includes resection of the enlarged transverse process of the supracacral vertebra, decompression of stenotic intervertebral foramina, impulsive radiofrequency ablation, and posterior fusion. Measures for the prevention of pathology are not currently developed.

The problem of the relationship of nutritional status with the risk of development, course features and prognosis of chronic obstructive pulmonary disease is of considerable scientific and practical interest, but remains poorly understood. However, in clinical practice, it is customary to calculate only the body mass index, but this indicator cannot provide a complete characterization of the nutritional status. We have reviewed the data of publications indicating the conditionality of the course of chronic obstructive pulmonary disease by the value of the body mass index, the amount of muscle mass of the body and such parameters of adipose tissue as its distribution in the body, hormonal activity and production of systemic chronic inflammation markers. To assess the dynamics of body mass index and spirometric parameters in patients with chronic obstructive pulmonary disease, 76 publications that were selected by the keywords “COPD”, “BMI” in the Scopus, PubMed, eLibrary databases for 1995–2022, were analyzed. Correlation analysis was carried out using Spearman's test. As a result, there was a trend towards an increase in body mass index in patients with chronic obstructive pulmonary disease in different countries and an improvement in spirographic parameters in a cohort of patients with chronic obstructive pulmonary disease over time. The data of the reviewed studies indicate the presence of a relationship between chronic obstructive pulmonary disease and nutritional status. At the same time, the mechanisms of the relationship between the pathogenesis of chronic obstructive pulmonary disease and adipose tissue dysfunction, as well as the role of adipose tissue and body composition in the course of the disease and its prognosis, have not been sufficiently studied.

Background. The current process of population aging manifests itself at the regional level with varying degrees of intensity, which should be taken into account when assessing the population's need for geriatric medical care and developing social support measures.

Aim. To give a comprehensive description of the dynamics of special indicators of population aging and to assess the demographic aging scale of the population of the Irkutsk region.

Material and methods. A comprehensive assessment of the dynamics of population aging was carried out using 6 special indicators of population aging and 3 indicators of demographic movement. The calculation of the values of the indicators was performed in accordance with the methodological provisions on demographic statistics. The scale of aging was calculated based on the results of determining the stages of aging using 4 parameters of population aging: the level of aging, the depth of aging, aging factors, and the rate of aging. The data source was the statistical accounting tables of Rosstat for the Irkutsk region: А12а_25 — natural population movement; t_pt1n — general results of population migration by incoming territories; 25_2PH — population by sex and age. The number of statistical accounting tables separately for each municipality of the Irkutsk region and the region as a whole amounted to 99 units for each year under study.

Results. The dynamics of the aging level parameter indicates an aggravation of the aging processes of the population, and not due to an increase in people at the age of longevity (from 75 to 90 years) and centenarians (90 years and older), but due to the population older than working age, women from 55 years old and men from 60 years — up to the age of 75 years. Indicators of aging factors that characterize reproductive and migration compensatory mechanisms are at a level that does not allow compensating for the growing processes of population aging. The value of the aging rate parameter in terms of the growth rate of the aging coefficient in dynamics indicates the stability of the demographic aging of the population. An analysis of the scale of population aging in the Irkutsk region and its districts showed that the Irkutsk region has an average value of parameters and is at an intermediate stage between the aging and old population.

Conclusion. The scale of the aging of the Irkutsk region is primarily due to the high value of the parameter of aging factors, the parameter of the level of aging is characterized by the presence of prerequisites for the transition to a more aggravated stage of population aging.

Aim. The study of the features of local and systemic indicators in chronic rhinitis.

Material and methods. The study groups included 21 patients with chronic allergic rhinitis, 20 patients with chronic vasomotor rhinitis, 9 patients with chronic atrophic rhinitis, 15 patients with chronic infectious rhinitis and 50 people from the control group. Diagnosis of chronic rhinitis, depending on the phenotype, taking into account the clinical recommendations of the Ministry of Health of Russia, was carried out by a doctor when the patient applied for treatment, followed by analysis of the data from a full range of instrumental examinations, clinical manifestations, anamnesis, and rhinoendoscopy results. 65 subjects with chronic rhinitis, as well as the control group, underwent a cytological examination of the nasal mucosa and an assessment of hematological parameters. Statistical analysis was carried out using the Statistica 10 package. Differences in groups were assessed using the nonparametric Kruskal–Wallis test (for three or more comparison groups) and Mann–Whitney test (for pairwise comparison). The critical level of statistical significance in testing scientific hypotheses was p ˂0.05.

Results. In chronic allergic rhinitis, three syndromes were locally identified: allergic syndrome (with a statistically significant increase in the absolute number of eosinophils up to 14 per field of view), non-specific inflammation syndrome (with a statistically significant increase in the number of leukocytes up to 9 per field of view) and a syndrome of protective changes in the nasal mucosa. At the same time, changes associated with allergic syndrome were recorded in the blood (with a statistically significant increase in the absolute number of eosinophils up to 0.84×10⁹/l). In chronic vasomotor rhinitis, changes in the nasal mucosa did not cause significant changes in the activity of blood cells. In chronic atrophic rhinitis, degenerative changes in the nasal mucosa (with a statistically significant decrease in the number of epithelial cells up to 2 per field of view; p1–4 <0.001, p2–4 <0.001) with local hemorrhagic syndrome were accompanied by the presence of statistically significant anemic (hemoglobin up to 10⁹ g/l; p1–4 <0.001, p2–4 <0.001, p3–4 <0.001, p4–5 <0.001) and inflammatory syndromes in terms of blood parameters (with statistically significant leukocytosis up to 10×10⁹/l; p1–4 <0.001, p2–4 <0.001, p3–4 <0.001). In chronic infectious rhinitis, local inflammatory syndrome with a statistically significant increase in the number of leukocytes up to 75 per field of view (p1–5 <0.001, p2–5 <0.001, p3–5 <0.001, p4–5 <0.001) with protective changes in the nasal mucosa confirmed by systemic inflammatory syndrome with statistically significant leukocytosis up to 12×10⁹/l (p1–5 <0.001, p2–5 <0.001, p3–5 <0.001, p4–5=0.04), neutrophilic granulocytosis up to 9×10⁹/l (p1–5 <0.001, p2–5 <0.001, p3–5 <0.001, p4–5=0.03) and an increase in the erythrocyte sedimentation rate up to 22 mm/h (p1–5 <0.001, p2–5 <0.001 , p3–5 <0.001, p4–5 <0.001) according to blood tests.

Conclusion. The greatest number of local and systemic changes was found in chronic allergic and chronic infectious rhinitis, which requires increased attention to these diseases.

The paper describes the main milestones in the life of one of the founders of the pediatric school in Kazan — Professor P.M. Argutinsky-Dolgorukov. He made a lot of efforts to organize the teaching of pediatrics at the Kazan Imperial University, was one of the initiators of the construction of a new children's clinic on the Arsk field in 1900. Professor P.M. Argutinsky-Dolgorukov connected mainly with the study of infectious pathology. His students Professor V.K. Menshikov, E.M. Lepsky, A.A. Agafonov later became well-known pediatricians and infectious disease specialists who took an active part in the creation of pediatric and infectious diseases services in the Republic of Tatarstan. P.M. Argutinsky-Dolgorukov was the founder of the study of malaria in children in Russia. Under the guidance of the professor, progressive methods of diagnostics and treatment were introduced into clinical practice, in particular, the method of treating scarlet fever with Moser's serum, the study of the measles causative agent, and X-ray examinations at the patient's bedside.

This publication is the Russian translation of the Plain Language Summary (PLS) of the Cochrane Systematic Review: Okwundu CI, Olowoyeye A, Uthman OA, Smith J, Wiysonge CS, Bhutani VK, Fiander M, Gautham KS. Transcutaneous bilirubinometry versus total serum bilirubin measurement for newborns. Cochrane Database of Systematic Reviews. 2023. Issue 5. Art. No.: CD012660. DOI: 10.1002/14651858.CD012660.pub2.