Vol 100, No 5 (2019)

Towards evidence based research
Lund H., Brunnhuber K., Juhl C., Robinson K., Leenaar M., Dorch B.F., Jamtvedt G., Nortvedt M.W., Christensen R., Chalmers I.
Kazan medical journal. 2019;100(5):733-739
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Theoretical and clinical medicine
Relationship Between Delta Troponin I Levels And In-Hospital Cardiovascular Endpoints In Acute ST Elevation Myocardial Infarction
Ercan A., Altug O., Selcuk Y., Salih S., Kocayiğit İ., Keser N., Huseyin G.

Abstract

Objectives. In this study, we investigated the relationship between the rate of increase in troponin I levels and in-hospital cardiovascular endpoints (outcomes) in patients with ST-elevation myocardial infarction (STEMI).

Methods. Eighty-four patients with acute STEMI who received thrombolytic treatment or who underwent primary percutaneous coronary intervention (PCI) were enrolled. After admission to hospital, delta troponin I levels, which were determinedby serial measurements after 2, 4, and 6 h of admission, and in-hospital major cardiovascular events were evaluated.

Results. There were 35 (41.7%) patients in the thrombolytic group and 49 (58.3%) patients in the primary PCI group. As major cardiovascular endpoints, death from cardiovascular events was seen in 7 (8.3%) patients, stroke/transient ischemic attack in 2 (2.4%), recurrent ischemia in 5 (6%), arrhythmia in 8 (9.5%), and urgent revascularization was performed in 5 (6%) cases. In patients with arrhythmia, ventricular fibrillation was seen in 3 (3.6%) patients, atrial fibrillation in 3 (3.6%), and ventricular tachycardia in 2 (2.4%) patients. The ventricular septal defect was observed only in 1 (1.2%) patient as a mechanical complication, and the patient underwent urgent surgery. The analysis of all patients and sub-groups of thrombolytic and primary PCI patients revealed no statistically significant difference between delta troponin I levels at time intervals of (0–2), (0–4), and (0–6) h and in-hospital major cardiovascular endpoints (p >0.05).

Conclusion. The analysis of delta troponin I levels is not a predicting factor of in-hospital endpoints (outcomes) in patients with STEMI treated by thrombolytic therapy or primary PCI. Randomized controlled studies with a larger study population are needed on this subject.

Kazan medical journal. 2019;100(5):740–745
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Stages of ovarian and endometrial cancer detection in women in the postmenapausal period in Baku city
Garashova M.A.

Abstract

Aim. To study the severity (according to the stages at the time of diagnosis) of female genital cancer detected in postmenopausal women in Baku in 2016–2018.

Methods. 306 postmenopausal women with various tumors of the reproductive system were examined. The average age of the examined women was 59.3±0.4 (48–83) years. 166 (54.2%) out of 306 patients had malignant tumors of the genitalia including ovarian cancer (n=97), endometrial cancer (n=50), cervical cancer (n=13), uterine sarcoma (n=6). Clinical, functional, laboratory, radiological, and morphological studies were performed. For the analysis of the obtained digital data, discriminant analysis methods were applied. The rate (Р%) and its 95% confidence intervals (±mp%) of ovarian and endometrial cancer of the postmenopausal period among female citizens of Baku were calculated. Statistical significance of the difference between the indicators in the groups was determined by Pearson χ2-criterion. All calculations were performed in Excel 2013 and SPSS-20.

Results. According to the data of the study, ovarian cancer in the postmenopausal period was diagnosed in 15.5±3.7% of females at stage I, in 8.2±2.8% at stage II, in 66.0±4.8% at stage III, in 10.3±3.1% at stage IV of the development of the tumor process. In 68.0±6.6% of patients with endometrial cancer in the postmenopausal period, the tumor was determined at stage I, in 30.0±6.5% of patients at stage II, and in 2.0±2.0% of patients at stage III of the development of the tumor process. On comparison of the stages at detection of ovarian and endometrial cancer, a significant difference between these two forms of malignant neoplasms was found for both stages I and III.

Conclusion. Detection of genital tumors in postmenopausal women is characterized by the diagnosis of ovarian cancer mainly in the later stages of the disease (compared to endometrial cancer), which indicates the need to develop effective screening methods for earlier detection of this tumor process.

Kazan medical journal. 2019;100(5):746-750
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Influence of seasonal course of maxillofacial region diseases on the structure of temporary ­disability in the Republic of Tatarstan
Saleev R.A., Abdrashitova A.B.

Abstract

Aim. To study the seasonality of diseases of the maxillofacial region as a factor affecting the duration of temporary disability in the Republic of Tatarstan.

Methods. The sources of information were the cases of temporary disability established by dental medical organizations of the Republic of Tatarstan (analysis of accounting and reporting forms 16-VN, 036/u, 035/u, 043/u for the period 2007–2016).

Results. The number of visits to dental medical organizations of the patients with diseases of the maxillofacial region leading to disability of the patient was different depending on the season. It was found that the differences in the structure of temporary disability due to diseases depending on the season for different years of the study period were statistically significant (p <0.001) in all groups except non-odontogenic inflammatory diseases. We have established two periods with an increased number of cases — from March to April and from October to December. In these months, cases of temporary disability in the general structure accounted for 8.9% and more.

Conclusion. Analysis of morbidity and factors leading to the occurrence of cases of temporary disability allows obtaining reliable information about the health of the economically active population of the Republic of Tatarstan, which will be the basis for planning preventive measures, appropriate comprehensive treatment and rehabilitation of patients.

Kazan medical journal. 2019;100(5):751-756
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X-ray spectral microanalysis of the sternum in patients with congenital pectus excavatum
Shamik V.B.

Abstract

Aim. To study the mineral composition of the sternum in patients with congenital funnel-shaped deformations of the chest.

Methods. X-ray spectral microanalysis of the sternum was performed in 10 patients with pectus excavatum aged 14–17 years (30 zones) on a scanning electron microscope with an accelerating voltage of 25 kV. The results of the sternum examination of 3 patients aged 14–16 years (10 zones) operated on for other diseases were used as the control.

Results. Graphic images of mineralization of each investigated zone of the sternum were obtained. As a result of processing the graphic data, the IBAS-200 system obtained average atomic orbital values, weight and atomic percent, net and background intensities and their ratios, intensity errors of the elements-constituents of mineral matrix of the sternum. The structures of the sternum in the main and control groups did not differ. The predominant elements are oxygen (O), phosphorus (P) and calcium (Ca). Their net intensity in patients and in healthy subjects of the corresponding age was 101.16±2.78 and 99.23±1.97 (р <0.001), respectively; 402.38±2.23 and 421.28±1.99 (р <0,001); 586.41±2.37 and 601.32±1.99 (р <0.001). Net intensity of phosphorus and calcium in healthy children was higher by 2.5–4.5%, and that of oxygen was lower by 1.9%. An important indicator is the ratio of the net and background intensities of the elements.

Conclusion. Net intensity of phosphorus and calcium in healthy children was higher, in the pathogenesis of the deformation of the chest, the sternum changes its shape secondarily.

Kazan medical journal. 2019;100(5):757-761
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Features of melatonin cyrcadian secretion in patients with gastroesophageal reflux disease associated with obstructive sleep apnea/hypopnea syndrome
Karpovich O.A., Shishko V.I., Shulika V.R.

Abstract

Aim. To evaluate the features of melatonin cyrcadian production in patients with gastroesophageal reflux disease associated with obstructive sleep apnea/hypopnea syndrome.

Methods. We examines 29 patients with gastroesophageal reflux disease were examined (group 1), 29 patients with gastroesophageal reflux disease associated with obstructive sleep apnea/hypopnea syndrome (group 2), and 22 patients with obstructive sleep apnea/hypopnea syndrome (group 3). The comparison group included 21 people without gastroesophageal reflux disease and obstructive sleep apnea/hypopnea syndrome (group 4). The content of 6-sulfatoxymelatonin was determined in 24-hour urine and separately in its daytime and night portions by enzyme immune assay. The night/day index was calculated. The compared groups were comparable by gender but the patients with obstructive sleep apnea/hypopnea syndrome and gastroesophageal reflux disease associated with this syndrome differed from the patients from comparison group by older age, which is consistent with epidemiology of sleep apnea. The analysis of the data obtained was performed using the program Statistica 10.0. When comparing quantitative indicators between four independent samples, Kruskel–Wallis test was used. In order to study the relationship between the phenomena, the Spearman rank correlation coefficient was calculated.

Results. A significantly increased level of 6-sulfatoxymelatonin in 24-hour urine was determined in group 2 (p=0.0000), as well as in day (0.0000) and night portions (0.015) compared to group 1, in 24-hour urine (p=0.0007) and its day portion (p=0.0001) compared to group 3, in day portion of urine compared to group 4 (p=0.029). In group 2 compared to group 4 a significant shift in melatonin synthesis peak during daytime hours was observed, which is expressed in a statistically significant decrease in the night/day index (p=0.0003). Correlation analysis revealed statistically significant relations between the level of 6-sulfatoxymelatonin in urine and the severity of sleep apnea (in 24-hour urine: r=0.64, p=0.0000; in daytime portion: r=0.62, p=0.0000; in night portion: r=0.40, p=0.003), as well as respiratory monitoring indicators indicating sleep fragmentation due to apnea (the number of awakenings associated with respiratory events: r=0.58; p=0.00001; activation of the central nervous system associated with respiratory efforts: (r=0.50; p=0.0002).

Conclusion. The patients with gastroesophageal reflux disease associated with obstructive sleep apnea/hypopnea syndrome have an increased level of 6-sulfatoxymelatonin in urine associated with the shift of its peak synthesis to daytime hours; the identified changes correlate with apnea/hypopnea index reflecting the severity of apnea and sleep disturbance.

Kazan medical journal. 2019;100(5):762-768
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Influence of a single-nucleotide polymorphism of AKT1 (rs2498796) and HEY2 (rs13328928) genes on the risk of endometrial cancer in women of the Republic of Tatarstan
Gabidullina R.I., Nukhbala F.R., Smirnova G.A., Orlova Y.I., Shakirov A.A., Valeeva E.V., Akhmetzyanova A.F., Fakhrutdinova G.R.

Abstract

Aim. To analyze the prevalence of different polymorphisms of AKT1 gene (rs2498796) and HEY2 gene (rs13328928) and to determine the association of revealed polymorphisms with the risk of endometrioid carcinoma in women living in the Republic of Tatarstan.

Methods. 161 female citizens of Tatarstan were enrolled. The study group included 60 patients with endometrial cancer (endometrioid carcinoma) and the control group enrolled 101 women without endometrial pathology. The age of the subjects ranged from 41 to 91 years. The single-nucleotide polymorphism of AKT1 gene (rs2498796) and HEY2 gene (rs13328928) was determined by real-time polymerase chain reaction. We ran a χ2 test and evaluated the odds ratio.

Results. The risk of endometrial cancer was higher in carriers of homozygous T/T genotype of AKT1 gene (rs2498796) without statistical significance (OR=1.61, 95% CI=0.61–4.21, p=0.62). Homozygous C/C genotype of HEY2 gene (rs13328928) with the mutant allele C was observed in endometrial cancer group with a frequency of 0.383 and 0.287 in the control group (χ2=1.70, p=0.43). The risk of endometrial cancer was higher in the group of homozygous C/C genotype without statistical significance (OR=1.54, 95% CI=0.79–3.03, p=0.43).

Conclusion. Among 161 females citizens of the Republic of Tatarstan included into the study, the associations of the mutant alleles of AKT1 gene (rs2498796) and HEY2 gene (rs13328928) with the risk of endometrial cancer were not identified; the prevalence of alleles and genotypes was found to be comparable with the European one.

Kazan medical journal. 2019;100(5):769-773
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The influence of diabetes mellitus on blood lipid profile in patients with coronary vessel restenosis associated with Helicobacter pylori
Gadzhieva S.Z.

Abstract

Aim. To determine the influence of diabetes mellitus on the level of blood lipid profile in patients with coronary restenosis associated with H. pylori.

Methods. The study included 50 patients with coronary artery disease and coronary restenosis associated with H. pylori infection. Patients were divided into 2 groups: with concomitant diabetes mellitus (group 1, n=10 patients) and without it (group 2, n=40). The groups were comparable by age, sex, and clinical and angiographic data. All patients along with basic therapy additionally received standard first-line anti-helicobacter therapy in accordance with the Maastricht Consensus-3 (2005) for 14 days. Before treatment and 90 days after treatment, blood lipid profile was evaluated with Siemens Dimension X pand plus device. To analyze the obtained digital data, the arithmetic mean of the indicator (M) and the error of the mean (m) were calculated. The statistical significance of the difference between the groups was determined by Pearson χ2 test. Differences were considered significant at p <0.05. Statistical data processing was performed using the SPSS statistical package and the Excel-2013.

Results. A comparative analysis of qualitative indicators showed that in both groups in most cases (90 and 87.5%, respectively), the level of low density lipids was above the norm, but they did not differ between the groups (χ2=0.047; р=0.828). After eradication in both groups, both qualitative (60 and 67.5% respectively) and quantitative values of low density lipids improved significantly (decreased to 98.2±8.6 and 97.6±7.9 mg/dl, respectively) however, no significant differences between the groups were found (p ˃0.05).

Conclusion. A history of diabetes mellitus in patients with coronary restenosis associated with H. pylori cannot be considered as an additional factor that increases the likelihood of developing the disorders of lipid profile; successful eradication therapy in this category of patients contributes to the normalization of lipid profile regardless of the presence or absence of concomitant diabetes mellitus.

Kazan medical journal. 2019;100(5):774-778
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The level of inhibin A in the blood serum of women suffering from chronic trichomoniasis as a predictor of infertility
Gudinskaya N.I., Boyko O.V., Gribova N.A., Mukhamedzyanova R.I.

Abstract

Aim. To determine the relationship between the level of inhibin A and biochemical factors of inflammation with the development of infertility in women suffering from chronic trichomoniasis.

Methods. The object of the study was the blood serum of 167 women suffering from chronic trichomoniasis. The level of inhibin A was determined by enzyme immunoassay. As a control, the blood serum of 22 practically healthy fertile women was used who had no history of trichomoniasis. The lymphocyte phenotype was determined using luminescent microscopy with monoclonal antibodies staining. The level of immunoglobulins in serum was determined by the standard Mancini method of radial immunodiffusion. The synthesis of cytokines was determined by the method of studying the spontaneous synthesis of interleukins-1β, -8, -10 and interferon γ. The level of cytokines and lactoferrin was evaluated by enzyme immunoassay. The concentrations of α2-macroglobulin and C-reactive protein were determined by the nephelometric method. The fibrinogen concentration was determined by the coagulometric method.

Results. In the group of patients with chronic trichomoniasis, a significant variability in the serum concentration of inhibin A from 4.3 to 29.4 ng/L was found. In a group of patients who had a reduced content of inhibin A, in 63.2% of cases, the development of secondary infertility was subsequently diagnosed; in the group of patients who had a normal level of inhibin A, secondary infertility developed only in 12.9% of cases.

Conclusion. It was found that among all acute phase proteins, only levels of C-reactive protein and lactoferrin have prognostic value and statistically significantly differ in groups of women with subsequently developed infertility and uncomplicated infertility trichomoniasis.

Kazan medical journal. 2019;100(5):779-784
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Social hygiene and healthcare management
Change in muscle strength of the hand flexors, muscle-to-fat ratio and walking speed in ­middle-aged patients living in rural areas after myocardial infarction during cardiac rehabilitation
Efremushkina A.A., Kozhedub Y.A., Elykomov V.A.

Abstract

Aim. To estimate in dynamics the changes in muscle strength of hand flexors, muscle mass and gait rate in men with ischemic heart disease and myocardial infarction during cardiac rehabilitation at the outpatient polyclinic stage where daily dosed walking with individually selected frequency steps under self-control was used as a phy­sical component.

Methods. The study included 66 men. Patients were divided into two groups comparable by age: 41 men with myocardial infarction (mean age 56.49±7.33 years) and 25 men with exertional angina without myocardial infarction (mean age 61.09±4.67 years). In all patients before and after 3 months of cardiac rehabilitation, where the physical component was represented by dosed walking, clinical and anamnestic characteristics were determined, muscle mass using bioimpedancemetry, muscle strength by wrist dynamometry, and walking speed using 6-minute walk test were measured. Statistical processing of the obtained materials was carried out by generally accepted methods.

Results. In patients with coronary heart disease and myocardial infarction, the muscle strength of the hand flexor on the right hand increased from 45.26±11 daN to 46.3±7 daN (p=0.05) and on the left hand from 43.78±11 to 43.78±11 (p=0.05), absence of changes in muscle-to-fat tissue ratio 48.5 (47.7; 49.7) to 48.9 (48.5; 49.9) (p=0.08), increase in gait speed from 450 m (420; 500) to 480 m (440; 500) (p=0.05). In patients with coronary heart disease without myocardial infarction, muscle-to-fat tissue ratio decreased from 48.6 (47.7; 49.2) to 47.7 (46.5; 48.3) (p=0.04); gait speed decreased from 400 m (380; 431) to 390 m (350; 400) (p=0.05), the muscle strength of the hand flexors did not change (from 45.72±8.03 to 44.8±8 for the right hand (p=0.54) and from 42.18±10 to 42.6±10 for the left hand (p=0.6).

Conclusion. After 3 months of cardiac rehabilitation at the outpatient polyclinic stage, patients with myocardial infarction had a positive effect reflected by muscle strength of flexors on both hands, insignificant increase of muscle mass relative to fat tissue and increase of gait speed as opposed to patients with coronary heart disease without myocardial infarction, who had a decrease in muscle strength of hand flexors, muscle-to-fat tissue ratio and gait speed during this period of time.

Kazan medical journal. 2019;100(5):785-790
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Integral health assessment of rural population for managerial decision making
Bayanova N.A., Kalininskaya A.A., Sulkina F.A.

Abstract

Aim. The development of a software product based on the methodology of integral assessment of the health status of the rural population for the rapid assessment of the situation and management decisions.

Methods. The study was conducted in the Orenburg region, which is part of the Volga Federal District. The object of the study was the rural population of the Orenburg region (40.1% of the population of the region) and 35 rural areas with a total number of 799 thousand people. As the initial information for an integral assessment of the health status of the population, the data of the state statistical reporting of the Medical Information and Analytical Center of the Orenburg Region were used. The health status of the rural population was studied in the context of rural areas. Among the indicators (P) for assessing the health status of the rural population the following were used: V — the average age of the population of the territory; Zp — an indicator of primary incidence; Zo — an indicator of the overall incidence; I — disability indicator; S — mortality rate. The methodology for calculating the integral indicators for assessing the state of health has been tested in all 35 rural areas of the Orenburg region. The analysis made it possible to calculate the number of rural areas that are optimal, favorable, limitedly favorable, unfavorable and especially unfavorable by integral indicators for assessing the health status of the rural population.

Results. Based on the application of our methodology, a software product has been developed that includes a two-dimensional assessment of the results: numerical and color, reflecting the degree of participation of each indicator in the integral assessment. The software product we developed allows us to evaluate public health indicators in a monitoring mode in rural areas. Using a software product makes it possible to assess and determine priorities for making strategic decisions at the level of heads of health authorities and institutions, as well as heads of administration of a subject of the Federation.

Conclusion. The software product for assessing the health status of the population in a rural area may be subject to further expansion and modification of the function, and is also recommended for the presentation of information on the website of administrative territories and the administrative apparatus.

Kazan medical journal. 2019;100(5):791-795
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Development of voluntary medical insurance in the Russian Federation
Arsentyev E.V.

Abstract

Aim. To analyze the dynamics of the development of voluntary medical insurance in the Russian Federation. To identify the factors hindering the development of this insurance sector in modern conditions.

Methods. In the course of the study, analysis was conducted of the legislative framework for organizing medical care for the population of the Russian Federation in the system of voluntary medical insurance. The problem-chronological, systematic, and analytical research methods were used.

Results. It has been established that, despite the development of voluntary medical insurance system over the past 25 years, the availability of this type of insurance for citizens of the Russian Federation still remains very low. The policy of voluntary medical insurance is mainly available only to working citizens, and only in those large enterprises where the employer is interested in preserving and protecting the health of its employees. For most citizens of the Russian Federation, the voluntary health insurance policy remains inaccessible due to the high cost of the policy, as well as due to relatively low incomes. At the same time, a voluntary health insurance policy is required by law for labor migrants to obtain a patent for employment in the Russian Federation. However due to the absence of legislative framework for voluntary health insurance, organization of medical care for labor migrants is not always standardized.

Conclusion. For the further development of voluntary medical insurance, it is necessary to develop the measures for decreasing the cost and increasing the availability of a voluntary medical insurance policy for citizens of the Russian Federation; to optimize organization of health care for labor migrants it is necessary to primarily develop re­gulatory framework of emergency health care.

Kazan medical journal. 2019;100(5):796-801
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Features of the health state of abandoning mothers from the urban districts of Chelyabinsk region
Markina A.Y.

Abstract

Aim. To study the incidence of abandoning mothers living in urban districts in order to reveal the diseases, which could possibly cause abandoning a child.

Methods. The source of information used was Form No. 96 “Birth History” during the period from 2009 to 2017 from archives of all city hospitals of 11 city districts of the region.

Results. On average, over the 9-year study period, among the mothers from urban districts morbidity rate was 2832.6±71.5 cases per 1000 of the corresponding contingent. By 2020, the morbidity rate is predicted to be 2583.3 cases per 1000 of the corresponding contingent. By 2020, a slow increase in the incidence rate of socially significant pathology among abandoning mothers is predicted: up to 928.1 cases per 1000 of the corresponding contingent, that is, 9 out of 10 women will be carriers of socially significant diseases.

Conclusion. The average morbidity rate among abandoning mothers is significantly higher than that of women in the control group; the fundamental difference in the morbidity of abandoning mothers is a higher average level of socially significant diseases (811.9±51.1 cases per 1000) compared to that among women in the control group (12.8 cases per 1000 of the corresponding contingent).

Kazan medical journal. 2019;100(5):802-809
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Innovative technologies in estimation of efficiency and activity efficacy of medical institutions of Stavropol region rendering primary health care
Mikhaylova Y.V., Son I.M., Golubev N.A., Sorokin V.N., Murav’eva A.A.

Abstract

Aim. To assess the efficiency and effectiveness of medical institutions (legal entities) that provide primary health care to the population of Stavropol Region, to form the analytical, scientifically based decision-making base for optimizing the primary health care sector of the Stavropol Region.

Methods. The comprehensive analysis of the efficiency and effectiveness of the activities of medical institutions providing primary health care based on the developed technique.

Results. The results of the study confirmed the objectivity of the developed system of multi-criteria evaluation of the effectiveness and efficiency of the activities of medical institutions providing primary health care to the population. The results of the assessment became an evidence base for improving the activities of medical institutions providing health care in outpatient settings, and allow providing the comparative analysis of their performance, which is integrated into a single indicator, the well-being index, to form the ratings of medical institutions in the region.

Conclusion. The results of the assessment will serve as the evidence base for choosing priority socially important directions and will optimize the activity of providing primary health care to each medical institution of the entire system of outpatient primary health care in Stavropol region.

Kazan medical journal. 2019;100(5):810-815
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Analysis and prognosis of the epidemic status of the combined HIV/tuberculosis infection in ­correctional facilities
Ponomarev S.B., Vostroknutov M.E., Аверьянова E.L.

Abstract

Aim. To study the current state of the epidemic status of co-infection of human immunodeficiency virus (HIV) and tuberculosis in penitentiary facilities and to predict its further development.

Methods. The material for the study was the data of departmental forms of medical statistical reporting for the period from 2005 to 2018.

Results. It has been established that the epidemic status of tuberculosis in the penitentiary system institutions is improving, reflected by a decrease in mortality rate over the study period by more than 90%. However, over the study period, the incidence of co-infection of HIV and tuberculosis in penitentiary institutions increased by 3.9 times, and the prevalence by more than 2.5 times. This trend is largely due to the growth of epidemiological indicators of HIV infection. This confirms the established fact that the proportion of HIV-infected people among people followed up with active tuberculosis increased by almost 10 times. Currently, more than one in three newly diagnosed patients with active tuberculosis is infected with HIV. Along with this, the proportion of cases with drug resistance is growing among bacillary patients with active tuberculosis.

Conclusion. The increase in the number of people with co-infection with HIV and tuberculosis and drug-resistant forms of tuberculosis raises doubts on further favorable prognosis for the development of the epidemic situation on tuberculosis both in penitentiary institutions and in the Russian Federation as a whole: an epidemic potential is emerging for an even more complex problem — HIV-associated tuberculosis with drug resistance.

Kazan medical journal. 2019;100(5):816-822
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Clinical observations
Clinical case of using epleronon and candesartan for correction of heart failure in patients with Ebshtein’s anomaly
Bublikov D.S., Duruda N.V., Kudeyarova T.V., Klester E.B., Pinaeva A.S., Турчина A.M.

Abstract

Aim. To evaluate the efficacy of eplerenone and candesartan in heart failure correction in a patient with Ebstein's anomaly detected in adulthood.

Methods. A clinical case of long-term follow-up of a patient with a rare pathology, Ebstein's anomaly detected in adulthood, is described. The data of subjective examination are given. The anomaly was identified during a screening heart ultrasound exam, the patient had no complaints before, and had no history of chronic diseases, including congenital heart defects among family members. Also, the patient underwent routine diagnostic methods — general clinical studies, cardiac echocardiography, magnetic resonance imaging of the heart, N-terminal pro-brain natriuretic peptide measurement. In addition, the effect of correcting the signs of heart failure with a combination of candesartan and eplerenone in the complex treatment of heart failure according to echocardiography data and the level of N-terminal pro-brain natriuretic peptide is shown.

Results. A decrease in the level of N-terminal pro-brain natriuretic peptide, an increase of the ejection fraction according to echocardiography with the use of eplerenone and candesartan in the complex treatment of heart failure in these patients were demonstrated.

Conclusion. Despite the limited data on the use of antagonists of mineralcorticoid receptors and angiotensin receptor blockers among the patients with Ebstein's anomaly, the clinical case presented in the article demonstrates high effectiveness of this combination in treating heart failure in such patients.

Kazan medical journal. 2019;100(5):823-827
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A case of open surgical treatment of staghorn calculus in a patient with factor VII deficiency
Imamverdiev S.B., Talybov T.A., Gadimova E.A., Talybova M.Z.

Abstract

The paper presents a clinical case of treatment of staghorn nephrolithiasis complicated in the postoperative period by bleeding caused by a latent deficiency of factor VII of the blood coagulation system. Often the disease is latent and is detected in serious injuries or during the surgeries. Sometimes the diagnosis is made in profuse bleeding. Under endotracheal anesthesia, the left-sided nephrolithotomy and intrarenal stenting with clamping of the renal artery was performed. The time of clamping of the renal artery was 12 minutes. Before clamping the renal artery, 3 mg of furosemide 0.2 mg of verapamil and 1 mg of methylethylpiridinol were introduced intravenously per kilogram of patient' weight. A stone sized 3.0×2.5 cm was removed from the kidney, and a number of small stones were washed out from the lower group of calyces. At the time of diagnosis, prothrombin time and prothrombin index were checked. The patient's hemostasis system, including clotting factors, were examined. The results showed that the patient's blood clotting time by Lee–White method increased to 15 minutes (reference, 7–13 minutes), and the time of activated partial thromboplastin time (aPTT) to 41.6 seconds (reference, 28–38 seconds), while the activity of factor VII decreased to 40% (reference, 70–120%). After that, the patient was diagnosed with factor VII deficiency or hypoproconvertinemia. During treatment, the patient was transfused twice a day with fresh frozen plasma and only once during the entire period, 1000 IU of antiinhibitoty coagulant complex (FEIBA) was administered intravenously. From the first day of treatment hematuria decreased, there was a reverse development of hemorrhagic syndrome. Obvious and latent comorbidities before and after the surgery should not be left out without attention. Only in this case it is possible to successfully complete the treatment and achieve the correct results.

Kazan medical journal. 2019;100(5):828-832
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Clinical experiences
Effectiveness of preoperative orthodontic therapy of an adolescent with skeletal form of mesial occlusion according to X-ray profilometry
Ayupova F.S., Gayvoronskaya T.V., Mikhaylyuk V.A.

Abstract

The aim of the study is a comparative analysis of the parameters of profile teleradiographs of the head of a teenager in the dynamics of orthodontic preparation for the surgical stage of treatment. Migration of individual teeth at the stage of orthodontic treatment led to the change in the inclination of occlusal plane (Ocp) relative to the jaw base and to the increase of the value of Wits index. In this regard, in order to clarify the volume of interventions at the surgical stage of patient’s rehabilitation, it is necessary to conduct dynamic comparative analysis of profile teleradiographs of the head obtained before and after the completion of pre-surgical stage of orthodontic treatment. The authors consider it appropriate to analyze the relative position and correspondence of the sagittal dimensions of the upper (NL) and lower (ML) jaws to the anterior section (SN) of the skull base, and to take into account the size of the chin protrusion determining the position of Pg point when measuring the profile angle and facial aesthetics according to Rickets.

Kazan medical journal. 2019;100(5):833-839
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Efficacy and safety of endovascular image-guided treatment of pseudoaneurysms of the celiac artery: clinical and organizational aspects
Goloshchapov-Aksenov R.S., Kicha D.I., Frolov S.K., Gurin A.V.

Abstract

Aim. To present the immediate results of the assessment of the effectiveness and safety of the use of endovascular technologies for the treatment of hemorrhagic complications of pseudoaneurysms of the visceral branches of the abdominal aorta, to offer organizational technologies for the provision of medical care to patients with gastrointestinal bleeding associated with pseudoaneurysms of the visceral arteries.

Methods. Endovascular image-guided treatment was performed in 12 patients with pseudoaneurysms of the branches of the celiac trunk. Mean age 54±6.6 years, patients were hospitalized urgently due to ongoing or recurrent gastrointestinal bleeding, severe anemia, with blood hemoglobin level of <80 g/l. The diagnosis of pseudoaneurysm of the visceral artery was established by computed tomography-angiography. The sizes of pseudoaneurysms varied from 12 to 54 mm in diameter. Endovascular surgery was performed on the first day of hospitalization. In all cases, the stent-graft was implanted into the gastrointestinal or splenic artery into pseudoaneurysm ostium. The average follow-up period was 35±2.2 days.

Results. Endovascular surgery was performed 28±6.3 hours after making a diagnosis, 2 hours after in-hospital admission. The effectiveness and safety of endovascular treatment was 100% and included stopping the ongoing gastrointestinal bleeding and prevention of its recurrence. Hospital stay of patients was 5 days. The effectiveness stent-graft implantation was confirmed by control angiography. There were no hemorrhagic and embolic complications during follow-up.

Conclusion. Endovascular image-guided treatment and prevention of gastrointestinal bleeding in patients with pseudoaneurysms of the branches of the celiac trunk is an effective and safe method; it is necessary to further improve the organization of endovascular care in order to make it more available to the population and to provide effective care in time in case of development of life-threatening diseases and complications.

Kazan medical journal. 2019;100(5):840-843
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Diagnostic informativeness of laboratory control of the severity of inflammatory and osteodestructive processes in periodontium
Kipiani S.G., Mironycheva K.V., Maksyukov S.Y., Prokhodnaya V.A., Maksyukova E.S., Pilipenko K.D.

Abstract

Aim. To offer a set of laboratory tests and to assess its informativeness in characterizing the severity of inflammatory and osteodestructive processes in periodontium.

Methods. At the first stage of the study, two groups were formed: the study group (clinical, n=95) and the control group (relatively healthy individuals, n=31). Further, depending on the clinical situation, the clinical group was divided into subgroups. Subgroup 1 (n=40) included patients with catarrhal and ulcerative gingivitis, subgroup 2 (n=32) with mild chronic generalized periodontitis and subgroup 3 (n=33) with moderate chronic generalized periodontitis. In patients’ gingival fluid or in the contents of periodontal pockets, the concentration of tumor necrosis factor-α, osteotropic mediators (soluble receptor activator of nuclear factor-κB ligand and osteoprotegerin) were determined by the immunoassay method.

Results. In patients with chronic generalized periodontitis, as well as with increase of severity of periodontal lesions, in the gingival fluid the concentration of tumor necrosis factor-α and soluble receptor activator of nuclear factor-κB ligand increases and the content of osteoprotegerin decreases. The change in the concentration of osteotropic mediators in the fluid from periodontal pockets occurred prior to osteolysis in the periodontium. The widest range of statistically significant correlations with periodontal indices was established for the concentration of tumor necrosis factor-α in the contents of the gingival sulcus with the depth of periodontal pockets (R=0.79; р <0.0001) and periodontal attachment loss (R=0.83; р <0.0001), as well as for soluble receptor activator of nuclear factor-κB ligand with the depth of periodontal pockets (R=0.75; р <0.0001) and periodontal attachment loss (R=0.87; р <0.0001).

Conclusion. In patients with mild chronic generalized periodontitis, a decrease in the concentration of osteoprotegerin (p <0.05) and increase in the content of soluble receptor activator of nuclear factor-κB ligand (р <0.05) in the gingival fluid relative to the norm requires active radiological monitoring of bone resorption.

Kazan medical journal. 2019;100(5):844-849
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Surgical techniques of intraocular lens-capsular bag complex stabilization during cataract phacoemulsification in patients with lens subluxation
Kopaev S.Y., Il´inskaya I.A., Burtseva A.A.

Abstract

Aim. To develop and to assess the efficacy of the method of one-step upper fixation of a single-piece intraocular lens to the iris during cataract phacoemulsification in patients with lens subluxation.

Methods. The study included 32 patients (37 eyes) with complicated cataract grade 2–3 combined with grade 1–2 lens subluxation. Both groups underwent cataract phacoemulsification with consequent implantation of a capsular tension ring and a single-piece intraocular lens. Group 1 (21 eyes) underwent intraoperative one-step upper haptic fixation of a single-piece intraocular lens in vertical position. In group 2 (16 eyes) in 13 cases 6±1.5 months later a single piece intraocular lens was repositioned and both haptics were sutured to the iris.

Results. In both groups no intraoperative complications occured. Visual acuity in group 1 on days 1–3 after the surgery was 0.77±0.19 and was stable during the follow-up. Intraocular pressure was 17.2±0.99 mm Hg. In group 2 the obtained good functional results 0.78±0.18 declined due to intraocular lens decentration, the intraocular pressure increased by 6.0±1.25 mm Hg (up to 24.2±0.65 mm Hg) which required an intraocular lens reposition in 81.3% of cases. According to ultrasound biomicroscopy, in both groups intraocular lens in all cases had intracapsular fixation and was in a central position.

Conclusion. The developed method of a one-step single piece intraocular lens fixation by suturing the upper haptic to the iris during cataract phacoemulsification in patients with lens subluxation is an effective and safe procedure that allows complete rehabilitation of patients with phacodonesis during a one-step surgical intervention.

Kazan medical journal. 2019;100(5):850-854
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Peripheral blood erythrocytes morphology in ovarian cancer
Fedotova A.Y., Gening T.P., Abakumova T.V., Dolgova D.R.

Abstract

Aim. To assess the morphology of circulating red blood cells in patients with stage III ovarian cancer.

Methods. The object of the study was the peripheral blood erythrocytes of primary patients with ovarian cancer (n=25) who had stage III according to International Federation of Gynecology and Obstetrics. Patients were examined in the gynecological department of Ulyanovsk Regional Clinical Oncology Center. The control group included 25 somatically healthy women. Morphological studies were performed using light microscopy. The number of red blood cells with an unchanged and altered shape was expressed as a percentage. By the method of atomic force microscopy, the topology and rigidity of red blood cells was studied.

Results. A statistically significant decrease in the number of circulating blood erythrocytes was found in patients with ovarian cancer compared to somatically healthy women. At the same time, the number of discocytes is markedly reduced while the number of morphologically altered forms: echinocytes, stomatocytes, spherocytes and erythrocyte rigidity are increased.

Conclusion. With the appearance of altered forms of red blood cells and increase of the transformation index and erythrocyte rigidity in patients with stage III ovarian cancer, total number of red blood cells decreases in circulating blood compared to somatically healthy women.

Kazan medical journal. 2019;100(5):855-859
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History of medicine
The results of 50-year-long activity of the department of anesthesiology, intensive care and transfusiology of Kazan State Medical Academy
Bayalieva A.Z., Shpaner R.Y., Nabiullina A.D., Davydova V.R.

Abstract

The article reflects the main scientific directions of the faculty of anesthesiology, intensive care and transfusiology of Kazan State Medical Academy since the moment of its formation. The founders and the first members of the faculty were associate professor F.N. Kazantsev, assistants A.N. Podolsky and Z.V. Nakhrova, who worked in the main clinical base, Kazan City Clinical Hospital No. 5. From the first years of its foundation, the department has been conducting intensive educational, methodical, scientific and medical work and has been the basis for training for doctors from all over the country. The main directions of scientific research of the department over 50 years were safety and efficacy issues in anesthesiology and intensive care. The department became the main base for the study and implementation of safety methods of anesthesia, intensive care in traumatology and orthopedics, surgery, obstetrics and gynecology.

Kazan medical journal. 2019;100(5):860-864
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Obituary
Professor Sergej Vasil'evich Hrushchyov
 
Kazan medical journal. 2019;100(5):865-866
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Cochrane Review Summaries
Electronic cigarettes for smoking cessation
 

Abstract

Электронные сигареты (ЭС — ЕС) представляют собой электронные устройства, которые производят аэрозоль (обычно называемый паром), который и вдыхает пользователь. В типичном случае этот пар содержит чистый никотин и не содержит большинства тех токсинов, которые курильщики вдыхают с сигаретным дымом. Электронные сигареты стали популярны среди курильщиков, которые хотят уменьшить риски курения. Этот обзор имел цель выяснить, помогают ли электронные сигареты курильщикам бросить курить и является ли использование электронных сигарет с этой целью безопасным.

Kazan medical journal. 2019;100(5):867
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Different doses, durations and modes of delivery of nicotine replacement therapy for smoking cessation
 

Abstract

Никотиновая заместительная терапия (НЗТ) — это лекарства, доступные в виде пластырей, жевательных резинок, назальных или пероральных спреев, ингаляторов, таблеток/леденцов для рассасывания, которые доставляют никотин к головному мозгу. Целью НЗТ является замена никотина, который курильщики обычно получают из сигарет, так что потребность в курении у них уменьшается, и они могут полностью бросить курить. Нам известно, что НЗТ улучшает шансы успешного прекращения курения и что люди используют этот метод лечения, чтобы бросить курить. В этом обзоре рассматривают различные способы использования НЗТ для отказа от курения, и какой из видов НЗТ лучше, чтобы бросить курить на 6 мес или дольше.

Kazan medical journal. 2019;100(5):868
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Telephone counselling for smoking cessation
 

Abstract

Существует несколько видов вмешательств, которые помогают людям бросить курить. Одним из таких вмешательств являются телефонные звонки с целью дать курящим информацию или совет, чтобы помочь бросить курить. Люди могут пользоваться этими услугами через самостоятельные звонки на телефонные линии помощи или через подписки на получение таких звонков от консультантов. Мы хотели выяснить, может ли телефонное консультирование помочь людям бросить курить. Наш наиболее поздний поиск доказательств был в мае 2018 г.

Kazan medical journal. 2019;100(5):869
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Combined pharmacotherapy and behavioural interventions for smoking cessation
 

Abstract

Поведенческая поддержка (такая, как краткий совет и психологическая помощь) и лекарственные средства (варениклин, бупропион и никотин-заместительная терапия: никотиновые пластыри и жевательные резинки) помогают бросить курить. Во многих руководствах рекомендуется совмещение использования лекарств с психологической помощью для того, чтобы помочь курильщикам бросить курить. Но нет ясности по вопросу большей эффективности той или иной комбинации по сравнению с другими, или работает ли такая комбинация лекарств с психологической поддержкой лучше при тех или иных условиях или в группах по сравнению с другими.

Kazan medical journal. 2019;100(5):869-870
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Acupuncture and related interventions for smoking cessation
 

Abstract

Мы провели критический обзор доказательств, чтобы ответить на вопрос, помогают ли людям, пытающимся бросить курить, игло­укалывание (акупунктура), акупрессура, лазерная терапия или электрическая стимуляция.

Kazan medical journal. 2019;100(5):870-871
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Antidepressants for smoking cessation
 

Abstract

Были исследованы некоторые лекарства, используемые для лечения депрессии (антидепрессанты), чтобы выяснить, могут ли они помочь людям, пытающимся бросить курить. Два антидепрессанта — бупропион (Зибан) и нортриптилин — иногда выписываются, чтобы помочь бросить курить. В этом обзоре мы решили выяснить: увеличивает ли использование антидепрессантов вероятность успешного отказа от курения в течение 6 мес и более, а также определить безопасность использования этих препаратов для помощи в отказе от курения.

Kazan medical journal. 2019;100(5):871-872
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