Vol 93, No 3 (2012)

The article is devoted to the health care system in Kazan during the Great Patriotic War. The activity of evacuation hospitals, organization of care for the wounded has been shown. The work of Kazan Medical Institute in preparing qualified medical personnel and conducting research in the field of military medicine has been discussed.

Aim. To study the content of endothelin-1, nitric oxide (II) and the activity of angiotensin-converting enzyme in the blood of patients with hemorrhagic fever with renal syndrome, depending on the period and the severity of the disease in order to assess their role in the pathogenesis and to develop a pathogenetically substantiated correction of the changes in the systemic vascular tone. Methods. The group of dynamic study included 114 patients (102 male and 12 female) with serologically confirmed hemorrhagic fever with renal syndrome aged 22-55 years. The moderately severe form was diagnosed in 66 patients, severe uncomplicated form - in 27, severe form with complications - in 21 patients. The control group comprised 23 practically healthy volunteers. The concentration of endothelin-1 in blood plasma, the contents of metabolic products of nitric oxide (II) and the activity of the angiotensin-converting enzyme in the blood serum were determined. Results. The concentration of endothelin-1 in the blood in the dynamics of the disease significantly decreased, the content of the final stable metabolites of nitric oxide (II) and the activity of the angiotensin-converting enzyme increased with statistical significance in all periods of the disease. These changes were most pronounced during severe forms of the disease with complications. Conclusion. In moderately severe and severe uncomplicated forms of the disease the endothelium is able to maintain the systemic vascular tone and tissue perfusion at a physiological level, however in severe form with complications the changes in the synthesis of vasomodulating substances may be involved in the development of complications.

Aim. To evaluate the effectiveness of pre-, intra- and postoperative intravenous administration of paracetamol in combined anesthesia in patients undergoing surgical interventions in the surgical oncology practice. Methods. Examined were 35 patients aged from 43 to 75 years, operated on under combined anesthesia. During the operation and after its completion an infusion of liquid paracetamol at a dose of 3.3 mg/h was performed. Cardiac monitoring was conducted, the content of cortisol in the blood and the Bispectral Index were determined. The pain indices measured by visual analogue and digital rating scales were determined in the postoperative period. The control group included 35 patients in whom anesthesia was performed without the use of paracetamol. Results. During the infusion of paracetamol an adequate level of analgesia was achieved without development of adverse reactions on the part of the vital systems. The use of paracetamol in the early postoperative period contributed to the reduction of pain on digital rating and visual analogue scales compared to the group with basic anesthesia. Conclusion. The use of liquid paracetamol is a promising and safe method of additional analgesia.

Aim. To conduct a retrospective analysis of intraoperative and postoperative blood loss during removal of brain tumors with the usage of tranexamic acid and infusion correction of hemodynamically significant blood losses. Methods. The study included 139 patients operated on for tumors of the brain and spinal cord, and treated with tranexamic acid. Distribution of patients according to the volume of blood loss was as follows: the first group - up to 500 ml of blood loss, 48 patients (34.5%); the second group - 500-1200 ml of blood loss, 72 patients (51.7%); the third group - more than 1200 ml of blood loss, 19 patients (13.9%). Results. The retrospective analysis has shown that 34.5% of patients (first group) were operated with the lowest blood loss - up to 10% of the circulating blood volume; 51.7% of patients (second group) - with a blood loss of 20 to 30% of the circulating blood volume. In the third group, which included 13.9% of patients, there was a blood loss of more than 30% of the circulating blood volume, which is defined as hemodynamically significant. It is in the third group, as shown by the analysis, that in addition a therapeutic dose of tranexamic acid 15-20 mg/kg was administered. The extent and intensity of intraoperative blood loss were dependent on many factors, mainly on the nature of the tumor process. Conclusion. It was established that the changes of the hemostatic system were depended on the degree of hemodilution; the use of tranexamic acid made it possible to reduce the amount of postoperative blood loss, despite the degree of intraoperative blood loss.

Aim. To evaluate the effectiveness of double indicator scintigraphy in the differential diagnosis of thyroid nodules. Methods. Analyzed was the data of radionuclide investigations of 25 patients with thyroid disease at the age of 36 to 72 years, who were operated on in 2009-2011. The radioisotope study was conducted in two stages. Evaluation of the scintigraphic uptake pattern of the radiopharmaceutical in the studied areas was performed visually and quantitatively. Results. The scintigraphic results were compared with cytological and histological studies. In the diagnosis of papillary thyroid cancer the sensitivity of the radioisotope investigation was 95%, specificity - 92%, diagnostic accuracy - 94%. The method was less precise and specific in the diagnosis of follicular cancer and macro-micro follicular adenomas (it gave positive results in the cases of adenoma and negative results in cases of follicular thyroid cancer). On average, the specificity of the double-phase radioisotope scintigraphy method using 99mTc-pertechnetate and technetril (99mTc-MIBI) in our study was 69%, accuracy - 75%, sensitivity - 79%. Conclusion. Radionuclide double-phase scintigraphy with the usage of 99mTc-pertechnetate and technetril (99mTc-MIBI) - is a highly informative method for the differential diagnosis of thyroid nodules, which can be used during atypical sonographic patterns and in the absence of clear histological data.

Aim. To reveal the dependence of alanine aminotransferase on the gender of the patient in the inactive form of chronic viral hepatitis B. Methods. Instrumental determination of the activity of alanine aminotransferase in 64 healthy subjects (32 males and 32 females) and 255 patients with an inactive form of chronic viral hepatitis B. According to the time of infection the patients were divided into three groups: up to 5 years, 5-10 years, and more than 10 years. Results. Normal alanine aminotransferase activity was detected in 18 (21.4%) males and 66 (78.6%) females. Among the 34 patients with constantly high indices of alanine aminotransferase activity were 24 (70.6%) males and 10 (29.4%) females, that is, increased activity is 2.8 times more frequently recorded in males. The higher absolute index of this enzyme’s activity (IU/L) in males was noted with disease duration of 5-10 years (1.25 times average increase in activity) and 10 years or more (1.5 times). Conclusion. The more marked and frequent increase in alanine aminotransferase activity among males with chronic viral hepatitis B, should be considered when interpreting the results of laboratory tests.

Aim. To study the features of the indices of the cardiovascular system and serum concentrations of several hormones and biogenic amines among the students under the impact of examination stress. Methods. The study was conducted on a group of young conditionally healthy volunteers. The starting group of study subjects consisted of 203 students who prior to participation in the study passed a medical examination, including medical history, calculation of body mass index, physical, instrumental and laboratory investigations. As a result, 93 students were selected; their own indicators outside the examination period were used as controls. The study individuals had an investigation of the state of autonomic reactions (measurement of systolic and diastolic blood pressure, heart rate, Kerdo autonomic index) conducted 1 hour before and within 1 hour after the examination. The hormonal status was investigated by enzyme immunoassay. The results of the study were verified using the software package «StatPlus». Results. Sympathicotonic nature of the vegetative response dominated, according to which two categories of students were allocated: with a steady and significant increase in Kerdo autonomic index (53%) and with the lack of such growth rate (47%). In the study of the hormonal profile a reduction in the serum concentrations of thyroid-stimulating hormone and cortisol levels, an increase in blood content of the tested biogenic amines - histamine, epinephrine (adrenaline), serotonin was revealed. Conclusion. The established changes in the indices of the cardiovascular and endocrine systems emphasize the individual nature of each subject’s reactions, and therefore require clustering of students into groups according to the characteristics of autonomic and hormonal responses to psychoemotional stress.

Aim. To evaluate the dynamics of the autonomic balance in children during tuberculin diagnosis (Mantoux test and skin prick test) by investigating the heart rate variability. Methods. In 30 children (14 boys and 16 girls) aged 7.5±0.54 years the parameters of heart rate variability were recorded before and during the Mantoux test and skin prick test. Results. The comparative analysis of the used diagnostic techniques revealed advantages of the prick test method: during the diagnostic testing procedure with the skin prick test the increase in the heart rate of all children was less by 53%, sympathetic activation of the regulation of cardiac activity according to the NN50 parameter (number of pairs of cardiac intervals, differing from the neighbouring ones by more than 50 ms) was lees by 35%, the activity of the sympathetic and parasympathetic tone was less by 32 and 15% compared to such during the Mantoux test. The index of tension of the regulatory systems during the skin prick test was 25% less than during the normal tuberculin test carried out with a syringe. Conclusion. During the performance of the skin prick test a general tendency of preservation of the vagal influence on the cardiac function in children was revealed in contrast to the Mantoux test; the technique of injecting tuberculin using the skin prick test is associated with development of less emotional stress in children.

Aim. To evaluate the effectiveness and safety of the use of artificial chords using polytetrafluoroethylene sutures during mitral valve replacement in patients with rheumatism. Methods. The study included 134 patients operated on for isolated rheumatic mitral valve disease. Immediate (10 days) and long-term (24 months) results were evaluated in the three groups of patients, depending on the method of valve replacement: creation of prosthetic chords using polytetrafluoroethylene sutures (37 patients), preservation of native chords (67 patients), total excision of the subvalvular apparatus (control group, 30 patients). Results. 24 months after surgery in the group of prosthetic chords and the group of preserved native chords recorded was a significant decrease in the pulmonary artery pressure, the left atrial size and a reduction in the end-diastolic left ventricular size. In the control group of patients reported was a reduction in left ventricular ejection fraction in long-term follow up. Conclusion. The use of polytetrafluoroethylene sutures in order to create new chords demonstrated their safety and effectiveness in preserving the physiological left ventricular geometry; artificial chords, as well as the preserved native chords, have a positive effect on the left ventricular contractile function in the remote postoperative period.

Aim. To study the state of the oxidation-reduction system in patients with primary open-angle glaucoma. Methods. Conducted were biochemical studies of the state of the oxidation-reduction system in 30 patients with primary open-angle glaucoma. The level of lipid peroxidation of cell membranes was determined in blood serum by the method of accumulation of malondialdehyde based on its interaction with thiobarbituric acid. The state of the antioxidant system was assessed according to the activity of superoxide dismutase, catalase, glutathione reductase and the content of thiol disulfide groups in the blood. The concentration of lactate in the blood serum was determined using an automated analyzer. Results. In patients with a chronic course of glaucoma elevated levels of oxidized thiol groups of proteins, increased activity of antioxidant enzymes, activation of lipid peroxidation processes, increased lactate content have been identified. Conclusion. Changes in the oxidation-reduction system in patients with primary open-angle glaucoma may be a sign of mitochondrial dysfunction.

Aim. To determine the changes in the content of cytokines, systolic intraventricular and interventricular dyssynchrony in patients with chronic heart failure. Methods. The study included 223 patients (174 males, 49 females) who suffered a Q wave myocardial infarction of the left ventricle, with clinical manifestations of chronic heart failure with functional class III according to the classification of the New York Heart Association. Pro- and anti-inflammatory cytokines (tumor necrosis factor alpha, interleukin-6, -4, and -10, interferon-gamma) were studied in blood plasma by enzyme immunoassay. Dyssynchrony was studied by pulsed-wave Doppler investigation, M-mode measurements of the left ventricle and pulsed-wave mode of tissue Doppler investigation of the myocardium. Results. Noted was an elevation of levels of tumor necrosis factor alpha, interleukin-6, interferon gamma, in combination with a reduction in the content of interleukin-4 and -10 in all groups. The maximum increase in the content of tumor necrosis factor alpha and interleukin-6 was found in the group of eccentric hypertrophy and dilatation of the left ventricle. Positive correleation links of medium strength have been established between the levels of interleukin-6 and the degree of interventricular mechanical delay, and between systolic and diastolic myocardial stress. In the group with eccentric hypertrophy and dilation of the left ventricle the content of tumor necrosis factor alpha directly correlated with the time interval from the beginning of the Q wave on the electrocardiogram to the beginning of the oflow in the left ventricular outflow tract, as well as with the concentration of N-terminal fragment of the precursor of the human brain natriuretic peptide. During remodeling according to the type of eccentric hypertrophy without dilatation of the left ventricle observed were positive correlation links of medium strength between the content of the tumor necrosis factor alpha and the intraventricular mechanical delay, end-diastolic pressure in the left ventricle. In the group of concentric hypertrophy the content of the tumor necrosis factor alpha and interleukin-6 is positively associated with electrocardiographic interval from the Q wave to the beginning of the systolic Doppler artifact S. Conclusion. One of the factors, which contributes to the preservation of abnormal levels of tumor necrosis factor alpha and interleukin-6 in blood plasma is the intraventricular and interventricular dyssynchrony; the combination of dilatation, myocardial hypertrophy, systolic and diastolic left ventricular dysfunction, dyssynchrony and the toxic effects of proinflammatory cytokines on the myocardium contributes to progression of chronic heart failure.

Aim. To study the absorptive function of the rat intestine on the background of prolonged alcohol intoxication. Methods. The study was performed on 24 nonlinear white male rats (12 animals in the control and experimental groups) weighing 220-240 g, which had a daily consumption of 20° ethanol solution (ethyl alcohol) for the duration of 180 days. After 6 months perfusion of the isolated segment of jejunum with a dextrose (glucose) solution 35 mmol/L was performed by in the rats the method A.M. Ugolev. The luminescence-histochemical method was used to examine the content of catecholamines and serotonin in the neuroamine containing structures. Results. In the control rats, the rate of absorption in the first 10 min of perfusion reached a maximum value with a further decrease in the intensity of absorption. The content of serotonin and catecholamines in the absorptive epithelial layer of the jejunal villi was lower than in the muscle membrane. In the experimental rats the content of biogenic amines in the wall of the jejunum increased: the amount of serotonin in the absorptive layer of the villi increased up to 122% and in the muscle membrane - up to 126%. The content of catecholamines also increased up to 154% in the muscle membrane and up to 124% in the epithelial layer in the area of the villi compared with controls. In conditions of chronic alcohol intoxication the rate of absorption of dextrose (glucose) during perfusion in the first 30 minutes was reduced by 33% compared with the control. During the next hour, the intensity of absorption reduced by 45% (55% of control). After 1.5 hours the absorption increased slightly, accounting for 64% of the control value and by the end of the 2nd hour the intensity of the absorption reached 91%. Conclusion. An increase in content of catecholamines and serotonin in the mucous and muscular layers of the intestine in chronic alcohol intake and a decrease in the intensity of the absorption of dextrose (glucose) was established; in the setting if modified combined effects of neurotransmitters on smooth muscle cells an increased motor effect is formed, which is accompanied by rapid evacuation of the intestinal chyme with a reduction in the rate of absorption

Aim. To assess the effect of newly synthesized quaternary phosphonium salts with highest alkyl substituents (C10, C12, C14, C16, C18) on the permeability of cell membranes for sodium ions in vitro. Methods. In vitro studied was the effect of different concentrations of new quaternary phosphonium salts with highest alkyl substituents on the cell membrane permeability to sodium ions according to the rate of Na+-Li+-countertransport in the erythrocyte membrane. Results. Low concentration (0.001 mM) of substance C10 increased the rate of Na+-Li+-countertransport in the erythrocyte membrane by 11.9%, substance C12 - by 11.8%, substance C14 - by 12.7%, substance C16 - by 13%, substance C18 - by 12.3%. Higher concentrations of substances (0.01-0.05 mM) had no significant effect on the cell membrane permeability to sodium ions. Conclusion. An increase in the rate of Na+-Li+-countertransport in the erythrocyte membrane is influenced by minimal concentrations of a substance, under the influence of other concentrations the rate of Na+-Li+-countertransport doe not change.

Personalized medicine involves the use of methods of genomics and proteomics by physicians for early diagnosis, prediction of the nature of the disease course and the choice of medicines and their doses based on personalized characteristics of the individual patient. Advances in the study of the human genome make it possible to reveal the interrelation between the individual mutations in the human genes (polymorphisms) and predisposition to certain diseases. Currently there are more than 10 million single-nucleotide polymorphisms in the human genome, however their biological role remains poorly understood. On the basis of a literature search of electronic full-text and abstract-only versions of articles, which was conducted in the PUBMED, OMIM and GENE databases, collected was the information on genetic predisposition to systemic atherosclerosis. The review is dedicated to polymorphisms of the major genes that play a role in the pathophysiology of atherosclerosis of the lower extremities.

Aim. To study the prevalence of metabolic syndrome in an unorganized population of Orenburg city. Methods. The sample was formed by the method of random numbers. Examined were 301 people aged 25 to 75 years, of which 148 were males and 153 females. Studied were the socio-demographic characteristics and medical history (including filling out of a questionnaire), the clinical status of study participants (with the measurement of blood pressure, height, weight, waist and hip circumference, biochemical blood analysis to determine the concentration of glucose and lipid profile). In order to identify the metabolic syndrome the following diagnostic criteria were used: of the Work Group on the treatment of adults of the National Cholesterol Education Program of the U.S. (2001-2005), of the International Diabetes Federation (2005) and of the All-Russian Scientific Society of Cardiology (2009). Results. The prevalence of abdominal obesity was reduced by using less stringent thresholds for waist circumference. The most common variant of the metabolic syndrome was the combination of the following components: abdominal obesity, arterial hypertension and a low content of high-density lipoproteins. According to the criteria of the International Diabetes Federation such a combination occurred in 7.6%, while in accordance with the Criteria of the Work Group on for the treatment of adults of the National Cholesterol Education Program of the U.S. - it occurred in 4.3%. Conclusion. The frequency of registration of the metabolic syndrome depends on the criteria for its diagnosis.

Aim. To analyse the causes of death of individuals infected with the human immunodeficiency virus (HIV)/patients with acquired immunodeficiency syndrome (AIDS) in the Clinical Infectious Diseases Hospital named after S.P. Botkin in 2008-2010 taking into account the timing of disease, comorbidities, and clinical and laboratory data. Methods. The study included 439 HIV-infected individuals, who died in the Clinical Infectious Diseases Hospital named after S.P. Botkin in 2008-2010. Two groups of patients were identified: deaths from HIV/AIDS (n=306) and from other diseases (n=133, HIV infection was considered to be a concomitant disease). In both groups, analyzed were the short-term mortality rates, the presence of drugs and/or alcohol dependency, and the main causes of death (according to autopsy results). Results. In the group of patients who died of HIV-infection/AIDS and who did not receive antiretroviral therapy, generalized tuberculosis was diagnosed most often (65.7% of cases). Other rare diseases were pneumocystis pneumonia, cryptococcosis, cerebral toxoplasmosis, generalized fungal infection, cerebral lymphoma, and cytomegalovirus infection. The most frequent causes of death in the group of patients whose HIV-infection was considered to be a concomitant diseases were chronic viral hepatitis in the cirrhotic stage (42.9%) and septic thromboendocarditis, which were mainly diagnosed in social maladjusted patients: patients with alcoholism or intravenous drugs users. During evaluation of the short-term mortality rates it was established that 21 to 29% of patients in different years died on the 1st-3rd day after admission, which was related to extremely severe conditions of the patients. In Russia, including St. Petersburg, an annual increase in the number of new cases of HIV infection and increased mortality are registered, which indicates the severity of the epidemic and makes it possible to predict the increase in the number of patients requiring hospital treatment. Conclusion. The main causes of death among HIV-infected individuals in 2008-2010 were generalized tuberculosis and chronic viral hepatitis in the stage of cirrhosis; the high index of short-term mortality among HIV-infected patients suggests the need for measures for early detection of HIV-positive individuals and their medical examination, as well as an increase in the number of beds in order to provide specialized care to HIV-infected individuals in St. Petersburg.

Aim. To assess the dynamics of the prevalence of excessive body weight (pre-obesity) and obesity, to identify gender differences among the workers of an industrial enterprise in the period 1994-2010. Methods. Population-based cross-sectional complex preventive studies of 2566 industrial workers (1579 males and 987 females) aged 18-64 years in order to identify the non-infectious diseases were conducted in 1994, 1999 and 2000. Pre-obesity, obesity and other risk factors were assessed according to the criteria of the program on Countrywide Integrated Noncommunicable Diseases Intervention of the World Health Organization and according to Russian recommendations regarding the metabolic syndrome. Results. The prevalence of excessive body weight (35.3%) and obesity (12.2%) in 2010 for males was significantly higher than in 1999 (31.1 and 7.7% respectively), the prevalence of obesity alone among them was significantly higher in 2010 than in 1994. In females the prevalence of obesity in 2010 was significantly higher than in 1999 (26.7 and 19.9% respectively) with no significant differences in the frequency pre-obesity (34.0 and 39.6% respectively). The prevalence of pre-obesity and obesity among females in 2010 did not differ significantly from such in 1994. Conclusion. Revealed was an increase in the prevalence of pre-obesity and obesity in males and females in the period from 1999 to 2010; mean body mass indices and frequency of pre-obesity and obesity in females were significantly higher than in males at all periods of the prospective study.

Aim. To assess the demographic situation in the city of Kazan in 1995-2010. Methods. An assessment has been conducted based on the analysis of the dynamics of population size and composition, indices of fertility and mortality. Calculations of intensive and extensive indicators and their dynamic comparison were used as the research methods. Results. The maximum value of natural decrease in the population of Kazan, resulting from excess mortality above the level of fertility, fall on the period 2000-2001. However, beginning from 2002 this parameter began to decrease, and in 2010, when the rates of mortality and fertility equaled, registered was a zero natural growth. Reduction in the total fertility rate of the population of the city in the last decade of the twentieth century gave way to the growth of this indicator in 2001-2010. In the structure of mortality of the population in the city of Kazan the leaders are diseases of the cardiovascular system (61.1%), then - malignant tumors (16.3%), followed by - traums, poisoning and accidents (10.3%). The mortality remains high in the working-age population and almost a four-fold prevalence of middle age male mortality over female mortality has been established. The slight increase in the population of Kazan is due to the influx of migrants to the city and to the annexation of the village communities to the city. In the population structure the proportion of middle-aged and elderly citizen increases, while the proportion of children decreases. Conclusion. The demographic situation, which determines the strategy of organization of medical care for the population, should be under the survailance of the society.

Aim. To evaluate the efficacy and safety of implantation of a free synthetic loop (Tension-free Vaginal Tape - TVT) in the treatment of stress urinary incontinence in women. Methods. Examined and operated were 80 patients suffering from stress urinary incontinence. Suburethral implantation of a free loop (sling) in 3 patients was performed using standard TVT kit, while in 77 - using the IVS kit (Intravagynal Sling), which has some design differences from the TVT kit. Results. The observation period ranged from 3 months to 5 years. According to a questionnaire survey designed by the authors, which includes 21 questions, the following results were obtained: good - in 72 (90%) patients, satisfactory - in 6 (7.5%), unsatisfactory - in 2 (2.5%) patients. According to uroflowmetry, after the conducted treatment the duration and volume of urination increased, the maximal urine flow rate decreased to the normal values. Conclusion. The operation of implantation of a free synthetic loop serves as a rational and effective treatment method for the correction of stress urinary incontinence in women without prolapse of the vaginal walls; the success of intervention largely depends on the proper selection of patients and on the surgical technique.

Aim. To summarize the results of treatment of opium withdrawal syndrome with naloxone under general anesthesia in a municipal hospital. Methods. During the period 2001-2010 examined were 102 pa-tients, of whom 80% were aged 20 to 30 years. Treatment was performed on a contractual basis, after a preliminary examination according to a unified program. After admission to the intensive care unit conducted was the general intravenous anesthesia with mechanical ventilation. Naloxone was administered in a bolus every 15 minutes during the first hour of anesthesia with the aim to detoxify, followed by 0.4-0.8 mg/h during the following 24 hours of treatment. Residual effects of the withdrawal syndrome were treated with additional drug therapy, including diazepam, clonidine, droperidol. The effectiveness of treatment was analyzed on the basis of the absence of clinical signs of the withdrawal syndrome, as well as with the test «NARCOCHEK». Results. By the end of the first day of treatment in 100% of patients no opiates were found in the urine. Weakness and depression was noted in 90 people, while in 18 noted was aggressive behavior, and at the same time the autonomic disorders were absent in all patients. The in-hospital course of treatment time amounted to 1.5 days. There were no complications during treatment. Conclusion. This method of therapy promotes rapid and painless relief of withdrawal syndrome, while serving only as the initial phase of treatment and rehabilitation of patients with opioid dependence.

Described was a case of massive (right upper and middle lobe and basal segments of the left lower lobe) clinically atypical pneumonia, «rapidly» resolving during treatment with beta-lactam antibiotics, but complicated by acute respiratory distress syndrome, acute respiratory failure, infectious and toxic shock, cerebral and pulmonary edema that led to a lethal outcome. No macroscopic pathological signs of pneumonia were found, histologically in one of the sections of the lower lobe of right lung in the alveoli some serous-leukocyte exudate was found. The paradox of the situation (pneumonia almost resolved, but the patient died) became the reason to conduct a retrospective analysis, which showed that over the preceding 10 years, there were 27 cases of progressive pneumonia (3.1% of 873 cases of pneumonia), usually atypical during treatment with beta-lactam antibiotics, four of which, including the described one, had a fatal outcome caused by acute respiratory distress syndrome. The remaining patients in whom beta-lactam antibiotics were changed to macrolides, recovered. This suggests the ability of beta-lactam antibiotics to participate in the pathogenesis of acute respiratory distress syndrome, or even be its cause.

Mukhametkhan Sakhipkireevich (Mstislav Aleksandrovich) Kulaev was not only a physician and a talented administrator, but also had broad and progressive views for his time on the ways of developing education in Bashkiria. He believed that it must go through the exposure of the Bashkir population to the Russian culture and through the Russian to the European culture.