Vol 97, No 5 (2016)

Aim. To study the indicators of bone metabolism in patients of psychiatric clinics on the background of dimephosphone oral intake.

Methods. Research was conducted at the Republican Clinical Psychiatric Hospital named after V.M. Bekhterev (Kazan). 64 patients (36 men and 28 women) aged 45 to 68 years (mean age 56.8±6.9 years) with various forms of mental disorders taking psychotropic drugs for the period of 3 years and over were examined. Resorption markers were determined - D-pyridinoline in urine, serum tartrate-resistant acid phosphatase, alkaline phosphatase, and the content of total and ionized serum calcium. All patients were divided into two groups: those who received dimephosphone in the combined systemic therapy and those who did not. The average duration of the dimephosphone administration was 22±4.2 days, the patients undergone on average 2.6±1.44 courses of treatment during 6 months.

Results. The activity of tartrate-resistant acid phosphatase in psychiatric patients was higher compared with those of the control group. The maximum value was registered in patients who were not taking dimephosphone. The alkaline phosphatase activity was the highest in mentally healthy patients of the control group. In psychiatric patients treated with dimephosphone, alkaline phosphatase activity was 20% lower compared with the control group. The minimum values of alkaline phosphatase were registered in patients with mental disorders not taking dimephosphone. When studying the concentration of total and ionized serum calcium there were no significant differences between patients of comparison group and psychiatric patients.

Conclusion. Shift in processes of bone remodeling toward its resorption indicates a high risk of pathological fractures in psychiatric patients and the need for osteoporosis prevention; identified changes in biochemical markers of osteoporosis on the background of dimephosphone intake allow to recommend it for the treatment of diagnosed osteoporosis in a psychiatric hospital settings.

Aim. To study the clinical course of chronic obstructive pulmonary disease in patients with metabolic syndrome and analyze the degree of influence of the metabolic syndrome components on chronic obstructive pulmonary disease and patients’ quality of life.

Methods. 100 patients with chronic obstructive pulmonary disease were examined: 30 patients without metabolic syndrome (the first group) and 70 patients with metabolic syndrome (the second group). Anthropometric measurements (weight, height, body mass index, waist circumference), laboratory tests (levels of triglycerides, cholesterol, low- and high-density lipoproteins, fasting blood glucose, the oral glucose tolerance test), physical examination, quality of life assessment were performed.

Results.Patients of the second group had statistically significant differences in the studied parameters in comparison with the first group. The number of exacerbations, calls to ambulance service, hospital admissions were 1.4; 1.3 and 1.5 times higher, respectively. Dyspnea intensity, cough and sputum score were 1.6; 1.7 and 1.6 times higher respectively as compared with the first group (p

Conclusion. Metabolic syndrome is associated with a more severe course of chronic obstructive pulmonary disease, which results in a higher frequency of exacerbations, hospital admissions, more severe clinical manifestations, greater influence of dyspnea on the physical activity limitation of patients, more severe airflow obstruction, low exercise tolerance with worse performance of everyday activities, emotional perception of the disease, worse psychosocial adaptation of patients.

Aim. To assess endothelial function in patients with hypertension and peripheral artery disease.

Methods. The study included 100 patients with an established diagnosis of essential hypertension. Ultrasonic duplex scanning of brachiocephalic arteries and lower limb arteries was performed. The functional state of the endothelium was evaluated using postocclusive reactive hyperemia test by D.S. Celermajer.

Results. Atherosclerotic plaques in the carotid arteries were found in 71% of patients, in the lower limb arteries - in 60%. The combined affection of both vascular beds was diagnosed in 51% of patients. Endothelial dysfunction was found in 64% of patients. In patients with carotid arterial system atherosclerosis, brachial artery dilation response was 6.1%, while in those with intact carotid arteries - 4.7% (p=0.041). The value of the brachial artery dilation response in patients with atherosclerotic lesions of lower extremities arteries was 5.9%. In the subgroup of patients with intact lower limbs arteries, the increase in brachial artery diameter was 9.60% an average (p=0.04). Among 51 people with affection of both vascular systems the brachial artery diameter increase was 5.4%, while in comparison, in the subgroup consisting of 49 patients without combined carotid and lower limb arteries lesions, - 9.9% (p=0.003). According to the results of the correlation analysis, the relation between endothelial dysfunction and the maximum percentage of stenosis of the carotid arteries and lower limb arteries at the level of tibial segment was revealed.

Conclusion. In patients with hypertension and peripheral artery disease, decrease in dilation response in endothelium-dependent vasodilation test was registered regardless of the localization of atherosclerotic lesions; endothelial dysfunction in essential hypertension was associated with the highest percentage of stenosis of the carotid arteries and lower limb arteries at the level of tibial segment.

Aim. To evaluate the functional state of the retina according to multifocal electroretinography and visual acuity in patients with proliferative diabetic retinopathy before and after vitrectomy.

Methods. 18 patients (19 eyes) were examined. Mean age was 57±15 years. All of patients were diagnosed with proliferative diabetic retinopathy complicated by vitreomacular traction syndrome. All the patients underwent vitrectomy. Visual acuity was measured and multifocal electroretinography was performed in all patients before and after surgery.

Results. During the optical coherence tomography, retinal profile deformation was revealed. Central retinal thickness was 347±106 microns. The average density of bioelectrical response of the macular area in patients with proliferative diabetic retinopathy complicated by vitreomacular traction, was sharply reduced and amounted to 44.987 nV/deg, in parafoveal area - 14.20 nV/deg. 1 month after vitrectomy averaged density of macular region bioelectrical response slightly increased and amounted to 51.52 nV/deg, in parafoveal area - 18.94 nV/deg. Visual acuity in patients before surgery was in average 0.09 (0.699 LogMAR). 1 month after pars plana vitrectomy visual acuity rose to an average of 0.32 (0.749 LogMAR).

Conclusion. In proliferative diabetic retinopathy, retinal thickness is increased, which is accompanied by multifocal electroretinography amplitudes depression; the correlation between morphological parameters of foveal avascular zone and its bioelectric activity was revealed.

Aim. To study the clinical course of pregnancy, labor and features of the structural changes in the cervix in women with precipitate labor.

Methods. We observed 186 women who delivered vaginally at 37-41 weeks of gestation. Main (I) group consisted of 146 women with precipitate labor. The comparison group (II) consisted of 40 women with a standard duration of delivery. Morphological and immunohistochemical study of cervical tissue, determining the expression level of collagen genes COL1A2 and SOL3A1 in the cervix and blood of women of studied groups were performed. Material sampling was carried out in the early postpartum period.

Results. In absolute majority of cases precipitate labor is not accompanied by intense patrimonial activity. Multiple complications develop during delivery, post-natal and early neonatal periods in 60% of patients with the precipitate labor. Pregnancy in women with a complicated course of precipitate labor occurs amid the infectious disease with predominant localization in the lower genital tract. The results of histological study of cervical tissue show numerous inflammatory changes. The expression levels of collagen genes in women with precipitate labor multifold exceed those in women with physiological duration of delivery.

Conclusion. Pathologic outcomes of precipitate labor are caused not by the character of patrimonial activity, but by adverse infectious background; accelerated cervical remodeling plays a key role in the genesis of precipitate labor; high rate of collagen metabolism in these women constitutes the epigenetic realization of the genetic determinants, formed under the influence of a number of exogenous and endogenous factors.

Aim. To reveal disorders of basic defense systems of the oral cavity in chronic generalized periodontitis of moderate severity in patients with chronic cerebral ischemia.

Methods. 52 patients with chronic generalized periodontitis of moderate severity were observed: 24 people without concomitant diseases and 28 patients with chronic generalized periodontitis in association with cerebral vessels atherosclerosis. The comparison group (control) consisted of 12 persons without somatic diseases at the age of 35-40 years with an intact periodontium. Levels of homocysteine and autoantibodies against heat shock proteins (HSP-70) in blood plasma and oral fluid were determined by enzyme immunoassay method.

Results. In chronic generalized periodontitis of moderate severity, high levels of antibodies to HSP-70 in saliva, 1.6 times exceeding the normal values, were revealed. These changes are more pronounced in patients with chronic generalized periodontitis and cerebral vessels atherosclerosis. Similar changes were observed in blood values in patients with chronic generalized periodontitis, in whom levels of antibodies to HSP-70 were 1.3 times higher than the «normal» value, and 1.9 times higher in combination of periodontitis with chronic cerebral ischemia. In patients with chronic generalized periodontitis of moderate severity combined with atherosclerotic vascular disease, in contrast to patients with only chronic generalized periodontitis, there was a more significant increase in homocysteine levels in the blood and saliva.

Conclusion. The findings confirm the importance of determining homocysteine levels in the blood in chronic generalized periodontitis, particularly when it is combined with atherosclerotic vascular disease.

Aim. To study the efficacy of shellfish dry extract with «Calcium-reparative» filler as a product of specialized medical nutrition to optimize bone metabolism.

Methods. Total of 44 female patients aged from 49 to 71 years, mean age of 54.5±3.8 years, with a combination of several osteoporosis risk factors were involved. 72.7% of all patients complained of pain of varying severity in major joints, in the thoracic and lumbar spine. The patients were randomly divided into two groups - study group (29 patients) and control group (15 patients). Within 30 days, the participants of the study group received «Calcium-reparative» - a product created on the basis of natural biologically active compounds isolated from Far Eastern marine shellfish and purified Altai Shilajit. The efficacy of the product was assessed by means of standard questionnaires for the assessment of quality of life, 10-point visual analogue scale, biochemical laboratory tests. Measurement of serum osteocalcin was performed by ELISA, and immunochemical method - N-terminal propeptide of procollagen type I (the biomarker of bone tissue metabolism).

Results. Adverse and allergic reactions to the product were not registered. Among those receiving the product 37.9% noted improvement of well-being and reduction of pain intensity from 6.9±0.45 to 4.28±0.74 points. In those receiving «Calcium-reparative» the level of synthesis of osteocalcin in the study group did not statistically significantly change and appeared to be 18.6±3.8 ng/ml. The increase in the concentration of procollagen type I from 20.9±3.0 ng/ml prior to administration of the therapeutic product to 37.6±5.8 ng/ml (t=0.006, p ≤0.001) after its administration was observed.

Conclusion. Product of medical nutrition «Calcium-reparative» has the ability to stimulate the cells of bone tissue to synthesize bone matrix protein collagen type I.

Aim. To develop medical and organizational measures to optimize the early diagnosis and prevention of hypertension complications.

Methods. A study of the hypertension incidence in population of Krasnogorsk city based on the analysis of report forms was performed. A questionnaire survey of 400 office workers of working age for the presence of high blood pressure was conducted.

Results. It was found that, despite the downward trend in the prevalence and incidence of hypertension in population served by Krasnogorsk City Hospital №1, as well as the decrease in the relative frequency of hospital admissions of patients with hypertension in 2011-2015, mortality due to hypertension-related causes does not decrease. The results of the survey and blood pressure measurement in 400 office workers of working age have shown that only 30.8% of respondents regularly monitor the blood pressure, and women 3.5 times more often than men. In 14.5% of examined persons, who claimed that they have no high blood pressure, unstable blood pressure, in 19.1% - high blood pressure is detected.

Conclusion. As an important measure for the early detection and correction of hypertension, the organization of units for measuring blood pressure at workplaces in organizations and institutions should be considered. Heads of organizations and institutions, in agreement and cooperation with the healthcare authorities, are recommended to organize units for measuring blood pressure at the personnel workplace and purchase devices for measuring blood pressure. Local healthcare authorities should organize trainings of the institutions personnel on self-measured blood pressure monitoring by means of collective actions involving volunteer health professionals in health centers, and in organizations and institutions, if possible.

Aim. To assess the risk of developing non-carcinogenic health disorders in adolescents depending on environmental factors and lifestyle.

Methods. Calculation of daily doses in inhalation exposure of substances was performed according to the monitoring data of The Federal Service for Hydrometeorology and Environmental Monitoring of Russia (ambient air of Angarsk) in 2003-2014 and the results of the control of impurity levels (formaldehyde, carbon monoxide, nitrogen dioxide, suspended solids) in ambient air, as well as in the air of study rooms and living accommodations, conducted in the laboratory of physical and chemical methods of investigation. The study of the impact of lifestyle factors was performed according to the results social hygienic survey of adolescents. Health problems in adolescents were identified as a result of the medical examination conducted with the participation of the pediatrician, ophthalmologist, otolaryngologist, neurologist, orthopedist, endocrinologist.

Results. It has been established that the risk of non-carcinogenic effects for adolescents of industrial city and suburban villages was caused by the presence of formaldehyde and suspended solids, mainly in indoor air. For adolescents living in areas with low exposure, the health risks were associated with the concentration of suspended solids in ambient air and indoor air. The adverse impact of lifestyle factors was observed only in urban adolescents. High relative risk of scoliosis, valgus feet, and flat feet was found for adolescents with insufficient physical activity, myopia - for those with long-term working at a computer.

Conclusion. The results are indicative of the specificity of the effects of combined factors (ambient air pollution and lifestyle) on the developing body; adolescents living in the city have higher relative risk of diseases of the upper respiratory tract, musculoskeletal system, visual organs, and autonomic dysfunction syndrome.

Aim. To conduct a comparative analysis of the overall morbidity of the population above working age (55 years for women and 60 years for men) in the Russian Federation and Novosibirsk region according to the data of patient attendance in 2009-2014.

Methods. The method of computing the mean value with amplitude of fluctuations by years, the analytical method were used. The data of official statistical compilations: Federal State Statistics Service (Rosstat), «Healthcare in Russia» and «Russian Statistical Yearbook» were analyzed.

Results. The difference in increase in the morbidity rate between the Russian Federation (42.4‰), and the Novosibirsk region (85.8‰) was 43.4‰, with difference of 36.0‰ in the value fluctuation amplitude by years. The main differences in the prevalence of diseases in the Russian Federation are characterized by higher rates of musculoskeletal system and connective tissue disorders, diseases of the skin and subcutaneous tissue, urogenital disorders, diseases of the ear and mastoid process (an increase by 23.2; 19.5; 18.9 and 12.8%, respectively), and in the Novosibirsk region - diseases of the blood and blood-forming organs, endocrine disorders, neoplasms, certain infectious diseases, injury and poisoning, digestive system diseases (by 33.3; 28.1; 16.8; 14.9; 13.5 and 11.1%, respectively).

Conclusion. Morbidity of the population above working age is higher in the Novosibirsk region; the differences in the indices of morbidity structure between the Russian Federation and the Novosibirsk region were identified.

Aim. To assess the capabilities of endoscopic hemostasis using self-expanding nitinol stents as an alternative to balloon tamponade using Sengstaken-Blakemore probe-obturator in the combined treatment program of patients with acute bleeding from esophageal varices.

Methods. In 15 of the 266 patients with portal hypertension of various origins and with high risk of rebleeding (or at the height of the latter) endoscopic hemostasis with Danis self-expanding nitinol stents was performed instead of the traditional balloon tamponade using Sengstaken-Blakemore probe-obturator.

Results. In all 15 cases, the Danis stent was inserted under intravenous general anesthesia with preservation of spontaneous breathing, using direct laryngoscopy. 5 of the 15 inserted by the manufacturer’s instructions stents (33.3%) migrated into the stomach: 1 did not deploy at all, 4 were in the expanded form. 10 (66.7%) stents were successfully inserted in a standard position in the esophagus without any complications. This was confirmed endoscopically immediately after the delivery device removal. In 2 of 4 patients who was inserted Danis stent at the height of esophageal bleeding, a reliable hemostasis was achieved. In none of the 15 cases, we did not observe any complications associated with the presence of the stent in the esophagus or its removal procedure. 4 of 15 patients (26.7%) died, despite the achieved endoscopic hemostasis, against the background of progressive multiple organ failure.

Conclusion. Endoscopic hemostasis in a combined treatment program of patients with bleeding from esophageal varices using Danis self-expanding nitinol stents can be considered as a reasonable alternative to balloon tamponade using Sengstaken-Blakemore probe-obturator.