Vol 99, No 3 (2018)

Aim. To comparatively characterize the state of local and general immunity in patients with the primary diagnosis of albinism and oral mucosal diseases.

Methods. In the dental clinic of FSBEI HE «Kazan SMU MOH Russia» 4 patients aged 16 to 17 years are observed with the primary diagnosis of albinism and comorbid oral mucosal diseases. On initial examination 2 patients from group 1 were diagnosed with chronic recurrent aphthous stomatitis, Sutton’s disease. K12.1. The control group (group 2) included 5 children aged 12 to 15 years diagnosed with chronic recurrent aphthous stomatitis. The state of local immunity was assessed by the level of lysozyme of the oral fluid before and after the treatment. Lysozyme activity in the oral fluid was evaluated and calculated by our newly developed method. The state of local immunity was assessed by immunograms. Patients’ microbiologic status was evaluated by microscopic and bacteriological methods.

Results. Among the patients from group 1 with the diagnosis of chronic recurrent aphthous stomatitis, Sutton’s disease, the analysis of immunograms prior to the study revealed severe neutropenia (5.4±0.4×109/l), lymphocytosis (Т-lymphocytes 85±3.5%), leukopenia (2.2±0.1×109/l), increased level of immunoglobulin A (2.69±0.1 g/l), decreased number of phagocytes (2.6) and circulating immune complexes (22±1.48). In patients from the control group leukopenia (2.89±0.23×109/l), lymphocytosis (Т-lymphocytes 74.3±1.32%), insignificant increase of immunoglobulin G level (14.5±0.59 g/l), decreased number of phagocytes (4.5±0.5) and circulating immune complexes (38.67±1.23), and neutropenia (25.5±0.1×109/l) were revealed.

Conclusion. Cellular component of the general immunity in albinos insignificantly differs from the patients of the control group but no restoration of the cellular immunity occurs even in long-term remission; to choose the method of treatment for patients diagnosed with chronic recurrent aphthous stomatitis it is necessary to determine the etiology of the disease, particularly, immunologic status of patients before and after the treatment.

Aim. To investigate the cellular mechanisms of chronic catarrhal gingivitis to develop the appropriate treatment schemes based on the analysis of obtained data.

Methods. 57 patients aged 16 to 22 years were observed and divided into the control group (18 subjects with the intact periodontium with no orthopedic constructions) and the study group of patients with chronic catarrhal gingivitis (39 subjects, group 1). The degree of gingival inflammation was evaluated by papillo-marginal alveolar index as well as by gingival bleeding index. In addition, laboratory parameters were measured: spontaneous nitroblue tetrazolium test and zymosan-stimulated nitroblue tetrazolium test. Leukocyte-modulating activity of oral fluid was determined by measurement of luminol-dependent chemiluminescence. The activity of lysosomal enzymes - acid deoxyribonuclease and acid phosphatase - was determined in whole oral fluid, supernatant fraction of oral fluid and in sediment, obtained by centrifugation. Antioxidant activity was determined in whole oral fluid by biochemiluminescent method with hydrogen peroxide.

Results. The performed investigations demonstrated that the development of chronic catarrhal gingivitis is accompanied by a sharp increase of the number of neutrophils and macrophages with a significant increase of their functional activity. At the same time, more than two-fold increase of the activity of lysosomal enzymes, lysosomal membrane labilization and release of enzymes outside the organelles and cells were observed, that indicated the increase of destructive potential in chronic catarrhal gingivitis. Use of indometacin in the complex treatment of chronic catarrhal gingivitis contributed to normalization of clinical parameters, increased neutrophil functional activity and enhanced their functional reserve, reduced the activity of phlogogenic factors and normalized the antioxidant activity of oral fluid. Pro- and anti-inflammatory factors secreted into the oral cavity during inflammatory periodontal diseases collectively have leukocyte-modulating activity.

Conclusion. The obtained data indicate the important role of both high oxygen-dependent and oxygen-independent biocidal activity of neutrophils and macrophages in the pathogenesis and clinical course of chronic catarrhal gingivitis.

Aim. To analyze the incidence of postfilling pain in the treatment of uncomplicated caries with filling materials approved by the program of compulsory medical insurance (CMI).

Methods. Retrospective analysis of medical records of patients of dental clinic of Far Eastern state medical university «Uni-Stom» treated for uncomplicated caries according to the program of compulsory medical insurance.

Results. In patients’ group 1 where cementation was performed with zinc-phosphate cement, the average duration of postfilling pain was statistically calculated to be 13 days (M±0.8). In group 2 of patients seeking dental care who had permanent filling performed with composite material without cementation, significant decrease (t=9.4; p <0.001) of time course of postfilling pain relief to 4 days (M±0.6) was revealed. In group 3 compomer material was used as cement, postfilling pain relief occurred significantly earlier (t=11.6; p <0.001) by 2.5 days (M±0.4). The best measures were observed in the group where chemically cured glass ionomer cement was used as cement; postfilling pain was controlled in 1.5 day (M±1.2), being statistically significant (t=8.3; p <0.001). The dependence of postfilling pain on the selected filling material is observed after the treatment of uncomplicated caries; when using zinc-phosphate cement «Uniphase», a complete postfilling pain relief occurs on average on day 14, when using a light-curing composite «Charisma» - on day 4, «Isolain» - on days 2-3 and «Tsemion» - on day 1-2.

Conclusion. Given the clinical results, positive qualities and low cost of glass-ionomer cement «Tsemion», its use is recommended for the treatment of uncomplicated caries in public dental practice.

Aim. Improvement of the safety of patients and of effectiveness of anesthetic protection for young children with Hirschsprung's disease during transrectal resection of the large bowel by comparative study of various methods of anesthesia and creating an effective and safe anesthesia regimen.

Methods. The study included 25 children with Hirschsprung's disease who underwent transrectal resection of the large intestine. All examined patients were divided into two groups depending on the chosen method of anesthesia. In clinical group 1 (n=13) multicomponent endotracheal anesthesia with high doses of fentanyl were selected for anesthesia, in clinical group 2 (n=12), surgical interventions were performed under general anesthesia combined with caudal block.

Results. The level of cortisol in patients from group 2 at the 2nd stage of the study significantly decreased by 22%, which indicated the adequacy of this technique of anesthesia. Also, in patients of this group at the 4th stage of the study the level of cortisol and glucose did not change. In patients from group 1 who underwent multicomponent general anesthesia with high doses of fentanyl, at the 4th stage of the study a significant increase occurred in the level of cortisol and glucose by 48.6 and 93.6%, respectively. This indicates the appearance of severe pain 24 hours after the surgery.

Conclusion. Caudal anesthesia combined with general anesthesia provides a reliable analgesic effect and miorelaxation in transrectal resection of the colon in Hirschsprung's disease in young children; the combined administration of trimeperidine (promedol) with ropivacain (naropine) into the caudal canal prolongs the analgesic effect up to 24 hours.

Aim. Study of the state of intestinal microflora in young children seen in an outpatient setting with acute enteric infections.

Methods. The state of microflora of 156 children was examined. All children underwent bacteriological study. Children were divided into following groups by age: 0-6 months - 59 (37.8%) patients; 6-12 months - 32 (20.5%) and 1-3 years - 65 (41.7%) subjects. Among them, 33 (21.1%) received breast milk, 46 (29.5%) received artificial feeding and 77 (49.4%) - mixed feeding.

Results. Conditionally pathogenic bacteria were revealed in 114 (73.08%) patients, mainly (92.98% of cases) Candida alone or in combination with other conditionally pathogenic microorganisms were detected in 57 (50.0%) children: Candida + St. aureus - in 32 (28.1%) patients, Candida + P. vulgaris - in 9 (7.9%), Candida + P. vulgaris + St. aureus - in 12 (10.5%), Candida + St. aureus + Ps. aeroginosa - in 4 (3.5%) subjects. In 42 (26.92%) children conditionally pathogenic flora was not detected. As a result of the study of intestinal microflora structure of outpatients, decreased number of E. coli and B. bifidum by 67.3 and 36.5%, respectively, was revealed. The leading place was taken by Candida albicans identified in more than 50% of outpatients.

Conclusion. Young children with acute enteric infections had mainly conditionally pathogenic and pathogenic microorganisms isolated in different associations.

Aim. To assess the prognostic significance of histopathological processes in the peritumoral zone with respect to the risk of biochemical recurrence in patients with localized prostate cancer after radical prostatectomy.

Methods. Histomorphological studies were conducted in the perifocal area of surgical tissue samples from 309 patients with localized prostate cancer (T1c-2cN0M0) after a radical surgery using light microscopy. Four groups of patients were identified depending on the risk of recurrence. Enzyme immunoassay was used to determine the concentration of prostate-specific antigen in the serum at baseline and every 3 months for two years after the surgery to detect biochemical recurrence.

Results. Histomorphological examination of the peritumoral zone made it possible to identify histopathological processes associated with adenocarcinoma in 257 out of 309 (83.2%) patients with localized prostate cancer. The risk of biochemical recurrence of a combination of prostatic adenocarcinoma and prostatic intraepithelial neoplasia-2 increased by 3.3 (p=0.02), and of a combination of adenocarcinoma, neoplasia and chronic inflammation in the perifocal zone increased by 4.5 times (p=0.005) compared to patients without histopathological changes of the peritumoral zone. In combination of prostate adenocarcinoma with neoplasia and chronic inflammation in the peritumoral zone, the number of patients with an intermediate risk of cancer recurrence after surgical treatment increased due to decrease of the proportion of patients with very low and low risk of recurrence of the oncologic disease.

Conclusion. The combination of prostate cancer with high-grade prostatic intraepithelial neoplasia and chronic inflammation in the peritumoral zone modifies the risk of biochemical recurrence of cancer after radical prostatectomy.

Aim. To study the prevalence of S. pneumoniae serotypes in nasopharyngeal carriage among different age groups in organized groups to optimize the information and analytical system of epidemiological surveillance of pneumococcal infection.

Methods. By classical bacteriological method 75 nasopharyngeal isolates of pneumococcus, which later were serotyped, were identified in 319 subjects of different age from children's and adults' organized groups in Barnaul.

Results. In 2017 the epidemiological screening was used to evaluate the prevalence of S. pneumoniae carriage. After identification, nasopharyngeal pneumococcal strains underwent serotyping. The greatest proportion of serological landscape of the studied strains was 3 and 19F serotypes, the total proportion of which was 75±9.7%. 13-valent pneumococcal conjugated vaccine had the maximum coverage of local strains - 62.5%. Based on the data on community-acquired pneumonia caused most often by pneumococcus, from information and analytical system received from the territories of the region, the database «Community-acquired pneumonia of the Altai Krai» was created. However, for an adequate assessment of the epidemiological situation regarding pneumococcal infection in the region, incoming information was not enough. The analysis of information from the territories on community-acquired pneumonia allowed identifying disadvantages of epidemiological surveillance of this nosology and inability to adequately assess the epidemiological situation with regard to pneumococcal infection in the region.

Conclusion. The results of serotyping allowed determining further tactics of immunization in the Altai Krai; information and analytical system requires supplementing microbiological monitoring data regarding antibiotic susceptibility and resistance to disinfectants of the etiological agent.

Aim. Early identification of risk factors of cardiovascular diseases in staff members of law enforcement body working in counter-terrorist operation mode in the Republic of Dagestan and evaluation of their overall cardiovascular risk.

Methods. 62 employees (males, average age 35.2±4.1 years) were the object of study. The follow-up period was 3.7±0.7 years. The examination included laboratory studies, electrocardiography, echocardiography, 24-hour blood pressure monitoring, duplex study of brachiocephalic arteries, examination of the vessels of the fundus.

Results. The following risk factors were identified: arterial hypertension, dyslipidemia, excess body weight, smoking.

Conclusion. Law enforcement officers are exposed to a range of unfavorable work-related factors (severity and labor intensity) in the course of labor activity, which are associated with operational activity of the Ministry of Internal Affairs employees and enable formation of risk factors of cardiovascular pathology (such as arterial hypertension, overweight, smoking).

Aim. To estimate the features of neurological status and drinking behaviour in rats during 20 days of chronic alcohol intake.

Methods. The current study was performed on 40 male Wistar rats (170-300 g). The animals from the study group were administered 15% solution of ethanol used as the only fluid source. On day 20 of the experiment the alcohol preference test and evaluation of neurological status were performed: tail-suspension (to determine paresis and paralysis), home cage motion activity (to determine gait disorders and stereotypic movements) and features of horizontal beam-walking (evaluation of movement coordination) were assessed, presence of the basic reflexes (startle reflex, external auditory canal reflex, corneal reflex) was controlled.

Results. The main neurological signs were presented as ataxic form, in which unsteady gait in beam-walking test was predominant. In the experimental groups, the signs of ataxic form of neurological deficit were demonstrated, when animals slipped off and fell off the beam within 40 s from the beginning of the test. This was associated with the significant increase of discrimination ratio in alcohol preference test.

Conclusion. In rat models of chronic alcohol intake, significant changes in drinking behavior and alcohol preference test were found on day 20 of the experiment, reflecting formation of alcohol addiction; changes in drinking behavior were associated with mild and moderate neurological deficit, primarily including movement coordination disorders that illustrates the malfunction of peripheral nervous system.

The review of national and foreign literature sources presents information on arterial blood supply of the umbilical region in newborns having relevant practical significance due to the development of new surgical approaches in that part of the anterior abdominal wall. Scientific data on the course and location of arteries participating in the blood supply of the umbilical region are summarized. Particular attention is devoted to the description of superficial, superior and inferior epigastric arteries and umbilical arteries. The issues of intervascular connections between the named arteries and other blood vessels are discussed including information on various anastomosis variations and their extent. Various existing viewpoints regarding the location and depth of anastomoses between the vessels essential for blood supply of the umbilical region are presented as well as the layers, through which the main arteries pass, and the character and level of their branching. Features of arterial blood supply of the umbilical region in newborns are also noted. The paper contains data on the role of umbilical arteries in the umbilical region supply in children of that age. It is demonstrated that blood supply of the umbilical region in newborns still poses issues that are insufficiently researched and solved, such as assessing functional capacity of the umbilical arteries, revealing histotopographic peculiarities in the location of blood vessels within the layers and various segments of the umbilical region, topographic and anatomic identification of the segments that are most and least supplied with arterial vessels in that part of the abdominal wall.

Aim. The study of the incidence among school-age children, and development of a complex of medico-biological, medico-social and organizational measures for improving health status of schoolchildren.

Methods. Statistical, mathematical, sociological.

Results. Morbidity among children in Kazan in 2015-2017 increased to 20.4%, incidence during this period increased by 38.6%. The conducted examination of physical development of schoolchildren revealed significant decrease of the ratio of students with normal physical development. While in primary school this parameter was 85.3±2.17%, in grades 8 to 11 it decreased to 77.8±1.98% (p <0.01). The social and hygienic health characteristics of schoolchildren's health include the following: 25% of surveyed students live in families with a low subsistence level; 30% of schoolchildren are brought up in single-parent families; in 10% of cases parents do not allocate money for child nutrition at school; 30.5% of schoolchildren of grades 8 to 11 smoke; 35.9% of students of grades 8 to 11 drink alcohol; 34.9% of schoolchildren have conflicts with their classmates; 17.1% of schoolchildren of grades 8 to 11 do not eat hot meals at school; 28% of students consider themselves not informed about the issues of proper nutrition, etc. The conducted study of the schedule at schools demonstrated that the workload of the junior schoolchildren exceeds the age standards by 5-7 hours, and in the middle and senior classes the load turned out to be higher than the age standards by 5-10 hours.

Conclusion. One-way ANOVA reflected that medico-biological, medico-social and organizational factors significantly influence the occurrence of diseases in school-age children; based on the data on the influence of unfavorable risk factors on the development of diseases in school-age children we will develop measures for medical and social prevention.

Aim. The study of the dynamics of the rate of complicated abdominal delivery in the Kyrgyz Republic.

Methods. A retrospective cohort study was conducted on the basis of the Kyrgyz state medical institute of retraining and advanced training of the Ministry of Health of the Kyrgyz Republic. The data of consolidated annual reports (form No. 14 «The hospital services report») of the Republican medical information center of the Ministry of Health of the Kyrgyz Republic on the number of abdominal deliveries and complicated abdominal deliveries in women of the Kyrgyz Republic in 2005-2016 were used. For the analysis of time series reflecting the change of the rate and dynamics of complicated abdominal delivery, the developmental cycle of 12 years was chosen. Medium-term prognosis of dynamics of complicated abdominal delivery was calculated till 2021 using the pair-wise linear regression equation, the equation parameters were calculated using the method of least squares.

Results. The study showed the increase in the number of abdominal deliveries in the Kyrgyz Republic during 12 years by 3.2 times and the increase of complicated surgical deliveries by 11.2 times and revealed negative, strong and reliable correlation between maternal and perinatal mortality and the number of abdominal deliveries. A two-fold increase of the rate of complicated caesarean sections in 2010 compared to 2009 (p <0.001), a decrease of this parameter in 2011-2012 by 1.8 times (p <0.001) and subsequent increase by 3.1 times from 2013 to 2016 (p <0.001) were revealed. The leading place in the rate of complicated caesarean sections is taken by Bishkek and Osh region, where the institutions of tertiary medical care are located and severe obstetric and extragenital pathology is concentrated. The medium-term prognosis for the dynamics of complicated abdominal deliveries calculated till 2021 indicates the continued increase of this parameter.

Conduction. The obtained results demonstrate the need for thorough study of this problem with revision and organization of information logistics to reveal a real state and determine cause-and-effect factors influencing these parameters.

Although hysteroscopy is considered a gold standard of diagnosis and treatment of different pathologies of uterine cavity and the postpartum period is not considered to be a contraindication to hysteroscopy, the study of the state of the uterus after delivery with the use of hysteroscopy is not common. We propose that hysteroscopy is a valuable diagnostic method in the postpartum period, potentially reducing the risk of postpartum complications. The article presents a brief literature review regarding the role of hysteroscopy in the diagnosis of uterine pathology in the postpartum period. The following effects of hysteroscopy on the postpartum uterus are observed: mechanical effect of fluid flow on the wall of the uterus increases contractility, provides washing out of the uterine cavity (blood clots, decidual tissue) and reduction of the number of bacteria (bactericidal effect of antiseptics). Indications for hysteroscopy in the postpartum period are presented. Hysteroscopic picture in the normal course of the postpartum period is described, as well as in such pathological conditions as uterine subinvolution, endometritis (after vaginal delivery and delivery by cesarean section) and placentation abnormalities. The technique of hysteroscopy in the postpartum period is described, which has some significant differences from traditional hysteroscopy. Photos of the uterine cavity one month after cesarean section are presented. Pathologies of the uterine cavity in the postpartum period are a subject that require further investigations not only by traditional non-invasive visualization techniques, but also by modern minimally invasive endoscopic technologies. Hysteroscopic visualization of the uterine cavity allows confirming the diagnosis and, if needed, accurately performing of the necessary intervention with minimal risk of intra- and postoperative complications.

The aim of the study was the analysis of domestic and foreign medical literature of different time periods, which describes the basic methods of surgical and conservative treatment of congenital or habitual dislocation of patella, as well as statistical analysis of the results of treatment. Due to the existence of a large number of options of surgical treatment for this pathology (more than 150 methods were developed) and high variability of its manifestations, it is necessary to know the basic methods and their results for planning tactics of treatment with individual approach to each patient. Based on this review, analysis was performed for the results of using different options for invasive treatment of congenital or habitual dislocation of patella. Also, the paper contains the indications and efficacy of conservative therapy for this disease. A comparative analysis was made on the results of surgical and conservative methods of treatment of patellar dislocation, which were used in different time periods, from the initial description of the first results of treatment of this pathology to modern surgical techniques that are currently used. It is shown that all methods of surgical treatment of the pathology are divided into three main groups: myofascioplastic surgeries, osteoplastic and combined surgical interventions. It is underlined that the diseases requires individual approach to the choice of correction method in each certain case to achieve positive outcomes.

The study was performed to identify the features of coronary artery calcifications with the use of coronary computed tomography angiography in patients suffering from rheumatoid arthritis. In the study, calcifications were found in one vessel in 5 (8.3%) patients, in two vessels - in 24 (40%) subjects, in three vessels - in 28 (46.7%), and in four vessels - in 3 (5%) patients. 100% of patients were diagnosed with calcifications in the left descending artery, 90.2% - in left circumflex artery, 56.9% - in right coronary artery, 9.8% - in the root of left coronary artery, 92.2% of patients were diagnosed with calcifications of the aortic arch. The highest calcium score was registered in left circumflex artery (343.5±10.0 HU), and the lowest one - in right coronary artery (262.1±17.7 HU). The study results demonstrated correlation between the stage of rheumatoid arthritis and coronary calcification. In 77.8% of patients with stage I of the disease and in all patients with stage II, III and IV, calcifications of various size and localization were revealed in coronary arteries and aortic arch. Also, the relationship between duration of the disease and calcinosis extent was revealed. The obtained results indicate the importance of coronary computed tomography angiography for the diagnosis of coronary atherosclerosis in patients with rheumatoid arthritis due to high risk of cardiovascular complications in these patients.

The article presents the reasons for the emergence and development of bioethics as a scientific direction in the world and in our country. In the end of 21st century, humanity faced the complex of global problems solving which affected its survival nowadays: these are the problems of peaceful coexistence of states and peoples, environmental security, demography, health and quality of life connected to health. The science of bioethics which appeared in 1970s started their discussion, understanding and finding solutions, using interdisciplinary approach, involving the general public and seeking political solutions. At the origins of bioethics stood the American biochemist V.R. Potter and doctor A. Hellegers, and a German pastor Fritz Jahr. Boris Grigorievich Yudin can be considered the founder of the Russian school of bioethics, who defined objectives, tasks, basic science perspective in the light of national and regional peculiarities and modalities and founded the platform for discussions. The development of bioethics in our country was multicentered: it is possible to distinguish Moscow, Volgograd and Kazan centers of science development, each of which has its own outstanding terms of reference. The article presents the authors' view of contribution of the brightest representatives developing bioethics in our country, and role of certain scientific and educational centers.

Ricardo Miledi (16.09.1927-18.12.2017) is an outstanding neurophysiologist and biophysicist who made a great contribution to the study of synaptic transmission functions. He proved the key role of сalcium ions in the release of neuromediators, developed methods of receptor expression and membrane fragments integration into large oocytes that provided huge possibilities for thousands of researchers to study subtle mechanisms of transmembrane proteins function in norm and pathology. Ricardo Miledi received his MD degree in the National Autonomous University of Mexico and in 1954 he defensed his dissertation on the study of electrical nature of cardiac fibrillation in the National Institute of Cardiology (Mexico). In 1956-1958 he underwent training in Canberra Health Research Institute (Australia) in the laboratory headed by John Eccles (Nobel Prize 1963). In 1958 R. Miledi was invited to the Department of biophysics of University College London where in cooperation with Bernard Katz (Nobel Prize 1970) made a number of important discoveries in the analysis of acetylcholine receptor expression in denervated mucle; determination of the role of calcium in neuromediators release; analysis of membrane noise on neuromediator application to neuromuscular synapses; study of the effect of antibodies from patients with myasthenia gravis on neuromuscular transmission. In the early 1980s Ricardo Miledi implemented the method of functional expression in Xenopus frog oocytes of receptors and ion channels from messenger ribonucleic acid (mRNA). His heritage running the gamut is presented in more than 500 articles.

Инактивированные вакцины могут снизить долю здоровых взрослых (включая беременных), заболевших гриппом и ГПЗ, но их влияние умеренно. Мы не уверены во влиянии инактивированных вакцин на число пропущенных рабочих дней или серьёзные осложнения сезонного гриппа.

Инактивированные вакцины могут снижать долю пожилых людей с гриппом и ГПЗ. Данные по смертности были немногочисленны, и мы не нашли данных по госпитализациям, связанным с осложнениями. Однако вариабельность результатов исследований означает, что мы не можем быть уверены в величине эффекта от вакцин в разные сезоны.