Vol 99, No 5 (2018)

Aim. To study the indicators of energy metabolism and oxidative stress in mononuclear leukocytes of peripheral blood and to assess the possibility of mitochondrial dysfunction development in chronic obstructive pulmonary disease and chronic bronchitis.

Methods. The study included 50 patients aged 40 to 75 years with chronic obstructive pulmonary disease (COPD) or chronic bronchitis. The first group included 13 patients with chronic bronchitis. In accordance with the GOLD spirometric classification, the second and third groups included patients with COPD of moderate severity (COPD 2) (n=17) and severe COPD (COPD 3) (n=20) respectively. In the isolated mononuclear leukocytes, the activity of superoxide dismutase (SOD), succinate dehydrogenase (SDH) and concentration of succinate were determined, a complex evaluation of oxidative modification of proteins was performed.

Results. Patients with chronic bronchitis compared to patients with COPD 2 and COPD 3 were found to have in mononuclear leukocytes higher activity of SOD by 3.38 times (p=0.0025) and 3.15 times (p=0.0058), higher activity of SDH by 4.55 times (p=0.0281) and 2.5 times (p=0.0263) and higher succinate concentration by 2.05 (p=0.0133) and 1.89 (p=0.005) times respectively. The level of spontaneously oxidized modified proteins in the group of patients with chronic bronchitis decreased by 2.45 (p=0.0176) and 2.94 (p=0.0168) times compared to the patients of groups 2 and 3, respectively There was a decrease in the reserve-adaptive potential of oxidative modification of proteins in COPD in the form of an increase of the ratio of spontaneously oxidized-modified proteins to metal-induced oxidized proteins by 1.58 times (p=0.0301) between groups 1 and 2, and by 1.44 times between groups 2 and 3 (p=0.0446).

Conclusion. In mononuclear leukocytes of COPD patients, secondary mitochondrial dysfunction is observed accompanied by significant oxidative damage of lymphocytes and monocytes. Patients with severe COPD compared to patients with COPD of moderate severity have less reserve-adaptive potential for the oxidative modification of mononuclear leukocyte proteins, which probably reflects a more severe course of the disease.

Aim. To identify clinical, epidemiological and laboratory-instrumental features of acute hepatitis C at the present stage according to the infectious hospital data.

Methods. The study included 111 patients with acute hepatitis C aged from 18 to 79 years who were hospitalized in Republican Clinical Infectious Diseases Hospital named after A.F. Agafonov in 2011 - I quarter of 2017. Acute hepatitis C was diagnosed in accordance with the guidelines of the Ministry of Health of the Russian Federation.

Results. In the study group, females aged 21 to 40 years, non-working, predominantly living in Kazan with medical transmission of infection (34 %) prevailed. The disease was mild and moderately severe (71 %). The icteric form was observed in 94 % of patients, in 3.6 % - with a cholestatic component. When comparing laboratory parameters, markers of cytolysis and cholestasis differed significantly in patients depending on the severity (p<0.001). Changes in the gallbladder walls (an ultrasound marker of cholestasis) were revealed in 21.4 % of patients. On specific examination, the viral RNA was detected in 100 % of patients. Analysis of serological markers revealed predominance of antibodies to core and NS3 proteins, M class antibodies were detected only in half of the patients. Specific antibodies were absent (“dark diagnostic window”) in 3 % of patients with mild and 6 % of moderate form of the disease.

Conclusion. The feature of the course of acute viral hepatitis C was the predominance of moderate forms (71 %) with medical transmission of infection. Icteric forms of acute viral hepatitis C were diagnosed in 94 % of patients (in 3.6 % cases with the development of cholestatic component). PCR is a mandatory method of specific diagnosis of acute viral hepatitis C, and in case of a “dark diagnostic window” becomes the leading method.

Aim. To analyze the influence of psychosocial risk factors on the dynamics of indicators characterizing temporomandibular disorders.

Methods. 61 clinical cases of temporomandibular disorders with chronic pain were investigated (18 % of the total number of observations of temporomandibular disorders). Diagnostic criteria of temporomandibular disorders were used: axis II, computed tomography and magnetic resonance imaging of temporomandibular joint. Interviewing method was used for clinical diagnosis of psychological phenomena and testing attitude to the disease, identifying communicative deviations according to R.C. Rogers (2002). Patients were divided into 2 groups: group A - patients with nociceptive pain, social adaptation is not disturbed; group B - patients with neuropathic pain, psychosomatization on the background of mental rigidity. In both groups, an identical treatment regimen was implemented for two years. Statistical processing of the obtained data was carried out using IBM SPSS 21 and included comparison of related groups by Friedman analysis and paired Wilcoxon test, comparison of independent groups by Mann-Whitney-Wilcoxon criterion, and comparison of the qualitative features by contingency tables by Chi-square Pearson.

Results. The radiological semiotics of temporomandibular joint in both groups is similar in the structure of nosology. At the beginning of the treatment cycle, the pain intensity and the temporomandibular index are similar. After 2 years of follow-up, patients in group A showed a significantly higher positive response to the therapy compared to patients in group B: pain intensity in group A was 15.36±2.53 and in group B - 37.32±3.45 (p<0.001); depression on the SCL-90-R scale - 0.29±0.04 and 1.12±0.12 (p<0.001), the degree of disability on the GCPS scale - 0.68±0.08 and 1.17±0.10 (p=0.001), temporomandibular index - 0.15±0.01 and 0.23±0.02 (p<0.001), respectively.

Conclusion. In patients of group B, affective disorders form the psychosomatic structure of personality and affect the outcome of therapy. When formulating the final diagnosis and planning the treatment in patients with temporomandibular disorders, it is necessary to take into account the psychosocial characteristics of the patient.

Aim. To study the effect of testosterone on the rate of oxygen consumption by rodent prostate homogenate. Methods. The study included 30 healthy old white outbred male rats divided into two groups with 15 animals in each group. The rats of the first group were administered the application of 1 % testosterone-containing gel Androgel before the operation. The rats of the second group received no testosterone. Under anesthesia prostatectomy was performed. Homogenate was immediately prepared from each prostate. Further every homogenate was placed into 250 ml vial to determine the rate of oxygen consumption. Then the device measuring the concentration of oxygen dissolved in water was placed into the vial, and the air-tightness was created. Each vial was put into the thermostat for 30 minutes at 36.6 ˚C. Then the measurement of the concentration of O2 dissolved in the water was performed. Results. Application of transdermal gel with 1 % testosterone was found to cause increase of oxygen consumption by prostate tissue. This fact can explain why the clinical effectiveness of testosterone is individual to each patient with benign prostatic hyperplasia (BPH) and chronic prostatitis (CP): oxygen supply to the prostate is different in each patient with BPH and CP. So not in every patient the oxygen-transporting system is capable of supplying prostate tissues with the amount of oxygen according to increasing demand of the organ on testosterone administration. Conclusion. Testosterone increases the rate of oxygen consumption by prostate tissue.

Ultrasound examination in obstetrics is a method of screening of pregnant women including identification of fetal macrosomia. Diagnosis of macrosomia is extremely important, along with other indications the conclusion about the presence of a large fetus may affect the tactics of giving birth. Gestational diabetes (GD) is a known clinical risk factor for fetal macrosomia and accounts for the majority of all types of diabetes observed during pregnancy. In women with GD fetal macrosomia is the main complication, which often together with others serves as an indication for a planned cesarean section in order to reduce potentially possible perinatal complications, as macrosomia of diabetic origin is characterized by disproportional distribution of subcutaneous adipose tissue in the fetus with predominant localization in the upper half of the trunk, which increases the probability of dystocia of the shoulders and damage to the brachial plexus. In perinatal morbidity and mortality the major proportion is presented by newborns weighing more than 4 kg but there is insufficient data in the literature on how prenatal ultrasound should be monitored in cases of suspected macrosomia in the fetus, especially in patients without diabetes. At the moment, to determine the estimated weight of the fetus, the formulas created more than 30 years ago are used and their accuracy is not always high. The difficulty is caused by the lack of data on the diagnostic accuracy of macrosomal markers. A search is being made for additional parameters capable of increasing the diagnostic value of ultrasound method for determining the estimated weight of the fetus.

This article reviews the immune system and its role in the relationship between the tumor and the body of a patient with tumor diseases. It is about controlling homeostasis by recognizing and eliminating genetically alien substances (antigens). Antitumor treatment is now not only considered as an “instrument” for eliminating and destroying tumor cells, but also its ability to change/restore impaired functions of the immune system attracts attention. The used antitumor treatment is widely known to be immunosuppressive, stress and radiation effects also cause and/or enhance immunosuppression. In this work, the authors provide literature data demonstrating current status and problems of cellular immunotherapy of malignant tumors with the use of activated lymphocytes, and the role of antigen-specific T-lymphocytes as one of its most important agents is reviewed. Currently, among the immunotherapeutic methods, a special place is occupied by approaches involving the use of autologous or allogenic ex vivo stimulated immunocompetent cells (adoptive immunotherapy). The importance of complex influence on various links (T-, B-, NK-cell) and stages (presentation, recognition, proliferation, differentiation, migration, activation, effector functions) of the immune response is considered. The emergence of targeted drugs based on antibodies, as well as vaccines, especially dendritic cells, has provoked the emergence of a new wave of interest in the formation of specific antitumoral immune response mediated by T lymphocytes, so the introduction of the latter can be classified as a kind of targeted therapy. The value of antigen-specific T-lymphocytes in the formation of antitumor immunity is shown, which emphasizes the importance not only of CD8+, but also of CD4+ T-lymphocytes. In addition, there are suggestions of the possible significance of both T- and B-cells for developing a strategy of cellular immunotherapy. The literature data suggest that not only cytotoxic lymphocytes, but also T-helpers and even B-lymphocytes can be effective as antigen-specific lymphocytes as a component of antitumor treatment. The authors consider the possibility of obtaining antigen-specific T cells, as well as their further storage. The possibility of elimination or selective inhibition of regulatory T-cells during adoptive immunotherapy aimed at removing the suppressor effect on cytotoxic lymphocytes is studied. Various strategies for the use of cell therapy are also discussed.

The article deals with the problem associated with the imperfection of the legislation on the issuance of prescription forms for drugs containing narcotic and psychotropic substances. The prescription, as a written prescription of a medicinal product in the prescribed form issued by a medical or veterinary worker who is entitled to it for the purpose of dispensing the medicinal product or its manufacture and release has several meanings. The medical value of the prescription is that it is an integral part in the treatment of the patient. This process includes the diagnosis by a doctor, paramedic or midwife, the choice of drug required by the patient, the dose of the drug, the intervals between doses, the duration of treatment and the dosage form. The financial and economic value of the prescription is manifested in the fact that it serves as a basis for mutual settlements between the pharmacy and the patient including within the framework of the organization of provision of medicines in order to provide state social assistance in the form of a set of social services for citizens of the Russian Federation. In modern conditions, it is also important to obtain a tax deduction when a patient purchases a medicine for cash which is possible only if a correctly prescribed prescription is available. But the prescription is not only a medical, but also a legal document. Prescription issued and prescribed not according to the regulations imposes judicial liability on the doctor or paramedic who wrote the prescription or the pharmacist who gave the medicine according to the wrong prescription. The relevance of the research topic is due to the fact that the variety of prescription forms in the medical field complicates the process of discharge and use of drugs as intended.

Aim. The assessment of quality of diagnosing acute poisoning by ambulance paramedics.

Methods. Retrospective analysis of the rate of diagnostic discrepancies and undifferentiated diagnoses in 1 242 patients delivered by ambulance paramedics of Kazan to the hospital with the diagnosis of acute poisoning.

Results. Referral diagnosis of acute poisoning among patients delivered by ambulance paramedics to the diagnostic department of the hospital was not confirmed in 792 cases, among which in 683 cases admission was not needed due to the absence of indications. Among refusals of hospitalization the majority of patients (70.8 %) were in the state of intoxication of various etiologies and healthy patients. In 8.5 % of cases of diagnostic discrepancies of acute poisoning paramedics delivered to the hospital patients with severe urgent somatic pathology - urosurgical, neurological, surgical, therapeutic, etc. The rate of diagnostic discrepancies in the group of alcohol, drug, undefined substances and mushroom intoxication was higher - 71.5 %, than in the group of medication and carbon monoxide intoxication - 39.7 %. In poisoning with impaired consciousness a direct dependence of the rate of diagnostic discrepancies on the rate of impaired consciousness was observed. The rate of undifferentiated diagnoses in the first group of poisoning was also higher - 82.3 %, than in the second group - 45. 8%, but no dependence on the impairment of consciousness was observed among patients.

Conclusion. High rate of diagnostic discrepancies (63.8 %) and undifferentiated diagnoses (71.1 %) are the consequence of lack of competence in medical toxicology among ambulance paramedics. In 98.2 % of cases, the probable etiological diagnosis of the disease, suspected as acute poisoning, in the study group of patients could be diagnosed using diagnostic methods available for paramedics.

The destruction of the tooth crown should be regarded as the cause leading over time to the disruption of the morphofunctional unity of the dentition and pathological condition of the entire dentoalveolar system. Untimely treatment of defects of hard tooth tissues leads to functional disorganization of the dentoalveolar system. The most eliminated defects are those of crowns of teeth determining the quality of aesthetics, phonetics, functions of biting and chewing. The destruction of the tooth crowns, which do not cause significant disruption of the above functions, are painless and almost asymptomatic. In such cases, deformation of the dentition and occlusion, dysfunction of masticatory muscles and temporomandibular joints as well as the development of pathological changes in periodontium occur slowly. Of great importance are the early diagnosis of pathological reconstruction of dentoalveolar system and the knowledge of pathogenesis of possible complications after the extraction of the teeth that determine the indications for prophylactic orthopedic dental treatment. The article presents a clinical case of restoration of destructed tooth crown 3.6 complicated by changes in bifurcation area. The patient underwent coronary-radicular separation with the use of cast metal cores, which allowed restoration of the sufficient size of the stump, function and anatomical shape of the tooth and hence the unity of dental arch.

Differential diagnosis of articular syndrome is one of the leading issues of primary medical sanitary care. Timely and correct diagnosis of rheumatic diseases made by an internist in an out-patient setting is a cornerstone of successful treatment and prevention of possible complications. The masks of clinical course, subtle symptoms, as well as pathomorphosis of the disease make the accurate diagnosis difficult to establish. Among rheumatic diseases more and more often isolated hematological manifestations are observed on the onset of the disease. Among them the leading place is taken by Felty’s syndrome. Being a form of seropositive rheumatoid arthritis, it is often associated with cytopenia. The aim of the article is to draw attention to the problem of timely diagnosis of Felty’s syndrome. The presented clinical case of Felty’s syndrome with agranulocytosis was based on clinical, laboratory, instrumental data obtained on examination of a patient. The features of the course, diagnostic methods and treatment methods of the pathology are discussed. The treatment efficacy of corticosteroids and cytostatics, similarities in clinical presentation and course of the syndrome with lymphoproliferative diseases and liver cirrhosis are presented. According to the obtained data a conclusion was made about the need for early diagnosis and complex examination in case of Felty’s syndrome for successful treatment of the nosology.

Aim. The article discusses the results of a long-term cohort study devoted to the search for the possible relationship of arterial hypertension morbidity and mortality with the rate of sodium-lithium countertransport (Na+-Li+-СT) in red cell membrane which is a marker of the structural and functional state of the cell membrane.

Methods. The study of the functional state of cell membranes by determining the maximal rate of Na+-Li+-CT in red cell membrane with quintiles analysis of the rate of Na+-Li+-CT. Screening clinical examination, including registration of blood pressure (BP), ECG study, the study of eyeground vessels, one- and two-dimensional echocardiography (EchoCG), the study of the lipid spectrum of the blood. Analysis of medical records.

Results. Based on the results of long-term follow up of the aging cohort total mortality is not associated with Na+-Li+-СT rate in red cell membrane. At the average age of 50 bimodality is detected in the development of new cases of primary arterial hypertension associated with the values of Na+-Li+-СT rate of the 1st quartile (36-206 micromoles of Li per liter of cells per hour) and 3d quartile (276-347 micromoles of Li per liter of cells per hour). At the average age of cohort of 55.6±6.7 years the distribution of patients with arterial hypertension by quartiles of Na+-Li+-СT rate becomes almost identical with the statistically non-significant prevalence of 4th quartile of Na+-Li+-СT rate.

Conclusion. The expected correlation between mortality among persons with hypertension and membrane disorders determined by the high rate of Na+-Li+-СT was not revealed. However, the tendency to the predominance of mortality at high Na+-Li+-СT rate suggests that with a much larger sample size a significant relationship may be confirmed. The necessity of studying the relationship between mortality from arterial hypertension and high rate of Na+-Li+-СT in female cohorts remains actual. Increasing difference of mortality rate among patients with and without arterial hypertension with high rate of Na+-Li+-СT can indicate the relationship between mortality from arterial hypertension and membrane disorders.

In the article devoted to the 120th birth anniversary of Professor V.N. Shubin, his life path from a student of the medical department to the head of the Department of General surgery of Kazan medical institute is presented. Vladimir Nikolaevich Shubin was awarded the order of Lenin, ten medals, the “excellent worker of public health of RSFSR” badge, certificates of honor. He is the author of over 100 scientific papers and 6 monographs. Under his supervision, 5 doctoral and 13 master's theses were executed. Two of his followers were in charge of surgical departments in Kazan (Professor N.P. Medvedev and Professor V.G. Morozov). From 1952 to 1968 Shubin V.N. was a vice-rector for scientific work at Kazan medical institute. On August 25, 2017, in a solemn atmosphere, the memorial plaque was installed on the facade of the “old clinic”. On the memorial plaque it is written “In this building from 1937 to 1971 worked an outstanding surgeon, scientist and public figure, Professor Shubin V.N.”. Scientific heritage of V.N. Shubin is our memory of Kazan school of surgeons. The study of life of V.N. Shubin is an incentive for all of us for thinking about modern medicine and surgery.

Aim. To show the short history of the origin and development of the eugenic ideas at the beginning of the 20th century.

Methods. Historical-genetic and historical-comparative methods were used.

Results. The article presents the results of historical and medical research that demonstrated that close by the tasks to medicine eugenics studied inherited properties, their social manifestations and historical changes. Science eugenics gained wide circulation and recognition in 1920s in USSR. The ideas became popular that achievements of the Soviet health care, its preventive direction lead to creation of higher sanitary culture and realization of eugenic tasks for creation of the harmonious Soviet identity. Since the early 1930s in the Soviet Union the eugenics underwent severe criticism. The eugenic ideas were completely discredited by Nazi programs of fascist Germany in 1933-1945 when millions of people were exterminated. In the end of the 20th century interest in eugenics has renewed because of development of genetics.

Conclusion. Despite the ambiguous past, the eugenics had played a certain positive role as it allowed understanding genetic and anthropological human features, and served as an incentive for development of medical genetics and study of genetic diseases.

Вопрос обзора. Мы изучили, являются ли гомеопатические препараты эффективными и безопасными средствами профилактики и лечения острых инфекций дыхательных путей (ОИДП) у детей в сравнении с неактивным лечением (плацебо) или другими лекарствами.