MEDICO-BIOLOGICAL SCIENCES
ORIGINAL ARTICLES
ADDITIONAL QUANTITATIVE METHOD FOR ASSESSING THE SELF-STIMULATION RESPONSE OF THE LATERAL HYPOTHALAMUS, REFLECTING THE ACTIVITY OF THE REINFORCING SYSTEMS OF THE BRAIN
Shabanov P.D., Likhtman Ya.B., Lebedev A.A.
Abstract: Objective. To develop an additional objective quantitative method for assessing the addictiveness index based on the analysis of the effects of amphetamine, morphine and ethanol on self-stimulation of the lateral hypothalamus in rats. Methods. We used the method of self-stimulation of the lateral hypothalamus (unconditioned reinforcement) in Wistar rats to develop additional quantitative criteria for dependence on psychoactive drugs. All animals (n=78) were divided into several groups, which received intraperitoneal doses in 4 doses: 1) saline (control; 0.1; 0.2; 0.4; 0.8 ml/rat), 2) psychomotor stimulant amphetamine (phenamine) hydrochloride (0.5; 1; 2; 4 mg/kg); 3) narcotic analgesic morphine hydrochloride (1; 2; 4; 8 mg/kg), 4) ethanol (0.5; 1; 2; 4 g/kg). Results. When all the studied substances were administered, an increase in the number of pedal pressings was recorded, although it did not always depend on the dose. The dose dependence was recorded only after the administration of amphetamine, when the number of pedal presses increased to 33-66%. At the same time, the “mismatch coefficient” decreased from 0.60 to 0.34. Both of these indicators indicate that amphetamine activates the rewarding systems of the brain. Based on these indicators, the “addiction coefficient” was calculated, which also increased in direct proportion from 2.22±0.03 to 4.88±0.09 in comparison with the control (1.15±0.02). The effects of morphine and ethanol on self-stimulation were less pronounced, although in all cases an increase in the “addiction coefficient” was recorded: with the introduction of morphine up to 32-61%, with the introduction of ethanol - up to 68-142%. Conclusion. It is concluded that the “addiction coefficient” of a psychoactive substance as the ratio of the increase in pedal pressings to the value of the “mismatch coefficient” is advisable to use as an additional quantitative method in assessing self-stimulation of the lateral hypothalamus. The “addiction coefficient” depends on the initial level of self-stimulation and is most appropriate for comparison within a group of related psychoactive compounds, for example, separately among opiates, barbiturates, benzodiazepines, psychostimulants, rather than between different groups.
Keywords: self-stimulation reaction, quantitative assessment, addiction coefficient, pharmacological analysis, amphetamine, morphine, ethanol, rats
IMMUNOLOGICAL EFFECTIVENESS OF VACCINE PREVENTION OF CORONAVIRUS INFECTION
Gorelov A.V., Ploskireva A.A., Muzyka A.D., Ponezheva Zh.B., Ugleva S.V., Pogorelova O.O., Omarova H.G., Nikolaeva S.V., Usenko D.V., Maryin G.G., Medvedeva E.A.
Abstract: Objective. To evaluate the immunological effectiveness of vaccine prevention of coronavirus infection COVID-19 with the EpiVacCorona peptide vaccine. Methods. A prospective study was conducted from December 12, 2020 to May 15, 2021 at the Central Research Institute of Epidemiology of Rospotrebnadzor. The study involved 1,736 people. Vaccination was carried out twice (the interval between administration is from 14 to 21 days) with a peptide vaccine against COVID-19, developed by the State Scientific Center of Virology and Biotechnology “Vector” of Rospotrebnadzor, “EpiVacCorona” (registration number LP-006504). Extended follow-up observation was carried out for 807 vaccinated people. Before vaccination, all vaccinated people were examined by PCR for the presence of the SARS-CoV-2 virus in biological material. The antibody study was carried out by enzyme-linked immunosorbent assay (ELISA) with the determination of anti-SARS-CoV-2 (COVID-19) IgG antibodies to the nucleocapsid protein; chemiluminescent immunoassay (CHLA) with the determination of Anti-SARS-CoV-2 (COVID-19) IgG neutralizing antibodies to the receptor binding domain (RBD) of the S1 protein and Anti-SARS-CoV-2 (COVID-19) IgM. Results. The immunological effectiveness of vaccination is higher in females: on average, CP is 7.4±0.2 units, while in men it is 6.3±0.2 units. The value of the average CP is inversely proportional to age. A high titer (1:200) was characteristic of a significantly younger age (45.81±1.05 years), 1:100 - 48.45±0.6 years, 1:50 - 52.66±0.92 years, less than 1:50 - 54.51±0.74. Comparison of the average level of CP for different vaccination schemes showed a higher level of CP when vaccinated according to the scheme after 14 days, 7.7±0.2 IU, while with the vaccination scheme after 21 days, this figure was 6.6±0.2 IU. Vaccination tolerance was good in all vaccinated people. Conclusions. The analysis showed that the peptide vaccine against COVID-19, developed by the State Scientific Center for Virology and Biotechnology “Vector” of Rospotrebnadzor, showed good tolerability and immunogenicity. It was established that immunological effectiveness is higher in females and is characterized by an inverse relationship with age.
Keywords: coronavirus, vaccination, immunological effectiveness, EpiVacCorona
DYNAMICS OF THE ETIOLOGICAL STRUCTURE OF WOUND INFECTIONS AND MICROBIAL ASSESSMENT OF COLONIZATION OF INTERNAL ORGANS AS PREREQUISITES FOR IMPROVING ANTIBACTERIAL THERAPY
Sokolova T.F., Fominykh S.G., Shukil L.V., Razumovskaya A.A., Skonikov A.S.
Abstract: Objective. To evaluate the dynamics of the etiological structure and qualitative properties of wound pathogens in polytrauma victims, the massiveness and duration of colonization by microorganisms of the blood and internal organs of rats with traumas and wounds to improve antibiotic therapy. Methods. In the experiment, the microbial contamination of the internal organs of rats after injuries and wounds was studied; after the introduction of P. aeruginosa to animals, and a high risk of death in experimental traumatic disease associated with the presence of pseudomonas infection was shown. To clarify the etiological structure of wound infections and the contribution of P. aeruginosa to the structure of purulent-septic complications in patients with polytrauma in real clinical practice, bacteriological studies of wound discharge in patients with traumatic disease treated in 2014-2022 were carried out in the multidisciplinary hospital of emergency medical care in Omsk. The sensitivity of pathogens to antibiotics was determined by the disco-diffuse method on a Muller-Hinton medium in accordance with CLSI standards. Results. In the experiment, 1 day after the injury, the number of infected rats was 67.5%. The microbial contamination of the lungs, spleen, and liver of animals reached 40.3%. After 30 days, bacteremia was observed in every fifth, colonization of internal organs in every third, and brain in every sixth animal. Infection of injured animals with P. aeruginosa led to an abundant growth of pathogens in the lungs, liver, spleen, lymph nodes, and brain. Predominantly gram-negative bacteria (66.5%) were detected in the wound contents of polytrauma victims, while gram-positive bacteria accounted for 31.0%. The most common were E. coli, K. pneumonia, S. aureus, S. epidermidis, P. aeruginosa. E. coli was highly sensitive to cefoperazone/sulbactam, imipenem/cilastatin, meropenem, ertapenem, K. pneumonia - to polymyxin, S. aureus - to all antistaphylococcal agents, except benzylpenicillin. Conclusion. Experimental data revealed the absolute necessity of prescribing antibiotics in case of polytrauma. Due to the revealed features of the etiology and localization of infectious complications, the antimicrobial spectrum of etiotropic therapy should be wide, including P. aeruginosa. The leading pathogens of wound infections in real clinical practice were E. coli, K. pneumoniae S. aureus, S. epidermidis, P. aeruginosa.
Keywords: pathogens of wound infections, polytrauma, microbial colonization of internal organs, antibacterial therapy
EFFECT OF PLANT-BASED ADAPTOGENS ON PROFESSIONAL ATHLETES
Agaeva E.N., Mallaeva R.M., Khanakhmedova K.Sh.
Abstract: Objectives. To investigate the effect of adaptogens of plant origin (propolis and Rhodiola rosea extract, eleutherococcus) on the physical performance and functional state of professional athletes. Methods. The assessment of the physical performance of the subjects was carried out in a bicycle ergometric test of a stepwise increasing load. The effect of drugs in the following doses was studied: eleutherococcus extract - 1.0; 2.0; 3.0; 4.0 and 5.0 ml per day; rhodiola rosea - 0.2; 0.4; 0.6; and 0.8; propolis tincture - 0.5; 1.0 and 2.0 on physical performance and functional status of 20 male athletes, aged 20-28 years. The abilities were assessed by a cycling ergometric test of gradually increasing load with parallel control of gas exchange and acid-base equilibrium (ACR) of the subjects. The testing was performed twice with an interval of 27 days. Statistical data processing was performed using the Microsoft Excel 2010 program. Results. The analysis of the data obtained at three stages allows us to conclude that the maximum increase in the physical performance of athletes in the cycling ergometric test of a stepwise increasing load is achieved during the use of a combination of 0.4 ml/day of rhodiola rosea extract + 1 ml/day of propolis tincture + 2 ml/day of propolis tincture + 2 ml/day for 20 days extract of Eleutherococcus. Conclusion. Adaptogens have a rather serious complex effect on the body, helping it to protect itself from harmful effects, increasing the efficiency of certain systems, forcing it to more actively activate its own reserves.
Keywords: testing, adaptogen preparations, bicycle ergometric test, eleutherococcus extract, rodiola rosea, propolis tincture
REVIEWS
PHARMACOLOGICAL NEUROPROTECTION IN ISCHEMIC BRAIN LESIONS (PART 1. PHYSIOLOGICAL AND PATHOGENETIC TARGETS FOR PHARMACOLOGICAL NEUROPROTECTION)
Novikov V.E.
Abstract: Objective. Evaluation of the effectiveness of pharmacological neuroprotection and the prospects for its clinical use in ischemic brain lesions. Methods. Collection, systematization and analysis of literature data and the results of our own research on the experimental and clinical study of pharmacological neuroprotection in ischemic brain lesions. Results. The first part of the work presents an analysis of the results of scientific research on the physiological mechanisms of neuroprotection, as well as the main pathogenetic pathways of the ischemic cascade leading to structural and functional disorders in the central nervous system. It has been revealed that physiological neuroprotection is realized by induction of such processes as neuroplasticity and neurotrophy, the leading triggers of which are neurotrophic factors. The key factors of the ischemic cascade, acting as inducers of subsequent pathophysiological changes in brain structures and the development of neurotoxicity, are glutamate excitotoxicity and oxidative stress. At the same time, many researchers reasonably consider glutamate excitotoxicity to be the main cause of neuronal death in cerebral ischemia as a result of necrosis and apoptosis. There is a natural interest in medicines that can prevent the development or reduce glutamate excitotoxicity. Conclusion. The mechanisms of neuroplasticity and neurotrophy, as fundamental biological processes constantly occurring in the central nervous system, can be considered as physiological targets for pharmacological neuroprotection. Potential pathogenetic targets for pharmacological regulation in cerebral ischemia may be processes associated with the development of glutamate excitotoxicity and oxidative stress. The choice of physiological and pathogenetic targets for pharmacological neuroprotection is a promising direction in the development of pharmacotherapy strategies for ischemic brain lesions.
Keywords: pharmacological neuroprotection, glutamate excitotoxicity, oxidant stress, cerebral ischemia, pharmacological targets
MODERN APPROACHES TO THE PHARMACOTHERAPY OF NICOTINE ADDICTION
Novikov V.E., Zaleskaya A.N., Pozhilova E.V.
Abstract: Objective. Comparative evaluation of the effectiveness and safety of modern pharmacotherapy of nicotine addiction. Methods. Collection and analysis of the results of scientific research by domestic and foreign authors on the relevant issue. Results. For the pharmacotherapy of nicotine dependence, drugs of three groups are used: nicotine preparations (nicotine replacement therapy), nicotine receptor agonists (cytisine, varenicline) and psychotropic drugs (bupropion, fabomotizol). Each group of drugs has its own pharmacodynamic characteristics, which determines their effectiveness and safety when used to facilitate patients' withdrawal from tobacco use. Conclusion. The choice of approaches and means of pharmacotherapy for nicotine addiction is determined by the personal characteristics of the patient, including their motivation to quit smoking, the amount of tobacco products smoked, and the severity of withdrawal symptoms. All three groups of drugs facilitate the withdrawal from tobacco smoking. In terms of efficacy and safety, it is preferable to use nicotine receptor antagonist agonists.
Keywords: nicotine addiction, nicotine replacement therapy, cytisine, varenicline, bupropion, fabomotizol
CLINICAL MEDICINE
ORIGINAL ARTICLES
SURVIVAL OF PATIENTS WITH COVID-19 BY USING VARIOUS DRUGS
Yelistratov N.D., Rzhevtseva E.D., Tsvetnaya M.P., Safonova K.A., Dekhnich N.N., Punin A.A.
Abstract: Objective. To assess the survival of hospitalized patients with COVID-19 using recommended etiological, pathogenetic and antimicrobial therapy. Methods. Our approach is based on a case history of 385 patients of Smolensk Clinical Hospital №1 with confirmed coronavirus infection complicated with double pneumonia and admitted from June 1st to August 31st in 2021.The article gives a sample of patients treated with one or another medicinal product and calculates the survival rate for each sample. Results. The median duration of hospitalization was 17.4±0.5 days. The overall survival rate is 78.4% (n=302), the survival rate for patients with severe and extremely severe disease cases is 43.4% (n=36). Survival with the use of favipiravir does not differ significantly from survival without its use - 77.9% and 80.0% respectively (p=0.33). A discontinuation of treatment with glucocorticoids (dexamethasone) is a significant risk factor for dying from COVID-19 with severe and extremely severe cases (RR=1.9; 95% CI: 1.51-2.28). The survival rate of patients receiving olokizumab does not differ significantly from patients who did not receive this drug and is 73.6% and 80.8% respectively (p=0.06). The survival rate of patients receiving tocilizumab (50.0%) is significantly lower than that of patients not receiving the drug (79.5%, p < 0.01). The group of patients receiving low-molecular-weight heparin (enoxaparin, nadroparin) shows a high survival rate of 89.9% compared to the control group that does not receive heparin therapy (69.2%, p=0.02). When using unfractionated heparin, survival rate (75.8%) does not differ significantly from survival rate of patients without heparin therapy (p=0.3). The survival rate of patients receiving a course of selective factor Xa inhibitors (apixaban, rivaroxaban) is 85.7% (control group survival = 78.3%, p=0.3). The survival rate of people with various types of antimicrobial therapy does not differ significantly from other patients, with the exception for the group receiving meropenem and cefepime. Conclusion. Low-molecular-weight heparins (enoxaparin and nadroparin) are the most important pharmacotherapeutic agents for patient survival. The use of glucocorticoids (dexamethasone) significantly reduced the risk of death in patients with severe and extremely severe COVID-19.
Keywords: COVID-19, survival rates, medications
POLYMORPHIC VARIANTS OF THE VITAMIN D RECEPTOR GENE IN OSTEOARTHRITIS IN POSTMENOPAUSAL WOMEN
Ignatenko G.A., Reznichenko N.A., Fedulichev P.N., Maylyan E.A.
Abstract: Objective. The aim of the work was to study the associations of genotypes and alleles of rs1544410 and rs10735810 vitamin D receptor ( VDR ) gene polymorphisms in postmenopausal women with knee osteoarthritis. Methods. A total of 483 postmenopausal women were examined. The age of the examined women was 61.7±0.40 years and the duration of postmenopause was 13.1±0.39 years. A total of 157 patients were diagnosed with knee osteoarthritis. The remaining 326 conditionally healthy women made up the control group. Molecular genetic studies included the determination of rs1544410 and rs10735810 VDR gene polymorphisms. Results. It was found that the genotypes distribution of rs1544410 and rs10735810 polymorphisms corresponded to the Hardy-Weinberg law (p > 0,05). The occurrence frequency analysis of AA, AG and GG genotypes of the rs1544410 polymorphism showed the uneven genotypes distribution between the two selected groups - healthy women and the patients with osteoarthritis (p=0,008). The frequency of the rs1544410 polymorphism GG genotype registration was significantly higher in patients with osteoarthritis than among healthy women (OR=1.82; 95% CI: 1.24-2.68; p=0,003). In the group of the patients with osteoarthritis the G allele of the above polymorphism was detected significantly more often (OR=1.46; 95% CI: 1.10-1.94). Genetic rs10735810 VDR gene polymorphism showed no association with the development of osteoarthritis in women (p>0,05). Conclusion. Thus, an association of the genetic rs1544410 VDR gene polymorphism with osteoarthritis has been established in postmenopausal women. The obtained results can be used in determining the risk of osteoarthritis developing in women and in prescribing personalized therapeutic and preventive measures.
Keywords: women, postmenopause, osteoarthritis, polymorphisms, vitamin D receptor gene
CLINICAL AND FUNCTIONAL MARKERS OF HEPATOPULMONARY SYNDROME IN PATIENTS WITH CIRRHOSIS
Tsymbal A.S., Karnaushkina M.A., Arisheva O.S., Kobalava Zh.D., Mirilashvili T.Sh., Garmash I.V., Strutynskaya A.D., Viveros Milena
Abstract: Objective. Hepatopulmonary syndrome (HPS) is a complication found in patients with chronic liver disease, the only treatment for which is liver transplantation. As one of the main diagnostic criteria for the diagnosis of HPS, data from an invasive, expensive study - echocardiography with intravenous contrast, which is available only in some clinical centers in Russia, are used. In this regard, it is necessary to search for simpler methods and markers for the diagnosis of this syndrome. Methods. A prospective study was conducted at the Department of Internal Medicine with a Course of Cardiology and Functional Diagnostics of V.S. Moiseev Russian Friendship University from October 2022 to May 2023. The study included 91 patients with cirrhosis of the liver. All patients underwent a comprehensive clinical and instrumental examination. In the presence of a combination of three signs (orthodoxia, platypnea and alveolar-arterial oxygen gradient (AaO2) ≥15 mmHg (or ≥20 mmHg if over 64 years of age and hypoxemia), a probable HPS diagnosis was established. Results. The diagnosis of probable HPS was established in 19 patients (21%), according to the selected criteria. It was revealed that in patients with probable HPS, the level of Sat O2 (p < 0.001), fibrinogen (p < 0.01) was significantly lower than in patients without this syndrome (p=0.014). The Child-Pugh and MELD scores were higher in patients with probable HPS (p < 0.05). All patients underwent a 6-minute walking test (T6MX). It was positive in 78.9% of patients with probable HPS, which is significantly higher than in patients without GPS (4.2%). Conclusion. In the course of the study, it was demonstrated that T6MX makes it possible to suspect a probable HPS without using echocardiography with contrast. Markers of probable HPS have been identified: Sat O2, PaO2, AaO2, MELD scores, the presence of nevi. There were no differences in hospital mortality in patients with and without probable GPS.
Keywords: hepatopulmonary syndromem, cirrhosis, orthodoxy, platypnea, six-minute walk test, MELD score
CLINICAL CASE OF MYOCARDIAL INFARCTION IN A WOMAN UNDER 50 YEARS OLD WITH DIABETES MELLITUS
Arshavskaya A.S., Agibalov D.A., Bazina I.B., Kozyrev O.A., Molotkova S.A., Shilina A.A.
Abstract: Objective. To present the case history of a patient with myocardial infarction developed against a background of uncontrolled type 2 diabetes mellitus (T2DM) combined with chronic kidney disease (CKD), arterial hypertension (AH) and a COVID-19 survivor. Methods. The article analyzes in detail the history and causes of myocardial infarction in a woman under 50 years old with fatal outcome against the background of uncontrolled diabetes mellitus (DM). The materials of the inpatient card, results of clinical, laboratory and instrumental methods of examination were analyzed. The domestic and foreign literature on the problem of the course of coronary heart disease with DM and AH was analyzed. Results. We presented a case of undiagnosed diabetes mellitus, which together with other risk factors led to the development of myocardial infarction with subsequent recurrence and fatal outcome. Uncontrolled diabetes mellitus combined with chronic kidney disease, arterial hypertension and COVID-19 should be considered one of the most important risk factors for a severe course of the disease. Such patients represent a group of patients at a very high risk of cardiovascular disease (CVD) and cardiovascular mortality. Patients require not only early diagnosis of these diseases, but also timely identification of risk factors for the development and progression of CHD for adequate correction in order to reduce cardiovascular risk. Conclusion. The presented case demonstrates the importance of timely diagnosis and treatment of diabetes mellitus, AH and CKD, which without adequate therapy is characterized by an unfavorable prognosis for the patient. In this clinical case, the patient was not treated for diabetes mellitus either before or after hospitalization. The combination of this disease with other risk factors resulted in myocardial infarction with subsequent recurrence and death.
Keywords: myocardial infarction, thrombosis, diabetes mellitus, arterial hypertension
RHEOENCEPHALOGRAPHY INDICATORS OF CHILDREN WHO HAVE SUFFERED CHRONIC INTRAUTERINE HYPOXIA AND WERE BROUGHT UP IN SOCIAL INSTITUTIONS
Shestakova V.N., Udovenko A.A., Sosin D.V., Evseev A.V., Glushchenko V.A., Indyukova E.D., Lyamets L.L.
Abstract: Objective. To identify the features of cerebral blood flow in children aged 7-11 years living in social institutions for minors who have suffered chronic intrauterine hypoxia in the antenatal period. Methods. The children of the orphanage aged 7-11 years (n=75) were taken for the study. Of these, 45 children who experienced chronic intrauterine hypoxia made up the main group, the comparison group included 30 children without a history of chronic intrauterine hypoxia. The assessment of cerebral hemodynamics was based on REG data recorded at rest and in a sitting position on the device "REO-SPECTRUM-3 6-channel computer rheograph". Statistical analysis was carried out using application programs on a personal computer. Results. As a result of the examination in children of both groups, the rheographic index in FMD and FMS leads in the main group was significantly lower than in the comparison group. There were no significant differences in this indicator in OMD and OMS leads between the main group and the comparison group. At the same time, a significantly more frequent decrease in pulse blood filling in the basin of the internal carotid arteries on the right and left was revealed in the main group compared with the comparison group. In the vertebral artery basin, a decrease in pulse blood filling is significantly more often observed only on the left, while no significant differences were found on the right. At the same time, the value of the amplitude-frequency index in the main group in the FMD and FMS leads is significantly lower than in the comparison group, and no significant differences were found in the OMD and OMS leads. The coefficient of asymmetry in FMD/FMS and OMD/OMS leads in the main group is significantly higher than in the comparison group, and significant asymmetry of blood filling in both basins of the internal carotid arteries and vertebral arteries in the main group is also significantly more often detected than in the comparison group. The dicrotic index in the main group is significantly higher in all leads than in the comparison group. The venous outflow index in the FMD, FMS and OMS leads was significantly higher in the main group than in the comparison group, and no significant differences were found in the OMD lead. In parallel, in the main group, obstruction of venous outflow in both basins of the internal carotid arteries and vertebral arteries on the right and left was significantly more often diagnosed than in the comparison group. The rate of rapid blood filling in the FMD and FMS leads is significantly lower, and in the OMD lead is significantly higher than in the comparison group. According to the OMS lead, no significant differences in the indicator were found. At the same time, it was revealed that significantly more often in the main group, the tone of the distribution arteries was increased in the basin of the internal carotid arteries on the right and left than in the comparison group, while in the basin of the vertebral arteries, there were no significant differences in the increase or decrease in the tone of the arteries on the right and left between the two groups. The rate of slow blood filling in the FMD and FMS leads is significantly lower in the main group than in the comparison group, and in the OMD and OMS leads, the indicator value does not significantly differ. An increase in the tone of the resistance arteries in the basin of the internal carotid arteries on the right and left was significantly more often detected in the main group than in the comparison group. There was also a significantly more frequent increase in the tone of the resistance arteries in the right vertebral artery basin in children of the main group, although there were no significant differences in the rate of slow blood filling in the OMD and OMS leads. There were no significant differences in the value of the modulus of elasticity in all leads between the two groups. Although significantly more deviations from the norm in the elastic properties of the arteries were detected in the basin of the internal carotid artery on the left in the main group than in the comparison group. In the basin of the vertebral arteries on the right and left, as well as in the basin of the internal carotid artery on the right, there were no significant differences between the two groups in the elastic properties of the arteries. Conclusions. In children with a history of chronic intrauterine hypoxia, features of cerebral blood flow were revealed, which mainly concern the basin of the internal carotid arteries. They had a decrease in the intensity of blood filling in the basin of the internal carotid arteries, which is confirmed by lower values of the rheographic index and a higher frequency of manifestations in comparison with children without chronic intrauterine hypoxia. At the same time, an increase in the tone of the distribution and resistance arteries in the basin of the internal carotid arteries on the right and left is characteristic, with lower rates of rapid and slow blood filling. At the same time, there was a violation of the elastic properties of the arteries only on the left in the basin of the internal carotid arteries. For such children, pronounced interhemispheric asymmetry is also characteristic. And there is also a more pronounced tendency to the occurrence of chronic cerebral circulatory disorders of the angiospastic type with values of REG indicators characteristic of the hypertensive type, especially for the basin of the internal carotid arteries.
Keywords: children of the initial stage of education, chronic intrauterine hypoxia, REG indicators
INDICATORS OF THE STRESS LEVEL CONTROL SYSTEM IN PRIMARY SCHOOL-AGE CHILDREN WHO HAVE SUFFERED CHRONIC INTRAUTERINE FETAL HYPOXIA AND WERE BROUGHT UP IN SOCIAL INSTITUTIONS
Sosin D.V., Udovenko A.A., Shestakova V.N., Evseev A.V., Glushchenko V.A., Indyukova E.D., Volkova E.A., Lyamets L.L.
Abstract: Objective. To study the features of the psychophysiological state of the central nervous system using the "Stress level control system" in primary school-age children from social institutions who have suffered chronic hypoxia in the antenatal period. Methods. Children aged 7-11 years living in a social institution were examined (n=75). Of these, 45 formed the main group, which included children with chronic intrauterine fetal hypoxia, the remaining 30 primary school-age children formed a comparison group that did not experience chronic hypoxia during the mother's pregnancy. The study was conducted using the software module "Stress level control system", designed for psychophysiological research, including the presentation of visual stimuli and measurement of reaction speed, determination of functional readiness, as part of the hardware and software complex «Health-Express». Statistical analysis was carried out using application programs on a personal computer. Results. As a result of the examination, it was found that in the group of children who underwent chronic intrauterine hypoxia in the antenatal period, the average value of the functional level of the central nervous system, reaction stability and functional capabilities was significantly lower than in the comparison group (p=0.01). In children of the comparison group, the indicators of the functional level of the central nervous system, reaction stability and the level of functional capabilities are more often higher than in the main group and above average values, while in the main observation group the indicators are below average and low values. Above the average level, reaction stability was significantly more common in the comparison group (p=0.01), while low reaction stability was significantly more common in the main group (p=0.03). Conclusions. The revealed features when using the "Stress level control system" in children with chronic intrauterine fetal hypoxia indicate a lower level of excitability of the central nervous system, which is expressed in a decrease in voluntary reaction in such children. Lower values combined with a higher frequency for low stability of reactions demonstrate insufficient stability of the functional state of the central nervous system among children who have suffered chronic intrauterine hypoxia, expressed in stronger fluctuations in attention. The level of functional capabilities at reduced average values with a simultaneously pronounced frequency of low indicators of this category of children indicates a lower efficiency of their nervous system and a violation of adaptive capabilities.
Keywords: primary school children, chronic intrauterine fetal hypoxia, stress level indicators, sensorimotor reactions
MЕDICAL AND SOCIAL ASSISTANCE TO CERTAIN CATEGORIES OF DISADVANTAGED FAMILIES WITH CHILDREN
Bogdanyants M.V., Bezrukova D.A., Shmeleva A.Yu., Krivenko I.V., Zakaryaeva M.M., Minakova G.M.
Abstract: Objective. To study the categories of families registered in the medical and social assistance office of the children's polyclinic, to identify the dominant risk factors and to assess the dynamics for 2020-2022. Methods. A complete study with a mathematical and statistical analysis of performance indicators based on primary accounting and reporting medical documentation was applied. Tabular and graphical methods, calculation of absolute and relative values, data processing in the Microsoft Excel spreadsheet environment were used. Results. The categories of families registered in the office of medical and social assistance were studied. It was found that the largest number of families - 73.9% of the total number, falls on the share of families in a difficult life situation. Families with children under guardianship (12.7 per cent) and families at risk (11.3 per cent) occupy the second and third places. Families with a disabled child occupy the fourth place - 2.1%. It is noted that in 2022 the number of dysfunctional families decreased in comparison with 2021 and 2020 by 11.3% and 26.4% respectively. The dominant risk factors for children in each category of families were identified. Conclusion. Health care for disadvantaged families should be improved, carried out comprehensively, but individualized, taking into account factors that negatively affect the health of the child.
Keywords: dysfunctional family, children, medical and social assistance, family categories, risk factors
CLINICAL OBSERVATION OF A FAMILIAL CASE OF NAIL-PATELLA SYNDROME
Kolcheva Yu.A., Lebedeva N.V., Arinkina A.O., Evsyukova T.A., Adrianov A.V.
Abstract: Objective. The purpose of this work was to analyze the features of the course of nail-patella syndrome in a 4-year-old child, the principles of diagnosis, and the assessment of genealogical history. Methods. We present a clinical case of Phong's disease in a 4-year-old girl. The existing clinical symptoms, results of additional examinations, life history data, and illnesses were analyzed. The course of the hereditary syndrome was traced over several generations. Foreign and domestic literature sources are analyzed. Measures are given to prevent the occurrence of severe complications accompanying this syndrome. Results. We present a clinical case of familial nail-patella syndrome. The genetic basis of this syndrome leads to significant variability in clinical manifestations, and therefore the syndrome may remain unrecognized for many generations. Systemic manifestations of the disease can masquerade as other diseases and, as a result, lead to improper therapy. We have developed a diagnostic search algorithm for identifying this syndrome in children. Conclusions.The clinical case we presented is of great importance for specialists in various fields, since it describes a rare combination of orthopedic pathology with systemic manifestations and the development of myopathic syndrome. For the greatest effectiveness of ongoing rehabilitation measures, it is important to use a multidisciplinary approach. Genetic counseling should be recommended for all patients suspected of having this syndrome, and screening for serious complications is important.
Keywords: nail-patella syndrome, Phong's disease, osteoonychodysplasia, myopathy
DYNAMICS OF THE HEALTH OF CHILDREN IN THE ORPHANAGE HOME IN ASTRAKHAN
Inozemtsova O.A., Burova O.I., Antonova A.A., Kashirskaya E.I., Kuznetsova A.G., Yamanova G.A.
Abstract: Objective. To study the features of the structure and dynamics of diseases among children in an orphanage for the period from 2020 to 2022. Methods. The study was conducted on the basis of the state government institution of the Astrakhan region «Specialized Children's Home «Kapelka» in Astrakhan. The structure and dynamics of nosological disorders in children were assessed according to the annual reports of the State Public Institution of JSC SDR Kapelka for the period from 2020 to 2022. Statistical processing of materials was carried out using the statistical software package STATISTICA 6.1 (StatSoft Russia, Russia), as well as Microsoft Excel, version 16.68 (Microsoft Corporation, USA). Results. For 3 years, a high level of morbidity among children has persisted. The highest morbidity rates were observed by class: respiratory diseases, congenital anomalies, chromosomal disorders, central nervous system, endocrine system diseases, nutritional disorders and metabolic disorders. Conclusion. The data obtained indicate a consistently high level and unchanged structure of general morbidity among orphans and children left without parental care, brought up in a specialized home. However, the observed upward trend in chronic and congenital pathologies over the past three years requires dynamic monitoring and the adoption of measures aimed at the prevention of these diseases and comprehensive rehabilitation from the first days of stay in the institution.
Keywords: orphans, specialized children's home, morbidity
FEATURES OF THE PHENOTYPIC PROFILE OF BRONCHIAL ASTHMA IN CHILDREN
Stroykova T.R., Bashkina O.A.
Abstract: Objective. Determining the clinical phenotype of AD is an important point for a personalized approach to patient management tactics. The main characteristics and concomitant conditions that are taken into account during phenotyping include determining the time of onset of the disease, age characteristics, the presence or absence of atopy in the family Methods. The study included 268 children aged 2 years 11 months to 17 years 11 months, with a verified diagnosis of atopic bronchial asthma of varying severity. Outpatient and inpatient medical records of patients were studied, and the analysis of clinical and anamnestic data of children was carried out. Statistical analysis of the data was carried out using the program "Statistica for Windows" 10.0 using nonparametric methods. Results. The absence of an associative relationship between gender and severity of the disease. chronic extragenital pathology in the mother was determined by us as a predictor of severe phenotype df=2, χ2=5.9, p < 0.05, the presence of bronchial asthma in the mother and allergopathology in relatives is a predictor of the phenotype of severe bronchial asthma (df=2, χ2 =9.369, p =0.01, df=2 OR - 3.485, DI 1,036-11.724, χ2 = 24.920, p = 0.01 OR - 5.722, DI 2.455-13.340). The high frequency of bronchoobstructive syndrome can be traced from early df= 2, χ2 = 9.519, p=0.01 to the preschool period (df= 2 χ2 = 13.538, p=0.01 OR=1.655, DI 0.5-4.0). Conclusion. Predictors of the severe phenotype of the disease are chronic extragenital pathology in the mother, high incidence of bronchoobstructive syndrome in early childhood, polyvalent sensitization, and comorbid diseases in the family and the severe phenotype was characterized by polyvalent sensitization.
Keywords: bronchial asthma, phenotype, severity, children
METHOD FOR DETERMINING INSULIN RESISTANCE INDEX
Zinchuk V.V., Al-Jebur J.Sh.O., Glutkina N.V., Padapryhara M.V., Zinchuk Vl.V.
Abstract: Objective. Development of a new method for determining the insulin resistance index. Methods. The studies were conducted on males in the age range of 45-60 years with different body weights. Blood sampling was carried out in the following groups: healthy, with insulin resistance with normal and overweight, with type 2 diabetes mellitus with normal and overweight. In the obtained blood plasma samples, the concentration of the hormone asprosin was determined using enzyme immunoassay. In addition, the concentrations of insulin, glucose and glycated hemoglobin were measured. To assess insulin resistance, the standard method for calculating the HOMA-IR index was used. Results. These patients were characterized by significant disturbances in carbohydrate metabolism in comparison with healthy ones. There was an increased content of insulin, glycated hemoglobin and a higher value of the HOMA-IR insulin resistance index. We propose to calculate the IR index (HOMA-AS) based on determining the concentration of insulin, glucose and asprosin in the blood plasma with subsequent calculation of its value using the formula: HOMA-AS= [insulin (μU/ml) × glucose (μmol/l) × asprosin (pmol/l]/225. The values of the insulin resistance index were calculated using the standard and our proposed methods. According to the calculations carried out to determine the IR index using the proposed method, the following values were obtained: in healthy people 1.06 (0.92; 1.22), in cases of carbohydrate metabolism disorders (CI) with normal - 6.23 (5.44; 6 .97) and overweight - 21.92 (19.92; 23.88), and for T2DM with normal - 36.70 (34.13; 40.03) and overweight - 76.95 (65. 69; 90.63). The obtained high values of the correlation coefficient between the proposed insulin resistance index and its value determined using the standard method reflect the close relationship between these parameters. Conclusions. The proposed method makes it possible to determine the severity of carbohydrate metabolism disorders, namely, insulin resistance, and can be used to assess its degree.
Keywords: insulin, asprosin, insulin resistance
ROLE OF THE ENVIRONMENT IN THE PREVALENCE OF ENDEMIC GOITER IN THE POPULATION
Karaeva A.F., Mollaeva N.P., Ovchinnikova M.A., Minatulaeva A.T., Azbalaeva M.S., Adilova M.A., Salikhov Sh.K., Yahiyaev M.A.
Abstract: Objectives. The work is devoted to the study of the geochemical role of Zn, Cu, Mn, Co in the development of endemic goiter in the population of Dagestan. Methods. The data source for the number of patients diagnosed with endemic goiter was the indicators of the RMIAC of the Ministry of Health of Dagestan. The content of Zn, Cu, Mn, Co in soils was determined by the AAC method on Hitachi 170-70. Results. The number of patients diagnosed with endemic goiter in Kizlyar, Kizilyurt, Khasavyurt and Babayurt districts was 1.53; 3.55; 3.87; 5.7% of the population. An analysis of the relationship between the number of patients diagnosed with endemic goiter and the level of elements (Zn, Cu, Mn, Co) in soils showed that low levels of Zn, Cu, Co and high Mn content in soils affect the morbidity and mortality of this pathology in the population of lowland Dagestan. A high positive correlation was found for Mn and a high negative correlation for Zn, Cu, Co with the pathology of endemic goiter. Conclusion. In addition to iodine, Zn, Cu, Mn, Co, which affect the functioning of the thyroid gland, participate in the etiology of endemic goiter. Due to the fact that the content of elements in the diet is due to the geochemical status of the territory where food was grown, the import of agricultural products from other regions of the world is practiced at the state level. In addition, the enrichment of missing elements of water and food on an industrial scale is practiced.
Keywords: surrounding environment, soil, Zn, Cu, Mn, Co, endemic goiter
CHRONIC ACTIVE EPSTEIN-BARR VIRAL INFECTION: MODERN PATHOGENETICALLY BASED APPROACHES TO TREATMENT
Emelyanov A.S., Emelyanova A.N., Ponomareva A.A., Muratova E.A.
Abstract: Objective. The aim was to study the effectiveness of a combination of antiviral drugs in patients with reactivation of chronic Epstein-Barr viral infection. Methods. In order to assess the functional activity of immunocompetent cells at various stages of disease, the antiviral therapy was evaluated in terms of the rate of lymphocyte-platelet adhesion (LPA). Results. In patients with reactivation of CHEBVI, a convincing tendency towards faster relief of the entire symptom complex was revealed when differential antiviral drugs were included in the basic therapy: Panavir® and meglumine acridone acetate (Cycloferon®). In the patients of the main group, the duration of manifestations of tonsillitis syndrome, enlargement and pain of peripheral lymph nodes, hepatomegaly, and the duration of the febrile period were significantly shorter. It was established that in patients receiving panavir+cycloferon, the number of outlet-forming lymphocytes increased to 11.9±1,2%, which is by 1.2 times more compared to the group taking acyclovir (8,9±0,9%). Conclusion. The use of panavir and cycloferon for EBVI was accompanied not only by a therapeutic effect but also the normalization of LPA indices which reflected stabilization of the pathological process and, accordingly, indicated a greater effectiveness of the therapy carried out with this antiviral drug.
Keywords: chronic Epstein-Barr viral infection, therapy of chronic EBVI, antiviral drugs, lymphocyte-platelet adhesion
MYASTHENIC CRISIS AT THE ONSET OF MYASTHENIA GRAVIS AFTER BOTULINUM THERAPY
Ramazanov G.R., Akhmatkhanova L.Kh.-B., Korigova Kh.V., Shevchenko E.V., Sinkin M.V., Aliev I.S., Kovaleva E.A.
Abstract: Objective. Raising awareness among doctors about the side effects and complications of botulinum therapy. Methods. In June 2023 at the Research Institute of SP named after. N.V. Sklifosovsky a clinical case of myasthenic crisis at the onset of myasthenia gravis after botulinum therapy was registered. Results. This article is devoted to the experience of treating myasthenic crisis resulting from the use of botulinum toxin type A (BTA) for cosmetic purposes. Conclusion. The treatment of various neurological diseases, in particular hyperkinetic syndromes, spasticity and migraines using botulinum toxin has revolutionized. However, patients receiving botulinum therapy may experience unwanted side effects in the form of neuroophthalmic syndrome, and in compromised individuals, the manifestation of myasthenia gravis. In clinical practice, before performing botulinum therapy, one should determine the indications for the procedure and remember possible complications, carry out a thorough history taking and examination to identify clinical symptoms that allow one to suspect latent myasthenia gravis.
Keywords: myasthenia, botulinum therapy, plasmapheresis
DIFFERENTIAL DIAGNOSIS OF SMALL CELL CANCER AND LUNG ABSCESSES BY DETERMINING PARAMETERS OF PULMONARY BLOOD FLOW WITH DYNAMIC COMPUTED TOMOGRAPHY
Khafizov M.M., Baikov D.E., Akhmadeeva L.R., Baikova G.V., Khafizova R.R.
Abstract: Objective. Analysis of the potential effectiveness of perfusion CT in the differential diagnosis between malignant neoplasms and lung abscesses. Particular attention is paid to the potential of this method in identifying key diagnostic features that can contribute to the early detection and differentiation of these diseases, as well as in assessing its advantages and limitations in comparison with other diagnostic approaches. The article reviews clinical cases demonstrating the potential of perfusion CT in improving the quality of differential diagnosis between pulmonary consolidation of inflammatory and malignant etiologies, which, in turn, can significantly affect the choice of treatment strategy and prognosis for patients. Methods. A retrospective analysis of studies of perfusion blood flow in patients with malignant tumors and lung abscesses, verified by histological examination of biopsy material, was carried out. Results. The study provided significant data regarding perfusion CT in the context of the differential diagnosis of small cell carcinoma and lung abscesses. The results indicate that perfusion characteristics can serve as important indicators for distinguishing between these two diseases, which has high clinical relevance. Conclusion. Perfusion CT is an important tool for the differential diagnosis between small cell carcinoma and lung abscesses, allowing more accurate planning of therapeutic and surgical treatment approaches based on objective quantitative measurements of perfusion.
Keywords: contrast-enhanced computed tomography, lung abscess, lung malignancies
COMBINED METHOD OF TREATING PATIENTS WITH TRANSCONDYLAR EXTENSOR FRACTURES OF THE HUMERUS WITH UNRESOLVED DISPLACEMENT
Skvortsov A.P., Andreev P.S., Khabibyanov R.Ya.
Abstract: Objective. Development of a treatment method for patients with transcondylar extensor fractures of the humerus with unresolved displacement, the presence of significant edema and epidermal blisters. Methods. In the Department of Pediatric Traumatology and Orthopedics of our clinic, for more than 30 years, a combined method of treating patients with transcondylar extensor fractures of the humerus with unresolved displacement, the presence of significant edema and epidermal blisters has been successfully used. The essence of the development is to combine the method of short-term skeletal traction to eliminate the displacement of fragments and epithelialization of epidermal blisters. After the achieved reposition of the fragments, without removing the limb from skeletal traction, subsequent fixation of the fracture area is performed with Kirschner wires. Results. The reason for unsuccessful reductions of transcondylar extensor fractures of the humerus in patients admitted for treatment in most cases was unresolved rotational displacement during the initial visit to a traumatologist at the place of residence. Using skeletal traction in our clinic, it was eliminated within 4-5 days. Relief of significant edema and epithelization of epidermal blisters also occurred at these times, which made it possible to perform osteosynthesis with wires. An analysis of the immediate and long-term results of treatment of 68 pediatric patients showed that the developed method of treatment significantly reduces the time of treatment in the hospital. The ease of implementation and the positive results obtained in treating this category of patients allow us to recommend the developed method of treatment for widespread use in the clinical network. Conclusion. The duration of skeletal traction as a treatment method is reduced by 4-5 times. Achieving elimination of fragment displacement in combination with further cruciate fixation of the fracture with two Kirschner wires allows us to recommend the proposed method for wide practical use in patients with transcondylar extensor fractures of the humerus with unresolved displacement and the presence of significant edema and multiple epidermal blisters.
Keywords: transcondylar fractures of the humerus, rotational displacement, epidermal blisters, Kirschner wire
COMBINED METHOD OF SURGICAL TREATMENT OF RHIZARTHROSIS
Fartdinov M.F., Mullin R.I., Pankov I.O.
Abstract: Objective. The search for a new minimally invasive method of surgical treatment of risarthrosis. Methods. In the period from 2016 to 2023, on the basis of the Department of Traumatology N2 of the Republican Clinical Hospital of Kazan, 28 patients with varying degrees of osteoarthritis of the 1st carpometacarpal joint were treated. Based on modern pathophysiological data on the development of osteoarthritis, we have proposed a new minimally invasive method of surgical treatment of osteoarthritis. The results were evaluated using a visually painful analog scale and a DASH questionnaire. Results. All patients were treated according to the method we proposed. The depth of the study was 1 year and showed good results at the 1st and 2nd radiological stages of osteoarthritis of the 1st carpometacarpal joint of the hand. At stages 3 and 4, a recurrence of the pain syndrome occurred by the 6th month, but had a lower intensity. Conclusion. Thus, our proposed method is a promising and minimally invasive method of treating osteoarthritis, justified from the point of view of the pathophysiology of osteoarthritis, helps to reduce pain and restore hand activity at stages 1 and 2 of the disease according to the classification of R.G. Eaton. At stages 3 and 4, this type of minimally invasive surgical treatment has a short-term therapeutic effect.
Keywords: osteoarthritis, and surgery, arpometacarpal joint, latelet-rich plasma, PRP
CURRENT TRENDS IN EARLY DIAGNOSIS AND PREVENTION OF THROMBOEMBOLIC COMPLICATIONS IN SEVERE MULTIPLE LIMB BONE FRACTURES
Sirazitdinov S.D., Pankov I.O., Vasiliev A.D.
Abstract: Objective. Reducing the risk of thromboembolic complications in patients with severe multiple limb bone fractures. Methods. In order to assess the immediate results of treatment of victims with severe multiple fractures of limb bones, all patients were divided into the main group and the comparison group. The authors present a perfect technique developed for the purpose of early prediction of the development of hemostasis disorders to reduce the risk of thromboembolic complications. Clinical examples and correlations with standard laboratory tests are considered. The effectiveness of this technique has been proven. Results. The use of the «Thrombodynamics» test for predicting and preventing the development of thromboembolic complications in patients in the main group made it possible to diagnose the development of thromboembolic complications in time, carry out timely and adequate drug correction of hemocoagulation, and prevent the development of fatal complications in all victims with severe multiple fractures of the extremities of the main group. Conclusions. The developed scheme of drug prophylaxis with low molecular weight heparins in severe multiple fractures of limb bones, using data from the laboratory analysis «Thrombodynamics», helps to prevent the development of thromboembolic complications.
Keywords: hemostasis disorder, traumatic disease, thromboembolic complications, severe multiple fractures of limb bones, laboratory test «Thrombodynamics»
REVIEWS
LONG-TERM RISK FACTORS FOR CEREBROVASCULAR COMPLICATIONS IN CANCER PATIENTS WHO HAVE RECEIVED RADIATION THERAPY
Meshkov N.A., Solodkiy V.A., Kulikova T.A.
Abstract: Objective. To analyze Russian and foreign research papers to understand the causes and estimate the probability of cerebrovascular complications of radiation therapy in cancer patients arising in the long term. Methods. We searched for relevant research papers in PubMed/MEDLINE, CrossRef. eLIBRARY/Russian Science Citation Index and CyberLeninka using the following key words: cancer, cerebrovascular complications, radiation therapy, age, and radiation dosage. We reviewed 85 research articles, selected 42 research papers, 12 of which met the entry criteria, and used Microsoft Excel 2016 for statistical processing. The probability of stroke after radiation therapy was estimated using relative risk and 95% confidence intervals. We looked for correlations between variables using the correlation and regression analysis and chose the c²criterion for assessing the significance of difference. The difference was considered statistically significant at p < 0.05. Results. Depending on the area exposed to radiation and cancer type, the highest risk of stroke in patients who received radiation compared to the non-irradiated group was found in patients with Hodgkin lymphoma (54.86; p < 0.001). The risks in patients who underwent radiotherapy to the head receiving doses of 22 Gy and 50 Gy were 8.68 (p=0.014) and 7.93 (p < 0.001), respectively. The risk of stroke in patients with Hodgkin lymphoma and lung cancer was 1.7 (p=0.029) and 3.17 (p=0.009) times higher than in patients who received cranial radiotherapy in childhood. After comparing patients who underwent cranial radiotherapy and received different doses, we found that the risk of stroke in those who received a dose of 64.14 Gy was 2.25 (p=0.003) and 3.51 (p < 0.001) times higher than in those who received doses of 22 Gy and 50 Gy, respectively. Conclusion. Prevention of the long-term consequences of radiation exposure and reduction of their incidence is still an issue that needs to be addressed by developing up-to-date, targeted diagnosis, prevention and treatment strategies for patients with a high risk of cerebrovascular diseases.
Keywords: cancer, cerebrovascular complications, radiation therapy, age, radiation dosage
PECULIARITIES OF PEROXIDATION AND ANTIOXIDANT STATUS IN THE PATHOGENESIS OF CHRONIC PANCREATITIS
Akulyonok E.V., Ivanishkina E.V., Nankevich I.N., Abbasov R.R.
Abstract: Objective. To analyse modern literature data of scientific researches concerning the functional state of lipid peroxidation system - antioxidant protection structure and function of cell membranes in the aspect of chronic pancreatitis without dependence on the etiological variant considering the efficacy of antioxidant therapy. Methods. The review is based on the analysis of literature sources of scientific electronic libraries "PubMed", "Scopus", "eLibrary". Sampled publications are relevant to the topic and represent the data of significant Russian and foreign research of the last decade. Results. The conducted research revealed a tendency of increasing researcher interest in the problem of mechanisms and processes of lipid peroxidation and antioxidant action in the antioxidant protection system in the pathogenesis of chronic pancreatitis with the validity of the use of antioxidant medications in the complex therapy of various forms of the disease. Laboratory indicators of metabolic disorders due to oxidative stress, mechanism of oxidative endotoxicosis with peculiarities of prevention of structural changes in glandular and vascular components of the pancreas were assessed. Conclusions. Lipid peroxidation, occurring under conditions of decreased antioxidant defense of the organism, is involved in the pathogenesis of chronic pancreatitis due to the development of peroxidation syndrome, damage to lipids of pancreatic membranes with decreased levels of antioxidant thiols, carotinoids and lycopene, folate and vitamin B12, leading to the formation of pancreatic insufficiency. The prescription of antioxidants is promising; however, their routine application as a part of complex therapy requires expansion of the evidence base of multicenter studies.
Keywords: chronic pancreatitis, lipid peroxidation, glutathione system, oxidative stress, free radicals, dysmetabolic disorders
EPIDEMIOLOGICAL ASPECTS OF MODERN INFECTIVE ENDOCARDITIS
Danilov A.I., Skotnikov A.S., Melnik M.V., Slivkin M.D.
Abstract: Objective. To highlight the current trends in the epidemiology of infective endocarditis (IE). Methods. Based on the conducted studies, the most significant epidemiological aspects of infectious endocarditis are presented. Results. The incidence of IE varies from 46.3 to 150 people per 1 million inhabitants per year, increasing with age (in people over 50 years old - 150 cases, and in people over 80 years old - 220 cases per 1 million people). The share of primary IE has been growing in recent decades. Among the heart diseases predisposing to the development of secondary IE, there is an increase in the role of prosthetic heart valves and degenerative heart defects in the elderly. According to national statistics in 2010-2020, the hospital mortality rate from IE was 23.1%, in Moscow - 34.7%). Conclusions. The increase in the incidence of IE is due to an increase in the number of cardiac surgical interventions and other invasive medical procedures (installation of vascular catheters and performing therapeutic/diagnostic manipulations). In addition, a high proportion of IE associated with intravenous drug use remains in a number of countries.
Keywords: infective endocarditis, epidemiology, risk factors, valvular heart apparatus
PHARMACEUTICAL SCIENCES
ORIGINAL ARTICLES
DEVELOPMENT OF METHODS FOR ISOLATING CARBAMAZEPINE FROM BIOLOGICAL OBJECTS
Habieva N.A., Lyust E.N., Timerzyanov M.I.
Abstract: Objective. To develop methods for isolating carbamazepine from biological fluids (blood serum, urine) and biological tissues (liver, kidney). Methods. To study the extraction of carbamazepine from aqueous solutions, a liquid-liquid extraction method was used on standard carbamazepine solutions with a concentration of 10 mcg/ml. Organic solvents were used as extractants: hexane, chloroform, diethyl ether, methyltretbutyl ether, ethyl acetate, a mixture of chloroform-propanol-1 (9:1), extraction was carried out from an alkaline medium (pH 9-10). An experiment to develop methods for isolating carbamazepine from blood serum and urine was carried out using model mixtures with carbamazepine concentrations of 1, 10, 100 mcg/ml. Chloroform and methyltretbutyl ether, were tested as extractants, the pH was 9-10. When studying the conditions for isolating carbamazepine from the tissues of internal organs, the liver and kidneys of intact laboratory animals (rats) were used to prepare model mixtures. To prepare the model mixtures, the biological sample was homogenized in distilled water (1:4) using an ultrasonic homogenizer. 250, 500, 1000 ml of carbamazepine aqueous solution with a concentration of 100 mcg/ml was added to 10 g of tissue homogenate (the introduced amount was 25, 50, 100 mcg). To extract the target substance from the tissue homogenate, water and acetonitrile acidified to pH 2 were tested. Next, the extraction was carried out with an organic solvent (chloroform, methyltretbutyl ether). The quantitative determination of carbamazepine in extracts from biological objects was carried out by high-performance liquid chromatography (HPLC). Results. The data obtained showed that chloroform and methyltretbutyl ether are promising for the development of methods for sample preparation of biological objects based on liquid-liquid extraction. Carbamazepine is more fully extracted from biofluids by chloroform. The results of studying the conditions for isolating carbamazepine from biological tissues (liver and kidney) showed that acidified polar solvents (water, acetonitrile) are effective as isolating agents for carbamazepine. Conclusion. It has been established that acetonitrile is the optimal solvent at the stage of carbamazepine isolation from biological tissues, and it is more expedient to use chloroform as an extractant to extract the substance from solutions.
Keywords: forensic chemical examination, carbamazepine, biological fluids, biological tissues, isolation, extraction, chloroform, acetonitrile
STUDY AND VALIDATION OF THE CONDITIONS FOR THE CHROMATOGRAPHIC DETERMINATION OF ANTI-TUBERCULOSIS DRUGS
Konovalova S.S., Illarionova E.A.
Abstract: Objective. To study the conditions for the identification and quantification of anti-tuberculosis drugs rifabutin, perchlosone and terizidone by HPLC on a domestic device. Methods. The objects of the study were the substances rifabutin, perchlorosone and terizidone and ready-made dosage forms containing them. The study was carried out on a microcolumn chromatograph manufactured in Russia « Milichrome A-02». Results. In the course of the work, optimal conditions for the chromatographic determination of the studied substances were assessed, selective and express methods for their quantitative determination in capsules (rifabutine and terizidone) and tablets (perchlorozone) were developed. The data obtained as a result of the analysis using the developed methods were statistically processed, the relative error did not exceed 1,18% for rifabutin; 1,19% for perchlorosone and 1,34% for terizidone. Conclusions. The suitability of the developed methods has been confirmed during the validation assessment, the results obtained are sufficiently reliable and reproducible.
Keywords: tuberculosis, perchlorozone, rifabutine, terizidone, high-performance liquid chromatography
STUDY OF ALLERGENICITY AND WOUND HEALING EFFECT OF SEXTAPHAG® DRUG PLATES
Kovyazina N.A., Nikolaeva A.M.
Abstract: Objective. To evaluate allergenicity and wound healing effect of Sextafag® drug plates on an experimental model of localized purulent skin wound. Methods. Preclinical study of allergenicity of Sextaphag®. drug plates was carried out using a test of skin applications on guinea pigs and rabbits. The skin reaction was counted daily using the skin test evaluation scale. The wound healing effect was evaluated in comparison with the official Levomekol ointment by the tensiometric method on white rats (model of "linear" aseptic wound) and by the planimetric method on the pharmacotherapeutic effectiveness of treatment of Chinchilla rabbits (model of "linear" purulent wound). Results. In the test of cutaneous applications it was established that the plates of the medicinal preparation Sextafag® have no allergizing properties. Daily application of the plates on the depilated skin area did not cause skin changes in rabbits and guinea pigs. Clinical manifestations (hyperemia, edema, peeling, itching, painful reaction at palpation, etc.) were not observed in laboratory animals during the whole period of the experiment. It was found that at application of Sextafag® medicinal plates in comparison with Levomekol ointment the scar strength increased and the number of infectious complications decreased, wound healing time was reduced: the index of acceleration of wound healing at treatment with Sextafag® medicinal plates in comparison with Levomekol ointment was 213,18%. Conclusion. As a result of experimental preclinical studies it was revealed that medicinal plates Sextafag® are non-allergenic, have a pronounced antibacterial and wound healing effect.
Keywords: allergenicity, bacteriophage, safety, purulent wound, treatment, medicinal plates, wound healing, Sekstafag®
INVESTIGATION OF PATTERNS OF ACCUMULATION OF NATURAL AND MAN-MADE RADIONUCLIDES BY MEDICINAL PLANT RAW MATERIALS OF THE CENTRAL BLACK EARTH REGION
Dyakova N.A.
Abstract: Objective. The purpose of the study is to study the patterns of accumulation of the most significant artificial and natural radionuclides on the example of medicinal plant raw materials harvested in the Voronezh region. Methods. Based on the grass of the bird mountain, harvested from 36 points of the Voronezh region, studies were carried out on the accumulation of the most significant artificial and natural radionuclides by plant objects from soils. Analysis of soil and grass samples of five-lobed motherwort was carried out on the gamma-beta-alpha-spectrometer-radiometer of the RADEK MKGB-01 with determination of the specific activity of basic (long-lived) artificial radionuclides (strontium-90, cesium-137) and natural radionuclides (potassium-40, thorium-232, radium-226), which are often found in nature. Results. All investigational medicinal herbal raw materials meet the existing radiation safety requirements (group one). Correlation analysis of the specific activity of natural and man-made radionuclides in the soil and grass of the bird mountain showed the presence of a close relationship between these numerical indicators, which confirmed their predominant transposed pollution. With an increase in the specific activity of strontium-90, cesium-137, thorium-232, potassium-40, radium-226 in the soil, their specific activity in the grass of the bird mountain increased. For the grass of the bird mountain growing in the Voronezh region, intensive accumulation from the upper layers of cesium-137 and potassium-40 soils was noted. Conclusion. A detailed analysis of the dependence of the calculated accumulation coefficients of natural and man-made radioisotopes in the grass of the bird mountain made it possible to note trends towards their decrease with an increase in the specific activity of radionuclide in the soil, which indicates the presence of physiological mechanisms for regulating their entry into the plant. For the first time, the patterns and mathematical dependencies of the accumulation of technogenic and natural radionuclides in the grass of the bird mountain revealed as a result of the study make it possible to predict the peculiarities of contamination of plant raw materials with these ecotoxicants.
Keywords: Polygonum aviculare L, Voronezh region, strontium-90, cesium-137, thorium-232, potassium-40, radium-226
COMPARISON OF AGAR DIFFUSION AND BIOLUMINESCENT ANALYSIS FOR DETERMINATION OF ANTIMICROBIAL ACTIVITY OF ANTIBIOTICS
Osmanova S.Ya., Safronyuk S.L., Kiyaev A.B., Katsev A.M.
Abstract: Objective. To compare the agar diffusion method and the bacterial bioluminescence assay in determining the antimicrobial activity of antibiotics. Methods. A comparative analysis of two methods was carried out - well diffusion in agar, which was carried out according to the methodology of the State Pharmacopoeia of the Russian Federation of the XIV edition by measuring the diameters of the growth inhibition zones of the test strain of microorganisms, and the bioluminescent method, which registers the antimicrobial effect of samples by changing the intensity of bacterial luminescence, under the action of antibiotics. P. leiognathi Sh1 was used as a test strain in the study. Comparison of methods was carried out by comparing the antimicrobial activity of 10 antibiotics of different chemical structures. Results. In the course of comparing the results of the antimicrobial activity of the studied antibiotics, obtained using bioluminescent analysis and well diffusion in agar, a high convergence of the data obtained, expressed by the Karl-Pearson coefficient, was revealed. Linear correlation coefficients between d and BLI were: -0.96, -0.83, -0.83, -0.80, -0.76, -0.74, -0.65 and -0.64 for tetracycline, cefotaxime, doxycycline, cefepime, penicillin G, gentamicin, streptomycin, and ceftriaxone, respectively. Conclusions. As a result, the applicability of the bioluminescent method for determining the antimicrobial activity of antibiotics for penicillin G, tetracycline, doxycycline, streptomycin, gentamicin, cefepime, ceftriaxone, and cefotaxime has been experimentally confirmed.
Keywords: antibiotics, antimicrobial activity, agar diffusion method, bioluminescent analysis
MEDICAL SOCIAL PORTRAIT OF PATIENTS AT RISK FOR OSTEOPOROSIS
Alekseeva V.A., Krikova A.V., Akulenkov A.Yu.
Abstract: Objective. To conduct a sociological study to determine the medical social portrait of a patient at risk for osteoporosis. Methods. The study was conducted by means of a self-developed original anonymous questionnaire. 75 patients observed in the Federal Center of Traumatology, Orthopedics and Endoprosthetics (Smolensk) were interviewed. The survey was conducted anonymously and voluntarily, during the admission of doctors of the following specialties: endocrinologist, surgeon and traumatologist. Results. The analysis of the age structure revealed that more than half of the respondents (65.33%) are over 50 years old, female persons predominate among the respondents (62.67%). The assessment of marital status showed that the majority of patients (62.67%) are married. We also assessed the presence of children in female respondents, 22 women (45.81% of the total number of women) have 1 child. 54.67% of respondents have higher education, 51 respondents (68.00%) had a job, 16 of them (21.33%) are working pensioners. Most of them (88.00%) noted that the average monthly income per family member is above the subsistence minimum. The study of living conditions showed that 65.33% of respondents live in urban areas, almost all (96.00%) have their own housing. Conclusion. The medical social portrait of a patient at risk for osteoporosis has been compiled. The age, gender composition, social status were determined, and it was also established which chronic diseases they have in their medical history. Conducting this study is an important stage for the timely diagnosis and initiation of treatment of the disease.
Keywords: diseases of the musculoskeletal system, osteoporosis, questionnaires, patients
ANALYSIS OF THE RANGE OF MEDICINES OF THE «ANXIOLYTICS» GROUP
Kitaev V.R., Bolgov A.S., Erigova O.A., Gudkova A.A., Chistjakova A.S.
Abstract: Objective. To conduct a structural analysis of the range of drugs in the anxiolytics group . Methods. To study the structure of the range of drugs of the pharmacological group «Anxiolytics», open information resources were used: the «grls.rosminzdrav.ru», Vidal pharmacological reference books, «rlsnet.ru» and the Internet resource «Analit.net». The data obtained is current as of December 1, 2023. Results. It was revealed that 17 international generic and 52 trade names are represented on the Russian pharmaceutical market of anxiolytic drugs. A total of 82 product lines are produced by 46 manufacturing companies, the majority of which are domestic (78%). It is shown that the drugs are presented in 11 different dosage forms, mainly in the form of solid dosage forms (tablets), making up 80% of the range. An assessment of the assortment in pharmacies in the city of Voronezh showed the presence of 30% of the drugs from the entire list presented on the Russian pharmaceutical market. Conclusion. As part of the study, it was revealed that the market of anxiolytic drugs in Russia is characterized by a wide range, mainly domestic production and a high level of information demand for individual drugs. However, availability issues in pharmacies may require additional attention and regulation.
Keywords: anxiolytics, assortment analysis, medicines
NECROLOG
IN MEMORY OF RESHEDKO VYACHESLAV VASILIEVICH ASSOCIATED PROFESSOR OF THE DEPARTMENT OF PATHOLOGICAL PHYSIOLOGY OF THE SMOLENSK STATE MEDICAL UNIVERSITY
Colleagues
Abstract: On March 30, 2024, at the age of 85, Vyacheslav Vasilievich Reshedko, Candidate of Medical Sciences, Associate Professor of the Department of Pathological Physiology, died after a serious long-term illness. Vyacheslav Vasilyevich lived a bright and interesting life. His distinctive features were deep humanity, genuine intelligence, high professionalism, love of life and optimism.
Keywords: RESHEDKO VYACHESLAV VASILIEVICH