IMMUNOHISTOCHEMICAL CHARACTERISTIC OF THE BONE MARROW WITH THE IMPACT OF SULFUR-CONTAINING GAS
Ovsyannikova O.A.
UDC: 616.419-003.219:546.221
Abstract: Objecive. The processes that occur in the bone marrow are important since the bone marrow is one of the main organs of the hematopoetic system, which promotes the creation of new blood cells to substitute the dead or dying ones. The main aim of the study was to assess the immunohistochemical characteristics of the bone marrow on the example of Bax, Ki-67 with chronic exposure to sub-toxic doses of hydrogen sulphide-containing gas. Methods. The experiment was carried out on 40 white mongrel male rats. Groups of two types were formed: I - control group, II - group exposed to sulfur-containing pollutants. Each species contained four groups of 5 individuals in each. The individual development of the animals corresponed to the people’s postnatal ontogenesis stages. Results. The author revealed immunohistochemical features of the bone marrow of rats during chronic exposure to natural hydrogen sulphide-containing gas at the sub-toxic concentration. With the help of various antibodies to Bax, Ki-67, the bone marrow of rats was assessed at various stages of postnatal ontogenesis. Conclusion. It was found that the most significant manifestation of the experiment was the intensification of apoptosis, characterized by an increase in the proapoptogenic protein (Bax), a decrease in the proliferation index (Ki-67) at all stages of ontogenesis in the experimental animals.
Key words: костный мозг, Вах, Ki-67, сероводородсодержащий газ, bone marrow, Bax, Ki-67, hydrogen sulphide-containing gas
PROBABLE PARTICIPATION OF OX1R OREXIN A RECEPTOR IN THE COMPULSIVE BEHAVIOR AND SUPPORT OF THE LEVEL OF ANXIETY AFTER VITAL STRESS IN RATS
Yakushina N.D., Tissen I.Yu., Lebedev A.A., Pshenichnaya A.G., Bychkov E.R., Shabanov P.D.
UDC: 616-092.9+612.82
Abstract: Objective. The aim of the study was to assess the effect of the orexin A OX1R receptor antagonist SB-408124 on the compulsive behavior and the anxiety in rats after the presentation of vital stress in a number of behavioral tests: marble test, elevated plus maze, in the open field and in the test "resident intruder." Methods. In the marble test, the behavioral components of the obsession (obsessive and obtrusive thoughts) and compulsions (obtrusive behavior), aimed to reduce anxiety, were modeled. Mental trauma was caused by a stressful effect, the essence of which was the experience of the animals of the circumstances of the partner’s death from the actions of a predator. A group of rats were placed once in the Python molurus terrarium.Results. After the action of vital mental stress in rats, two connected behavioral phenomena were observed: a high level of anxiety and an increase in the number of buried balls. This was accompanied by a decrease in communicability. These signs were assessed as posttraumatic stress disorder (PTSD). Intranasal administration (for 7 days) of orexin A antagonist OX1R receptor SB-408124 after presentation of the vital stress reduced the level of anxiety, and normalized the communicative activity of animals and the number of buried balls, i.e. compulsive behavior. Conclusion. Thus, the orexin system of the brain is an important component of psychotraumatic mechanism. OX1R antagonists of orexin A receptors can potentially be considered as correctors of obsessive-compulsive disorders on the background of PTSD. Intranasal administration of OX1R antagonists of orexin A receptors in clinical settings will allow the use of small doses of the substances and thereby reduce their possible toxic effects.
Key words: OX1R рецептор, орексин А, обсессивно-компульсивное расстройство, компульсивное поведение, тревожность, закапывание шариков, посттравматическое стрессорное расстройство, orexin A, OX1R receptor, obsessive-compulsive disorder, compulsive behavior, anxiety, marble burning test, posttraumatic stress disorder
INFLUENCE OF IMUNOFAN ON THE ORGANOMETRIC PARAMETERS OF THE ADRENAL GLANDS OF LABORATORY ANIMALS IN THE EXPERIMENT
Kashchenko S.A., Semenchuk S.N.
UDC: 611.451:59.085+615.37
Abstract: Objective. The aim of the experiment was to study the changes of the organometric parameters of the adrenal glands of laboratory animals after administration of the imunofan as immunomodulator. Methods. The study was carried out on 60 white young age male-rats of the reproductive age. The animals were divided into two groups. The first group received imunofan at a dosage of 50 μg five times according to the scheme. The second group was the control one and received 0.9% NaCl. The absolute mass of the organ and the linear dimensions (height, thickness, width) were measured; relative mass and volume were calculated. Results. As the result of the study, it was revealed that there were no significant differences between the investigated organometric parameters of the adrenal glands of the laboratory animals of the experimental and control groups in the early observation periods (1, 7 and 15 days). Statistically significant changes in morphometric parameters on the 30th and 60th days after the finishing of imunofan administration were noted, which is typical for the slow phase of the drug that manifests itself by normalization of the parameters of cellular and humoral immunity and increased production of specific antibodies. Conclusion. After the statistical processing of received data, the obtained results indicated an active reaction of the adrenal glands.
Key words: надпочечник, крысы репродуктивного периода, имунофан, органометрия, иммуномодуляция, adrenal gland, rats of the reproductive period, imunofan, organometry, immunomodulation
MORPHOFUNCTIONAL DISTURBANCES IN THE HIPPOCAMPUS OF RATS AFTER INCOMPLETE ISCHEMIA
Bon L.I., Maksimovich N.Ye., Zimatkin S.M.
UDC: 616.831.31-005.4.-092.913:618.33
Abstract: Objective. The objective was to study morphofunctional disorders of neurons in hippocampus of rats after incomplete cerebral ischemia.Methods. The experiments were performed on female white rats weighing 230±20 g. Incomplete cerebral ischemia was modeled by ligation of both common carotid arteries under intravenous thiopental anesthesia (40-50 mg/kg). Results. Histological and histochemical characteristics of CA1 hippocampal field neurons in rats under incomplete cerebral ischemia were studied. There was a decrease in the amount of normochromic and an increase in the number of pathological forms of neurons, their size and shape changed significantly, dehydrogenases activity decrease: NADH, succinate, glucose-6-phosphate, an increase in lactate dehydrogenase and acid phosphatase activity. Conclusion. Incomplete cerebral ischemia leads to significant morphological changes and severe energy deficiency of the hippocampal neurons in rats .
Key words: нейроны, гиппокамп, ишемия, neurons, hippocampus, ischemia
DYNAMICS OF FREE AMINO ACIDS CONCENTRATIONS CHANGES IN PEYER’S PATCHES AFTER INTRODUCTION OF INFESOL40
Shejbak Владимир Михайлович, Pavlyukovec A.Yu., Smirnov V.Yu., Shejbak L.N., Zhmakin A.I.
UDC: 612.017.1: 577.112.3
Abstract: Objective. The aim of the study was to analyze the changes in the concentrations of free amino acids in Peyer's patches of rats in dynamics after a single intragastric administration of Infezol40. Methods. The experiment was carried out on 30 rats; the animals of the experimental groups were injected intragastrically with the solution of Inphezol40 at a dose of 20 ml/kg of body weight. The animals were decapitated after 10 min, 20 min, 30 min or 45 min. Peyer's patches were used for the analysis, free amino acids were determined by reversed-phase HPLC. Results. The results showed that in the Peyer's patches after intragastric administration of the solution Infezola40 the relative amount of proteinogenic amino acids increases. In the first 20 minutes after the injection of the amino acid solution, the total amount of proteinogenic amino acids increases, but after 30 minutes the nominal effect is absent, and after 45 minutes the concentration of asparagine, serine, glutamine and threonine is decreased. Conclusion. Thus, changes in the concentrations of free amino acids in Peyer's patches after a single intragastric administration of Infezol40 are the result of activation of Peyer's patch cells.
Key words: крысы, пейеровы бляшки, свободные аминокислоты, Инфезол40, rats, Peyer's patch, free amino acids, Infezol40, rats, Peyer's patch, free amino acids, Infezol40
EFFECT OF GLYCOSYLATED POLYPEPTIDES COMPLEX ISOLATED FROM SEA URCHIN ON THE ACTIVITY OF CYCLOXYGENAZE IZOPHORES AND 5-LIPOXYGENASE
Katelnikova Anastasia E, Kryshen Kirill L., Makarova Marina N, Makarov Valeriy G, Vorobieva Viktorya V., Shikov Aleksandr N
UDC: 615.324:593. 95:547.964.4.07
Key words: комплекс гликозилированных полипептидов, морские ежи вида S. droebachiensis, циклооксигеназа
INTRA-ABDOMINAL PRESSURE LEVEL IN THE DYNAMICS OF THE DEVELOPMENT OF ACUTE INTESTINAL OBSTRUCTION
Koishibayev Zh.M., Turgunov Ye.M., Azizov I.S., Zhumakayev A.M., Khalmuminov D.D.
UDC: 616.381-008.718/.34-007.272
Abstract: Objective. To study the dynamics of intra-abdominal pressure in acute intestinal obstruction in the experiment. Methods. One hundren and eight white non-breed rats were used in the experiment for measuring the intra-abdominal pressure on 1, 3, 5 and 7 days in modeling of acute intestinal obstruction. Results. According to the results of the study, a statistically significant increase in intra-abdominal pressure appears on the first day of intestinal obstruction in comparison with the initial indices. During the entire period of the intestinal obstruction, there was a gradual increase in intra-abdominal pressure and on the 7th day, there was the maximum increase of 2.61 times from the initial indices. When comparing the group with the intestinal obstruction model and the sham group, a noticeable difference was already observed on the 1 day, intra-abdominal pressure was 4.5 times greater than in the group with laparotomy, but without the model of AIO (p=0.002). Conclusion. The most pronounced increase in intra-abdominal pressure is observed on the 3rd and 5th days of the disease, which is statistically significant in comparison with the baseline (p<0.001) and in the comparison group (p=0.002). The obtained experimental data suggest an important role of intra-abdominal pressure in the development of pathophysiological mechanisms in acute intestinal obstruction and the necessity to monitor this index in the dynamics of the development of the disease.
Key words: острая кишечная непроходимость, внутрибрюшное давление, эксперимент, acute intestinal obstruction, intra-abdominal pressure, experiment
PROTECTIVE EFFECT OF METAL-COMPLEX AND AMINOTHIOL ANTIHYPOXIC SUBSTANCES IN EXPERIMENTS ON RATS IN ACUTE HYPOXIC HYPOXIA
Evseev A.V., Surmenev D.V., Evseeva M.A., Sosin D.V., Kulagin K.N., Shalaeva O.Ye., Putenkova L.Yu.
UDC: 616-001.8:615.355
Abstract: Objective. The aim of the study was to confirm the antihypoxic action of the metal-complex (Zn) compound πQ2721 in experiments on rats on the model of acute hypoxia with hypercapnia (AH+Hc), The compound turned out to be the most effective of 11 selenium-containing substances previously studied in experiments on mice. Two antihypoxants of the aminothiol origin - Amtizole and Sunazole and metal-complex compound πQ1983 with the confirmed antihypoxic effect were used as substances for comparison. Methods. The experiments were performed on 182 male rats of Wistar line weighing 150-170 g. The study of antihypoxic activity of the substances was carried out on the AH+Hc model. The condition of acute hypoxia in rats was developed by placing them in glass airtight containers with a free volume of 1.0 l. The antihypoxic effect was evaluated by the life expectancy of the animals in the described conditions. Substances πQ2721, πQ1983, Amtizole and Sunazole were administered once intraperitoneally at the doses of 25, 50 and 100 mg/kg. Previously each substance was dissolved in 0.9% NaCl (1.0 ml). Testing the effectiveness of the substances on AH+Hc model was carried out 1hour following the administration of the substances and in 24 h. The animals of the control groups were injected with 1.0 ml of 0.9% NaCl. In the animals exposed to test AH+Hc 1 hour following the administration the measurements of the rectal temperature were performed before the experiment and 1 hour following the administration, i.e. before AH+Hc. In the animals selected for 24-hour observation, rectal temperature was measured before the experiment, and then in 1, 3, 6, 12, 18 and 24 hours of observation, after which they were exposed to AH+Hc. Results. The antihypoxic effect of the selenium-containing substance πQ2721 based on Zn was confirmed in experiments on rats. In the number of substances for comparison πQ2721 confirmed its effectiveness. It was found that 1 hour following the administration at a dose of 50 mg/kg πQ2721 is more effective than all the studied compounds, including Sunazole. An important advantage of the new promising antihypoxic agent is the prlogation of its action for 24 hours after injection. Conclusion. In the experiment on rats, the antihypoxic effect of πQ2721 was fully confirmed. In the number of substances for comparison πQ2721 confirmed its effectiveness. It was found that 1-hour following the administration at a dose of 50 mg/kg πQ2721 is more effective than all the studied compounds, including Sunazole. An important advantage of the new promising antihypoxic agent is the prolongation of its action for 24 hours after injection.
Key words: острая гипоксия, металлокомплексные соединения, антигипоксанты, крысы, acute hypoxia, metal-complex compounds antihypoxants, rats
REGULATORY EFFECT OF EXOMETABOLITES BIFIDOBACTERIUM BIFIDUM ON THE PROLIFERATIVE ACTIVITY OF CONDITIONALLY PATHOGENIC MICROORGANISMS
Markov A.A., Timokhina T.H., Perunova N.B., Paromova Ya.I.
UDC: 579.61
Abstract: Objective. The search for new drugs with high bactericidal properties and high biological safety for people is an important issue in modern medicine. Methods. Experimental study of the influence of exometabolites Bifidobacterium bifidum, obtained taking into account the chronobiological aspects, on the proliferative activity of different concentrations of the most common antibiotic-resistant hospital isolates of the following conditionally pathogenic microorganisms: Staphylococcus aureus 889 (MRSA), Staphylococcus epidermidis 2041, 9672 Pseudomonas aeruginosa obtained from wound discharge of patients with paraproteins infection and osteomyelitis undergoing treatment in trauma and orthopedic department. Confirmation of the high proliferative activity of the studied laboratory strains and hospital isolates of conditionally pathogenic microorganisms was obtained by cultivation on a nutrient medium and seeding on the egg yolk high salt agar culture medium. For Bifidobacterium bifidum exometabolites regulating influence assessment, the bacteriological method (CFU/ml) was used. With the aim of improving the accuracy of the study and the informational value, the effect of Bifidobacterium bifidum exometabolites on the following microorganisms of the American collection of standard cultures (ATSS): Staphylococcus aureus ATSS 25923, Pseudomonas aeruginosa ATSS 27853 was studies as well. Results. The results demonstrate almost 100% bactericidal effect on all the studied concentrations of the laboratory strains with high sensitivity and antibiotic-resistant opportunistic nosocomial isolates. The obtained results confirm the high inactivating effect of Bifidobacterium bifidum exometabolites on the proliferative activity of the most common in trauma and orthopaedic practice antibiotic-resistant opportunistic nosocomial isolates. Conclusion. Proven regulatory activity of Bifidobacterium bifidum exometabolites in relation to conditionally pathogenic microorganisms can serve as the basis for the development of future directions for the prevention and treatment of purulent-septic complications in trauma, orthopedic and general surgical practice.
Key words: пролиферативная активность, экзометаболиты Bifidobacterium bifidum, гнойно-септические осложнения, госпитальные изоляты, условно-патогенные микроорганизмы, proliferative activity, exometabolites Bifidobacterium bifidum, purulent-septic complications, hospital isolates, opportunistic pathogens
AGE FEATURES OF TESTES STRUCTURE OF THE SECOND GENERATION RATS, OBTAINED FROM FEMALE RATS, DEVELOPED IN CHOLESTASIS OF THEIR MOTHER
Macjuk Ja.R., Voronik Ju.N., Mihal'chuk E.Ch.
UDC: 612.617:611.068:[618.3-06:616.36-008-811.6]-092.9
Abstract: Cholestasis is a disturbunce of synthesis, secretion and outflow of bile. This pathology often occurs in pregnant women and burdens the course of pregnancy and childbirth. As a result of the previous experiments, rather negative effect of cholestasis of pregnant women on the testes of their offspring developed in this pathology was revealed. Objective. The aim of the study was to analyze the features of the testes of the second generation outbred white rats, born from the first-generation females, developed directly during subhepatic obturation cholestasis experimentally modeled on the 17th day of their pregnancy. Methods. The histological and morphometric methods of investigation of testes of outbred white rats with subsequent statistical analysis were used. Results. In the course of the study, a delay in the physical development of the second-generation animals was established, accompanied by severe structural disturbances in the testes that had an adverse effect on spermatogenesis. Conclusion. The changes revealed in the testes of second-generation offspring are similar to those that occurred in males that developed directly in the mother's cholestasis.
Key words: потомство, семенники, холестаз, крысы, offspring, testes, cholestasis, rats
PRECONDITIONING AS A METHOD OF METABOLIC ADAPTATION TO HYPOXIA AND ISCHEMIA
Novikov V.E., Levchenkova O.S., Pozhilova E.V.
UDC: 616-005.4
Abstract: Objective. To analyze the possible mechanisms of development and ways of the preconditioning realization. Methods. Сollection, systematization and analysis of the current scientific literature data and the results of the authors’ research on the relevant problem. Results. A review of publications devoted to experimental and clinical trials about the effectiveness of physical forms of preconditioning is presented in the article. The mechanism of ischemic preconditioning development with a detailed description of the main stages - trigger, signaling and effector is described. It is shown, that at the first stage as a result of causative factor (hypoxia, ischemia) influence on tissues, receptor-dependent and independent substances-inducers (triggers) are released from cells. At the next stage, under the action of triggers, mediators of the enzymatic nature (kinase pathways) are activated to transmit the signal to the cell effector targets. Expression of regulatory protein genes occurs in the effector stage of preconditioning. Many effector mechanisms of preconditioning are aimed at normalization of mitochondrial function. The possibility of pharmacological preconditioning in hypoxia and ischemia with the help of selective exogenous modulators on the stages of preconditioning is discussed. HIF-1α, GSK-3ß, NO-synthase targets are of great interest in this regard. Conclusion. Preconditioning as a way of ischemic and hypoxic organism tolerance development is a perspective scientific direction in medicine. Initiation and regulation of adaptive responses to the hypoxia/ischemia action by pharmacological agents allow to use pharmacological preconditioning and to develop optimal schemes of potentiating of physical preconditioning. The development of effective preconditioning schemes will significantly improve the prevention and treatment of many diseases in the pathogenesis of which there are hypoxia and ischemia state.
Key words: гипоксия, ишемия, прекондиционирование, фармакологическая регуляция процессов адаптации, hypoxia, ischemia, preconditioning, pharmacological regulation of adaptation
TUBERCULOSIS AS A GLOBAL HEALTH THREAT: GLOBAL AND REGIONAL EFFORTS TO CONTROL TUBERCULOSIS
Ulrichs Timo
UDC: 616-002.5
Abstract: Objection. To assess global epidemiological situation concerning tuberculosis infection as well as to assess global and regional efforts to fight TB. Methods. Our study involved assessment of the current epidemiological situation concerning tuberculosis infection, factors that can aggravate its course as well as TB co-morbidities to provide an overview involving TB expert and politicians’ activities at the global and regional level. In order to address current challenges of TB control and to join efforts to fight the disease, a series of symposia, conferences and meetings were organized in 2017, whose major contents and results as well as impacts on research and control issues in the TB field are presented in the following chapter Results. The study involves such a global health problem as tuberculosis infection with a particular emphasis on multi-drug resistance and co- morbidities. In 1993, the World Health Organization declared TB as a global health emergency with two aggravating factors including increasing numbers of resistances per clinical isolate of Mycobacterium tuberculosis and increasing rates of multidrug resistant cases, and HIV-TB comorbidity. In our days, the WHO European Region is the only world region with increasing rates of new HIV infections. Conclusion. To support joint activities of TB experts and politicians to fight the disease, a series of symposia, conferences and meetings were organized in 2017, whose major contents and results as well as impacts on research and control issues in the TB field are presented in the following article.
Key words: tuberculosis, co-morbidity, Koch-Metschikov Forum, World Health Organization, туберкулез, коморбидность, Форум им. Р. Коха и И.М. Мечникова, Всемирная Организация Здравоохранения
THE COURSE OF WOUND PROCESS AFTER CHOLECYSTECTOMY IN HIGH MOUNTAINS AND LOW MOUNTAINS
Omorov T.B., Zholdoshbekov E.Zh., Avasov B.A.
UDC: 616.366-002-089:616-001-092
Abstract: Objective. Study of the features of the course of the wound process in patients living in high mountains and low mountains, using ultrasound (ultrasound) of the operating wound after the operation of cholecystectomy.Methods. Echomorometry of wounds after cholecystectomy in persons living in high mountains (95 people) and low mountains (54 people) was carried out. The echomorometry of postoperative wounds was performed by the MEDISON device in real time for 1, 3, 5 or 6 days after cholecystectomy. Laboratory and clinical indicators (body temperature, intensity of pain syndrome, number of bed-days, complications) were studied to assess the overall status.Results. Analysis of the course of the postoperative period in 3 groups of patients with calculous cholecystitis showed that the postoperative period was more smooth in patients living in low mountains. In patients with high altitude, the percentage of complications was significantly higher (5.3%), and a longer period of inpatient treatment was observed compared with patients from low mountains (7.4±0.41 and 5.2±0.37 hospital days, respectively).Conclusion. In persons living in high mountain conditions, wound complications occur more often in the postoperative period. It has been established that ultrasound scores are a sufficiently informative test for assessing the course of the wound process.
Key words: желчный пузырь, холецистит, холецистэктомия, раневые осложнения, высокогорье, низкогорье, gall bladder, cholecystitis, cholecystectomy, wound complications, high mountains, low mountains
LAPAROSCOPIC TENSION-FREE PLASTY OF ABDOMINAL WALL WITH POSTOPERATIVE VENTRAL HERNIAS
Nekrasov A. Y., Istomin N.P., Velichko E. A.
UDC: 616.381-007.43-089:616.381-072.1
Abstract: Objective. The aim of the study was to examine the outcome of assisted surgery hernioplasty in patients with postoperative ventral hernias. Methods. An analysis of 83 laparoscopic hernioplasty of incisional hernias perfomed 2012 to 2016 was conducted. Laparoscopic hernioplasty was performed in 2 ways. First method: U-shaped incision and separation of the parietal peritoneum, after which in the preperitoneal space polypropylene implant was set, which was sutured using the Endoclose needle to the anterior abdominal wall from the inside by tying the knots over the aponeurosis. Then a continuous suture over the mesh restored the integrity of the peritoneum. The second method was laparoscopic IPOM hernioplasty. Results. Pain syndrome duration was assessed using the VAS scale. In the postoperative period after laparoscopic hernioplasty, the pain syndrome persisted for 5.5±1.2 days on an average, which is related to the size of the wound. Following laparoscopic IPOM hernioplasty the pain in the postoperative wound persisted for 3.2±1.3 days (p=0.031). The duration of laparoscopic hernioplasty was 84.2±3.3 minutes, that of laparoscopic IPOM hernioplasty - 54.7±3,7 min (p=0.033). In the group where laparoscopic hernioplasty was performed, postoperative complications were detected in 2 (5%) patients. In the group where the patients underwent laparoscopic IPOM hernioplasty, postoperative complications were not identified. The duration of hospitalization was 5.4±0.9 days following laparoscopic hernioplasty and 3.1±1.1 days following laparoscopic IPOM hernioplasty (p=0.028). After laparoscopic IPOM hernioplasty the recurrence of hernia was diagnosed in one (2.3%) of patient. The recurrence of ventral hernia after laparoscopic hernioplasty were not diagnosed. Conclusion. The laparoscopic IPOM hernioplasty is preferable in patients with incisional hernias, as it takes less time to fix the mesh prosthesis, moreover, the prosedure is less difficult to perfom, but has one drawback -high cost of composite mesh and staples. Laparoscopic hernioplasty is not advisable when the size of the hernial orifice is W 3-4 or in case of recurrent hernias. In these patients it is appropriate to use laparoscopic IPOM hernioplasty.
Key words: лапароскопическая герниопластика, лапароскопическая герниопластика IPOM, послеоперационная вентральная грыжа, техника герниопластики, ненатяжения герниопластика, laparoscopic hernioplasty, laparoscopic hernioplasty IPOM, postoperative hernia, hernioplasty technique, tension free hernia repair
OZONE THERAPY IN UROLOGY
Murzaliev A.D., Zholdoshbekov E.Zh., Avasov B.A.
UDC: 616.6-08:615.84
Abstract: Objective. Determination of markers of endotoxicosis to control the effectiveness of the treatment methods in 66 patients with acute pyelonephritis. Methods. The levels of middle-weight molecules, lipid peroxidation parameters were determined by spectrophotometry and leukocyte index of intoxication according to Kalf-Kalif Ya.Ya. (1941) for assessing the severity of endotoxicosis in patients with acute purulent kidney pathology. To clarify the nature of the microflora that caused the infectious process in the kidneys and the conduct of selective antibacterial therapy, urine culture was studied for sterility and sensitivity to antibiotics according to standard methods.Results. When carrying out complex therapy, which in addition to antibacterial and anti-inflammatory treatment was supplemented with ozone therapy, there was a significant decrease in endotoxicosis in patients of the main group (22 patients) than in the control group (44 patients) who received standard treatment. Conclusion. Significant improvement in clinical and biochemical parameters was more often observed in patients of the main group, which along with traditional therapy received intravenous ozonotherapy. The antioxidant, bactericidal and anti-inflammatory effects of an ozonized sodium chloride solution with an ozone concentration of 3-4 mcg/ml with urosepsis are proved in the clinical settings.
Key words: пиелонефрит, эндотоксикоз, озонотерапия, pyelonephritis, endotoxicosis, ozone therapy
INTERRELATIONSHIPS OF VASCULAR REMODELING AND STRUCTURAL PROGRESSION OF OSTEOARTHRITIS
Kabalyk M.A.
UDC: 616.72-018.3-002-07:612.018:617.3
Abstract: Objective. To assess the relationship between vascular wall remodeling and joint tissues in osteoarthritis. Methods. 62 patients with osteoarthritis aged 65.9±8.8 and 18 volunteers without clinical and roentgenologic signs of osteoarthritis aged 60.7±7.9 were examined. All patients underwent magnetic resonance imaging of knee joints. For the analysis of magnetic resonance imaging, quantitative measurements of articular cartilage thickness, transverse size of subchondral cysts, and the size of the joint gap in the medial part of the knee joint were used. The thickness of the vascular wall, the external diameter, the vascular index (SI) - the ratio of the diameter of the lumen of the vessel to the thickness of the popliteal artery (PA) wall, the branch of the upper lateral artery (LA), the medial artery of the knee (MA) were measured. Results. Correlation analysis of the relationship of vascular remodeling with changes in knee tissue in osteoarthritis, which revealed that the age of osteoarthritis patients did not have statistically significant connections with the parameters of the vessels involved in the blood supply of the knee. The thickness of the articular cartilage of the condyles of the femur had a reliable negative relationship with the thickness of the wall of the PA, LA and directly correlated with the SI of HLA and MA. The thickness of the articular cartilage of the tibial plateau showed a reverse significant relationship with the thickness of the wall of the PA, LA and directly correlated with SI MA. The size of subchondral cysts had an inverse correlation with SI MA and a straight line with wall thickness of PA, MA. The size of the marginal osteophytes of the knee joint was directly related to the thickness of the wall of PA, LA, MA. The magnitude of the osteophytes was inversely related to the SI PAS, LA. The width of the articulation gap directly correlated with the diameter of PA, LA and SI LA and MA. Conclusion. Vascular remodeling can lead to ischemia, venous congestion in the subchondral bone, promoting the formation of cysts, osteophytes, degradation of articular cartilage due to reduced trophic potential of the underlying bone. It ican be suggested that joint tissues are the target of cardiovascular diseases, which are realized through systemic vascular remodeling.
Key words: остеоартрит, остеоартроз, сосудистое ремоделирование, коленный сустав, сосудистый индекс, подколенная артерия, osteoarthritis, osteoarthrosis, vascular remodeling, knee joint, vascular index, popliteal artery
THE PREVALENCE OF ANTIMICROBIAL RESISTANCE OF IN THE SMOLENSK REGION IN 2015-2017
Dehnich N.N., Ivanchik N.V., Kozlov R.S., Alimov A.V., Steshic A.S., Kirsov P.P.
UDC: 616.33-002.44(470.332)
Abstract: Objective. To study the prevalence of resistance in strains of H. pylori to clarithromycin, amoxicillin, metronidazole, levofloxacin and tetracycline, isolated in adult patients in the Smolensk region in 2015-2017. Methods. Overall 573 adult patients were studied with positive rapid urease test at the time of gastroscopy for dyspeptic complaints. Antimicrobial susceptibility testing of H. pylori isolates to clarithromycin, amoxicillin, metronidazole, levofloxacin and tetracycline was performed by the agar dilution method. Results. 143 strains of H. pylori isolated in 2015-2017 were tested. The level of resistance of strains of H. pylori , isolated in 2015-2017 to clarithromycin was 6.3%, amoxicillin - 1.4%, metronidazole - 23.8%, levofloxacin - 24.5%, tetracycline - 0.7%. Conclusion. The prevalence of resistant H. pylori strains to clarithromycin and metronidazole in the Smolensk region is low, therefore standard triple therapy is recommended as an empirical therapy for H. pylori infection of the first line in adults. Preference in choosing a second-line empirical therapy between quadruple therapy with bismuth and triple therapy with levofloxacin, quadruple therapy with bismuth should be preferred because of the high level of H. pylori resistance to levofloxacin.
Key words: Helicobacter pylori, резистентность, кларитромицин, метронидазол, левофлоксацин, Helicobacter pylori, antimicrobial resistance, clarithromycin, metronidazole, levofloxacin
ANALYSIS OF DRUG INTERACTIONS IN PATIENTS UNDERGOING TOTAL HIP OR KNEE REPLACEMENT SURGERY
Morozova T.E., Minnigulov R.M., Yudina I.Y., Lychagin A.V.
UDC: 615.036.2
Abstract: Objective. The objective of our study was an analysis of drug interactions among elderly patients after major orthopedic surgery in routine clinical practice. Methods. There was a retrospective pharmacoepidemiologic study including analysis of pharmacotherapy and analysis of drug interactions. The analysis was based on the study of medical records (n=224) from an archive of the clinic of trauma, orthopedics and pathology of joints, Sechenov University. The study involved 182 (81.3%) women, and 42 (18.8%) men; the mean age of the patients was 65±9.5 years. Total hip replacement surgery was performed in 98 patients (43.8%), total knee replacement surgery - in 126 (56.3%). Statistical analysis of data was carried out using SPSS Statistics 18 computer program. The methods of descriptive statistics were used in this study. Results. In the postoperative period a larger number of patients received dabigatran as thromboprophylaxis (n=200, 89,3%). The patients were taking comedications (from 1 to 5 drugs). Polypharmacy was noted in 155 patients (69.2%). 800 drug interactions were detected, including 235 major, 533 moderate and 32 minor drug interactions. 200 patients had major dabigatran - ketoprofen interaction. This drug interaction increases the risk of bleeding. Hematuria was reported in 7 patients (3.1%) received dabigatran. Conclusion. In the postoperative period, all patients received ketoprofen as an analgesic, which has major drug interaction with anticoagulants. In the routine clinical practice, there is a need for further personalization of anticoagulant thromboprophylaxis. The personalization can be achieved by using pharmacogenetic tests.
Key words: межлекарственные взаимодействия, прямые пероральные антикоагулянты, эндопротезирование тазобедренного сустава, эндопротезирование коленного сустава, дабигатран, ривароксабан, эноксапарин, drug interactions, direct oral anticoagulant, total hip replacement surgery, total knee replacement surgery, dabigatran, rivaroxaban, enoxaparin
EXPERIENCE OF SURGICAL HEMOSTASIS DURING CESAREAN SECTION
Musin I.I., Yaschuk A.G., Maslennikov A.V., Gaisina K.A., Ivakha V.I., Shuginova V.V., Iskandarova
UDC: 618.56-005.1
Abstract: Objective. The purpose of the study was to evaluate the effectiveness of compression sutures in the early postoperative period accompanied by the preceeding long labor. Methods. The study included 36 women, who were imposed hemostatic sutures on the uterus, in view of the increased bleeding over the past 10 months. Results. Indications for operative delivery were as follows: dehiscence of uterine scar in 44.4% of cases (16 women), in 16.6% (6 women) - subcompensated fetal hypoxia, in 11.1% (4 women) - decompensated fetal hypoxia, in 13.5% (5 females) - premature detachment of normally situated placenta, in 5.5% (2 women) - secondary weakness of labor activity, and in 5.5% (2 women) - weak bearing-down period, and in 2.7% (1 female) - clinically narrow pelvis. 38.8% of cases (14 women) underwent additional compression sutures on the uterus. In 30.5% (11 women) ligation of the vascular bundle was performed to stop bleeding in hypotension uterus. In 8.3% cases the ovarian artery was ligated, in 8.3% - the uterine artery and in 2.7% - the internal iliac artery. None of the patients had complications in the early postpartum period. Conclusions. Hemostatic sutures are effective in controlling postpartum hemorrhage, easily performed and allow to save the uterus.
Key words: послеродовые кровотечения, компрессионные швы на матку, postpartum hemorrhage, compression sutures on the uterus
CLINICAL EFFICACY OF VITAMIN D IN COMPLEX THERAPY OF VARYING DEGREES OF ACTIVITY OF CHRONIC SPONTANEOUS URTICARIA
Vitchuk A.V., Kovrigina N.V., Aksenova S.A., Slabkaya E.V., Volkova E.V., Bityutskaya V.V., Meshkova R.Ya.
UDC: 616.514+615.356
Abstract: Objective. The aim of the study was to determine the clinical efficacy of vitamin D in complex therapy of patients with chronic spontaneous urticaria with varying degrees of its activity. Methods. The study included 50 patients with chronic spontaneous urticaria over 18 years of age. All patients were divided into groups, depending on the activity of urticaria, which was determined before the study began on the indicators of the validated UAS-7 scale. Group 1 included 16 patients with mild urticaria; Group 2 - 20 patients with medium-heavy disease activity; Group 3 - 14 patients with severe activity. All patients in addition to the basic therapy recieved an aqueous solution of vitamin D3 at a dosage of 10,000 units / day. The duration of vitamin D3 intake was 4 weeks. The effectiveness of the therapy was determined by re-determining UAS-7 in patients at the end of a 4-week course of vitamin D3 intake. Results. The use of vitamin D3 significantly reduced the activity of chronic spontaneous urticaria in patients with severe and moderate-severe disease, while in patients with mild activity, the disease effect from treatment was not achieved. Conclusion. The use of vitamin D3 at a dose of 10,000 units per day for 4 weeks in complex treatment of chronic spontaneous urticaria leads to a positive clinical effect in patients, regardless of the initial level of vitamin D in them.
Key words: хроническая спонтанная крапивница, витамин D, шкала активности крапивницы, chronic spontaneous urticaria, vitamin D, urticaria activity score
PREVENTION OF COMPLICATIONS IN HEMOCOAGULATION ENDOPROSTHESIS CONGENITAL HIP DISLOCATION
Safarov J.M., Artikov K.P.
UDC: 616.151.511 616-001.68
Abstract: Objective. Reduction in the frequency of postoperative hemocoagulation complications in patients with congenital hip dislocation who underwent endoprosthetics of the hip joint. Methods. In the clinical and diagnostic center, "Madadi Akbar" 36 patients were examined before and after the operation of hip replacement with congenital hip dislocation for the period from 2006 to 2016. The ptients, depending on the degree of hip dislocation, were divided into three groups. The first group included patients with hip dislocation up to 3 cm (16 patients), the second - up to 5 cm (11 patients), the third - over 5 cm (9 patients). All the patients were women. The mean age was 23.7±2.3 years (p>0.05). Results. It is established that against the background of antithrombotic therapy in patients with congenital dislocation of the hip after hip replacement, there is inhibition of the processes of blood coagulation and an increase in total anticoagulant activity. On the 14th day after the operation, normalization of functional relationships between pro and anticoagulant links of the blood coagulation system was observed, which allows to recommend mandatory thrombolytic therapy for these patients. Conclusion. Thus, antithrombin and fibrinolytic activity of blood plasma on the 3rd-7th day after endoprosthetics were significantly inhibited, which is a reaction of the body to operation trauma. This indicates a high thrombosis risk in postoperative period, which dictates the need for control over the state of hemocoagulation and the implementation of preventive measures aimed at restoring antithrombin activity of blood in all patients undergoing hip arthroplasty.
Key words: врожденный вывих бедра, эндопротезирование, гиперкоагуляция, коагулография, свертывающая система, тромбозоопасность, congenital hip dislocation, endoprosthesis, hypercoagulation, coagulography, coagulant system, thrombosis
DEEP BRAIN STIMULATION IN PATIENTS WITH PARKINSON'S DISEASE: INDICATIONS, SELECTION PROCEDURE, TREATMENT RESULTS
Likhachev S.A., Vashchylin V.V., Buniak A.G., Alekseevec V.V., Zabrodzec G.V.
UDC: 616.858-08:616.831-089
Abstract: Objective. To improve the tactics of selection of patients with Parkinson's disease, indications and contraindications for surgical treatment with the use of deep brain stimulation and to evaluate the results of surgical treatment. Methods. The observation group included 51 patients with DBS. The dynamics of motor functions before and after surgery was evaluated on UPDRS, changes in drug therapy were assessed using LEDD. Results. The criteria for selecting patients with PD were formulated, the results of treatment were analyzed using the dynamics of the motor function of patients during follow-up and the change of the LEDD before and after surgery. The article discusses the indications and contraindications for surgical treatment of Parkinson's disease. Issues concerning the algorithm of programming, the onset of programming, and its targeted sites are discussed in the article a well. Conclusion. The treatment of patients with PD using deep brain stimulation - a complex and multicomponent process, allows to achieve significant progress, but at the same time requires neirologist’s and neurosurgeon’s active attention and understanding of the processes.
Key words: болезнь Паркинсона, хроническая глубокая стимуляция мозга, cубталамическое ядро, леводопаэквивалентная доза, Parkinson's disease, chronic deep brain stimulation, subthalamic nucleus, levodopaequivalent dose
CLINICAL CASE OF CATASTROPHIC ANTIPHOSPHOLIPID SYNDROME
Mikhalik D.S., Zhukov G.V., Nikolaenkova L.I., Gerasimov S.A., Morozova N.V., Davydova J.A., Novikova M.A.
UDC: 616-008.9:547.953-07
Abstract: Objective. To demonstrate a male patient case history of catastrophic antiphospholipid syndrome with a positive outcome. Methods. The authors observed a clinical case of a male patient with catastrophic antiphospholipid syndrome with a positive outcome. An analysis of clinical information on antiphospholipid syndrome in Russian and foreign references was performed. Results. A positive outcome of the catastrophic antiphospholipid syndrome revealed in clinical conditions was provided by early verification of this case as well as its optimal medical treatment. Conclusion. At multidisciplinary therapeutic hospitals, primary antiphospholipid syndrome can be diagnosed with the following appropriate criteria: a clinical episode of arterial or venous thrombosis, thrombocytopenia and high titres of G and M antibodies to the cardiolipin antigen. Provided appropriate pathogenetic treatment the catastrophic antiphospholipid syndrome can have a positive outcome.
Key words: антифосфолипидный синдром, аутоиммунное заболевание, клинический случай, antiphospholipid syndrome, autoimmune disease, case history
CLINICAL CASE OF SARCOIDOSIS AND TUBERCULOSIS IN COMBINATION WITH LOSS OF VISION
Punin A.A., Molotkov A.O., Gulyaeva S.A., Pikalova O.S., Horuzhenko O.M., Korotkova E.A., Venidiktova D.Yu., Maksimova Yu.S.
UDC: 616.24
Abstract: Objective. The authors aim to exchange dignostic experience with therapists, pulmonologists, phthisiatricians, ophtalmologists concerning examination of a patient with vision loss and pulmonary dissimination and diagnosing combined course of sarcoidosis and tuberculosis. Methods. The study includes a comprehensive analysis of the materials of the medical history, outpatient card, the results of clinical, laboratory, instrumental and morphological methods of the patient's examination with independent retrospective analysis of the histological preparation of the optic nerve in various scientific institutions of the country. Results. The data of observation and diagnosis of a 29 year-old patient with a combination of lung sarcoidosis, intrathoracic lymph nodes and tuberculosis with the formation of brain tuberculoma and loss of vision to the right eye are presented in the article. The diagnosis took eight months in five hospitals of the therapeutic, rheumatology, pulmonary and tuberculosis profiles and included repeated review of histological preparations performed by morphologists in four medical and scientific institutions of Smolensk and Moscow. The debut of the disease with loss of vision to the right eye led to the need for pterional craniotomy (removal of glial tumor) of the right optic nerve, the morphological type of which required differentiation between sarcoidosis, Wegener's disease and tuberculosis. The identification of different uneven foci of necrosis, similar to caseification, and the presence of deposits in the zones of necrosis, similar to the acid-fast mycobacteria when stained by Ziehl-Neelsen in glial tumor of the optic nerve, combined with the positive trend against the backdrop of tuberculosis therapy were the basis for the diagnosis of brain tuberculoma in the right optic nerve. Histology transbronchial biopsy of the lung parenchyma with the identification of epithelioid lymphocytic granulomas without caseous necrosis and giant multinucleated cells by Pirogov-Langhans confirmed the presence of pulmonary sarcoidosis. Conclusion. The presented case demonstrates the importance of attracting specialists of different profiles to the diagnostic process, and broad discussion of the problem of differential diagnosis in disseminated lung diseases.
Key words: саркоидоз, туберкулез, потеря зрения, sarcoidosis, tuberculosis, vision loss
CLINICAL OBSERVATION OF OSSIFICATION OF HEMATOMA OF THE SPLEEN
Nikolsky A.V., Narezkin D.V., Timoshenkov D.V., Fedorin P.I.
UDC: 616.61-006.6-089
Abstract: Objective. To present a rare clinical observation of ossification of a hematoma(abscess) of the spleen, manifested in the late period by the clinical symptomatology of the “acute abdomen” with the phenomenaof peritonitis, which required diagnostic laparotomy and a repeated radical operation - splenectomy. Methods. In patients with spontaneous or traumatic spleen damage, hematomas are often organized and do not show themselves for a long time. At the same time, ossification takes place in the organized hematoma. The size and position of such calcified hematomas vary widely. This in turn can be accompanied by a variety of clinical manifestations and complications, which often requires emergency surgery. Results. During emergency surgery in the retroperitoneal space near the tail of the pancreas and the gates of the spleen, a "stony" density of the infiltrate is found. In the postoperative period, after additional investigation - spiral computed tomography - the "calcified tumor" associated with the spleen was verified. The second operation was performed to remove the spleen together with the formation. The histological conclusion is: the spleen is chronically generalized full-blooded. It is a light and organized spleen infarction (with signs of petrification). Conclusion. In retrospective analyzing the clinical manifestations of the disease, it can be assumed that the patient, due to unidentified causes, had either a heart attack or a spontaneous, possibly subcapsular rupture of the spleen. For a long time, the patient's condition remained satisfactory. The organized infarction (hematoma) in the form of an osteophyte located in the retroperitoneal space near the main vessels (a.et v. lienalis), possibly violated the blood supply and exerted pressure on nearby organs, resulting in the clinical picture of peritonitis.
Key words: оссификат селезенки, подкапсульная гематома, инфаркт селезенки, спленэктомия, ossification of the spleen, subcapsular hematoma, infarction of the spleen, splenectomy
CLINICAL EXPERIENCE OF CHRONIC APICAL PERIODONTITIS THERAPY
Shashmurina V.R., Kupreeva I.V., Devlikanova L.I., Lubinskaya E.V., Mishutina O.L.
UDC: 616.314.17.008.1
Abstract: Objective. The efficiency of endodontic treatment of destructive apical periodontitis forms was studied clinically in terms of the use of temporary root canal luting with calciferous paste “Calasept” within the nearest and distant time intervals. Methods. 58 patients were examined, both males and females aged 22 to 69 years old, who underwent conservative treatment for chronic apical periodontitis (K 04.5) of 60 teeth with temporary root canal luting with the calciferous paste “Calasept” and the following permanent filling (main group). The experimental group consisted of 45 patients who received conservative treatment for chronic apical periodontitis (K 04.5) of 48 teeth excluding temporary root canal luting with “Calasept” paste with the use of permanent filling only. Results. The analasys of the cone-beamed computerized tomography data revealed a decrease of the apical periodontitis size of periapical destruction of bone tissue within 12 months following treatment. 33 teeth showed complete tissue recovery from periapical destruction which estimates 55%, 27 teeth demonstrated partial recovery which estimates 45%. The main group demonstrated either no changes of apietis or an increase of tissue destruction of the periapical area 12 months following treatment. The experimental group`s X-ray examination held 12 months following the conservative chronic apical periodontitis treatment of 21 teeth (44%) revealed partial bone tissue recovery of apietis and complete bone tissue recovery of 16 teeth (33%) out of 48 teeth examined. The X-ray examination of 11 teeth, estimating 23%, showed areas of bone tissue destruction the size of which remained unchanged. The X-ray control indicated no apietis destruction development among the experimental group within 12 months following chronic apical periodontitis therapy. Conclusion. The research proves that the use of temporary root canal luting with the calciferous paste “Calasept” in combination with drug-induced and instrumental treatment while curing destructive forms of apical periodontitis are efficient and can provide an alternative method in chronic apical periodontitis therapy.
Key words: хронический апикальный периодонтит, корневой канал зуба, «Calasept», кальцийсодержащие материалы для эндодонтии, apical periodontitis, root canal, “Calasept”, calciferous endodontic materials
ANALYSIS OF FUNCTIONING TERMS AND CAUSES OF SUPPORTING TEETH REMOVAL IN ARTIFICIAL CROWNS PRODUCTION
Abolmasov N.N., Adaeva I.A., Khachatryan A.V., Chebotarenko O.Y., Lukin O.A.
UDC: 616.314-089.29:616:314-089.87
Abstract: Objective. The aim of the study was to identify the terms of functioning as well as the causes leading to the loss of teeth covered with artificial crowns. Material. We analyzed the causes of removal of 148 teeth in 106 patients aged 43 to 88. Results. Due to the destruction of hard tissues of the teeth, mainly occurring in the cervical region, 42 teeth were removed including 40 (95.2 %). 30 teeth were removed due to caries complications or poor endodontic treatment; 60 teeth - due to functional overload of the parodontium, including 46 (76.7%) with prior endodontic interventions. The terms of functioning for teeth covered with artificial crowns are the following: up to 1 year - 2 teeth (1.35%), from 1 to 5 years - 16 teeth (10.81%), from 5 to 10 years - 70 teeth (47.30%), from 10 to 15 years - 36 teeth (24.32%), over 15 years - 24 teeth (16.22%). Conclusion. The obtained data made it possible to conclude that devitalization negatively affects the terms of supporting teeth functioning, leading to their loss within 10 years after prosthetics in 51.4% of cases.
Key words: опорные зубы, специальная терапевтическая подготовка, несъемные ортопедические конструкции, срок службы несъемных протезов, supporting teeth, special therapeutic preparation, permanent orthopedic constructions non-removable prostheses working life
MODERN PROBLEMS OF SECONDARY PREVENTION OF CEREBROVASCULAR DISEASES
Kamyshnikova K.A., Maslova N.N., Dovgan Ye.V.
UDC: 616.831-005.1-084
Abstract: Objective. The aim of the study was to analyse modern statistical data on morbidity and mortality from stroke in Russia and abroad; to assess the degree and completeness of primary and secondary prevention of cerebrovascular diseases and the impact of comorbidity on the occurrence of polypragmasy. Methodology. The basis of this study was a survey of modern foreign and national literature on this topic. Results. The study showed a trend towards an increase in morbidity and mortality from stroke in the Russian Federation. The main risk factors for the onset of stroke and the directions of primary and secondary prevention were assessed. The factors contributing to the spread of cerebrovascular diseases were updated. Conclusion. One of the reasons for the high rates of morbidity and mortality from cerebrovascular diseases in the Russian Federation is the irrational use of primary and secondary prevention and, conversely, high levels of polypragmasy in vascular patients. To increase the effectiveness of ongoing prevention, it is necessary to explain to the patients the importance of long-term treatment with the rational use of stroke prevention, which will significantly reduce health care costs.
Key words: цереброваскулярные заболевания, инсульт, вторичная профилактика, полипрагмазия, коморбидность, cerebrovascular diseases, stroke, secondary prevention, polyprogram, comorbidity
MIDWIVES IN THE HISTORY OF MEDICINE OF RUSSIA (XVIII - MID. XIX CENTURY)
Pushkareva N.L., Mitsyuk N.A.
UDC: 618.2-07+396.6
Abstract: Objective. To study the process of institutionalization of the obstetric profession among women, and also social and gender roles of midwifes (Russian term «povituch») in the socio-cultural life of Russia XVIII-mid XIX century. Methods. Relevant approaches and methods of gender history and microhistory were used by the authors. The analysis of legislation, medical literature, and archival documents was also used. Results. The transition from traditional to scientific obstetrics was hampered by the persistence of traditional perceptions of childbirth. Due to the rarity of obstetric specialization among male doctors to preserve female space of childbirth, the authorities relied on the development of midwifery education. The specified features became the reason of the state support of female professional education. On its basis in the 19th century the first female professional identity was formed. Midwives became a strategic force for the spread of scientific (organized) childbirth. In the middle of the 19th century the main normative documents regulating their activity were accepted. The professional hierarchy was formed and, for the first time, women were able to enter the official service. Their activities were not limited to birthing; they performed a wide range of medical and social activities. Conclusion. In the middle of XIX the obstetric profession in Russia was legislatively issued. Confrontation between obstetricians and midwives, displacement of the latter, began to appear in the middle of the XIX century, which was associated with the development of clinical obstetric care.
Key words: история медицины, история акушерства, история деторождения, повивальные бабки, повитухи, history of medicine, history of obstetrics, history of childbirth, midwives, «povituchi»