EFFECT OF L-ARGININE AND L-NAME NITRIC OXIDE SECRETIONBLOCATOR ON THE SPECTRUM OF FREE AMINO ACIDS IN BLOOD PLASMA OF RATS UNDERGOING SUBTOTAL CEREBRAL ISCHEMIA
Razvodovsky Y.E., Smirnov V.Y., Pereverzev V.A., Maksimovich N.Ye., Semenenya I.N.
UDC: 616.441.577.112
Abstract: Objective. To estimate the changes in the pool of free amino acids and their derivatives in plasma of rats undergoing subtotal cerebral ischemia (SCI) and treated with L-arginine and L-NAME. Methods. The experiment was carried out on 18 rats: 12 animals were undergoing bilateral filament occlusion of carotid arteries; L-arginine and L-NAME were administrated to 6 of them. The analyses of free amino acids levels in the blood plasma extracts were carried out by reversed-phase HPLC. Results. Subtotal cerebral ischemia induced imbalance in the pool of plasma amino acids. Concentrations of several amino acids were elevated after subtotal cerebral ischemia, including aspartate, glycin, taurine, alanine and phenylalanine. Administration of L-arginine and L-NAME partially prevented the imbalance of the amino acids pool, caused by SCI. Conclusions. Preventive injection of L-arginine and L-NAME alleviate the imbalance in the pool of free amino acids of blood plasma caused by SCI.
Key words: аминокислоты, плазма крови, субтотальная ишемия головного мозга, L-аргинин, L-NAME, amino acids, blood plasma, subtotal cerebral ischemia
HISTOLOGICAL CHANGES OF PARIETAL CORTEX NEURONS IN THE DYNAMICS OF STEADY SUBTOTAL CEREBRAL ISCHEMIA
Bon’ E.I., Maksimovich N.Ye., Zimatkin S.M.
UDC: 616.831.31-005.4.-092.913:618.33
Abstract: Objective. The aim of the study is to analyze changes in the morphological characteristics of neurons of parietal cortex of rats at different periods in the dynamics of stepwise subtotal experimental cerebral ischemia. Methods. The experiments were performed on 42 males of outbred white rats. Step subtotal cerebral ischemia was performed as follows: first, one common carotid artery was ligated, simulating partial ischemia. Then, with the intervals of 1 day (subgroup 1), 3 days (subgroup 2) or 7 days (subgroup 3), the second common carotid artery was ligated. Results. A microscopic study of the size, shape, degree of chromatophilia of the cytoplasm and the content of ribonucleoproteins in pyramidal neurons of parietal cortex was carried out. Conclusion. Studies have shown the dependence of the severity of brain damage on the interval between the cessation of blood flow in both carotid arteries. Adaptation was better with a 7-day interval between dressings, while in the ligation with an interval of 1 day, the degree of morphological changes was maximum, indicating a lack of resources for the implementation of adaptation mechanisms
Key words: ишемия, теменная кора, нейроны, ischemia, parietal cortex, neurons
REMOTE CONSEQUENCES OF ANTENATAL ALCOHOLIZATION FOR THE BRAIN NEURONS
Bon’ E.I., Fedina E.M., Zaerko N.V., Zimatkin S.M., Kot V.N., Rabchenya A.V.
UDC: 616.89-008.441.13:618.33
Abstract: Objective. A comparative study of the effect of antenatal alcoholization on the histological characteristics of neurons of the frontal cortex in 90-day-old and two-year-old rats. Methods. The experiments were performed on 24 females of outbred white rats with an initial weight of 230±20 g and their offspring (24 rats). Rats of the experimental group throughout pregnancy received a 15% solution of ethanol as the only source of drinking. Rat slaughter was carried out on the 90th day and 2 years after birth. Results. Long-term consequences of the antenatal alcoholization included a significant reduction in the size of neurons and the deformation of their pericaryons. A decrease in the number of normochromic neurons was observed, and the content of their pathological forms increased. Conclusion. Рrenatal effect of alcohol leads to persistent, irreversible morphofunctional disorders of rat brain cortical neurons in postnatal ontogenesis. Moreover, these violations look not only as a consequence of the direct damaging effect of alcohol, but also as a violation of a certain “development program” of neurons of the cerebral cortex in postnatal ontogenesis, possibly through genetic and epigenetic mechanisms.
Key words: крысы, антенатальная алкоголизация, кора головного мозга, rats, antenatal alcoholization, cerebral cortex
CAJAL BODIES IN DEVELOPING HISTAMINERGIC NEURONS OF RAT BRAIN
Phedina K.M., Zaerko A.V., Zimatkin C.M.
UDC: 612.822:577.175.824]-092.4
Abstract: Objective. The aim of the study is to assess the features of Cajal bodies formation in rat brain histaminergic neurons from the 5th to the 45th days of postnatal ontogenesis. Methods. The scientific work was performed on the offspring of outbred white rats (12 animals). The decapitation of rats was carried out on the 5th, 20th and 45th days after birth. In the work we used histological, electron microscopic, morphometric and statistical research methods. The obtained data were processed by nonparametric statistics. Results. From the 5th to the 45th days of the postnatal period, in the nuclei of rat hypothalamus histaminergic neurons Cajal bodies, mainly in contact with the nucleolus or lying freely, are detected. In the process of establishing close association with the nucleolus, these structures are attached to it, forming a “cap” on its surface. On the 20th day, an increase in the degree of nucleoli association with Cajal bodies is revealed, which is manifested by the formation of perinucleolar ring clusters from Cajal bodies in the form of rosettes. Conclusion. During the described period of postnatal ontogenesis of histaminergic neurons, Cajal bodies do not undergo significant changes in shape and size, which could be related to the age of the animals. The frequency of occurrence of these structures decreases by almost 2.6 times.
Key words: тельца Кахаля, гистаминергические нейроны, постнатальный онтогенез, Cajal bodies, histaminergic neurons, postnatal ontogenesis
METHOD FOR CALCULATING THE POWER OF THE -TEST IN MEDICAL AND PHARMACOLOGICAL STUDIES
Lyamec L.L., Evseev A.V., Kozlova E.K., Kolpakova M.A.
UDC: 519 253
Abstract: Objective. In statistical analysis of experimental data, there is a number of methods to test statistical hypotheses based on Student’s distribution. These methods are based on the algorithm of calculations, which has a common popular name t -test. The most common use of the t -test is to test the statistical hypothesis that assumes that there are no significant differences between the mean values of two samples distributed according to the normal law. The procedure of decision-making in relation to the tested statistical hypothesis described in most literature sources when using the t -test is based on the calculation of the p -value and its subsequent comparison with the fixed level of significance , which determines the probability of error of the first kind and the specificity of the criterion . In this case, the mathematical calculations necessary to quantify the error of the second kind and sensitivity are not given,as a rule. The purpose of the theoretical study was to develop a convenient for practical use method for calculating the power and error of the second kind for the t -test. The method is intended for use in biomedical research, as well as to identify significant differences in conditions caused by pharmacological effects. Method. A review analysis of printed and electronic publications on the application of the t -test to test the statistical hypothesis that there are no significant differences between the mean values of the two samples distributed according to the normal law was carried out. The performance of computational procedures associated with the implementation of t -test and calculating p -values, error of the second kind and power of t -test are described, based on the integration of the Student's distribution and non-сentral Student's distribution. The basic computational actions which can present certain difficulties for researchers who do not have basic physical and mathematical education are revealed. The possibility of automation of complex computational procedures using available software and information resources of the Internet is considered. Practical examples of computing power and errors of the second kind for the t -test are given for the case when the variances of statistical aggregates are assumed to be unknown and the same, as well as for the case when the variances are assumed to be unknown and different from each other. Results. A method for calculating the error of the second kind and the power of the t -test using modern information technologies in the public domain is developed. The method is based on automation of Student’s distribution integration operations as well as Student’s non-сentral distribution integration operations. Automation of calculations significantly simplifies the calculation of the values necessary to test the hypothesis of no significant differences between the mean values of two samples distributed according to the normal law, as well as the calculation of the error of the second kind and the power of the t -test. The developed method significantly reduces the time spent on performing the required mathematical calculations and reduces the probability of computational errors by automating the calculations. Conclusion. As a result of the theoretical study, a method for calculating the power and error of the second kind for the t -test is developed to be used to test the statistical hypothesis that there are no significant differences between the mean values of two samples distributed according to the normal law. The proposed method makes it possible to automate complex computational operations associated with the integration of probability distribution density functions. For automation of calculations the built-in statistical functions of the table processor Excel and the Internet resource Keisan Online Calculator, which is in open access are offered. The proposed method of calculating the power and error of the second kind for the t -test may be of practical interest forscientists conducting research in the field of pharmacology and evidence-based medicine and using statistical methods of analysis of experimental data.
Key words: мощность статистического критерия, ошибки первого и второго рода, t-распределение Стьюдента, нецентральное t-распределение Стьюдента, t-критерий, power of statistical criterion, errors of the first and second kind, Student's t-distribution, Student's non-central t-distribution, t-test
DYNAMICS OF COGNITIVE DISTURBANCES IN PATIENTS IN THE EARLY RESTORATIVE PERIOD OF ISCHEMIC STROKE
Golovina O.S., Eliseeva E.V., Kalinskii P.P., Perelomova O.V.
UDC: 616.831.-005.1-06:616.89-008.454-085.214.2
Abstract: Objective. To assess the dynamics of cognitive changes in patients in the early recovery period of ischemic stroke for 12 weeks, who were only on basic therapy and who received additional treatment with a drug containing antibodies to the brain-specific S-100 protein and endothelial NO-synthase. Methods. Surveyed 112 patients in the early recovery period of ischemic stroke, the average age was 59.7±7.69 years. Evaluation of cognitive status at each stage of treatment was carried out using the MMSE (Mini-mental State Examination) scale. Results. The most pronounced and significant dynamics of cognitive functions was noted in the first group. When prescribing a daily dosage of 0.036 g (group 1), statistically significant differences (p <0.001) were obtained at each stage of treatment (after 4, 8, and 12 weeks of treatment). In the treatment with a preparation containing antibodies to the brain-specific protein S-100 and endothelial NO-synthase at a dosage of 0.018 g per day (group 2), a clear and statistically significant (p <0.001) dynamics was observed by week 4 of treatment and between 8 and 12 weeks of admission. Improvement of cognitive functions in the control group was observed only from the 8th week of therapy (p=0.007).
Key words: ишемический инсульт, ранний восстановительный период, когнитивные нарушения, антитела к мозгоспецифическому белку S-100 и эндотелиальной NO-синтазе, фармакологическая коррекция, Ischemic stroke, early recovery period, cognitive impairment, antibodies to the brain-specific S-100 protein and endothelial NO-synthase, pharmacological correction
ON THE ISSUE OF NEW SOURCES OF ENDOGENOUS GLUCOSE IN BLOOD DURING FASTING
Pereverzev V.A., Sikorsky A.V., Blazhko A.S., Evseev A.V., Nikitina O.S., Razvodovsky Yu.E., Velkom M.O., Pereverzeva E.V.
UDC: 612.352.12
Abstract: Objective. To establish new sources of endogenous glucose in the blood to maintain the proper level of glycemia in different functional states (rest and mental work) of a person under conditions of starvation, when its exogenous intake is minimal or absent. Methods. The study was carried out with the participation of 13 young women aged 19-29 years. Each test subject had 14 determinations of glucose content: in whole capillary blood taken from 4 fingers of a non-working hand (7 times); in whole venous blood taken through a catheter from the median ulnar vein of the same inoperative upper limb (also 7 times immediately after capillary blood sampling). The first (initial) determinations of glucose in whole capillary blood and in whole venous blood were made in subjects in a state of functional rest on an empty stomach (10-12 hours after eating, night fasting). The following 12 determinations of blood glucose were performed in young women 2 times during their mental activity (first in whole capillary and then in whole venous blood) at 1, 2, 3, 4, 5, and 6 hours from the start of work. The glucose content in whole (capillary and venous) blood was determined by the glucose oxidase method with amperometric detection using the Rightest GM100 glucose level control system (Bionime, Switzerland) in 1-3 μl of blood with an accuracy of 0.1 mM / L. Absolute glucose values in whole capillary blood and whole venous blood were determined, and capillary-venous difference in glycemia level was additionally calculated. The positive values of capillary-venous difference in glycemia was considered as evidence of the use (consumption) of glucose by cells of tissues of the non-working arm. Negative values of capillary-venous difference in glycemia were considered as evidence of glucose from the cells of tissues of the non-working arm into the blood. Results . A significant decrease in glucose was found in whole capillary (by 6.8-13.9%) and whole venous (by 7.9-18.3%) blood of young women with mental work on an empty stomach 2-6 hours after its start, compared with the initial level of glycemia in the same subjects in a state of functional rest. An individual analysis of the capillary-venous difference in glucose content in the vessels of an idle hand on an empty stomach in a state of both functional rest and functional activity (mental work) showed the presence of two groups among the subjects. The first group consisted of young women (8 people), in whom capillary-venous difference in glycemia in the state of functional rest and mental work on an empty stomach was negative in 100% and 83.3±5.4% (p<0.001) cases, respectively. The second group of five young women consisted of subjects in whom the glucose content in whole capillary blood was higher than its content in whole venous blood, both initially in a state of functional rest on an empty stomach and during mental work during fasting. A significantly higher glucose content in whole venous blood compared with whole capillary blood in young women of the 1st group indicates that the source of its entry into the blood is tissue cells of the upper extremities - endothelial cells of the vessels of the non-working arm (as the main and / or intermediate source) and possibly other cells (e.g. skin epithelial cells or others). The calculated contribution of this new endogenous source of glucose (endothelial cells of the blood vessels of the hand and, possibly, other cells) to the maintenance (increase) of the proper fasting in the subjects of the 1st group glycemia was 34.2% (p<0.005) and mental work in a state of functional rest under fasting conditions, from 16.8% to 33.7% (p<0.01). Conclusion. The facts obtained, excluding the participation of cells of the liver, kidney and intestine to increase the level of glycemia in venous blood flowing from of the non-working arm compared to the capillary, and analysis of scientific literature make it possible to reasonably assume that a new, previously undescribed source of endogenous glucose in blood on an empty stomach may be the endothelial cells of blood vessels outside a main or intermediate (when glucose is supplied to them from the epithelial cells of the skin) source or other cells (e.g.the formed elements of blood).
Key words: глюкоза, гликемия, цельная кровь (капиллярная, венозная), источник, эндотелиоциты, glucose, glycemia, whole blood (capillary, venous), source, endotheliocytes
СHARACTERISTIC OF CLINICAL PRESENTATION OF GASTROINTESTINAL TRACT DISEASES IN CHILDREN OF KURSK REGION
Muzaleva Yu.A., Matvienko E.V., Telegina I.A., Razin`kova N.S., Zhiznevskaja I.I., Gorban` G.Je.
UDC: 616.342-002+616.34-002.44
Abstract: Objective. To study the features of clinical presentation of chronic gastrointestinal tract diseases in children and teenagers of Kursk region. Methods. During the study 110 case histories of children with chronic gastroduodenitis and peptic ulcer disease hospitalized in the II pediatric department of Kursk Regional clinical children`s hospital wereanalysed. All patients were complexly examined. The presence of Helicobacter pylori was detected by enzyme immunoassay. A morphologically confirmed diagnosis of chronic gastroduodenitis and peptic ulcer disease of the stomach or duodenum was a criterion of inclusion in the study, an exclusion criterion were severe organic diseases of the gastrointestinal tract. Results. The most common complaint among all patients was upper abdominal pain. In case of PUD the pain was due to hunger and appeared at night, and in case of chronic gastroduodenitis the pain didn`t depend on eating. Light abdominal palpation caused pain in all regions of the abdomen with gastroduodenitistwice often compared with cases of PUD. Nearly half of children with PUD and only a fifth part of patients with gastrodudenitis had a pain in the umbilical region (p˂0,05). Pain in the right hypochondriac region was presented three times more often in case of PUD (p˂0,05). Speaking about comorbid diseases, reactive pancreatitis co-occurred with chronic gastroduodenitis more often than PUD, but inflection of the gallbladder coexisted with almost the same frequency. EGD showed that the most frequent localization of peptic ulcer is duodenum and the most frequent stage - recent ulcer. Conclusion. Therefore,subjective manifestations of chronic gastroduodenitis and peptic ulcer disease among children of various ages have a similar pattern, but in objective examination there are some differences between them.
Key words: язвенная болезнь, хронический гастродуоденит, дети, подростки, peptic ulcer disease, chronic gastroduodenitis, children, teenagers
ASSESSMENT OF VEGETATIVE NERVOUS SYSTEM IN INFANTS BORN WITH VARIOUS TYPES OF MILD INTRAUTERINE GROWTH AND DEVELOPMENT RETARDAТION
Ivanov D.O., Derevtsov V.V.
UDC: 616-053.3:618.3-06:616-008.6:612.89
Abstract: Objective. To assess the vegetative nervous system of infants born with various types of mild intrauterine growth and development retardation (IGDR). Methods. 734 comprehensive examinations of babies were conducted. Since the birth under observation were 166 children, out of them 72 (gr. 1) babies were born as a result of a complicated pregnancy including those with slight fetus gworth retardation, and 69 (gr. 2)- without it, from mothers with burdened somatic and obstetric and gynecologic anamnesis. Symmetrical IGDR was diagnosed in 15 (20.83%) (sub-gr. 1b), dissymmetric - in 57 (79.17%) (sub-gr. 1a) children from gr. 1. Healthy infants born by healthy mothers after normal pregnancies made up gr. 3 (25 subjects). All infants were full-term new-borns. The children were examined when they were 1 (156), 3 (143), 6 (134), and 12 (135 children) months old. Outcome recording methods were a comprehensive case history analysis, physical examination, assessment of cardiointervalography and distribution-free statistical analysis methods. Results. It is proved that the level of sympathetic activity (АМ, Ме) on the 2-3 days in children of sub-gr. 1a (39 con. un.) and 1b (39 con. un.) was lower than that of gr. 2; at the age of 1 month it was lower in children of sub-gr. 1a (43.5 con. un.) than in sub-gr. 1b, in children of sub-gr. 1b (49.5 con. un.) than in gr. 2, in children of gr. 1 (45 con. un.) than in gr. 2, in children of gr. 1 than in gr. 3; at the age of 3 months it was lower in children of 1a sub-gr. (41con. unit) than in sub-gr. 1b, higher in children of sub-gr. 1a and 1b (47 con. un) than in gr. 2; at the age of 6 months it was higher in children of sub-gr. 1a (37.5 con. un.) than at sub-gr. 1b, at children sub-gr. 1a than at the gr. 2nd below at children sub-gr. 1b (36 con. un.) than ib gr. 2; at the age of 12 months it was lower in children of sub-gr. 1a (34 con. un.) than in sub-gr. 1b, and higher in children of sub-gr. 1b (40 con. un.) and gr. 1. than in gr. 2. Conclusion. Mild IGDR (both symmetric and dissymmetric types) in infants facilitates changes in vegetative nervous system.
Key words: вегетативная нервная система, младенцы, замедление внутриутробного роста, vegetative nervous system, infants, intrauterine growth and development retardation
MAIN INDICATORS OF LIPID SPECTRUM IN PATIENTS WITH ISCHEMIC HEART DISEASE RESIDING AT DIFFERENT MOUNTAIN HEIGHTS
Rajabzoda M.E., Odinaev F.I., Fayzulloev H.T., Tursunov R.A.
UDC: 616.12
Abstract: Objective. To study the effect of the lipid spectrum in patients with coronary heart disease living at various mountain altitudes. Methods. The study included 430 patients with coronary heart disease, residents of different mountainous regions of the republic: low mountains (n =150, Dushanbe, 860 m above sea level), middle mountains (n=140, Khorog, 2200 m above sea level) and high mountains (n=140, settlement Murgab, 3600-5600 m above sea level). The control group consisted of 25 healthy people aged 55 to 65 years living at appropriate heights. Results. The analysis of total lipids in patients with coronary heart disease in residents of low mountains showed mainly low density lipoproteins in elderly people (over 65) - 5.7±0.03 mmol/l, for patients of mid-mountain heights - moderately increased, but significantly reduced compared to the previous groups, accounting for 6.2±0.03 mmol/l. In patients with coronary heart disease living in high altitude conditions, despite excessive consumption of fats, the average level of total cholesterol in the blood plasma was slightly increased in comparison with the control indicators, but lowered in comparison with the previous groups. Conclusions. Some regular features have been established, namely, blood plasma lipids in patients with myocardial ischemia living in various mountain and climatic conditions are determined by the climate and living conditions, which depend on the mechanisms of formation and course of ischemia at different heights. In this regard, it can be argued that identical pathogenetic atherosclerotic mechanisms under conditions of varying degrees of hypoxia and extreme mountain climate factors proceed differently. So, the mid- and alpine altitude contributes to the enhanced process of lipid peroxidation and lipolysis of fats.
Key words: ишемическая болезнь сердца, липиды, липопротеидов, ишемия миокарда, атеросклеротические процессы, горный климат, coronary heart disease, lipids, lipoproteins, myocardial ischemia, atherosclerotic processes, mountain climate
ROLE OF ESSENTIAL ARTERIAL HYPERTENSION AS A RISK FACTOR FOR THE DEVELOPMENT OF ACUTE CEREBROVASCULAR ACCIDENT
Punina A.A., Punina M.A., Shkitin V.A., Shuvalov A.D.
UDC: 616.1/.9+616.1+616.8-005
Abstract: Objective. To assess the significance of risk factors leading to acute cerebrovascular accident in patients with essential arterial hypertension; to study the features of essential arterial hypertension in patients with ischemic stroke. Methods. We analyzed case histories of 99 patients with ischemic stroke and essential arterial hypertension aged 38 to 78 years (the main group). The control group consisted of 115 patients aged 33 to 75 years with essential arterial hypertension. A comparative analysis of the main modifiable and unmodifiable risk factors for the development of acute cerebrovascular accident was performed based on questioning, data of the case histories, physical and instrumental methods of examination. Results. Acute cerebrovascular accidents occurred more often in patients aged over 70 years with such concomitant diseases as diabetes mellitus, atrial fibrillation, hypercholesterolemia, with a long-term arterial hypertension. The level of arterial blood pressure had no influence on the incidence of ischemic stroke. According to our data, stroke equally occurs among both men and women. Such risk factors as smoking, alcohol and salt abuse did not directly affect the occurrence of stroke. The comparison of antihypertensive therapy did not reveal a significant difference betweenthe patients of both groups in such parameters as effectiveness and regularity of treatment. Conclusion. The development of stroke is not affected by the level of blood pressure, but it is affected by the duration of hypertension. The greatest role in the development of acute cerebrovascular accident belongs to the age over 70 years, diabetes mellitus, atrial fibrillation and hypercholesterolemia.
Key words: эссенциальная артериальная гипертензия, ишемический инсульт, факторы риска, essential arterial hypertension, ischemic stroke, risk factors
FEATURES OF CENTRAL HEMODYNAMICS IN YOUNG MEN WITH ISOLATED SISTOLIC ARTERIAL HYPERTENSION
Kovaleva O.A., Milyagin V.A.
UDC: 616.12-008.331.1
Abstract: Objective. To study the features of central hemodynamics in young men with isolated systolic arterial hypertension. Methods. The method of applanation tonometry (SphygmoCor apparatus) was used to study blood pressure (BP) levels and features of the central and peripheral pulse wave in 138 healthy young patients (aged from 17 to 25 years) with isolated systolic hypertension. The control group consisted of 90 young people with normal blood pressure. Results. In young men, an isolated increase in systolic blood pressure (SBP) was determined as a result of an increase in stroke volume of the heart and central pulse blood pressure (PAD). Due to a high amplification (by 179%) of the pulse wave passing to the periphery due to the reflected waves, the peripheral PAD and SBP are significantly increased, an isolated systolic hypertension (ISAG) is formed, in which the SBP on the hands increases. Pulse wave amplification is aimed at increasing the efficiency of peripheral hemodynamics, primarily muscle blood flow, in order to ensure high physical activity of young men. However, in most young people there is no increase in central SBP over 120 mm Hg, and central and peripheral DBP does not exceed 75 mm Hg. This leads to the formation of a “false” ISAG - an isolated increase in the SBP on the hands with a normal value of the SBP in the aorta. With this variant of hypertension, the risk of cardiovascular complications is low, because it is determined by the magnitude of the increase in SBP in the aorta and in the central organs. With a more pronounced increase in central DBP in the aorta, the SBP exceeds 120 mm Hg. In this version of ISAG, an increase in DBP occurs not only due to an increase in vascular resistance, but also due to an increase in augmentation of the diastolic part of the central pulse wave returning to the heart from the periphery of the reflected waves. This helps to improve the propulsive ability of the cardiovascular system, more effective hemodynamics of predominantly central organs, which allows for more effective homeostasis, but with this hemodynamic variant, the central SBP exceeds 120 mmHg, in this case it is not a false formation, but true isolated systolic hypertension. Conclusion. The study showed that at a young age in men, as a result of increased stroke volume and high pulse wave amplification, an isolated systolic arterial hypertension is formed, in which the central SBP can be less than 120 mm Hg. In this case, a “false” ISAG is diagnosed, in which there are no restrictions on the choice of profession and drug therapy, which is very important when examining young people of draft age.
Key words: артериальная гипертензия, аппланационная тонометрия, аугментация пульсовой волны, амплификация пульсовой волны, ложная изолированная систолическая АГ, arterial hypertension, applanation tonometry, pulse wave augmentation, pulse wave amplification, false isolated systolic hypertension
EFFECTS OF FETUIN-A ON BONE TURNOVER IN PATIENTS WITH RHEUMATOID ARTHRITIS
Papichev E.V., Korolik O.D., Zavodovsky B.V., Seewordova L.E., Akhverdyan Y.R., Polyakova Y.V.
UDC: 616.72-002.772
Abstract: Objective. To study the association of fetuin-A and markers of bone turnover in patients with rheumatoid arthritis. Methods. We studied 30 patients with rheumatoid arthritis and secondary osteoporosis, 30 patients with uncomplicated rheumatoid arthritis and 30 healthy controls. Fetuin-A serum concentration and bone mineral density (BMD) were measured in all groups. Collagen type 1 C-telopeptide, N-terminal propeptide of type I procollagen, serum calcium and serum alkaline phosphatase were measured in patients with rheumatoid arthritis. Statistical analysis was performed with the “Statistica 10.0” software package. Results. Fetuin-A mean level in patients with rheumatoid arthritis was lower, than in healthy controls (731,21±109,9 ug/ml vs 812,9±76,2 ug/ml; F=13,34; p=0,0004). Mean level of fetuin-A in group with osteoporosis was 711,01±134,2 ug/ml vs 751,4±75,5 ug/ml for patients without osteoporosis (F=2,06; p=0,15). We observed significant moderate positive correlation between fetuin-A level and BMD of femur neck (r=0,307; p=0,017) and weak - of total hip (r=0,274; p=0,034). However, weak positive unsignificant correlation was observed between fetuin-A level and BMD at lumbar spine (r=0,184; p=0,161). We observed significant moderate negative correlation between fetuin-A with collagen type 1 C-telopeptide (r=-0,423; p=0,001) and N-terminal propeptide of type I procollagen (r=-0,3911; p=0,002). Conclusions. Fetuin-A serum concentration is lower in patients with rheumatoid arthritis than in healthy controls. Fetuin-A level correlates positively with BMD of femur neck and total hip. Fetuin-A correlates negatively with collagen type I C-telopeptide and N-terminal propeptide of type I procollagen. Fetuin-A may be considered as a laboratory marker for bone turnover and bone protector.
Key words: ревматоидный артрит, фетуин-А, минеральная плотность костной ткани, МПКТ, С-телопептид коллагена I типа, N-концевой пропептид проколлагена I, rheumatoid arthritis, fetuin-A, bone mineral density, BMD, collagen type I C-telopeptide, N-terminal propeptide of type I procollagen
PUNCTURE INTERVENTIONS AND THEIR IMPORTANCE IN THE DIAGNOSIS AND TREATMENT OF NODULAR PATHOLOGIES OF THE THYROID GLAND OF VARIOUS ORIGINS
Sobolev Yu.A., Belyaeva A.I.
UDC: 616-089.82-039.56+616.441-006.2
Abstract: Objective. Consideration of the method of fine-needle aspiration puncture biopsy (FAPB) of the thyroid gland under the control of ultrasonic navigation and analysis of its effectiveness in identifying benign and malignant nodules of the thyroid gland. Methods. 520 patients were examined in the period of 2017-2019, who have indications for a fine-needle aspiration puncture biopsy. The manipulation was carried out in a small operating room, using the “free hand” method without using local anesthesia. Ultrasonic monitoring made it possible to identify the localization of nodes, reduce blood aspiration and trace the course of the needle. Nodes larger than 1 cm were punctured. Next, preparation of smears was carried out. Cytological examination was carried out using light microscopy. Results. An accurate cytological diagnosis was made in 495/520 (95.2%) patients and was represented by unchanged follicular epithelium, cystic elements, epithelium with proliferative activity, autoimmune thyroiditis, various types of goiter, follicular adenoma. A number of patients were indicated for surgical intervention. The main operations performed on the thyroid gland were thyroid resection, thyroidectomy, and hemithyroidectomy, the last of which was organ-preserving. Conclusion. A fine-needle aspiration puncture biopsy under ultrasound control is a highly effective minimally invasive method for the diagnosis of nodular formations of various origins, allowing to detect malignant neoplasms with a diagnostic accuracy of up to 90%. The optimal treatment method, if a proliferating activity of follicular tissue is detected during FAPB, is surgical intervention, which consists in the partial or complete removal of the damaged thyroid gland.
Key words: щитовидная железа, тиреопатия, тонкоигольная аспирационная биопсия, ультразвуковой контроль, узловой зоб, фолликулярная опухоль, эндемичность, thyroid gland, thyreopathy, fine-needle aspiration biopsy, ultrasound control, nodular goiter, follicular tumor, endemic
ALCOHOLISM AS A THREAT TO THE NATIONAL SECURITY OF THE RUSSIAN FEDERATION
Ivanichkina E.V., Didenko V.N., Krikova A.V., Evseev A.V., Zaitsevа V.M., Dmitrieva E.V., Andreeva O.V., Nankevich I.N., Udovikova O.I., Volk S.V.
UDC: 616-01/-099
Abstract: Objective. Comprehensive analysis of legislative background and certain trends in strategic development of public health of the Russian Federation in the context of medical care in alcoholism as well as assessment of autopsy protocols were performed. Methods. The study involved 127 autopsy protocols (98 males and 29 females). Content analysis of official information available, continuous sampling method and statistical methods were used. Results. The study performed clearly demonstrates social significance of the disease and its impact on health and demographic situation in the country. Alcoholic liver disease (K70) was studied. The age of autopsy bodies was 49,9±1,2 years; males (77%) aged 50,3±1,3 years, females (23%) aged 51,0±1,5 years. The history of unemployment was registered in 44% cases, 33% were retired, 5%-skilled workers, 1% had diverse jobs. The most common diagnoses made were hepatitis, liver cirrhosis, pancreatitis, chronic alcoholic hepatitis, alcoholic cardiomyopathy and liver cirrhosis. Among concomitant diagnoses confirmed with clinical and postmortem records there were chronic bronchitis, chronic pyelonephritis, pneumosclerosis, emphysema and coronary heart disease. Conclusion. According to statistic data, efficient implementation of social and economic methods to combat chronic alcohol intoxication (increase in the cost of alcohol beverages, promotion of low dosed alcohol, prohibition of sale to adolescents, etc.), as well as the promotion of a healthy lifestyle can result in a decrease in mortality rates associated with alcohol-induced lesions of internal body organs, but the problem still remains urgent and unsolved and requires new approaches to pathogenetically targeted drug therapy of alcoholic polyvisceropathy.
Key words: алкоголь, болезни печени, смертность, профилактика, alcohol, liver disease, mortality, prevention
REVERSE SHOULDER ARTHROPLASTY IN COMPLEX CLINICAL CASES
Kesyan G.A., Urazgil'deev R.Z., Karapetyan G.S., Arsen'ev I.G., Kesyan O.G., Shuyskiy A.A.
UDC: 616-001+616.7+617.3
Abstract: Objective. To study the features of implantation of reverse shoulder endoprotheses and to evaluate the effectiveness of treatment in complex clinical cases. Methods. Between 2017 to 2019, 156 patients with complex clinical cases were treated, who underwent reverse shoulder arthroplasty. Results. The results were evaluated after 3, 6 and 12 months after surgery. The stability of components and periimplant resorption of bone tissue were evaluated on radiographs. Excellent results (<25 points on DASH) were observed in 76 patients, good results (26-50 points) - in 74 patients. In 6 patients, the results were assessed as satisfactory (51-75 points). Among all cases of observation, in 2 patients there was a dislocation of the endoprosthesis as a result of a fall with an emphasis on the operated upper limb, there were no other complications. At the end of the observation period, there was no instability, migration of endoprosthesis components, bone resorption according to radiographs. Conclusion. Reverse shoulder arthroplasty can help patients with the following pathologies: defects and osteoarthritis of the articular surface of the glenoid, massive irreparable tears of the rotator cuff, severe hypotrophy of the deltoid muscle, which confirms the relevance and interest in the development of the technique. Careful preoperative planning and preparation, the use of specialized implants, which are available at the present stage of development of traumatology and orthopedics, in most cases allows to achieve positive clinical results.
Key words: реверсивное эндопротезирование, ревизионное эндопротезирование, плечевой сустав, омартроз, асептический некроз, вывих эндопротеза, reverse arthroplasty, revision arthroplasty, shoulder joint, omarthrosis, aseptic necrosis, dislocation of the endoprosthesis
SOFTWARE PROCESSING AND VISUALIZATION OF THE RESULTS OF SELF-EXAMINATION OF PATIENTS WITH FOOT PATHOLOGY
Golubev G.S., Hadi R.A., Bahaa Ayyad Y.A., Evseev O.A.
UDC: 617.586:004
Abstract: Objective The aim of this study was to enable objective control of feet pathology treatment results. The validated self-estimation scales were used to achieve this aim. Methods A retrospective observational design was used to compare AOFAS-HS and FAOS self-estimation scales. To simplify all stages of the work with these scales, VBA-application for the Excel table processor was developed. This application manages data according to algorithms recommended by the scales authors. Patients' data were stored and processed by non-parametric statistical methods. Results. The application tested a sample of data collected from the forms which were sent to patients who undergone calcaneal fractures. 68 forms were sent and 43 returned. Two of 43 were damaged. The average follow-up period between the fracture and questioning was 16 months. The application was validated. A database of treatment results assessment was created (AOFAS-HS - 25 fields, FAOS - 42 parameters). Conclusion. Both AOFAS-HS and FAOS have equal discrimination capabilities of “good” and “bad” results, but the “moderate” interval for AOFAS-HS is more extensive than for FOAS. The application simplifies routine work for specialized questionaries analysis.
Key words: переломы пяточной кости, подтаранный артроз, боли в стопе, калькуляторы шкал, AOFAS-HS, FAOS, самоанкетирование, calcaneal fractures, subtalar arthrosis, heel pain, calculators of clinical scales, self-tests
SOCIO-PSYCHOLOGICAL ASPECTS OF THE TENDENCY TO AFFECTIVE PATHOLOGY OF HIV-INFECTED
Osipova N.N., Krikova A.V., Bespalova L. I., Evstafiev V.V., Evseev A.V., Dmitrieva E.V., Mikheeva A.V., Zaitseva V.M.
UDC: 616-01
Abstract: Objective. To study the socio-psychological aspects of the tendency to the affective pathology of the bipolar spectrum of HIV-infected people. Methods. In the course of the experiment, an analysis of studies and reports was conducted, which provided information regarding stigma and discrimination against HIV-infected patients. A sociological anonymous survey of healthy respondents was carried out in 2018, 84 people participated, with an average age of 24.72±1.99 years (from 17 to 68 years). A sociological anonymous survey of the respondents with HIV-positive status was carried out on a voluntary basis in 2018 at the Smolensk AIDS Prevention and Control Center. The survey involved 36 people with an average age of 32.3±5.9 years (18 to 55 years). A study of addiction with affective pathology using screening methods was conducted. Statistical data processing included descriptive statistics; statistical significance was recognized with a probability of > 95% (p<0.05). Statistical analysis of the results was performed in Microsoft Excel 16 using the Data Analysis add-in. All experimental and clinical procedures were performed in full compliance with Russian and international ethical standards of scientific research. Results. In general, the analysis of screening scales revealing a tendency to hypomanic states and bipolar affective disorder showed that the average values in the studied sample do not reach threshold values, which indicates a lack of tendency to BAR. Subsequently, a study of the propensity for BAR in male and female samples was conducted. Exceeding the screening threshold was detected in the female sample on the Zang depression susceptibility scale (52.3±1.4; CI: 49.6-55.0). Conclusion. Most healthy people do not display a discriminatory attitude towards HIV-infected people, they are ready for full communication and interaction with them. In turn, HIV-infected patients do not experience stigmatizing effects from those around them that could cause mental discomfort. A study of the tendency to affective pathology for bipolar disorder revealed an excess of the screening threshold for depression chalet, which may indicate a reduced emotional background of a nosogenic nature.
Key words: ВИЧ-инфицированные, аффективные расстройства, социально-психологические аспекты, HIV-infected, affective disorders, socio-psychological aspects
CASE OF INFECTIVE ENDOCARDITIS IN ADOLESCENT
Danilov A.I., Bekezin V.V., Peresetsky O.V., Pleskachevsky T.A., Starkova A.E.
UDC: 616.126-002 + 053.2
Abstract: Objective. To present a clinical case of infective endocarditis in an adolescent. Methods. According to the case history of the inpatient, the results of the survey in the framework of the clinical, microbiological and imaging methods of diagnostics and prescribed antimicrobial therapy, a clinical case of infective endocarditis in a patient aged 16 years hospitalized in the infectious hospital, and later in the Children's clinical hospital was studied. Results. Fever with hectic numbers, accompanied by severe chills, headache, myalgia and ossalgia was the cause of hospitalization in the infectious hospital with suspected meningococcal infection. In the infectious department, severe intoxication was joined by the hemorrhagic syndrome with localization of hemorrhages on the distal extremities. As a result of microbiological diagnosis, meningococcal infection was not confirmed, staphylococcus aureus was isolated from the blood. Negative dynamics during auscultation of the heart, expressed in a significant increase in the intensity of systolic noise, which began to drown out the I tone and acquired a blowing timbre, as well as identified vegetation on the valves and chords of the mitral valve during dynamic observation during echocardiography allowed to diagnose infectious endocardium. The patient was referred to the pediatric hospital of general somatic profile. Conclusions. On the background of the therapy the patient felt much improved, fever disappeared, his appetite improved; the size of the liver and spleen decreased;twicenegative results of blood cultures were obtained; blood tests revealed normal levels of leukocytes and leukocyte formula. Auscultation of the heart revealed a rough systolic murmur of the blowing timbre, which occupies the entire systole, drowning I tone at the apex, and also in III, IV intercostal space. In addition, increased circulatory failure in the form of tachycardia and dilatation of the left heart was noted. In accordance with this, after teleconsultation, the patient was referred to continue treatment in the Bakulev national medical research centre of cardiovascular surgery.
Key words: инфекционный эндокардит, бактериологическое исследование крови, эхокардиография, антимикробная терапия, хирургическое лечение, infective endocarditis, microbiological diagnosis, echocardiography, antimicrobial therapy, surgical treatment
CASE OF A CHRONIC VIRAL MIXED HEPATITIS B+D+C WITH AN OUTCOME TO CIRRHOSIS AND HEPATOCELLULAR CANCER
Kaplunov K.O.
UDC: 616.92/.93
Abstract: Objective. An exchange of clinical experience with doctors of the infectious profile, hepatologists, oncologists on management of patients with chronic viral hepatitis with probable adverse outcomes. Method. A comprehensive study of the patient's outpatient records, the results of clinical and epidemiological and laboratory (general clinical, serological, molecular genetic) methods of study of the patient. Therapy of the described patient was not carried out. Results. The observation presents a clinical case of chronic viral mixed hepatitis B+D+C with an outcome in cirrhosis of the liver and hepatocellular cancer in a 43-year-old man who was previously a user of injectable drugs. Initially, the diagnosis of chronic mixed hepatitis B+C was established in the process of oncological examination in the conditions of the regional oncologic dispensary, where oncology of the liver was first diagnosed. The patient underwent resection of 5-6-7 segments of the liver. Currently, the patient is being dynamically monitored by both oncological and infectious services. During a regular examination, signs of replication of HBV infection were detectedfor the first time, the patient was examined for Delta infection, which was also diagnosed in the replication phase. Conclusion. During the diagnostic search, the verifieddiagnosis was chronic viral mixed hepatitis B+D+C, replication phase for HBV+HDV infections, minimal biochemical activity with an outcome in cirrhosis of the liver (Child-Pugh class A) and hepatocellular cancer (T3N0M0). Dynamic observation is carried out, the necessity of antiviral therapy of HBV infection is considered.
Key words: хронический вирусный микст-гепатит, цирроз печени, гепатоцеллюлярный рак, chronic viral mixed hepatitis, liver cirrhosis, hepatocellular cancer
MINIMALLY INVASIVE METHODS IN THE TREATMENT OF GALLSTONE DISEASE IN OLDER PATIENTS
Omorov R.A., Aitikeev A.U., Aliyev M.Zh., Toktosunov A.S.
UDC: 616.366-003.7-089.87-053.8
Abstract: Objective. To evaluate the comparative results of minimally invasive methods of treatment of cholelithiasis in the elderly and senile patients. Methods. Under observation there were 2 groups of patients: 1st group included 132 patients with cholecystectomy from minilaparotomic access and 2nd group -106 patients with cholecystectomy from laparoscopic access; all patients were aged over 60 years with concomitant pathologies. In acute cholecystitis, prophylaxis included the administration of antibiotics intramuscularly, the ultrahigh-frequency magnetic field of the surgical wound and the inhalation therapy of the upper respiratory tract (3-4 sessions). Results. Inflammatory complications were identified after cholecystectomy with mini-appliance access in 10 cases (7.6%), fatal outcome - in 1 (0.7%), and in the 2nd group from laparoscopic cholecystectomy in 7 cases (6.6%), mortality - in 1 case (0.9%). Conclusions. Endovascular surgical treatment is a more mild method, but combined diseases, indications and contraindications should be taken into account. In surgical treatment of cholelithiasis in older patients, both mini-apparatus access and endovascular surgery can be used. In our opinion, one method should not be opposed to another, since both methods should be performed taking into account contraindications and thorough implementation of the technique of the stages of operations. Concomitantpathologies are a valuable indicator in preparing patients for surgery.
Key words: желчнокаменная болезнь, минилапаратомия, лапароскопическая холецистэктомия, осложнения, летальность, ультравысокочастотное магнитное поле, ингаляция, gallstone disease, minilaparatomy, laparoscopic cholecystectomy, complications, mortality, ultrahigh-frequency magnetic field, inhalation
CASE OF SERONEGATIVITY FOR TORCH INFECTIONS IN A PATIENT WITH LONG-TERM SUBFEBRILITY
Kaplunov K.O.
UDC: 616.92/.93
Abstract: Objective. The exchange of clinical experience with doctors of the infectious profile, therapists, obstetricians-gynecologists on examination of long-term febrile patients. Method. A comprehensive study of outpatients’ records, the results of clinical and epidemiological and laboratory (general clinical, serological, molecular genetic) methods of examination of the patient. The therapy of the described patient was not carried out. Results. The observation presents a clinical case of seronegative examination for TORCH infection of a 31-year-old man suffering from long-term subfebrility. Serological study was conducted to diagnose ubiquitous infectious pathology: toxoplasmosis, cytomegalovirus infection, herpes simplex viruses 1, 2 types. To all these viral agents, the patient had no specific IgG. Conclusion. In the process of the diagnostic search, infectious pathology was excluded, given the "oncological" nature of the complaints, the patient was referred to the primary outpatient consultation of an oncologist. Prospective patient data are unknown.
Key words: инфекционные болезни, TORCH-инфекции, серонегативность, infectious diseases, TORCH infections, seronegativity
LEGAL ASPECTS CONCERNING IMPROVEMENT OF BIRTHRATES IN THE RUSSIAN FEDERATION
Shestakov N.V., Krikova A.V., Konyshko N.A., Evseev A.V., Dmitrieva E.V., Zaitsevа V.M., Shestakova O.V., Malikova D.M.
UDC: 616-01/-099
Abstract: Objective. The aim of the study was to analyzelegal documents and national strategies concerning such an urgent health and social problem as improvement of birth rates in the Russian Federation. Methods. Content analysis of official sources of information was performed. Statistic processing of the data obtained included descriptive statistics. Results. The article reflects the results of an analysis of Russian National strategies targeted at increase of birthrates in the Russian Federation with a particular emphasis on Smolensk regional regulatory documents. Changes in the legislative background of the problem are considered and analyzed. National Public Health Strategies aimed at medical support to families suffering from infertility and potentials of in vitro fertilization procedures covered by compulsory national health insurance policy are emphasized. The registry of medicines was analyzed and thus, totally 61 drugs used in vitro fertilization procedures, including drugs for general anesthesia were identified. Conclusion. Low birth rates are an urgent national health problem considered by the Russian Government. National aims in the context are clearly formulated in the Russian National Project «Demography». Several priorities are focused on, including accessibility and affordability of in vitro fertilization procedures covered by the national compulsory health insurance policy.
Key words: legal aspects, assisted reproductive technology, infertility
CLINICAL CASE OF PURULENT PLEURAL EFFUSION IN FEMALE PATIENT RECEIVING MULPTIPLE SCLEROSIS THERAPY
Vishnevsky Oleg A, Mikhalik Dmitrii S, Zhukov Gennadii V., Nikolaenkova Ludviga I., Vakal Tatyana N., Simonenko Vadim V.
UDC: 616.25-002.3+616.832-004.2
Abstract: Objective. To demonstrate the case history of purulent pleural effusion in a female patient suffering from multiple sclerosis receiving corticosteroid pulse-treatment and her positive outcome. Methods. The authors described a clinical case of a female patient with multiple sclerosis receiving pathogenetic corticosteroid pulse-treatment complicated with purulent pleural effusion and her positive beneficial outcome. An analysis of clinical information on possible infectious complications of multiple sclerosis therapies in Russian and foreign references was performed. Results. A positive beneficial outcome after the treatment of left purulent pleural effusion revealed in thoracic surgery department in case of 67-years old female patient with multiple sclerosis was provided by early verification by means of X-ray examination and consequent spiral computer chest tomography as well as its optimal medical treatment. Conclusion. At multidisciplinary therapeutic hospitals, the possibility of the occurrence of nosocomial opportunistic respiratory tract infectious complications in immunocompromised patients receiving hormonal treatment should be considered.
Key words: multiple sclerosis, autoimmune disease, purulent pleural effusion, case history, рассеянный склероз, аутоиммунное заболевание, эмпиема плевры, клинический случай
FEATURES OF CLINICAL PICTURE AND COURSE OF LESIONS OF GASTRODUODENAL ZONE IN CHILDREN IN COMBINATION WITH GIARDIASIS
Mironova T.A., Shestakova V.N., Musetova D.A., Borovkova V.N.
UDC: 616.33-002.44-053.2
Abstract: Objective. To study clinical features and course of gastroduodenal lesions taking into account secretory function in children with giardiasis, but without HP infection, for a tactical approach to early preventive care. Methods.The object of the study was teenage children (n=60). Of these, 30 children had lesions of the gastroduodenal zone in combination with giardiasis without HP infection (the main observation group, 10 children with increased secretory function, 10 children with preserved secretory function and 10 children with reduced secretory function). The comparison group consisted of 30 children with lesions of the gastroduodenal zone without giardiasis invasion and without HP infection. The diagnosis of gastroduodenal lesions was verified by esophagogastroduodenoscopy with targeted mucosal biopsy followed by histological examination. Results. The aim of this work was to study the characteristics of the clinic and the course of lesions of the gastroduodenal zone, taking into account the secretory function in children against lambliosis for a tactical approach to early preventive care. It was found out that in children with lesions of the gastroduodenal zone with preserved secretory function on thebackground of lambliosis, the disease begins at the age of 7-9 years, for a long time it is latent, the clinical picture is unclear, the leading symptoms are characterized by the presence of body weight deficit, changes in the autonomic nervous system in the form of asthenic neurotic syndrome. In children with lesions of the gastroduodenal zone with a reduced secretory function against the background of lambliosis, the disease begins at the preschool age (4-6 years), proceeds with severe asthenic and neurotic reactions, dyspeptic syndrome, which manifests itself in the form of nausea, decreased appetite, easing of the chair and moderate pain syndrome. Patients with lesions of the gastroduodenal zone with high secreting function on the background of lambiosis, the disease starts at the age of 10-15 years, runs a clearly outlined pattern with a pronounced pain syndrome, neurotic reactions prevail over depressive disorders. These children have a low-grade fever, nausea and heartburn in the morning. Significant severity of pain syndrome in children in combination with lambiosis is due to dyskinesia of the stomach and duodenum by hypermotor type with spasm phenomena and frequent combination with dyskinesia of the gallbladder by hypertensive type. Peculiar kind of three-wave rhythm of exacerbation during the year important to be considered when working with this contingent of children. Conclusion. In patients with lesions of the gastroduodenal zone with preserved secretion on the background of giardiasis without HP infection, the disease begins at the age of 7-9 years, for a long time it proceeds latently, the clinical picture is unclear, the leading symptoms are characterized by the presence of body weight deficit, changes in the autonomic nervous system in the form of astheno-neurotic syndrome. Patients with lesions of gastroduodenal zone with reduced secretion on the background of giardiasis without HP infection, the disease begins at a preschool age (4-6 years), runs with pronounced asthenic and neurotic reactions, dyspeptic syndrome, is manifested as nausea, reduced appetite, loose stools and mild pain.
Key words: children of adolescence, giardiasis, gastroduodenal lesions
FEATURES OF PHYSICAL DEVELOPMENT OF PRESCHOOL CHILDREN WITH DEFECTS OF SPEECH DEVELOPMENT
Svoboda P.N., Shestakova V.N., Sosin D.V., Borovkova V.N.
UDC: 616.22.-008.5-053.2
Abstract: Objective. The aim of this work was to study the indicators of the level of physical development in preschool children with general underdevelopment of speech for timely corrective measures. Methods. The study involved 52 children of preschool age. Of these, 26 children had speech defects (the main observation group). The 1st main subgroup consisted of girls (n=13), the 2nd - boys (n=13). The comparison group included 26 children who had no speech defects. In this observation group, the 1st comparison subgroup was girls (n=13), the 2nd subgroup was boys (n=13). All children lived in the same region and were consulted by narrow specialists, including a surdologist, speech therapist and speech pathologist. Clinical assessment of health was carried out in accordance with the guidelines developed in the research Institute of hygiene of children and adolescents. Physical development was assessed by the main somatometric (height, weight, chest circumference) indicators using the centile method. Results. It was found that children with general underdevelopment of speech are less well-fed, have lower body length and less body weight, compared with peers without speech defects. Children at preschool age with general underdevelopment of speech are prone to disruption of the harmony of physical development, boys are more prone to this, which is important to consider when working with such a contingent of children. Conclusion. Children at preschool age with general underdevelopment of speech should regulary undergo the assessment of the anthropometric data. When identifying deviations, urgent correction is necessary, since as the child grows, there is an increase in violations of the harmony of physical development, which negatively affects the health of children. Children with general underdevelopment of speech are less well-fed, have lower body length and lower body weight, compared with peers without speech defects. In girls with general speech underdevelopment, the rate of weight gain, growth, breast circumference are less pronounced than in peers and children without speech defects. Children at preschool age with general underdevelopment of speech are prone to violation of the harmony of physical development, boys are more prone to this, which is important to consider when working with such a contingent of children.
Key words: дети дошкольного возраста с общим недоразвитием речи, уровень физического развития, здоровье, preschool children with General underdevelopment of speech, the level of physical development, health
COMPARATIVE CHARACTERISTICS OF PHYSICAL PERFORMANCE, VITAL CAPACITY OF LUNGS AND VITAL INDEX OF ADOLESCENT GIRLS BROUGHT UP IN SUBSTITUTE FAMILIES
Borovkova V.N., Svoboda P.N., Shestakova V.N., Musetova D.A.
UDC: 612.24:616-055.23
Abstract: Objective. To study physical performance, lung capacity and life index of girls living in substitute families, to preserve and strengthen their health. The study revealed that girls raised in substitute families have a reduced level of physical performance, low life index, low resistance to hypoxia. They have lower functionality, which is important to consider when compiling programs for physical activity. In order to facilitate adaptation to new conditions and restore functional indicators of the physical component of health, girls from substitute families need constant medical, psychological and pedagogical support. Methods. To assess the functional state of the child's body, indicators were used to identify the initial changes in the body at the prenosological level, as well as complex indicators to assess the dynamic changes in functional systems in the process of growth and development. 70 girls aged from 12 to 15 years were under supervision. Of these, 20 girls lived in substitute families (main observation group) and 50 girls were raised in full families (comparison group). Physical performance was assessed by step-test, CVC (ml)/body weight (kg) - vital index reflecting the functional abilities of the respiratory system, CVC was determined by spirometry. Results. The analysis of functional parameters in girls showed that the overall physical performance (OPP) fell within the parameters of the average values for the Russian Federation in all groups of observation and had no significant differences. It should be noted that in the age range of 10-15 years, the indicators of OFRS in the main group are significantly lower by 89.13 kg/min than in the comparison group (p<0.05). Their growth did not exceed 29.14 kg/ min in the main group and 61.19 kg/ min in the comparison group. The girls of the comparison group at 10-11 years of age had more OFRS by 19.0 kg/min, and 12-15 years by 51.06 kg/min, than in the main group (p<0.05), but they corresponded to the average values for the Russian Federation. The number of children with low rates of OFRS increased by only 4.0% in girls from the comparison group and 10.0% from the main observation group. Conclusion. Girls brought up in substitute families have a reduced level of physical performance, low resistance to hypoxia. Girls raised in substitute families have lower lung capacity and life index scores, which reflect a decline in the functional capacity of the respiratory tract, so they need constant monitoring of physical activity. In order to facilitate adaptation to new conditions and restore functional indicators of the physical component of health, girls from substitute families need constant medical, psychological and pedagogical support.
Key words: девочки подросткового возраста, физическая работоспособность, жизненная емкость легких, жизненный индекс, здоровье, физические нагрузки, teenage girls, functional indicators, health, physical activity
ACUTE OTITIS MEDIA IN PEDIATRIC PRACTICE
Danilov A.I., Danilova E.M.
UDC: 616.284-002+053.2
Abstract: Objective. To study the features of the course and treatment of acute otitis media in the pediatric population. Methods. The research was carried out in the framework of the study of the clinical picture and treatment of acute otitis media in the pediatric population. The data published in the modern scientific literature were used in the preparation. Results. Acute otitis media is an inflammatory process that covers all three parts of the middle ear: the tympanic cavity, the cells of the mastoid process, the auditory tube and manifests itself with one or more characteristic symptoms (ear pain, fever, hearing loss). The main etiological factor in the occurrence of acute otitis media is the impact on the mucous membrane of the middle ear of a bacterial or viral agent, often in conditions of altered reactivity of the body. The main complaints are ear pain, fever, in some cases - pus from the ear and hearing loss. In most cases, it is sufficient to carry out conservative therapy aimed at restoring the airway and drainage function of the auditory tube. Paracentesis is indicated in severe clinical symptoms and otoscopic picture (hyperemia, infiltration, swelling of the tympanic membrane) with non-perforative form of acute otitis media. Paracentesis is also indicated in the "erased" clinical picture, but with the deterioration of the patient despite the antimicrobial therapy and the increase in indicators of inflammation markers. Conclusions. The duration of acute otitis media is not more than three weeks, but it is possible to develop a prolonged or recurrent infectious process. The recurrent course of acute otitis media leads to the development of chronic inflammatory pathology of the middle ear, to a progressive decrease in hearing, causing a violation of speech formation and general development of the child.
Key words: острый средний отит, диагностика, антимикробная терапия, парацентез, acute otitis media, diagnosis, antimicrobial therapy, paracentesis
PREVENTIVE EVENTS IN PRESCHOOL CHILDREN WITH SOMATIC DISEASES IN THE EARLY POSTOPERATIVE TIME
Avdeeva T.G., Evseev A.V., Usachev R.K.
UDC: 616-053.2-089.5
Abstract: Objective. To analyze the possible ways of development and features of the complications in preschool children with somatic diseases in the early and late postoperative time. Methods. Collection, systematization and analysis of modern scientific literature data and research results on the relevant problem Results. The article presents a review of publications devoted to experimental and clinical studies of the ways of development of complications in children after an emergency or planned anesthetic intervention and especially the course of the postoperative time, taking into account the initial state of children's health, gender and age characteristics. A phased way for the development of stressful, hypoxic and immunological processes in children with various health conditions in the initial, intra- and post-anesthetic period is considered. Correlation relationships of the studied mechanisms were carried out, taking into account the type of anesthesia, the age of the child, gender and somatic health. In addition, the history of children's health after anesthesia has been studied with the determination of the quality of dispensary observation and rehabilitation. Conclusion. Prevention of somatic diseases and careful monitoring of the child in the early postoperative time is one of the most important tasks of both the doctor supervising the child in a hospital and the local pediatrician. The main criteria for evaluating the follow-up during discharge of a child for outpatient treatment should be the nature of the intervention (planned or emergency), the amount of surgery, the duration of the anesthesia, complications at the time of the anesthetic intervention, concomitant somatic diseases, age and health group of the child. At the moment, it is not fully understood how the immune system of a child undergoing anesthesia in a hospital responds in the near postoperative time.
Key words: дети, наркоз, стресс, гипоксия, иммунитет, соматические заболевания, children, anesthesia, stress, hypoxia, immunity, somatic diseases
MORPHOMETRIC CHARACTERISTICS OF THE HEART AND VESSELS IN CHILDREN AT DIFFERENT AGE PERIODS ACCORDING TO THE SCT AND MRI RESEARCH DATA
Lebedenko A.A., Semernik O.E., Appoeva A.A., Ivanova D.N., Inkina E.V.
UDC: 616.12-71+ 616-71
Abstract: Objective. To study the morphometric features of the structure of the heart in children at different age periods. Methods. The results of CT and MRI studies of chest organs in 125 children aged 1 year to 18 years were analyzed. SCT and MRI were performed using a Philips Achiva magnetic resonance imager with a magnetic field voltage of 1.5 Tesla, in 16 projection sections of the T1 VI, T2 VI, STIR and NeuViz CT scanners by Ltd. Company, China with a slice thickness of 2 to 6 mm. Scanning was carried out in various projections. The resulting scans were recorded in DIACOM format on an optical disc. The scans were analyzed on a personal computer using the Radiant DICOM Viewer 1.99.21.9398 (BETA) program. Results. An analysis of the results revealed the presence of significant fluctuations in the morphometric sizes of the heart in children of different age groups. It was revealed that the older the child, the greater the angle alpha, i.e. there is a change in the position of the heart in space. Also, with age, there is an increase in the distance from the sternum to the anterior wall of the heart at the level of the upper border of the heart, tracheal bifurcation and at the level of the angles of the shoulder blades, while at the age of 1 year to 5 years this indicator decreases. At the age of 15 to 18 years, there is an increase in the distance from the sternum to the anterior wall by a factor of 1.5-2 at the level of the upper border of the heart and tracheal bifurcation. Conclusions. The data obtained showed that the study of the cardiovascular system using SCT and MRI makes it possible not only to assess changes in morphometric parameters at different age periods, but also to describe the topography of some objects from the perspective of three-dimensional visualization.
Key words: диагностика, сердце, сосуды, дети, СКТ, МРТ, diagnostics, heart, vessels, children, SCT, MRI
COMPARATIVE ANALYSIS OF THE NON-STEROIDAL ANTI-INFLAMMATORY DRUGS COMPETITIVE ADVANTAGES
Olejnikova T.A., Pozhidaeva D.N., Ul'janov V.O.
UDC: 615.276:339.13
Abstract: Objective. To create a priority list of non-steroidal anti-inflammatory drugs on the basis of comparative characteristics of consumer properties. Methods. Content analysis of scientific publications, a comparative analysis of consumer properties of non-steroidal anti-inflammatory drugs by the method of expert analysis, matrix analysis, grouping, ranking, point-and-factor scales. Research tools: a specially designed questionnaire containing questions about the «professional portrait» of a specialist and rating of consumer properties of non-steroidal anti-inflammatory drugs, an original point-and-factor scale. Results. Nomenclature of drugs consumer properties has been formed by means of content analysis. Consumer properties were grouped into three blocks: general (pharmaceutical), merchandising, and specific. High importance level parameters were determined according to the results of expert analysis of consumer properties by their degree of significance for the patient. They included 8 general, 13 merchandising and 9 specific properties. Based on the results obtained, a point-and-factor scale of 19 key criteria was developed. Summarizing the results of expert analysis of 6 international generic names represented by 45 drugs, a matrix analysis involving drugs grouping by two parameters was carried out according to the degree of their consumer properties manifestation rate. As a result, among the proposed international nonproprietary names we have identified the leaders within prescription and OTC drugs. Drugs characteristics analysis by point-and-factor scale has demonstrated the comparability of the obtained results with other methodological approaches. This will allow to evaluate the expanded selection of non-steroidal anti-inflammatory drugs in order to determine trade names with an optimal combination of features. Conclusion. An algorithm to identify competitive advantages of drugs has been developed; the list of priority trade names of non-steroidal anti-inflammatory group has been formed. An original point-and-factor scale has been developed, which allows to evaluate new trade names entering the market, as well to make comparative analysis of original and reproduced preparations.
Key words: потребительские свойства, нестероидные противовоспалительные препараты, балльно-факторная шкала, экспертная оценка, consumer properties, non-steroidal anti-inflammatory drugs, point-and-factor scale, expert analysis
DRUG RESOURCE AS THE BASIS OF PHARMACOTHERAPY OF PATIENTS WITH PSORIASIS
Ganzjuk A.V., Ovod A.I.
UDC: 615.26:339.13
Abstract: Objective. A study of Russian pharmaceutical market of medication used in psoriasis treatment. Methodology. The study is based on methodology of systematic approach which involves division of objects into separate subsystems, the study of attributes and properties of those elements and their relations to each other. The system of medical treatment for psoriasis patients was divided into the elements which define the treatment: pharmaceutical and economical. The structure of medical facilities was studied according to International Nonproprietary Names (INN), market nominations and corresponding medicine. In the course of the study, a phased analysis of a range of medicine in the ATC classification group (Anatomical, Therapeutical, Chemical ATC - classification) takes place upon various marketing characteristics. The observations of medical market for psoriasis treatment were carried out through the content analysis. Results. According to the marketing analysis of the whole segment of Russian medicine for psoriasis treatment, a range of medications define a macro contour with the following parameters: monocomponent medications (95,87%), group C - the cardio-vascular system (42,28%), solid form medications (66,27%), out of which pills prevail (57,82%), domestically produced (80,95%), offered at the international market of producers form 29 countries. Conclusion. The existing assortment of medications is sufficient for procurement of full medical therapy for psoriasis, but is not fully employed by the dermalogists for the treatment of this pathology.
Key words: псориаз, маркетинговый анализ, фармацевтический рынок, psoriasis, marketing analysis, pharmaceutical market
RECENT PROBLEMS OF CHILDREN PHARMACEUTICAL DOSAGE FORMULATION IN RUSSIAN FEDERATION
Egorova S.N., Kondakov S.E., Gordeev V.V., Belezky S.O., Hayatov A.R., Ikhalaynen E.S.
UDC: 615.03+615.15
Abstract: Objective. Analysis and generalization of literature data on the problems and methods of dosing drugs in pediatric practice. Method. The basis of this study was a review of modern domestic and foreign literature on the subject. Results. The review noted the specificity of pharmacotherapy in Pediatrics, due to the anatomical and physiological characteristics of the child's body. Specific requirements to children's dosage forms are considered. The main problems of providing the treatment process in pediatric practice with special dosages of medicines are revealed: prescription of medicines to children on unregistered indications; lack of special children's dosage forms of industrial production; non-indifference of excipients in corrected children's dosage forms, imperfection of the material base of production pharmacies, i.e. the lack of special equipment for the manufacture and quality control of dosage forms containing reduced ("children's") doses of medicines.A comparative analysis of the methods of dosing pharmaceutical substances for children was carried out. The perspective directions of improvement of dosage of medicines for children: use of triturations-semi-finished pharmaceutical substances of industrial production for pharmaceutical production of low-dose children's powders; introduction of additive technologies into pharmaceutical practice - 2D- and 3D-printing of dosage forms for children with individual dosages. Conclusion. The presented data characterize the current state of the problem of dosing medicines in pediatrics and provide the basis for the development of special children's dosage forms of pharmaceutical manufacture and industrial production.
Key words: лекарственные средства, дозирование, детские лекарственные формы, drugs, dosage, children's dosage forms
ASSORTMENT OF MEDICATION FORMS APPLIED IN STOMATOLOGIC PRACTICE
Losenkova S.O., Morozov V.G., Losenkov P.V., Evseev A.V., Gladkaya Y.V.
UDC: 615.454.1:615.07
Abstract: Objective. The review of assortment of medication forms applied in stomatologic practice. Methods. Research of normative documentation (State Pharmacopoeia 14 edition) and literature sources in order to identify the range of medication forms used in dental practice. Results. The article presents the range and compositions of soft, solid, liquid and gaseous medication forms used in dental practice. Conclusion. Gels and films are the most popular dosage forms for medical use in dental practice. Due to the polymer base, they allow to implement the whole complex of requirements of remineralizing therapy and to coordinate them with aspects of social and economic life of patients.
Key words: гели, стоматологические пленки, лекарственные формы, стоматологическая практика, gels, dental films, medical forms, dental practice
USE AUDITING TO ASSESS THE QUALITY OF HOSPITAL CARE FOR CHILDREN
Brynza N.S., Kniazheva N.N., Reshetnikova Y.U.S., Deyukina E.S., Kurmangulov A.A., Gerdt R.S.
UDC: 614.39
Abstract: Objective. To assess the quality of inpatient care for children by applying the updated systematized standard of World Health Organization (second edition). Methods. The audit of the quality of inpatient medical care for children was carried out in 4 medical organizations of the Tyumen region for 5 days by experts of the National medical research center for children's health of the Ministry of health of the Russian Federation, the Department of health of the Tyumen region, leading pediatricians of the region. Information was collected from four different sources: hospital statistics, medical records, direct monitoring of health care, interviews with staff and mothers or caregivers. The evaluation was carried out using instrumentation for quality assessment of inpatient treatment of children. Each quality indicator was evaluated in points from 0 to 3. Also, an analysis of 167 case histories on patient compliance with therapy standards of medical care was conducted. Observance of children's rights was assessed by interviewing children and their parents, interviewing staff. Results. The audit identified high performance (average score >2.4) of hospital support services (structure of medical units, staffing, availability of basic services). However, the audit showed similar problems in the management of patients with frequent diseases (average score <2.0). This is the lack of necessary equipment, consumables, as well as the lack of skills of staff about its proper and safe use, low knowledge in sorting incoming children and providing them with medical care. The analysis of medical records revealed the discrepancy of medical care delivery to international and national standards and the lack of adequate follow-up of patients in dynamics. Conclusion. The audit made it possible to give not only a qualitative assessment of the activities of children's departments of hospitals, but also served as the basis for the next step in improving the quality of medical care in each individual medical organization - the development of projects to optimize technologies based on the audit system and supporting monitoring of medical care.
Key words: аудит, стационарная помощь детям, качество медицинской помощи, стандарты ВОЗ, audit, inpatient care for children, quality of medical care, standards of the World Health Organization
PASSPORT OF MEDICAL ORGANIZATIONS AS THE BASIS FOR MODERNIZATION OF PRIMARY HEALTH CARE
Klykov A.I., Frolova N.A., Dekhnich S.N., Kosareva E.A.
UDC: 614.2
Abstract: Objective. To consider the goals and objectives of the introduction of the passport of the medical organization in accordance with the decree of the Government of the Russian Federation of 9 October 2019 № 1304 "On approval of the principles of modernization of primary health care of the Russian Federation and Rules of carrying out of examination of projects of regional programs of modernization of primary health care, monitoring and control of implementation of regional programs of modernization of primary health care". To find out the role of certification of medical organizations providing primary medical care in the process of modernization of health care. Methods. The work was performed using the methodology of analysis of legal acts and medical literature. Results. The main stages of modernization of primary health care of the Russian Federation are considered. The role of certification of medical organizations providing primary health care, especially the formation of the passport of the medical organization, its role in regional programs of modernization of primary health care is clarified. Conclusion. The passport of the medical organization providing primary health care is a key link in the formation of the project of the regional program of modernization of the subject of the Russian Federation and the basis for further measures to improve the quality of primary health care in the regions.
Key words: модернизация здравоохранения, паспорт медицинской организации, первичное звено здравоохранения, первичная медико-санитарная помощь, modernization of health care, passport of medical organization, primary health care, primary medical care
MEDICAL EXAMINATION IN THE DEVELOPMENT OF OBSTETRICS-GYNECOLOGICAL KNOWLEDGE
Koldman S.D., Mitsyuk N.A.
UDC: 61(091); 618.16; 340.65
Abstract: Objective. The aim of the article is to study judicial precedents that influenced the development of obstetrics and gynecology in Russia in the 19th century. Methods. The research methods were historical-systemic and historical-genetic. Results. The article considers the unscientific and unreliable information on female fertility experienced by obstetricians in their judicial practice as medical experts in the 19th and early 20th centuries in Russia. Doctors resolved controversial issues such as: what are the signs of rape, what does the hymen rupturelook like in reality; what is an ectopic pregnancy and are there any other ways for the natural exit of the fetus, for example rectally; is it possible to determine the death of the fetus at the stage of its development; whether childbirth is possible after the death of a woman, when the body is already buried; how much breast milk can be excreted after childbirth and whether these terms are a criterion for establishing the fact of a crime against a newborn; what is self-help of women in childbirth and whether such behavior of a woman during childbirth is characteristic of Russia. Conclusion. The study revealed the absence of obstetric and gynecological instruments, and the forced use of improvised means bydoctors of the XIX century. One of the reasons for the slow development of practical knowledge for forensic medical experts in the field of obstetrics and gynecology was the forced nature of attracting experts to the examination, with a separation from their own patients and with insufficient, or completely absent, payment for the professional service rendered. There was no legal security for obstetricians. The expert’s decision influenced the outcome of court cases, and the obstetrician involved in the examination was charged with criminal liability for the results of the examination, the accuracy of which he could not guarantee due to the lack of similar judicial experience both in personal and in obstetric practice in Russia in the 19th - early 20th centuries.
Key words: история медицины, история женщин, гендерная история, медико-социальная работа, медико-судебная экспертиза, история акушерства и гинекологии, history of medicine, medical and social work, medical and judicial examination, history of obstetrics and gynecology, medical examination, female fertility