MONOAMINERGIC SYSTEM OF THE RAT BRAIN AFTER PRENATAL MODULATION WITH CHOLINOTROPIC DRUGS
Stashina E.V., Ganzenko M.A., Lisovskiy A.D., Magradze R.N., Kozar Ya.V., Fisenko D.E., Bairamov A.A., Shabanov P.D.
UDC: 612.6, 616-092
Abstract: Objective. To evaluate the effects of prenatal administration of the central cholinolytics metamisil and gangleron at different gestation periods on the content of the neurotransmitters dopamine and serotonin, as well as their metabolites in the brain of embryos by the 20th day of prenatal development. Methods. Pregnant female rats at different gestation periods were given three-time intramuscular injections of N-cholinoblocker gangleron at the dose of 10 mg/kg or M-cholinoblocker metamizil at the dose of 2 mg/kg (the drugs doses were determined by the selectivity of their cholinolytic action). The study of the content of mediators and metabolites in rat fetuses was carried out on 20-day-old rats embryos. The brain without the cerebellum was isolated in the cryostat at -20 C. The concentration of dopamine and serotonin neurotransmitters and their metabolites in the brain homogenate was determined by high-efficiency liquid chromatography. Results. In the gestational period, the administration of M- and N-cholinolytic drugs to pregnant female rats for 3 days caused a significant change in the activity of brain monoaminergic system in the 20-day-old rats fetuses. Comparative analysis shows that in the prenatal period, the serotoninergic system is more sensitive to the effects of cholinolytics, compared with the brain dopaminergic system. A decrease in the concentration of serotonin and its turnover is observed in all "critical periods" of the second half of pregnancy when exposed to both metamizil and gangleron. The brain dopaminergic system on genotypic male and female embryos is more sensitive to the effects of the N-cholinolytic gangleron. Prenatal exposure of the gangleron helps to smooth out sexual dimorphism in the content of dopamine in brain tissues and to strengthen this difference in the serotonin content. Conclusion. Prenatal exposure to cholinolytics to pregnant females leads to sex-dependent disorders of the brain dopaminergic and serotonergic systems in 20-day-old rat fetuses, which determines the nature of future behavioral dysfunctions in puberty rat offspring.
Key words: гестационный период, серотонин, дофамин, центральные холинолитики, метамизил, ганглерон, головной мозг, эмбрионы крыс
ACTIVITY OF ENZYMES IN THE CYTOPLASM OF HEPATOCYTES OF FETUSES OBTAINED FROM FEMALE WHITE RATS WITH ALTERED T-CELL IMMUNITY DURING PREGNANCY
Lis R.E., Aladyeva T.L., Shimchuk E.I.
UDC: 616-092.12:612.6
Abstract: Objective. To determine possible changes in the metabolism of hepatocytes of white rat fetuses under the separate action of concanavalin A and cyclophosphamide and the combined action of concanavalin A and cyclophosphamide when administered to female white rats during pregnancy before and after implantation. Methods. The study was conducted on 43 pregnant female white rats and their fetuses. Concanavalin A and cyclophosphamide were administered to pregnant female white rats either separately or in combination during the first or second half of pregnancy. On the 20th day of pregnancy, the activity of succinate dehydrogenase (SDH), lactate dehydrogenase (LDH), NADH dehydrogenase (NADHDH) and NADPH dehydrogenase (NADPHDH) in the cytoplasm of hepatocytes of fetuses obtained from experimental females was determined. Results. The combined action of concanavalin A and cyclophosphamide before and after implantation does not lead to a significant change in the activity levels of the studied enzymes. With separate administration of drugs, the level of LDH activity was significantly increased with the introduction of cyclophosphamide on the 5th day of pregnancy and concanavalin A on the 13th day of pregnancy; the level of NADPHDH activity was significantly reduced with the introduction of concanavalin A on the 13th day of pregnancy and cyclophosphamide on the 15th day of pregnancy. The activity levels of SDH and NADHDH vary unreliably regardless of the duration and type of exposure. Conclusion. Modeling of T-cell immunodeficiency during pregnancy in the mother does not lead to a significant change in the levels of activity of SDH, LDH, NADHDH and NADPHDH in the cytoplasm of fetal hepatocytes.
Key words: конканавалин А, циклофосфамид, крысы, антенатальное развитие, гепатоциты плода, СДГ, ЛДГ, НАДНДГ и НАДФНДГ
NEUROGLIA AND ITS ROLE IN THE PATHOGENESIS OF ISCHEMIC BRAIN DAMAGE. IMMUNOHISTOCHEMICAL MARKERS OF NEUROGLIA
Bon E.I., Maksimovich N.E., Malykhina A.V.
UDC: 616.831.31-005.4.- 092.913:618.33
Abstract: Objective. Analysis and systematization of literature data on morphofunctional features of neuroglia, immunohistochemical markers of gliocytes and its role in the pathogenesis of ischemic brain damage. Methods. The study was based on a literature review on this topic. Results. Glia cells have a number of important functions. With brain damage, gliocytes, like neurons, undergo a number of changes, but they are more resistant, which is due to the stability of the processes of RNA synthesis and transport occurring in their nucleus and cytoplasm. Immunohistochemical markers of glial cells are glial fibrillar acidic protein, glutamine synthetase, type 2 deiodinase (DIO-2), aldehyde dehydrogenase (astrocytes), proteolipid protein, myelin basic protein, oligodendrocyte basic protein associated with myelin-associated mylicopetin, myelin-associated gelin oligodendrocyte glycoprotein (oligodendrocytes), lba-1 protein, CD68 protein, CDllb protein (microgliocytes). Markers are used to detect glial cells, which contributes to the deepening of knowledge about the participation of gliocytes in the pathogenesis of brain damage. Conclusion. Neuroglia, through the synthesis of neurotrophic factors, has a neuroprotective effect and ensures the process of reorganization of interneuronal connections in cerebral ischemia through the control of neuronal activity at the gene level. Neuroglia contributes to the survival of neurons in case of damage and the preservation of their vital activity.
Key words: нейроглия, ишемия головного мозга, иммуногистохимические маркеры
PHARMACOTHERAPY OF BRAIN EDEMA: THE CURRENT STATE OF THE PROBLEM
Novikov V.E., Ponamareva N.S., Yasnetsov V.V., Kulagin K.N.
UDC: 616-08-035
Abstract: Objective. To evaluate the effectiveness and prospects of modern pharmacotherapeutic approaches to the correction of brain edema based on the analysis of scientific literature and the results of our own research. Methods . Collection and analysis of the results of modern experimental and clinical scientific research on this problem. Results. The pharmacotherapy of edema-swelling of the brain remains largely empirical. Combined therapy is used taking into account etiotropic and other factors. Diuretics are still widely used; in severe cases corticosteroids and barbiturates are prescribed. According to the indications, the complex pharmacotherapy of edema-swelling of the brain includes inhibitors of the kallekrein-kinin system, low-molecular-weight heparins. Of the psychosedative drugs, propofol and benzodiazepines (mainly midazolam) are used more often than others. The effectiveness of the use of opioid analgesics (morphine, fentanyl, sufentanil, etc.) in TBI and their effect on the formation of edema-swelling of the brain is contradictory. In vascular and traumatic brain injuries, the use of calcium channel blockers (nimodipine) is justified. Nootropics (piracetam, nooglutyl, etc.) are often used in the treatment of edema-swelling of the brain of various origins. They have a positive effect on metabolic processes and the main neurotransmitter systems. Antioxidants and antihypoxants are reasonably used in the treatment of edema-swelling of the brain. One of the most effective and prescribed in clinical practice for this purpose is the original domestic drug mexidol (2-ethyl-6-methyl-3-hydroxypyridine succinate). The drug is an effective energy corrector for cerebral ischemia and other pathologies, the pathophysiology of which is associated with a hypoxic state. Nootropics, antioxidants and antihypoxants have high prospects for further use in traumatic and vascular lesions of the brain, including edema-swelling of the brain. Water channels of brain cells (aquaporins, their blockade reduces the development of cytotoxic edema), Na+-K+-2Cl- cotransporter (its blockade with bumetanide reduces the permeability of the BBB and swelling of brain cells during TBI), matrix metal prostheses, the channel of the sulfonylurea receptor-1 can become new potential therapeutic targets for the pharmacological correction of edema-swelling of the brain. The ability to block the sulfonylurea-1 receptor and matrix metalloprosthesis-9 is shown by glibenclamide. Conclusions. Currently, along with traditional drugs (diuretics, psychosedatives, analgesics, glucocorticoids, calcium channel blockers), drugs with nootropic, antioxidant and antihypoxant activity are increasingly used for the pharmacotherapy of edema-swelling of the brain. New directions are being developed in the pharmacotherapy of traumatic and vascular brain lesions, including the development of edema-swelling of the brain associated with the exposure to molecular targets (water channels, ion transporters, matrix metal prostheses, etc.). However, new approaches to the pharmacotherapy of edema-swelling of the brain require a deep experimental and clinical justification of their therapeutic effectiveness.
Key words: отек-набухание головного мозга, черепно-мозговая травма, противоотечные средства, ноотропы, антиоксиданты, антигипоксанты
THE PROBLEM OF OFF-LABEL PRESCRIPTIONS IN THE TREATMENT OF NEONATAL SEIZURES
Iakovleva E.E., Tadtaeva Z.G., Galustyan A.N., Sardaryan I.S.
UDC: 616-053.1
Abstract: Objective. In accordance with innovative approaches to quality management in medical institutions, to highlight the issues of off-label prescriptions and conduct a pharmacological analysis of the most widely used anticonvulsants in neonatology. Methods . Collection and analysis of the results of modern scientific research on this problem. Results. Analyzing the data, we can conclude that phenobarbital remains the standard first-line drug for the treatment of neonatal seizures. In the absence of the effectiveness of first-line therapy, second-line drugs, including benzodiazepines, phenytoin, topiramate, levetiracetam, can be recommended by a medical consultation, taking into account a careful assessment of the potential effectiveness and possible risk of adverse events in each specific clinical case. Conclusions. Taking into account the lack of registration of the drugs used in this age group due to the lack of a full-fledged evidence base according to the results of clinical studies in newborns, the problem of the safety of the use of anticonvulsants for children under the age of one year remains extremely relevant. In this regard, there is a need to determine the optimal protocol for the treatment of seizures in this population of children, based on the comprehensive knowledge of clinicians about the effectiveness, safety, as well as the pharmacodynamic and pharmacokinetic features of the applied pharmacotherapy.
Key words: качество медицинской помощи, off-label терапия, неонатальные судороги, антиконвульсанты, фенобарбитал, бензодиазепины
LEVEL OF FASTING GLYCEMIA, ITS DYNAMICS AFTER TAKING 75 G OF GLUCOSE AND THE PREVALENCE OF METABOLIC DISORDERS IN HEALTHY YOUNG WOMEN WHO DRINK ALCOHOL
Blazhko A.S., Pereverzev V.A., Sikorsky A.V., Evseev A.V., Pravdivtsev V.A., Yurenya E.V., Pereverzeva E.V.
UDC: 612.352.12-008.9-055.2:612.821.44
Abstract: Objective. To study glucose content in capillary whole blood in young women who consume and do not consume alcohol, on an empty stomach and during the performance of an oral glucose tolerance test (OGTT) to identify the presence or absence of hypo- or hyper-glycemic disorders of carbohydrate metabolism and their prevalence to justify new indicators of the regime and dose of low risk of ethanol use in young women. Methods. The study was carried out with the voluntary participation of 120 young women 18-29 years old, drinking alcohol (n=101), and teetotalers (n=19). For each subject, 5 determinations of glucose level were made, taken from 4 fingers of the non-working hand: initially (on an empty stomach, after 10-12 hours of fasting (1st) night and after 30 (2nd), 60 (3rd), 90 (4th) and 120 (5th) minutes after taking 75 g of glucose dissolved in 200-250 ml of water. The glucose content was determined by the glucose oxidase method with amperometric detection. To judge the inter-sex characteristics of carbohydrate metabolism, an additional similar study was conducted with the voluntary participation of 53 young men (10 teetotalers and 43 drinking alcohol) of the same age. Results . The analysis of the prevalence of the detected cases of fasting violation of carbohydrate metabolism showed their insignificance (1 case of hypo - and hyper-glycemia) in the group of teetotallers (22=2,111; p=0.348 at df=2) and very expressed significance (15 cases: one - hypoglycemia; 14 - hyperglycemia /13 people with impaired fasting glycemia, fasting glucose disorder, + 1 participant with diabetes mellitus, DM) in the group of women who drink alcohol (χ2=16,203; p<0.001 at df=2). As a result of a comprehensive analysis of the serum glucose in capillary whole blood on an empty stomach and during OGTT, the insignificance of the prevalence of various types of hyperglycemic violation of carbohydrate metabolism was established (only 1 case / impaired fasting glucose/ - 5.3 impaired fasting glucose%) in young teetotal women (22=1,029; p=0.311 at df=1) and the pronounced significance of their prevalence among women who drink alcohol (χ2=22,432; p<0.001 at df=3), namely: the specific weight of cases of impaired fasting glucose is .9% (in 13 people), impaired glucose tolerance (impaired glucose tolerance) is 7.9% (in 8 individuals, including 4 of them in combination with impaired fasting glucose ) and type 2 diabetes in 3.0% (in 3 respondents). The low-risk mode of alcohol users, taking into account the detected hyperglycemic violation of carbohydrate metabolism in young women, should be considered only 1 point scored on the scale of the "AUDIT" test, since the calculated strength of the relationship between this risk factor (alcohol users mode) and their specific weight of 3.7% (1 case of impaired fasting glucose out of 27 observations) is insignificant (the normalized value of the Pearson coefficient с=0.065). For all the other girls (74 participants) with different alcohol users regimens (from 2 to 17 points scored on the "AUDIT" test scale), the risks of hyperglycemic violation of carbohydrate metabolism were significant and on average by 4.878 times higher than the absolute risk in the control group of teetotallers. A dose of a low risk of episodic (less than 1 time per month) alcohol consumption by young women due to the threat of hyperglycemic violation of carbohydrate metabolism should be recognized as a dose of no more than 20 ml/month in terms of absolute ethanol (but not 10 g/time 5 times/week, which in terms of a week or a month will be, respectively, 50 g/week or 200 g/month, specified in the Instructions of the Ministry of Health of the Republic of Belarus "Algorithm for clinical diagnosis of alcoholic liver disease", 2013). The ideas about the need to maintain a complete analysis of the sugar curve during OGTT and to calculate a number of glycemic coefficients for an earlier and broader diagnosis of glucose tolerance are confirmed. The prevalence of glucose tolerance according to the results of calculations of glycemic coefficients ranges from 10.0% (in boys) to 57.9% (in girls) of cases among young teetotallers and significantly expands among young people: up to 53.5% in men (22=9.947; p=0.002; df=1) and up to 80.2% in women (χ2=4.447; p=0.035; df=1). It was found that in 65.3±4.7% (p<0.001) of women, alcohol users on an empty stomach serum glucose in capillary whole blood exceeded the threshold level of stimulation of insulin secretion, which may contribute to increased release of this hormone by beta cells, leading to a decrease in the sensitivity of insulin-dependent tissues to its effects. This is evidenced by a significantly higher increase in glycemia during OGTT and a greater prevalence of elevated glycemic coefficients in sober respondents. Conclusion. The low-risk mode of alcohol users for young women, taking into account the prevention of the development of hyperglycemic violation of carbohydrate metabolism in them, should be considered only 1 point scored on the scale of the "AUDIT" test, and the low-risk dose is a dose of no more than 20 ml/month in terms of absolute ethanol.
Key words: алкоголь, доза (низкого риска), глюкоза, кровь, режим употребления (низкого риска)
ADIE'S SYNDROME (MYOTONIC PUPIL SYNDROME) IN MIGRAINE WITH AURA IN TEENAGE PATIENT (CASE REPORT)
Tadtaeva Z.G., Galustyan A.N., Iakovleva E.E.
UDC: 616.8-00
Abstract: Objective. Consideration of the etiology, pathogenesis and clinical picture of Adie's syndrome (myotonic pupil syndrome) in migraine with aura, presented by own observation. Method. The article presents brief anatomical and physiological mechanisms of regulation of the pupillary reflex arc, information about the etiology, clinical manifestations, diagnosis of the myotonic pupil of Adie and its relationship to migraine. Results. The diagnosis of Adie's syndrome is based on the characteristic clinical symptoms. Pharmacological tests with pilocarpine, indicating a lesion or denervation of the parasympathetic ciliary ganglion or postganglionic fibers, play an important role for differential diagnosis. Additional research methods were used to exclude severe concomitant diseases. The patient underwent a course of preventive migraine therapy, which contributed to a significant reduction in headache attacks. It is proposed to continue treatment and follow-up with an ophthalmologist. Conclusion. A rare case of Adie's syndrome in a teenage patient with migraine with aura is presented. The mechanism of the development of the myotonic pupil in Adie's syndrome is associated with the lesion or denervation of the parasympathetic ciliary ganglion or postganglionic fibers. More research is needed to understand the possible link between Adie's syndrome and migraine.
Key words: синдром Эйди, тонический зрачок, мигрень
PREVENTION AND TREATMENT OF OSTEOPENIA IN CHILDREN AND ADOLESCENTS IN RUSSIA
Alekseeva V.A., Ovsyankin A.V., Kuzminova E.S., Krikova A.V., Krutikova N.Y., Zaitseva V.M.
UDC: 615.036
Abstract: Objective. Conduct a review of the regulatory framework governing treatment and preventive measures with manifestations of osteopenia in children and adolescents in the Russian Federation, study the current range of calcium-containing preparations and vitamin D preparations used in children and adolescents. Methods. The analysis of regulatory documents governing treatment and preventive measures for children and adolescents with manifestations of osteopenia in the Russian Federation, and content analysis of calcium-containing preparations and vitamin D preparations in the reference documentation (Register of Medicines, 2021) by the method of descriptive statistics. Results. Preserving and maintaining the health of the young population is an important problem of the Russian Federation, which is regulated at all levels of legislation. For osteopenia in children and adolescents, it is recommended to take vitamin D and calcium, the preparations of which are presented in various oral forms. The use of some is allowed from an early age, which makes it possible to choose the necessary medicine. Conclusion. Children and adolescents can receive timely and high-quality medical care, but due to insufficient coverage of the problem of osteoporosis, an increase in the number of cases occurs. Organization of educational activities, early detection of bone mineral metabolism disorders, expansion of the preventive direction, as well as preferential provision of patients with osteoporosis this will make therapy available to all segments of the population.
Key words: остеопения, кальций, дефицит витамина D, дети и подростки, медицинская и фармацевтическая помощь, нормативно-правовая база
PSYCHOPHYSICAL TRAINING IN ADOLESCENTS WITH HIGH NORMAL BLOOD PRESSURE
Nezhkina N.N., Timofeeva L.N.
UDC: 616.12-008.331-0523.7-084
Abstract: Objective. To evaluate the effectiveness of psychophysical training in adolescents with high normal blood pressure Methods. 80 adolescents aged 12-16 years with high normal blood pressure were observed. 40 people (the main group) underwent a course of psychophysical training consisting of 12 classes, the remaining 40 patients underwent a standard set of non-drug measures (the comparison group). The examination program included the analysis of heart rate variability with the use of an active orthostatic test and bioimpedance measurement with an assessment of the body component composition. Results. It was found that there was a significant decrease in blood pressure in adolescents of the main group. After passing the course of psychophysical training, according to the analysis of heart rate variability, an increase in the total power of the spectrum of neurohumoral regulation at rest and a decrease in sympathetic reactivity were noted. The results of the orthostatic test indicate an increase in the functional activity of the parasympathetic system. Positive dynamics of the body component composition was registered in the form of a decrease in the proportion of adipose tissue and extracellular fluid against the background of an increase in the percentage of active cell mass in the lean body mass. Conclusion. Psychophysical training is an effective method of non-drug correction of elevated blood pressure in adolescents.
Key words: высокое нормальное артериальное давление, подростки, психофизическая тренировка
SYSTEMIC BLOOD CIRCULATION WITH DIFFERENT DYNAMICS OF THE ARTERIAL DUCT IN DEEPLY PREMATURE NEWBORNS
Nikolaeva T.N., Maiden I.V., Klimachev A.M.
UDC: 616.131.3-053.32
Abstract: Objective. To characterize the systemic circulation depending on the dynamics of the ductus arteriosus in deeply premature newborns to establish additional criteria for its long-term persistence The methodology. Echocardiography was used to examine 30 preterm infants with very low (n=16) and extremely low (n=14) birth weight. The diameter of the arterial duct was determined on days 3 and 5. There were 2 groups: the main group, which consisted of 20 patients with hemodynamically significant OAP remaining on day 5, and the comparison group - 10 children whose OAP had become hemodynamically insignificant by this time. Systemic circulation was studied by echocardiography on the 3rd day of life. The systolic and diastolic diameters and volumes of the left ventricle, the size of the right ventricle and the left atrium, the thickness of the interventricular septum, the parameters of the pumping and contractile function of the myocardium, as well as the linear velocities of blood flow through the main vessels were evaluated. Results. Deep-premature newborns with favorable dynamics of OAP by the 5th day of life have high indicators of gestational age, weight and body length at birth; they are less likely to have a low score on the Apgar scale. Their systemic circulation is characterized by smaller dimensions of the ventricular cavities and the left atrium, the aortic root and the thickness of the interventricular septum. With unfavorable dynamics of OAP, the indicators of shock and cardiac indices are higher, which indicates an energy-consuming hyperkinetic type of systemic circulation. Conclusion. A factor contributing to the preservation of a hemodynamically significant arterial duct by the 5th day of life in deeply premature newborns are disorders of systemic circulation in the form of dilation of the ventricles, left atrium, aortic root, an increase in the thickness of the interventricular septum, as well as hyperkinetic orientation of central hemodynamics.
Key words: недоношенные дети, артериальный проток, системное кровообращение
ACUTE CORONARY SYNDROME IN PATIENT WITH SARS-COV-2 INFECTION
Mamadaliev D.M., Bibikov V.N., Litvinov A.A., Ulbashev D.S.
UDC: 616.12
Abstract: Objective. To demonstrate the possibility of an acute coronary syndrome pattern in a patient infected with the SARS-CoV-2 via a presented clinical case. Methods. In hospitalized for emergency reasons at the "COVID-19 Hospital" of the Pirogov Center patient S. detailed examination with an analysis of complaints, anamnesis, laboratory and instrumental examinations was performed. Despite positive dynamics after therapy, on the 10 day an aggravation of symptoms was noticed. It seemed that the patient’s clinical parameters corresponded to a myocardial infarction without ST elevation. A council of physicians including the infectiologist, cardiologist, resuscitator, cardiovascular and endovascular surgeons decided to perform an emergency coronary angiography in order to detect and eliminate a hemodynamically significant obstacle. Results. No significant brake in coronary circulation was detected. Only delayed distal contrast was noted. Conclusions. Physiology of the acute myocardial injury caused by SARS-CoV-2 infection is of great interest. We assume there is a direct damage of myocytes by the virus during its penetration into the cell through the APF2 receptors. Respiratory dysfunction and hypoxemia have an additional cytopathic effect on cardiomyocytes. Microvascular thrombosis after cytokine storm, endothelial dysfunction and coagulopathy reduces coronary myocardial perfusion.
Key words: SARS-CoV-2, COVID-19, острый коронарный синдром, инфаркт миокарда
CLINICAL RESULTS OF BALLOON ANGIOPLASTY IN PATIENTS WITH ISCHEMIC AND NEUROISCHEMIC FORM OF DIABETIC FOOT SYNDROME
Musaev A.I., Kulbaev U.A., Aliev M.Zh.
UDC: 616.379-008.64-089.844
Abstract: Objective. To evaluate the results of balloon angioplasty in patients with ischemic and neuroischemic forms of diabetic foot syndrome. Methods. A total of 41 patients with diabetes mellitus complicated by purulent-necrotic process of the lower extremities were studied. Two groups were identified: control (20 people) and main (21 people). In the main group, the patients underwent balloon angioplasty, and in the control group, traditional treatment (antibiotics, vasodilators, anticoagulants, hypoglycemic agents) was carried out. In addition to the general clinical examination, Doppler ultrasound, duplex ultrasound scanning, and transcutaneous oximetry were performed. Before and after angioplasty, angiography of the vessels of the lower extremities was performed to identify the level of damage to the great vessels and to evaluate the performance of balloon angioplasty. The immediate and long-term results were studied. The patients were examined 1 month later, 6 months later, 1-2 years after surgery for 2 years. Results. In the immediate period after balloon angioplasty, the patients felt satisfactory, wound healing was faster. In the main group, in the long-term period, 2 patients had a recurrent ulcer with a purulent-necrotic process, 2 patients had a violation of the popliteal artery patency, they underwent repeated balloon angioplasty. In the control group, complications were noted in 7 patients: 2 of them had amputation at the hip level after a year, 4 - recurrent ulcers, and 1 patient had necrosis of the toes (exarticulation of the toes). Long-term results of both groups from 1 month to 2 years were studied. Up to 1 month, 40 patients were examined, up to 6 months. - 37, up to 1 year- 35 and up to 2 years - 34 patients. Conclusions. The method allows to reduce the frequency of high amputations of the lower limb and to eliminate the purulent-necrotic process, improve the blood supply to the soft tissues of the lower leg and the condition of patients. After angioplasty, it is necessary to continue complex treatment, observation and examination.
Key words: сахарный диабет, синдром диабетической стопы, ишемия, нейроишемия, лечение, баллонная ангиопластика
CORRECTION OF THE SYSTEMIC INFLAMMATORY REACTION SYNDROME IN ACUTE PANCREATITIS USING 5-FLUOROURACIL AND RONCOLEUKIN
Ibraimov D.S., Aliev M.Zh., Zhusup U.U.
UDC: 616.37-002.4-08:615.37:615.277.3
Abstract: Objective. To evaluate the effectiveness of the correction of the systemic inflammatory response syndrome in acute pancreatitis using roncoleukin and 5-fluorouracil. Methods. The results of the correction of the systemic inflammatory response syndrome in 38 patients are presented. A control group (18 people) and a main group (20 people) were identified. The patients in the control group received pain relievers, antienzyme, infusion, antibacterial, anti-inflammatory and symptomatic therapy. In the main group, along with traditional therapy, the patients received roncoleukin and 5-fluorouracil. Roncoleukin was received intravenously at a dosage of 0.5-1.0 mg, depending on the severity of the patient's condition and laboratory parameters with an interval of 3 days for a course of treatment of 3-4 injections, 5-fluorouracil was received intravenously at a dose of 10-15 mg/kg body weight and intraoperatively (irrigation of the omental bursa), and intraductally 2 ml of the drug, after aspiration of pancreatic juice from the Wirsung duct. Additionally, we studied the clinical criteria of the systemic inflammatory reaction syndrome (body temperature, respiratory and pulse rate), as well as laboratory (leukocyte intoxication index, procalcitonin) and instrumental (ultrasound, computed and magnetic resonance imaging) criteria. Results. In the control and main groups, before the start of treatment, the majority of patients showed 3-4 signs of SIRS. Studies carried out in dynamics showed that in the group of patients where roncoleukin and 5-fluorouracil were used, a decrease in SIRS values was noted already on the 3-4th day, and on the 6-7th day only 2 patients retained the number of signs of inflammation. Also, a positive trend was noted as a result of laboratory studies, a decrease in the number of LII indicators, as well as the level of amylase and procalcitonin, which confirmed the effectiveness of treatment of patients in the main group. Conclusions. In acute pancreatitis, it is necessary to investigate the signs of the systemic inflammatory response syndrome in dynamics, to assess the effectiveness of treatment and timely identify complications, since the indicators determine the severity of the inflammatory process and intoxication. The use of roncoleukin and 5-fluorouracil in the complex promotes the correction of SIRS.
Key words: поджелудочная железа, острый панкреатит, ССВР, методы коррекции синдрома системной воспалительной реакции, ронколейкин, 5-фторурацил
DURATION OF RELAPSE-FREE COURSE BETWEEN RADICAL SURGERY AND THE APPEARANCE OF METASTASES IN PATIENTS WITH SKIN MELANOMA T1-T4NOMO AND T1-T4NXM0
Solovyov V.I., Zuj V.S., Bochkova M.A.
UDC: 616-006.81
Abstract: Objective. To assess the duration of relapse-free course in the period between radical surgery and the appearance of metastases in patients with skin melanoma T1-T4NoMo and T1-T4NxM0 in the Smolensk Regional Oncology Dispensary. Methods. The study was based on the data of the territorial cancer registry of the Smolensk Regional Oncological Clinical Dispensary (SOOKD). The official accounting and reporting medical documentation from the surgical departments N1 and N2 of the SOOKD from 2016 to 2019 (operating logs, medical histories and outpatient records) of patients with a diagnosis of skin melanoma was studied. This study is based on the analysis of the results of treatment of 207 people. The patients were divided into groups depending on their age, gender, stage, duration of the light interval and treatment outcomes. The number of patients in the main group was 187, and in the control group - 20. Results. When comparing the results of treatment in both groups, it was found that 40 patients from the main and control groups (n=207) showed disease progress and the difference in the duration of relapse-free course between the two groups is significant (p<0.05). Conclusions. It is established that the problem of diagnosis and treatment of this malignant neoplasm is still a problem of modern medicine that requires close attention and study. It is necessary to make more efforts aimed at more thorough and frequent monitoring for the timely detection of metastases in skin melanoma. Close attention should be paid to early detection of skin melanoma. It is necessary to specify the objectification by such methods as dermatoscopy, siascopy, ultrasound examination of the tumor and regional zones.
Key words: меланома, безрецидивное течение, метастазы
MARKER OF SYSTEMIC INFLAMMATION AS A PROGNOSTIC FACTOR FOR SEVERE COMPLICATIONS AFTER RADICAL CYSTECTOMY
Ryndin A. A., Solovyov V.I., Zuy V.S.
UDC: 613.81:616-036.886
Abstract: Objective. To investigate the prognostic factors for complications of grade ≥3 according to the Clavien-Dindo classification after radical cystectomy (RC) with different methods of urinary diversion in bladder cancer (BC) patients. Methods. The results of a series of RCs performed on BC in our institution from 1999 to 2012 are retrospectively analyzed. In total, the study included 849 patients (75 women and 774 men) aged 30 to 90 years (median-67 years). Data on severe complications, grade ≥3 according to the Clavien-Dindo classification in the early postoperative period (90 days after surgery) were obtained from medical records. The relationship of the severe complication rate with more than 90 different perioperative factors characterizing the patient's biology, tumors, surgery, and perioperative management using uni- and multivariate logistic regression was analyzed. The analysis was carried out using the software package Windows 10, Microsoft Excel and SPSS 13.0. on the basis of the Department of Oncology of the Smolensk State Medical University under the Ministry of Health of the Russian Federation. Results. A total of 116 patients (13.7%; 95% CI 11.4-16.0%) had complications of grade ≥3 within 90 days after surgery in the study cohort. In the analysis of the obtained data, the patient's age (p=0.04), the surgeon (p=0.013), and ESR (p<0.0001) had a statistically significant association with the occurrence of complications ≥3 degrees according to the Clavien-Dindo classification. The association of ESR with postoperative complications was investigated, and it turned out that the frequency of complications ≥3 degrees with ESR ≤10 mm/h, 11- 30 mm/h and >30 mm/h was 6.6%, 25.5% and 5.4%, respectively. The independent prognostic value of ESR in the range from 10 to 30 mm/h was confirmed in a multivariate logistic regression analysis, the odds ratio was 4.6 (95%CI 2.4-8.8; p <0.0001). When analyzing the structure of complications, it was noted that the increase in the number of complications in the group of patients with preoperative ESR of 11-30 mm/h occurred due to the main categories requiring relaparotomy (gastrointestinal, urinary, wound) and did not include thromboembolic complications. Conclusion. In this study, we showed for the first time a significant prognostic value of ESR in predicting of severe postoperative complications after RC. At the same time, the risk-to-ESR ratio was non-linear, with a maximum complication rate at ESR values from 10 to 30 mm/h.
Key words: рак мочевого пузыря, радикальная цистэктомия, тяжелые осложнения, СОЭ
POSSIBILITY OF EMERGENCY SURGICAL INTERVENTION AGAINST THE BACKGROUND OF ORAL ANTICOAGULANTS
Ramazanov G.R., Fayn A.M., Akhmatkhanova L.B., Klychnikova E.V., Kuzmina I.M., Novikov R.A., Petrikov S.S.
UDC: 616-005.6:616-089+615.015
Abstract: Objective. Knowledge development of the possibility for emergency surgery in patients receiving oral Anticoagulants. Methods. Collection, systematization and analysis of data from the scientific literature and the results of own research on the relevant problem. Results. In the present clinical case, a patient receives anticoagulant therapy with dabigatran etexilate. The patient underwent emergency surgery while the anticoagulant effect was inactivated by taking a specific antagonist. Conclusion. Patients, who are taking anticoagulants, may experience emergency cases such as repeated ischemic strokes, bleeding, acute surgical pathology or limb injuries. They require immediate inactivation of the anticoagulant effect. Surgical measures or systemic thrombolytic therapy is acceptable only after inactivation of the anticoagulant effect for patients taking dabigatran etexilate. It can be done by the administration of idarucizumab, which is a specific antagonist. Idarucizumab quickly and persistently neutralizes the anticoagulant effect of dabigatran etexilate and does not have a prothrombotic effect.
Key words: криптогенный инсульт, кардиоэмболический инсульт, фибрилляция предсердий, идаруцизумаб, дабигатрана этексилат
METHOD OF POLYPHENOL OXIDASE INHIBITION IN POMACE DURING SORBENTS PREPARATION
Ryabinina E.I., Zotova E.E., Nikitina T.N., Ponomareva N.I.
UDC: 634.11+547.562.1]:66.081
Abstract: Objective. To develop an economical and environmentally safe method for inhibiting enzymatic oxidation in pomace during the apple powder production and to preserve pectin substances as much as possible in relation to their initial content in raw materials. Methods. The object of the study was pomace dried at a temperature of 85°C (apple powder 1) and 50°C, after inhibiting the enzymatic oxidation process (apple powder 2). Sorption activity of the powders towards lead, copper, nickel and zinc ions was determined by titration using Trilon B solution. Results. The main drawback of making an apple powder based on pomace is the dark grey colour of the fiber, which appears due to the production of polyphenols oxidation products with air oxygen in the presence of polyphenol oxidase. The new method of oxidation processes inhibition in pomace, based on the use of sodium chloride, ascorbic acid and low temperatures, leads to a decrease in the polyphenol oxidase activity, to the contact of the pulp with molecular oxygen, and, as a result, to lowering the rate of polygalacturonic acid decomposition having a high sorption activity. It has been proved that applying the method of polyphenol oxidase inhibition in pomace we produce apple powder 2 that has 7% more sorption activity compared to apple powder 1. The reasonability of using apple powder 2 to obtain a pectin-containing enterosorbent has been shown. Conclusion. The new method for inhibiting enzymatic oxidation in pomace to make a pomace-based apple powder (sorbent) has been developed. The proposed method is economical and environmentally friendly: the substances used (sodium chloride and ascorbic acid) have a low cost; they do not require additional washing-out, which reduces energy consumption, the volume of water consumed, and the volume of sewage; and the substances used (sodium chloride and ascorbic acid) are safe for the human body and the environment. It has been shown that the temperature regime used in this method (t=50°C), together with the oxidation inhibition stage, allows to preserve more pectin substances and increase the sorption activity of the apple powder.
Key words: яблочные выжимки, яблочный порошок, сорбент, тяжелые металлы, полифенолоксидаза
REGRESSION ANALYSIS IN DEVELOPMENT OF PROCEDURE FOR ISOLATION AND QUANTITATIVE DETERMINATION OF WATER-SOLUBLE POLYSACCHARIDES OF RHIZOMES AND ROOTS OF DEVYASIL
Dyakova N.A., Velikanova L.A.
UDC: 615.322
Abstract: Objective. The aim of the study is to select the optimal parameters of ultrasonic extraction of water-soluble polysaccharides from roots and rhizomes of a high devisil based on regression analysis. Methods. For the experiment, raw materials purchased in one of the pharmacies in the city of Voronezh were used. A sample of raw material (1.0 grams) scales was placed in the Grad 40-35 ultrasonic bath, which allows maintaining the necessary temperature and frequency of ultrasound with a given duration of time. Then, 10 (15 or 20) ml of water purified from impurities at a temperature of 60°C to 80°C were measured with a measuring flask and extracted from 10 to 20 minutes with a multiplicity of 1 to 3, and after each of the multiple studies, the same raw material was further filtered with a new solvent. Results. The initial conditions and the data obtained during the experiments made it possible to present the regression model in the form of a linear multiple regression equation, which can be used with sufficient accuracy in prediction and analysis. The consistency level of the initial data according to the Kochren criterion was G=0.013 < Gcrit=0.05, which confirms the homogeneity and statistical reliability of the experimental conditions. The adequacy of the model is confirmed by testing the hypotheses according to the Pearson x. The correlation coefficient derived from the values of the regression coefficient and the mean square deviation was used in determining the tightness of the overall relationship between the source and the obtained data. In addition, a detailed study of a sample of those variables whose priority was not clearly expressed was carried out by processing when fixing their values. Conclusion. The most important conditions for the extraction of rhizomes and roots of the high devyasil in order to obtain the most stable performance should be considered: the extraction temperature is 80°C; the extraction multiplicity - equal to 3; the ultrasound frequency - 35 kHz. It should be noted here that raw material grinding can vary from 0.5 mm to 2 mm, extraction time can range from 15 min to 20 min, the ratio of raw material and extractant can vary from 1 g per 10 ml to 1 g per 15 ml.
Key words: водорастворимые полисахариды, инулин, корневища и корни девясила высокого
DEVELOPMENT OF THE COMPONENT COMPOSITION OF THE PLANT COLLECTION WITH GYNECOLOGICAL ANTI-INFLAMMATORY ACTION
Privalova E.G., Tsyrenzhapov A.V., Mirovich V.M.
UDC: [615.322:547.918]:618
Abstract: Objective. To establish the optimal ratio of components of the gynecological plant composition which has an anti-inflammatory activity. Methods. The optimal ratio of phytocomponents of the collection was determined by the results of the content analysis of the main active substances. The amount of flavonoids and arbutin was determined by the spectrophotometric method, the amount of polyphenols - by the titrimetric method, extractive substances - by the gravimetry. The anti-inflammatory activity of the gynecological phytocomposition was studied in in vivo experiments and was reduced to assessing the effect on the alteration process, on the exudative phase of inflammation and the proliferation phase. Pharmacological studies were carried out in accordance with the requirements of Directive 2010/63/EU of the European Parliament and of the Council of 22.09.2010 on the protection of animals used for scientific purposes. Results. Five variants of the gynecological plant composition were studied. The composition of biologically active compounds of the collection includes flavonoids, tannins and simple phenolic compounds. The content of quercetin, luteolin, naringenin, cinaroside, hyperoside, rutin, and arbutin was determined. The maximum content of active substances was established in the plant composition of the gynecological version 5 ( Pentaphylloides fruticosae cormus 80 g, Orthiliae secundae herba grass 10 g, Pyrolae rotundifoliae folia, Pyrolae asarifolia folia (1:1) 10 g. The anti-inflammatory activity of this composition was dose-dependent and was evaluated as pronounced. Conclusion. Theoretically and experimentally, the composition and ratio of the components of the gynecological plant collection containing polyphenolic compounds, flavonoids, and arbutin is justified. The developed phytocomposition shows a pronounced dose-dependent anti-inflammatory activity.
Key words: растительная композиция противовоспалительная, полифенолы, флавоноиды, арбутин
CONTENT SOLUTIONS OF INFORMATION SYSTEMS OF MEDICAL ORGANIZATIONS OF THE RUSSIAN FEDERATION
Kurmangulov A.A., Kroshka D.V., Kononykhin A.A.
UDC: 614.2:34.06
Abstract: Objective. Conducting a substantive analysis of individual points of the criterion "Organization of the information system in a medical organization" of a new model of a medical organization providing primary health care. Methods. The research used the methods of content analysis in scientific databases Google Scholar, Scopus, Elibrary, PubMed, MEDLINE. A systematic analysis was carried out with elements of structuring the information of regulatory legal acts of the Russian Federation related to the provision of medical care for the period from 2010 to 2021, using the computer reference legal systems "ConsultantPlus", "Garant", as well as the electronic fund of regulatory, technical and regulatory - legal information of the Consortium "Code" - Docs.cntd.ru. Results. In the course of the analysis of the legal regulation of the presentation of information in the visualization systems of healthcare facilities, it was established that at the moment in the domestic legislative framework there is an approved by the Deputy Minister of Health of the Russian Federation E.G. Kamkin. in the form of methodological recommendations, a methodology for assessing the availability, relevance and relevance of information elements of the information system for informing medical organizations providing primary health care. This methodology is valid for assessing the information systems of medical organizations providing primary health care. Along with this, among specialists in the field of healthcare organization and public health, there are certain difficulties in interpreting the concepts and terms used in the proposed checklists for assessing the organization of the information system in a medical organization. In addition, there is no detailing of the volume, structure and form of presentation of information on medical insurance organizations operating on the territory of the constituent entities of the Russian Federation, on the types of medical care provided, on medical care provided in accordance with the program of state guarantees and the territorial program of state guarantees for providing citizens of the Russian Federation free of charge. medical care. Conclusion. In order to improve the methodology for assessing the compliance of medical organizations and their structural units providing primary health care, the new model seems to be expedient to detail and standardize individual points of the criterion "Organization of the information system in a medical organization", including through the use of visual models (best practices) presentation of information elements in medical organizations.
Key words: федеральный проект, визуализация, стандартизация, система информирования, новая модель медицинской организации
STUDY OF APPROACHES TO IMPROVING THE PHARMACEUTICAL EDUCATION OF MOROCCAN CITIZENS STUDYING IN RUSSIA
Guryanov P.S.
UDC: 615.15 378.14
Abstract: Objective. Studying of the features of pharmaceutical education in Morocco, comparing it with the Russian education that citizens of Morocco receive in Russia, analyzing the degree of satisfaction of Moroccan citizens with studying in Russia - in order to find ways to increase the competitiveness of Russian pharmaceutical universities. Methods. Comparison of the syllabus of pharmaceutical universities in Morocco according to data published on the official websites of universities, with the syllabus of Russia according to the Federal State Educational Standard 3+, a sociological study by questioning Moroccan citizens studying at the Perm State Pharmaceutical Academy. Results. In Morocco, pharmaceutical education can be obtained at 4 public universities, 2 private and 1 military educational institution. Education in public universities is free, but the requirements for applicants are very high. Education in non-state universities is extremely expensive (up to 6 times more expensive than in Russia). The education lasts 6 years. The syllabuss of Russia and Morocco are similar, but there are no next academic disciplines in Russia: medicines in Morocco, pharmaceutical law in Morocco, hospital pharmacy and a number of others. The main competing countries of Russia: France, Canada, Ukraine. Education in Russia is affordable, prestigious, which graduates recommend to their friends and family. Disadvantages of the educational process in Russia: lack of knowledge of foreign language teachers, insufficient access to computers and the Internet; not enough internships in pharmacies, hospitals and pharmaceutical industries. Conclusion. To improve education in Russia, it is advisable: to train teachers in foreign languages, to teach the citizens of Morocco the disciplines of elections in the areas most in demand among them, to strengthen internships at Russian enterprises for Moroccans, organize training courses in a distance form for Moroccan graduates of Russian pharmaceutical universities.
Key words: фармация, обучение, Марокко, учебный план
JUSTIFICATION OF ECONOMIC AND SOCIAL NECESSITY OF MOBILE CLINICAL LABORATORY INTRODUCTION (USING THE EXAMPLE OF SMOLENSK REGION)
Atroshchenko A.M., Sokolova M.G., Moiseenkova L.G., Mazur A.S.
UDC: 616-071 (470.332)
Abstract: Objeсtive. Аssessment of social and economic criteria of mobile clinical laboratories introduction using the example of Vyazma District of Smolensk Region. Methods. The study was carried out using applied sociological comparative study technique - questionnaire (including primary health workers and population of Vyazma District using the example of Andreykovskoe, Vyazma-Bryanskoe, Semlyovskoe and Tumanovskoe villages) and customized technique of economic study on the base of laboratory of Regional State Funded Healthcare Facility «Vyzma Central District Hospital» - statistical technique study (overview of quantifiable and qualitative values). The object of the social study is statistical data of the necessity of introduction of mobile clinical laboratories questionnaire. The objects of the economic study are quantifiable and qualitative values of Regional State Funded Healthcare Facility «Vyzma Central District Hospital» laboratory. Results. Rural population of Smolensk Region make up 28,1% of all population. Ageing of the population is an ongoing process in Smolensk Region, which contributes to an increase of morbidity of both city and rural area residents. In Smolensk Region several reasons of death can be distinguished, such as diseases of the circulatory system (50,5%), malignancy (16,1%) and cerebrovascular diseases (11%). Most of the surveyed rural area residents of Vyazma District (41% of the respondents) think that laboratory tests should be integrated into the treatment-and-prophylactic process. They are also willing to pay the prime cost of sampling and sample transportation to avoid visiting their local hospital on condition that prime cost of tests will cost less than equivalent test in commercial laboratory (39% of respondents). Some of them found it difficult to answer because they don’t know if the prime cost would cover the transportation expenses to the local hospital (34% of respondents). 62,5% of primary health workers respondents think that clinical diagnostics will be more up to date with possible mobility of clinical laboratories. According to the data from Regional State Funded Healthcare Facility «Vyzma Central District Hospital» clinical laboratory registry book, the number of performed clinical and biochemical tests make up to 36700. However, the number of tests performed for Vyazma District residents is 24466, because some biochemical tests are delivered from Gagarin Central District Hospital and Safonovo Central District Hospital. Therefore, regular workload of the laboratory of Regional State Funded Healthcare Facility «Vyzma Central District Hospital» is 67 tests per day, which indicates the importance of laboratory tests in this municipal district. Cost-effectiveness is based on coverage of operating costs. The cost of the test will be equal to the cost recovery of operating costs. Conclusion. The necessity of mobile clinical laboratory introduction exists and the most important goal is accessibility of clinical laboratory tests for residents of hard-to-reach and underpopulated areas, which is confirmed by residents’ opinion and importance of laboratory tests in Vyazma District.
Key words: ФАП, своевременная диагностика, клинические исследования, мобильные биохимические лаборатории, малонаселённые пункты
FEDERAL INNOVATION PLATFORM: EXAMINATION OF THE MEDICAL UNIVERSITY STUDENTS TENDENCY TO ADDICTIVE BEHAVIOR
Dmitriev M.V., Andreev V.A., Dmitrieva E.V., Krikova A.V., Kozhurina A.A., Kozlov R.S.
UDC: 378+159
Abstract: Objective. To carry out express diagnostics of the alcohol, psychotropic and narcotic substances consumption risks during the implementation of the innovative project "HEALTH of the first year student - HEALTH of the physician - HEALTH of the nation!" and to develop programs to prevent harmful habits for the students of the Smolensk State Medical University (SSMU). Methods. Test-questionnaire "Addictive tendency" was developed by V.V. Yusupov, V.A. Korzunin. The survey was performed in November 2020 using https://docs.google.com/forms/. 381 students participated as volunteers in the survey. Statistical data analysis included the methods of descriptive statistics. Statistical significance was recognized with a probability of >95% (p<0.05) and 99% (p<0.01). Results. It was found that out of 381 students, 327 belong to the low risk group of addictive behavior; 31 - to moderate risk of addictive behavior; 23 - to high risk of addictive behavior (pronounced features of a tendency to addictive behavior). When the data was coped, it was found that there were no such persons among the students of the second and sixth years; but among the 5th year students 5 persons were revealed, among the 4th year - 7, among the 3rd year - 7, and among the 1st year - 4. Conclusions. The results of the medical university students’ survey will identify the problem of tendency to addictive behavior on the early stages with future training in the context of a healthy lifestyle in general. A complex of psychological and pedagogical support of the students to identify the cause-and-effect relationships of the disorders and their complications development (depression, epilepsy, cardiovascular diseases, etc.), training skills of early diagnosis of mental functioning violations and associated states of addiction are planned on the basis of a Federal innovative educational platform.
Key words: аддиктивное поведение, обучающиеся, профилактика, федеральная инновационная площадка