MEDICO-BIOLOGICAL SCIENCES
ORIGINAL ARTICLES
Concordance between blood phosphatidylethanol and self-reported alcohol consumption
Razvodovsky Yu.E., Schuriberco A.V., Pereverzev V.A.
Abstract: Objective. To assess concordance between blood phosphatidylethanol (PE) concentrations and self-reported alcohol consumption.
Methods. The concentration of PE was determined in 480 blood samples of Grodno residents of both sexes aged 18-65 years. The blood was obtained from the laboratory of the medical advisory center, where it was submitted for routine biochemical analysis. Immediately prior to blood sampling, the clients were asked to complete the AUDIT questionnaire. Determination of the concentration of FE was carried out using the method of high performance liquid chromatography – tandem mass spectrometry (HPLC – MS). Statistical data processing was carried out using the Statistica 10.0 program.
Results. Discrimination by the level of alcohol consumption using the concentration of PE showed that the proportion of abstinents (practically not drinking alcohol) was 63.51%; the proportion of moderate drinkers was 28.51%; the proportion of those who abuse alcohol was 7.82%. The distribution by level of alcohol consumption according to the total score of the AUDIT test was as follows: abstinents – 23.75%; moderate drinkers – 71.56%; alcohol abusers – 4.69%. Correlation analysis did not reveal any relationship between the concentration of FE and the total score according to the AUDIT test (r=0.07; p<0.734).
Conclusion. The data obtained indicate a low concordance between the concentration of PE in the blood and self-reported alcohol consumption. Determining the concentration of PE in the blood is a more reliable way to diagnose alcohol abuse than the use of screening tools.
Keywords: phosphatidylethanol, AUDIT, alcohol consumption
Evaluation of the dynamics of the hepato-splenic index after extended liver resection in the cases of preliminary vascular exclusion in the experiment
Leonov S.D., Panchenkov D.N., Rodin A.V., Karasev A.S., Sorokina A.A.
Abstract: Objective. Evaluation of changes in the mass of the liver remnant and spleen in dynamics after extended liver resection with preliminary vascular exclusion in the experiment.
Methods. The study was carried out on 38 white Wistar rats weighing 180-270 g. The experimental animals were divided into 3 groups: 1st – sham-operated (SO) animals (control group) (n=11), 2nd – with extended liver resection (n=15); 3rd – with extended liver resection, performed under conditions of preliminary vascular exclusion (VE) of the liver for 15 minutes (n=12). Extended liver resection (ELR) was modeled by removing 70% of the liver. On the 3 and 14 days, the animals underwent relaparotomy, the liver and spleen were removed and weighed. The hepato-splenic index was calculated as the ratio of the liver mass remaining after ELR to the mass of the spleen.
Results. The mass of the liver in the SO group of rats on the 3 day after laparotomy was 9,06 (6,42; 12,45) g, the mass of the spleen was 0,96 (0,69; 1,47) g. The median of the hepato-splenic index was 9,69 (6,05; 11,85). The mass of the removed liver on the 3 day of the experiment in the 2nd group of experimental animals was 5,09 (4,19; 6,55) g, and in the 3rd – 5,32 (4,79; 7,81) g, and it was statistically significantly less than in the SO group of rats (p<0,05). The mass of the spleen in the group of animals that underwent ELR and ELR in combination with VE on the 3 day after ELR was, respectively, 0,94 (0,83; 1,17) g and 0,85 (0,5; 1,11) g, which did not differ from the control values. The hepatic-splenic index on the 3 day after ELR in the 2nd group was 5,27 (4,99; 6,13) and was statistically significantly less than in rats without ELR. In the 3rd group, this indicator was 7,72 (4,32; 10,3) and did not differ statistically from the SO of animals. On the 14 day, the weight of the liver in the experimental animals of the 2nd and 3rd groups was 6,39 (4,65; 7,19) g and 6,34 (5,5; 12,63) g, respectively, which was statistically significantly less than in SO animals. The mass of the spleen in rats of the 2nd group was 1,11 (0,77; 1,25) g, and did not differ from the values on the 3 day. However, the mass of the spleen in the third group increased statistically significantly relative to the values on the 3 day to 1,2 (1,17; 1,75) g. At the same time, the hepatic-splenic index on the 14 day of the postoperative period in the 2nd group was 6,11 (5,11; 7,23), and in the 3rd group – 5,08 (4,7; 7,63), which was statistically significantly less than the control values.
Conclusions. The hepato-splenic index objectively represents the dynamics of changes in mass and, consequently, the intensity of regenerative processes in the liver and spleen after ELR. During the first 3 days after ELR, the mass of the liver in experimental animals increased by about 2,5 times compared to that remaining after resection, which indicates the peak of liver regeneration. Vascular exclusion before ELR provokes the development of spleen hypertrophy, which can be interpreted as one of the markers of a complicated course of the postoperative period.
Keywords: extended liver resection, vascular exclusion, liver and spleen regeneration
Coronavirus infection in patients with bronchial asthma
Dmitriev I.V., Ignatova N.B., Bunkov K.V., Kireeva O.K., Frolova I.V., Alekseev V.F.
Abstract: Objective. To clarify pathological conditions, including nosological forms that contributed to death of patients who had been suffering from bronchial asthma and died from coronavirus infection COVID-19.
Methods. A non-randomized, comparative, retrospective study of the materials of 937 protocols of pathoanatomic autopsies of people who died from COVID-19 in the period from May 2019 to April 2022 and were examined in the departments of the Smolensk Regional Institute of Pathology. 53 patients with bronchial asthma were found among them. Then 937 protocols of pathoanatomic autopsies were analyzed, of those who died not from COVID-19 in the period from May 2019 to April 2022 and were examined in the same departments of the Smolensk Regional Institute of Pathology, among which 29 patients with bronchial asthma were found.
Results. Among the 937 deaths from COVID-19, the rate of bronchial asthma was 5.42%, with well-controlled bronchial asthma - 3.77%, partially controlled - 69.8% and uncontrolled – 26.43%.Among the 937 deaths without COVID-19, the rate of bronchial asthma was 3.04%. Their bronchial asthma was well-controlled – 6.89 %, partially controlled – 34.49 % and uncontrolled – 58.62 %. In the groups of deaths from COVID-19 and without it, the average age was the same (67.12 + 10.05 and 68.72 + 11.04, respectively). In both groups, women led (64 and 58 %). In the group of deaths from COVID-19 with the presence of bronchial asthma, the most common comorbid diseases were: coronary ischemic heart disease (92.45%), arterial hypertension (77.35%), obesity (66.04%), chronic bronchitis (62.26%), pneumosclerosis (58.49%), emphysema (56.6%). Diabetes of type 2 was reported in 32.07%. Compared with this data, in the group of deaths without COVID-19, the following diseases were less often found: coronary heart disease by 2.3 times, arterial hypertension by 3.7 times, obesity by 3.1 times, Diabetes of type 2 by 3.4 times. In the group of deaths without COVID-19 of people who suffered from bronchial asthma instead of coronavirus infection, the diagnosis "Underlying disease" included the following conditions: in 38% chronic obstructive pulmonary disease; in 20% ischemic heart disease; 16% cerebral infarction; 12% lobar pneumonia; 8% bronchial asthma directly and 6% rheumatoid polyarthritis. At the same time in 34% bronchial asthma was registered in the heading of "concomitant diseases", and in other cases it was in a background or combined pathology. For COVID-19 patients with bronchial asthma, the incidence of chronic obstructive pulmonary disease was by 11.5% higher than in the group of deaths without COVID-19, but the frequency of uncontrolled bronchial asthma, which is accompanied by more pronounced morphological changes in the second group, was 2 times greater than in the first group.
Conclusion. Most of the patients in the group with COVID-19, in addition to bronchial asthma, either had several diseases at once, or one, but quite severe pathology. For patients suffering from bronchial asthma who died from coronavirus infection, the most frequent comorbid diseases were coronary heart disease, arterial hypertension, obesity, chronic bronchitis, pneumosclerosis, emphysema. The last three forms were observed mainly for patients with uncontrolled bronchial asthma and most likely were not independent nosological forms, but a consequence in the progression of bronchial asthma. The presence of uncontrolled asthma in the COVID-19-free group confirms the significant impact of COVID-19 on death. Although the incidence of asthma in the COVID-19 group was 2 times higher compared to the group of deaths without COVID-19, the prevalence of bronchial asthma in this group was low (5.42% of cases).
Keywords: coronavirus infection, bronchial asthma
Study of pharmacotherapy indicators in disabled people suffering from cardiovascular diseases against the background of ongoing rehabilitation
Sabirova E.R., Nizamov R. Kh., Burykin I.M., Khafizianova R.K.
Abstract: Objective. To analyze the correspondence of the actual clinical practice of managing patients who received rehabilitation with pathology of the cardiovascular system in the Republic of Tatarstan with the principles of evidence-based medicine.
Results. A retrospective observational study was carried out, which included persons with a confirmed diagnosis of arterial hypertension, including in combination with coronary heart disease, who were first recognized as disabled by the Bureau of Medical and Social Expertise of the Republic of Tatarstan in 2013 and who applied for re-examination in 2015. The object of the study was primary medical documentation.
Based on the current clinical guidelines for cardiovascular diseases, criteria were formulated, which were analyzed using statistical methods. Statistical analysis was performed using the open source program Jamavi (www.jamovi.org). An assessment of 990 prescriptions of drugs in the advisory opinions of cardiologists and extracts from the medical history of an inpatient was carried out.
Conclusion. In accordance with the quality criteria of the World Health Organization, over two years, an increase in the proportion of patients with polypharmacy (p=0.03), the proportion of drugs prescribed by the generic name (p=0.02) were identified. There was a significant increase in the frequency of prescribing beta-blockers (p=0.03), drugs of the category C01 (p=0.05). There was a significant increase in the frequency of recommendations for spironolactone (p=0.005), amlodipine (p=0.01), losartan (p=0.02), rosuvostatin (p=0.03), acetylsalicylic acid (p=0.007). A significant decrease in the frequency of prescribing a combined preparation of magnesium hydroxide + acetylsalicylic acid (p=0.04), enalapril (p=0.05) was revealed. The study recorded an increase in PDD of trimetazidine, amlodipine, ramipril, rosuvostatin. We found a decrease in the PDD values of bisoprolol, atorvastatin, torasemide and spironolactone.
Keywords: Republic of Tatarstan, disability, cardiovascular diseases, pharmacotherapy, clinical guidelines
Changing the sensitivity of gram-positive microorganisms to doxycycline in the presence of zinc aspartate and tryptophan
Artyukh T.V., Sheibak V.M., Ostrovskaya O.B.
Abstract: Objective. To evaluate the effects of L-tryptophan and zinc aspartate on the antibacterial activity of doxycycline in relation to clinical strains of S. aureus and S. haemolyticus in the state of plankton and in biofilms.
Methods. During the study, the minimum inhibitory concentration (MIC90) of doxycycline and its combinations with tryptophan and zinc aspartate were determined in relation to the planktonic forms of the studied strains S. aureus 2738 and S. haemolyticus 2642 on the turbidity detector of suspensions DEN-1 Biosap. Microbial biofilms were cultured in immunological tablets under static conditions. The MIC of drugs in relation to microorganisms was determined by the reduction of XT based on 1% resazurin. The biofilms were visualized using transmission electron microscopy JEM 1011 (JEOL, Japan). The research data were processed by means of MS Excel 2010, as well as a package for statistical data processing Statisticf 10, using multivariate analysis of variance.
Results. The addition of tryptophan and zinc aspartate to the culture medium at concentrations of 0.2-2000 mcg/ml increases the antibacterial activity of doxycycline against planktonic forms of S. aureus and S. haemolyticus p<0.05. The addition of tryptophan and zinc aspartate to the medium at a working concentration of 1000 mcg/ml increases the antibacterial activity of doxycycline against S. aureus and S. haemolyticus biofilms in vitro by 2 times.
Conclusions. The addition of tryptophan and zinc aspartate increases the antibacterial and antibiotic film effect of doxycycline, which allows them to be considered as modulators of antibacterial activity.
Keywords: zinc aspartate, tryptophan, doxycycline, planktonic forms, biofilms
REVIEWS
Peptide signaling systems in teleost fish are new molecular models for experimental neuropharmacology
Khokhlov P.P., Bairamov A.A., Brazhenko A.A., Bychkov E.R., Lebedev A.A., Kazakov S.V., Shabanov P.D.
Abstract: Objective. The review material analyzes on the significance of peptide signaling systems in teleost fish as a new molecular model for experimental neuropharmacology.
Results. In recent decades, due to the development of phylogenomics, new ideas about the evolution of vertebrates and about the homology of peptide signaling systems within vertebrates, about the similarities and differences in molecular structure within vertebrates, have developed. Comparative sequencing of signal peptides and the genes encoding them made it possible to draw conclusions about the relationship of peptide systems and their evolutionary origin from the same ancestral molecular systems within vertebrates.
Conclusion. A high level of similarity in the molecular structure of signal peptides and corresponding receptors is noted, which leads to the conclusion that the use of bony fish representatives as model organisms for studying peptide signal systems as pharmacological targets is promising. In this case, one should take into account the differences in the physiological effects of signal peptides in fish, on the one hand, and in humans and higher mammals, on the other.
Keywords: intercellular signaling systems, neuropeptides, bony fish
Modern views on therapy of urinary tract infections during pregnancy
Stepankova E.A., Suhorukova A.O.
Abstract: Objective. To study and analyze the current data concerning current approaches to the therapy of urinary tract infections in pregnant women.
Methods. Literature data on the treatment of urinary tract infections during pregnancy were collected and analyzed.
Results. The paper presents current views on the issues of antibiotic therapy of urinary tract infections during pregnancy and reviews alternative therapies.
Conclusion. Thus, urinary tract infections are a pressing problem during pregnancy. The presence of infection can adversely affect the course of pregnancy, delivery, the postpartum period, as well as the condition of the fetus and the newborn baby, and its further development. Timely diagnosis and initial antibiotic treatment can significantly reduce the risk of complications. The drugs of choice are antimicrobials, which should be chosen with consideration for antimicrobial sensitivity, and also take into account safety in a particular trimester. Uroseptics, ascorbic acid can be used to prevent the development of urinary tract infections in pregnant women, as well as in addition to basic therapy.
Keywords: Urinary tract infections, pregnant, diagnostic, treatment, antibacterial therapy
CLINICAL MEDICINE
ORIGINAL ARTICLES
Challenging issue of treating patients with geriatric syndromes and high cardiovascular risk
Golovanova E.D., Erokhina A.S.
Abstract: Objective. To investigate the peculiarities of cardiovascular drugs prescription for patients with sarcopenia, comorbidity and multifocal atherosclerosis.
Methods. 139 patients form the cardiology hospital were divided into groups: with sarcopenia "S+" and without it "S-". The diagnosis of arterial hypertension (AH), ischemic heart disease (IHD) and chronic heart failure (CHF) was carried out according to the recommendations of the European and Russian Cardiological Society. Sarcopenia was diagnosed according to the criteria of the European Working Group on Sarcopenia in Older People 2010 and 2018; The presence of atherosclerotic plaques (ASP) – according to the Criteria of the International Consensus 2006-2010.
Results. Patients with "S+" significantly more commonly had: stage 2-3 AH, IHD (II–IV functional class), postinfarction cardiosclerosis, stoke in the anamnesis, CHF, diseases of peripheral vessels, chronic cerebral ischemia, atrial fibrillation (p<0.05). Patients "S+" were older (p<0.05). Patients with "S+" were characterized by the presence of prolonged, concentric, with an uneven surface, heterogeneous hypoechoic and unclassifiable due to severe calcification of ASP (p<0.05), and for patients with "S-" – local, with a flat surface ASP (p<0.05) was characterisric. Patients with "S+" more commonly intake beta-blockers, i-ACE, antiplatelet agents, anticoagulants, nitrates and statins for a long time – more than 3 years (p<0.05). In patients with severe sarcopenia there was no significant difference in the doses and duration of statin administration for patients with unstable and stable ASP (p<0.05). The level of total cholesterol did not differ in patients with stable and unstable ASP (p>0.05.
Conclusion. In patients from cardiological hospital "S+" is associated with a severe comorbid background and the presence of unstable (potentially thrombogenic) ASP, that’s why they have a very high risk of cardiovascular complications. The prescription of statins is carried out in accordance with clinical recommendations. Identification of unstable ASP simultaneously with sarcopenia requires a personalized approach to the management of geriatric patients.
Keywords: sarcopenia, atherosclerosis, ultrasound dopplerography of the main vessels of the neck
Meaning of clinical and radiographic markers for predicting short-term outcomes and progression of COVID-19
Strutynskaya A.D., Karnaushkina M.A., Tyurin I.E., Dvoretskyi L.I., Dyadina Yu.A.
Abstract: Objective. To study the clinical value of laboratory and radiographic markers for early prediction of progressive course and death in hospitalized patients with COVID-19.
Methods. The study included 162 hospitalized patients with COVID-19. The prognostic ability of the laboratory and radiological predictors of the disease progression was assessed by the need to transfer the patient to the ICU or mechanical ventilation. Statistical analysis included regression analysis with the construction of the ROC curve. Differences in patient survival were assessed using bilogistic regression and Kaplan-Meier analysis.
Results. 124 (76.5%) patients had a progressive course of COVID-19. 86 patients died (53%). Compared with mild patients, patients with severe and very severe COVID-19 had higher levels of neutrophils, LDH, CRP, frequency of complications, progression, adverse outcome, and high CT severity score, while lymphocyte, calcium, and blood glucose levels were lower (p <0.05). Regression logistic analysis with the construction of the ROC curve showed that the model that combines the levels of CRP, lymphocytes, calcium and CT severity had the AUC of 0.863 (0.823 - 0.918). With a specificity of 79.2% and a sensitivity of 85.9%, it predicted a progressive course. For another predictive model for the lethal outcome, which used a combination of lymphocyte levels, calcium, and CT severity the AUC was 0.832 (0.767 - 0.856), specificity 75.6% and sensitivity 82.1%. Survival analysis showed that patients over 65 years of age with high LDH, neutrophils, CT severity above 20, or low lymphocytes were significantly less likely to survive (p<0.001).
Conclusion. A predictive model including CRP, LDH, lymphocytes, neutrophils, calcium, and CT severity can be an effective predictor of the progressive course and death of COVID-19.
Keywords: COVID-19, laboratory markers, computed tomography, progressive course, death
Features of personalized therapy for chronic lymphocytic leukemia in the republic of Khakassia
Smirnova O.V., Kulumaeva K.A.
Abstract: Objective. To study the effect of therapy on the clinical course of chronic lymphocytic leukemia.
Methods. The study group included 39 patients with CLL, aged 51 to 88 years, who were treated in the fourth therapeutic department at the Republican Clinical Hospital. Statistical significance of differences was determined using the nonparametric χ2 test - Pearson's chi-square test, Fisher's test, chi-square test with Yates correction. Differences were considered statistically significant at p<0.05.
Results. Of all the treatment regimens, the RFC protocol was used most frequently in 34 patients. Complete response was achieved in 18 patients, partial response - in 10 patients; disease progression was detected in 6 patients. At the initial admission, all patients with CLL showed only hematological changes, after the therapy, hematological complications expanded, hemorrhagic, infectious, cerebral, gastrointestinal disorders, and cell decay syndrome were added. A high comorbidity of CLL with cardiovascular diseases and diseases of the gastrointestinal tract was revealed.
Conclusion. The RFC protocol was most often used in the treatment of patients with chronic lymphocytic leukemia. The combination of RFC allows obtaining an overall response in 82% of primary CLL patients, while 53% of patients have a complete remission. The effectiveness of cytostatic therapy in patients with CLL is higher with standard RFC therapy relative to all other programs, and the use of the RFC protocol significantly increases the likelihood of achieving complete remission. When using various chemotherapy regimens for CLL, both non-hematological and hematological complications occurred. The greatest number of adverse events from chemotherapy occurred with the FCR treatment regimen, the smallest - with rituximab monotherapy. An unfavorable prognostic factor is the presence of additional oncological diseases and kidney diseases; we consider it appropriate to determine creatinine clearance in all patients with CLL before starting chemotherapy. Acute vascular pathology significantly limits the possibilities of chemotherapy in patients with CLL.
Keywords:chronic lymphocytic leukemia, chemotherapy, rituximab
Assessment of myocardial electrical instability indices in women with arterial hypertension and sleep breathing disorders
Tsareva V.M., Sundukova K.A., Osipova M.S., Tsarev S.A., Evseev A.V.
Abstract: Objective. To study ventricular repolarization processes in women with arterial hypertension and sleep breathing disorders.
Methods. 121 patients with arterial hypertension (AH) of grade 1 and 2 in postmenopause were examined. The patients were divided into 2 groups. The first group consisted of 89 women with AH and sleep breathing disorder (SBD), who were divided into 2 subgroups. Subgroup Ia consisted of 42 women with mild sleep apnea severity (IAH over 5-14/hr). The Ib subgroup included 47 women with moderate to severe sleep apnea (IAH more than 15/hr). The second group consisted of 32 patients with AH without VAT. The patients underwent Holter ECG monitoring ("Myocard-Holter", Russia) with the assessment of ventricular repolarization processes (QTc, QTcd, QTcmax, QTcmin) and respiratory monitoring (SomnoCheck micro (Germany). Data were statistically processed using STATISTICA 10.0 software package.
Results. The mean QTc interval in women of groups I and II was within normal limits and did not differ significantly. The QTc value was significantly higher (by 10.7 ms; p<0.05) in patients in subgroup Ib versus those without VAT. QTc interval prolongation >450 ms for 1 minute or longer was found 20% more frequently in women with sleep apnea (χ2=5.5; p=0.02). In the Ib subgroup, there was a 24% higher incidence compared to patients without VAT (χ2=4.5; p=0.04) and a 24.4% higher incidence compared to patients with mild sleep apnea (χ2=5.3; p=0.02). An increase in QTc variance was observed as the severity of sleep breathing disorders increased. In subgroup Ib, QTcd was 11.9% greater compared with group II (p<0.01). Moderate to severe apnea increased the chance of developing QTc>450 ms (≥1 minute) by 2.7 times compared to patients with mild apnea and by 2.72 times compared to patients without VAT (p<0.05).
Conclusion. Sleep breathing disorders of moderate and severe degree in women with AH in older age group are associated with prolongation of diagnostically significant QTc>450 ms.
Keywords: sleep apnea, sleep breathing disorders, arterial hypertension, repolarization, QT interval
Efficacy of cardiac contractility modulator in patient with reduced ejection fraction and atrial fibrillation
Zhukova N.A., Zhukov G.V.
Abstract: Objective. To present a clinical case of diagnosis and treatment of a patient with chronic heart failure with reduced ejection fraction, who was implanted with a new type of device that optimized his heart contractions.
Methods. Data of an out-patient survey card and case report form of a patient with chronic heart failure observed in an out-patient department after his hospitalization in a cardiology clinic for implantation of a heart rate modulator are presented. The authors analyzed Russian and foreign literature on the diagnosis and innovative high-tech treatment methods of chronic heart failure with reduced ejection fraction and permanent atrial fibrillation.
Results. The male 75 years old patient has been observed in an out-patient department at the place of his residence for 15 years. In 2018, after suffering a lower lateral myocardial infarction and with permanent atrial fibrillation, the patient’s chronic heart failure with reduced left ventricular ejection fraction (23-25%) deteriorated. In August 2022 at the FSBI "National Medical Research Center of Cardiology named after Academician E.I. Chazov" of the Ministry of Health of Russian Federation he was implanted with a cardiac contractility modulator. In the postoperative period, during four months of out-patient follow-up and optimal drug treatment his left ventricular ejection fraction increased from 25% up to 37%.
Conclusion. Up to date, in patients with atrial fibrillation and chronic heart failure (CHF), who despite optimal drug treatment retain symptoms of CHF with reduced left ventricular ejection fraction and who have no indications for cardiac resynchronization therapy and catheter ablation, implantation of a new generation cardiac contractility modulator may be recommended.
Keywords: chronic heart failure, reduced ejection fraction, atrial fibrillation, cardiac contractility modulator, surgical treatment, clinical case
Clinical case of persistent hypoglycemia in a newborn child
Alimova I.L., Demyanenko A.N., Ibatulin A.G., Dontsova A.A.
Abstract: Objective. To present a clinical case of persistent hypoglycemia in a newborn child.
Methods. We presented a clinical case of persistent hypoglycemia in a newborn child. We analyzed the materials of the inpatient card, the results of clinical, laboratory, and instrumental diagnostic methods. We analyzed domestic and foreign literature on the issue of persistent hypoglycemia and congenital hyperinsulinism. We conducted a comparative analysis of clinical manifestations, therapy in previously described cases of persistent hypoglycemia.
Results. Persistent neonatal hypoglycemia is hypoglycemia that persists for more than 7 days of a newborn's life. The most common causes of persistent neonatal hypoglycemia are deficiency of contrainsular hormones, decreased sensitivity to adrenocorticotropic hormone, hyperinsulinism (Beckwith-Wiedemann syndrome, hyperplasia, adenoma of cells of the islets of Langerhans, nisidioblastosis), diseases associated with impaired synthesis of amino acids and impaired oxidation of fatty acids, with impaired formation liver glucose. We present a case of observation of a child with persistent hypoglycemia, and we present the results of a diagnostic search and the features of the treatment.
Conclusions. The presented clinical case demonstrates a diagnostic search algorithm for detecting cases of severe persistent hypoglycemia in a newborn, which, without adequate therapy, is characterized by an unfavorable prognosis for the patient. Important aspects are the early detection of hypoglycemic conditions, regardless of their etiopathogenesis, pathogenic correction, including the relief of these conditions. These aspects save the life of the child and improve the quality of life in the future due to the timely prevention of severe cerebral pathology in the neonatal period.
Keywords: persistent hypoglycemia, hyperinsulinism, newborns, Beckwith-Wiedemann syndrome
Efficacy and safety of immunomodulatory drugs in the complex therapy of acute respiratory viral infections with complicated course in children
Zhilina E.A., Sokolovskaya V.V., Smolyankin N.N.
Abstract: Objective. To study the efficacy and safety of immunomodulatory drugs in the complex therapy of acute respiratory viral infections (ARVI) complicated by pneumonia in children aged 2 to 6 years who were hospitalized in the infectious diseases department of Smolensk in 2019.
Methods. A retrospective analysis of 60 case histories of children aged 2 to 6 years, with confirmed acute respiratory viral infections, complicated by pneumonia, who were hospitalized in the infectious diseases department of Smolensk in 2019 was perfomed. The patients were divided into 2 groups: Group 1 (main) – 30 patients who received interferon alpha-2b (rectal suppositories) 150,000 IU 2 times a day after 12 hours daily for 10 days; Group 2 (comparison) – 30 patients who received the drug umifenovir 50 mg 4 times a day orally for 5 days. Standard therapy included symptomatic agents (nasal drops, inhalations with saline solution), antipyretic drugs (according to indications), antibacterial therapy (according to indications).
Results. The evaluation of the effectiveness of immunomodulating drugs was carried out on the basis of clinical, laboratory and instrumental examination data with dynamic observation of patients at different stages of the disease. The duration of intoxication, catarrhal and bronchopulmonary syndromes, the duration of hospitalization were evaluated. The safety (tolerability) of the use of immunomodulatory drugs was assessed by comparing the frequency of adverse events. Retrospective analysis showed that the duration of elevated body temperature in patients was the same and amounted to 5.4±0.49 days in the group of children receiving interferon alpha-2b and 5.5±0.36 days in the group of children receiving umifenovir.Significant differences in the duration of intoxication syndrome were revealed: in group 1 it lasted 6.6±0.59 days, while in group 2 it was longer – 8.4±0.54 days (p<0.05). There were no significant differences in the duration of catarrhal syndrome: 9.3±0.66 versus 8.93± 0.56 days, respectively, in group 1 and 2 (p>0.05). The duration of cough was also comparable and amounted to 10.9±0.69 days in the main group and 10.97±0.53 days in the comparison group. The improvement in the general condition of patients, which was assessed based on the positive dynamics of the main clinical symptoms of the disease against the background of therapy, was 5.4 ±0.49 days in group 1, 5.7±0.35 days in group 2 (p>0.05). There were also no significant differences in the number of bed days: 7.2±0.35 versus 6.5±0.31, respectively, in group 1 and 2 (p>0.05).
Conclusion. As a result of the study, the effectiveness and safety of the use of immunomodulatory drugs in the complex therapy of acute respiratory viral infections complicated by pneumonia in children 2-6 years old has been proven. The clinical efficacy of interferon alpha-2b, rectal suppositories is due to a faster relief of intoxication syndrome in patients (p<0.05). According to the duration of catarrhal and bronchopulmonary syndromes, the timing of the onset of improvement, the results of laboratory and instrumental examination methods, there were no significant differences in the main group and the comparison group (using the drug umifenovir) (p>0.05). After the 5-day course of immunomodulatory therapy, the children of the main group for health reasons reasonably needed to increase the duration of the course of therapy, which was increased to 10 days. When assessing the safety of immunomodulating drugs, their good tolerability was noted in the first and second observation groups.
Keywords: children, acute respiratory viral infections, immunomodulatory drugs, pneumonia
Markers of oxidative stress in diabetic ketoacidosis in children and adolescents
Bykov Yu.V., Baturin V.A., Vorobieva A.P., Vartanyan A.A.
Abstract: Objective. To study the markers of oxidative stress (OS) in the setting of diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes mellitus (DM).
Method. A total of 74 children took part in the study: 50 children with DKA (study group) and 24 apparently healthy children (control group). The study group was split into two subgroups: subgroup 1 – 27 children with DKA in the setting of new-onset DM, and subgroup 2 – 23 children with DKA in the setting of chronic DM. The following OS markers were measured in plasma using ELISA: 8-isoprostane (8-IP), 8-deoxyguanosine (8-DG), malondialdehyde (MDA) and protein oxidation products (POP). To assess differences between the mean values, the Mann-Whitney test and the Kruskal-Wallis test were used.
Results. In patients with DKA, the mean values were higher for 8-IP at 91.645 [80.17-139.32] Pg/ml and 8-DG at 512.41 [413.72-586.08] Pg/ml, compared with 78.495 [66.68-92.03] Pg/ml and 404.1 [285.5-455.25] Pg/ml respectively in apparently healthy children. The mean values of MDA and POP did not differ from the apparent normal values. The highest increases in values were seen for 8-IP and 8-DG in children with DKA in the setting of chronic disease, compared with patients with DKA in the setting of new-onset disease.
Conclusion. Signs of OS in the setting of DKA were discovered in children and adolescents with type 1 DM. The manifestations of OS in DKA grow more pronounced with time. Timely diagnosis of OS in patients with this pathology may improve therapeutic outcomes in DKA by prompting the prescription of antioxidants as an add-on treatment.
Keywords: diabetic ketoacidosis, oxidative stress, children and adolescents
Using a modified trochlayer suture in augmentation mammoplasty
Saidov M.S.
Abstract: Objective. To optimize the technique of inframammary suture in patients during their augmentation mammoplasty.
Material and methods. The study included 171 patients who applied to the Department of reconstructive Surgery of the Republican Scientific Center for Cardiovascular Surgery in the period from 2005 to 2022. The age of the patients ranged from 19 to 45 years, the average age of the patients was 28.5±3.1 years. Congenital glandular tissue deficiency was observed in 96 (56.1%) cases, in 75 (43.9%) cases, the deficiency occurred after childbirth and lactation.
Results. All patients were divided into two clinical groups. The first group included 82 patients who received a standard intradermal Halsted suture. The second clinical group included 89 patients who had a three-layer suture, upgraded by specialists of the Center. The age and other characteristics of the women were comparable in both clinical groups. As for long-term complications, they were estimated in terms of up to one year and above. During the survey in clinical group I, 32 patients called the cosmetic result in the suture area good, 27 women called them satisfactory, and 23 – unsatisfactory. At the same time, 46 patients in the II clinical group called the results of scar healing good, 31 patients – satisfactory, and only 12 patients classified them as unsatisfactory.
Conclusion. Thus, the technique of applying a three-layer suture can significantly improve the cosmetic results in the area of implant insertion, which in turn improves the psychological state of patients in the postoperative period. Although current clinical research considers suturing in augmentation mammoplasty to be of minor importance, the findings show that this is far from the case.
Keywords: augmentation mammoplasty, breast augmentation, three-layer suture, plastic surgery, silicone implants
Surgical treatment of metastatic lesions of the spine using three-dimensional endoscopic imaging
Ivliev D.S., Ovsyankin A.V., Balaev P.I., Lyulin S.V., Burtsev A.V.
Abstract: Objective. To evaluate the effectiveness of three-dimensional endoscopic visualization in the surgical treatment for patients with spinal metastases.
Methods. Surgical treatment included pedicular screw fixation of the affected vertebra according to usual technique and removal of the tumor-affected posterior part of the vertebra, followed by removal of the anterior part of the vertebra and decompression of the spinal cord using minimally invasive techniques and tree-dimensional endoscopic imaging. The effectiveness of surgical treatment was assessed by the results of the analysis of the values of the SF-36 and VAS scales.
Results. During the post-operative period, according to the results of the analysis of the SF-36 scale, an improvement was found in all parameters, exept for GH, where the deterioration was associated with the progression of the oncological process. A significant reduction in pain intensity was also found. In addition, the method allows to reduce blood loss and surgical trauma, which is confirmed by the absence in the values of the Karnovsky performance scale.
Conclusions. Less invasive and less traumatic surgical treatment is appropriate for patients with spinal metastases. The multidisciplinary approach provides tumor control with the help of radiotherapy and chemotherapy and, as a result, an increase in the life expectancy of patients.
Keywords: spine, instability, metastases, quality of life, three-dimensional endoscopy
Contrast-free MR perfusion in patients with chronic kidney disease of variable etiology: interim results
Krasova A.I., Telesh A.А., Morozova T.G.
Abstract: Objective. To evaluate the clinical and diagnostic value of contrast-free Arterial spin labeling Magnetic Resonance perfusion of the kidneys for patients passing hemodialysis treatment.
Methods. In the course of the work, patients with chronic kidney disease, acute renal impairment and a group of healthy volunteers were examined. The results of a laboratory test, ultrasound examination of the kidneys with duplex scanning of the arteries of the kidneys and MRI with ASL-perfusion of the kidneys were used for the analysis.
Results. The values of ASL-perfusion of the kidneys in healthy volunteers and in patients for each stage of chronic kidney disease were found in comparison with data from other studies.
Conclusion. The use of ASL-perfusion in patients with CKD makes it possible to evaluate the effectiveness of hemodialysis and predict an unfavorable outcome.
Keywords: Magnetic Resonance Imaging, Non-Contrast Magnetic Resonance ASL-Perfusion, chronic kidney disease, hemodialysis
Computed tomography as a modern method of early diagnosis and control of therapy effectivenes
Ledneva V.S., Ulyanova L.V., Lednev S.A., Razuvaeva Yu.Yu., Yurova I.Yu.
Abstract: Objective. Evaluation of the possibilities of CTVR for detecting early changes in the lungs and monitoring the effectiveness of therapy in patients with cystic fibrosis identified by the results of neonatal screening.
Methods. The study group included 28 patients with cystic fibrosis aged from 1 month to 6 years, who were diagnosed based on the results of neonatal screening (out of 34 patients in the main group). CT scan of the chest organs was performed in all patients of group 1 during diagnosis verification at the MV center (patients aged from 4 to 6 months) and was repeated 2 times a year later during planned hospitalizations.
Results. On the control CT picture, we found convincing and reliable evidence of a decrease in the activity of the inflammatory process, the scale of morphological changes, and a decrease in the degree of damage to the peripheral parts of the lungs, while standard radiography did not allow us to draw such conclusions. The search for modern diagnostic methods for reliable, objective assessment of the state of the bronchopulmonary system in children, and alternative indicators for evaluating the effectiveness of therapy in patients younger than 6 years is extremely relevant.
Conclusion. The use of complex therapy during periods of exacerbations made it possible to improve CT parameters in more than 80% of patients, while during two-year monitoring it was possible to maintain a stable state of morphological parameters (according to CTVR) in 68% of patients, which reliably indicates the convincing effectiveness of the therapy.
Keywords: computed tomography, children, radiation diagnostics, cystic fibrosis, effectiveness of therapy
REVIEWS
Cardiac arrhythmias in postcovid syndrome
Kuzmin E.V., Kozyrev O.A.
Abstract: Objective. To study the pathogenetic mechanisms of SARS-CoV-2 heart disease, the pathogenesis of arrhythmic complications in postcovid syndrome (long COVID), statistical data on the forms of cardiac arrhythmias in long COVID and their clinical manifestations.
Methods. A literary review of domestic and foreign scientific sources on this problem.
Results. As a result of the analysis of literature sources, the pathogenetic mechanisms of arrhythmias in long COVID were clarified (direct myocardial damage, acute systemic inflammatory response and cytokine storm, mismatch between myocardial oxygen demand and its consumption, ischemia due to atherosclerotic changes in coronary arteries, electrolyte imbalance). The most common arrhythmias in long COVID are sinus tachycardia, atrial fibrillation. Less often, malignant cardiac arrhythmias occur (ventricular tachycardia, ventricular fibrillation).
Conclusions. It is concluded that there is a direct connection between COVID-19 and arrhythmic complications, which are a rather formidable manifestation of long COVID.
Keywords: SARS-CoV-2, COVID-19, long COVID, arrhythmias, POTS syndrome
Modern methods for treatment of instability of the femoral component of the hip joint endoprosthesis
Varfolomeev D.I.
Abstract: Objective. To study and analyze the current literature devoted to the problem of instability of the femoral component of the endoprosthesis. To study the issues of prevention and treatment of patients with mechanical complications.
Methods. The analysis of papers, including individual clinical cases, meta-analyses, articles, and conference materials, was carried out. The most relevant publications of recent years from the Elibrary, Scopus, Ebsco, Pubmed, Wipo databases were used. Own developments for the treatment of mechanical complications were presented. The data of domestic and foreign literature, devoted to the problem of instability of the femoral component of the endoprosthesis, were collected and systematized.
Results. The article presents modern views on the prevention and treatment of patients with this pathology. Traditional types of surgical interventions are presented, as well as new operations developed recently. Minimally invasive technologies, used in the treatment of endoprosthesis stem instability, are described. Conservative methods of treatment are considered.
Conclusion. Aseptic loosening of the femoral component is one of the most common complications of hip arthroplasty. A steady increase in the number of patients with this pathology has been observed in recent years. A large number of different surgeries and implants for the treatment of stem instability have been developed recently. Their use in combination with an individual approach to the treatment of each patient can restore the support ability of the limb and improve the quality of life of patients.
Keywords: revision hip arthroplasty, aseptic loosening, femoral stem
Evolution of first-line systemic therapy for metastatic renal cell carcinoma
Semenov D.V., Orlova R.V., Shirokorad V.I., Kostritsky S.V.
Abstract: Objective To demonstrate the basic principles and further directions of the study of first-line systemic therapy in patients with metastatic renal cell carcinoma.
Methods. The work is based on materials of full-text articles available on Pub Med.
Results. The analysis of introduction into clinical practice of the targeted drugs blocking angiogenesis, inhibiting targets of rapamycin, as well as immunotherapy drugsis performed. The principles of studying the effects of their combinations and the directions of further research are outlined.
Conclusion. Understanding the molecular profile of tumor cells led to the development of systemic treatment methods, and the study of antitumor immunity changed the clinical picture of the disease. The paradigm has changed twice in the last decade, improving patient outcomes through the use of combined regimens using checkpoint inhibitors and VEGF inhibitors (axitinib plus pembrolizumab or avelumab). Currently, such combinations of drugs are approved and are part of an ever-expanding arsenal for therapy. Nevertheless, this raises the need for the detection of predictors and prognostic biomarkers capable of personalizing the treatment of patients in order to increase the effectiveness and reduce the toxicity of therapy.
Keywords: metastatic renal cancer, systemic therapy, first line
PHARMACEUTICAL SCIENCES
ORIGINAL ARTICLES
Study of accumulation of natural and artificial radionuclides by medicinal plant raw materials on the example of five-bladed dummy grass
Dyakova N.A.
Abstract: Objective. The aim of the study is to study the accumulation of the most significant artificial and natural radionuclides in medicinal plant raw materials the example of five-bladed dummy grass.
Methods. On the basis of 10 plant objects used for the preparation of medicinal raw materials, selected from 36 points of the Voronezh region, studies were carried out on the content and storage capacity of plant objects from strontium-90, cesium-137, thorium-232, potassium-40, radium-226 soils.
Results. Based on the grass of five-bladed dummy, harvested from 36 points of the Voronezh region, studies were carried out on the accumulation of the most significant artificial and natural radionuclides by plant objects from soils. Analysis of soil and grass samples of five-lobed motherwort was carried out on the gamma-beta-alpha-spectrometer-radiometer of the RADEK MKGB-01 with determination of the specific activity of basic (long-lived) artificial radionuclides (strontium-90, cesium-137) and natural radionuclides (potassium-40, thorium-232, radium-226), which are often found in nature.
Conclusion. It was revealed that with an increase in the specific activity of strontium-90, cesium-137, thorium-232, potassium-40, radium-226 in the soil, their specific activity in the of five-bladed dummy grass. The transition patterns are described by mathematical dependencies with the maximum approximation validity factor.
Keywords: Leonurus quinquelobatus, Voronezh region, strontium-90, cesium-137, thorium-232, potassium-40, radium-226
Evaluation of the safety of extracts from the herb Thymus marshallianus willd and Thymus serpyllum L. in the analysis of general toxic effects
Sheremetyeva A.S., Karetnikova A.Yu., Matvienko U.A., Durnova N.A.
Abstract: Objective. To study the general toxic effect of Thymus marshallianus (TM) and Thymus serpyllum (TS) extracts from the herb in an acute experiment and evaluate their effect on the biochemical parameters of the blood of experimental animals with repeated administration in a chronic experiment.
Methods. In the experiment on the study of acute toxicity, mice were divided into 13 groups (6 individuals in each): control (intact animals) and 12 experimental, which were intraperitoneally injected with aqueous and alcoholic extracts from the herb TM and TS at a dose of 1000, 3000, 5000 mg /kg. The study of biochemical parameters in a chronic experiment was carried out on 3 groups of rats: a control group and two experimental groups (24 animals each), which received an aqueous extract from the herb TM at a dose of 100 mg/kg daily intragastrically for 28 days (the first experimental) and water extract from TS grass at a dose of 100 mg/kg (second experimental).
Results. In the experiment on the study of acute toxicity, it was found that, according to the classification of K.K. Sidorov, all extracts belong to the “Relatively harmless” group (VI class of toxicity). In the experiment on the study of chronic toxicity, when assessing carbohydrate metabolism, a decrease in glucose levels was revealed in both groups, while a more pronounced hypoglycemic effect was exerted by an aqueous extract from the herb TM. During the entire experiment, after the introduction of aqueous extracts from the herb TM and TS, no statistically significant deviations in the activity of alkaline phosphatase, LDH and the content of cholesterol, TAG were found. An increase in the activity of hepatic aminotransferases compared with control animals, the absence of pronounced functional changes in the level of urea and creatinine were noted.
Conclusions. The results of the study showed the non-toxicity of the studied extracts and did not reveal significant changes in the biochemical parameters of the blood of rats with the introduction of aqueous extracts from the herb TM and TS, which at the biochemical level confirms the safety of the use of extracts from this type of plant material.
Keywords: Thymus marshallianus Willd., Thymus serpyllum L., acute toxicity, chronic toxicity, biochemical parameters
Regularities in the distribution of elements in the aboveground part of Centaurea cyanus L.
Khanina M.A., Lezhnina M.G., Podolina E.A., Zinin D.S., Kuznetsova Yu.A., Rodin A.P.
Abstract: Objective. To identify patterns in the distribution of elements by organs of C. cyanus (leaves, stems, baskets, edge flowers, grass) depending on their concentration and atomic order number.
Methods. The elemental composition of the C. cyanus specimens has been investigated using inductively bound plasma mass spectrometer ELAN DRC-e ICP-MS and the Agilent 715 ICP-OES optical emission spectrometer. Sample preparation for element analysis included attachment treatment of plant material with nitric acid followed by microwave decomposition systems Speedwave TM MWS-3+ and BERGHOF. Statistical processing of the obtained chemical analysis results was carried out in Microsoft ® Excel 2010 with calculation of errors of indirect measurements, on the basis of reference values of element concentrations and their errors. Concentrations of 60 elements were compared using the least squares method.
Results. 66 elements were found in the studied herbal specimens and morphological parts of C. cyanus. The specimens are identical in composition but differ in content. Accumulative series of elements with decreasing concentrations for each object of study have been compiled. A comparison of 60 element concentrations (according to a logarithmic scale) showed high correlation (R2 = 0.99) in the study subjects. For grass and morphological parts of C. cyanus, geometric mean values of 60 chemical elements, their logarithms have been calculated. It reveals a similar pattern, deposited in the logarithmic scale, in the distribution of elements depending on their concentration and atomic sequence number in the grass and morphological parts of C. cyanus.
Conclusions. A same type of regularityin the distribution of chemical elements in the grass and morphological organs (edge flowers, stems, leaves, baskets) of C. cyanus has been identified, depending on the concentration and atomic sequence number of the element.
Keywords: Centaurea cyanus L., concentration logarithms, correlation, elemental profile
Study of anatomical signs of Lepidium draba L.
Fedotova V.V.
Abstract: Objective. Lepidium draba L. (syn. Cardaria draba (L.) Desv.), family Brassicaceae has an interesting and diverse chemical composition, which includes alkaloids, saponins, glucosinolates, flavonoids, tannins, leucoanthocyanins, acids, terpenoids, essential oil. This plant is characterized by pharmacological effects such as anticancer, hypoglycemic, hypocholesterolemic, antibacterial, antifungal antioxidant, carminative, laxative and expectorant. Thus, L. draba is promising for pharmaceutical use.
Methods. L. draba herb was collected during the flowering period in the vicinity of Pyatigorsk and Mount Mashuk, Stavropol region, Russia in May 2022. The State Pharmacopoeia XIV was the basis of microscopic analysis of L. draba as a raw material.
Results. Anatomical signs of L. draba are stomata anisocytic type, trichomes unicellular, heavily sinuous walls of cells of the upper and lower epidermis. Mesophyll of two types – palisade and spongy. The bilayer collenchyma is located under the lower epidermis. In the center is a large vascular bundle of ovoid shape. The stem consists of epidermis, collenchyma chlorenchyma, lignified parenchyma, vascular bundles, sclerenchyma. Cells of epidermis of a petal and sepal of a flower polygonal, the sepal has the anisocytic stomata and the petal has outgrowths.
Conclusions. The received findings will provide reference information for standardization, identification and purity for use of herb of L. draba as raw materials for pharmacy and medicine.
Keywords: Lepidium draba, collenchyma, cross-section, mesophyll, stomatal anisocytic type, trichomes, vascular bundle
Import dependence of the russian market of gynecological medicines and possible ways to overcome it
Orlov A.S., Knutareva A.S.
Abstract: Objective. Assessment of the degree of import dependence of the Russian market of gynecological drugs and development of a set of measures to help overcome it.
Methods. The study was based on data from an audit of retail sales and hospital purchases, as well as an audit of preferential medication supply in the segment of the Russian pharmaceutical market, including medicines for the treatment of gynecological diseases, between 2012-2021. Data are provided by the research team DSM Group.
Results. It is shown that the Russian market of gynecological drugs is highly dependent on imports, the share of foreign drugs in its individual segments reaches 90%. The highest share of imports is observed in the retail segment, among the original gynecological drugs and medicines not included in the Vital and Essential Drugs List, and in terms of ATC classification – in subgroup G03 [Sex hormones and modulators of the reproductive system]. Among the leading gynecological medicines in terms of sales both in kind and in value terms, as well as manufacturing companies, mainly foreign ones predominate.
Conclusion. A set of measures aimed at activating the process of import substitution in the Russian market of gynecological drugs is proposed. The practical implementation of all planned activities should contribute not only to overcoming import dependence, but also to the development of the production of new domestic gynecological drugs, which will increase their availability for the population and healthcare institutions and, in general, increase the level of drug safety in our country.
Keywords: Russian pharmaceutical market, gynecological diseases, gynecological drugs, import substitution, import dependence
REVIEWS
Alcoholic liver disease: medical and pharmaceutical care in the Russian Federation
Bondarenkova O.A., Krikova A.V., Ivanishkina E.V
Abstract: Objective. To evaluate the effectiveness and prospects of modern medical and pharmaceutical care for persons with alcohol-induced liver disease on the basis of official sources of information, 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 the problem.
Results. The problem of lesions of internal organs and systems associated with excessive alcohol consumption has an important medical and social significance. It is widely known that one of the target organs in this case is the liver, and its lesion – alcoholic liver disease is the most frequent cause of disability and mortality in this category of patients. According to V.S. Moiseev et al. (2009) the alcohol intake leads to hospitalization in 20-35% of in-patients, to referral to outpatient clinic in 10-20% of outpatients, to referral to a psychiatrist for consultation in more than 40% of patients with psychiatric diseases. Pathogenetic mechanisms of liver damage are manifold and lead to the development of cytolysis, inflammatory reaction with subsequent progression of fibrosis. It is known that one of the leading mechanisms of disturbance of structural and functional integrity of cell membranes is the activation of free radical lipid peroxidation and violation of antioxidant protection. Generally accepted drug therapy, including inflammatory-destructive diseases, in some cases does not give the desired result, or the clinical efficacy of treatment remains quite low, given the patient population.
Conclusions. Anti-alcohol policy in the Russian Federation in recent decades has been aimed at reducing the number of persons with alcohol addiction. Nevertheless, in Russia the number of alcoholics reaches 5 million, which accounts for 68% of deaths from liver cirrhosis, 60% from pancreatitis, and 23% from cardiovascular pathologies. Since the highest mortality rate is characteristic of alcoholic cirrhosis of the liver, this indicator serves as a kind of indicator of alcohol consumption in each specific country. The mortality rate from alcoholic cirrhosis in Russia has been and remains substantially higher than in the European countries: in 2010, it reached 50 per 100,000 people in large cities. Traditional domestic treatment of alcohol-induced liver disease is primarily reduced to abstinence from alcohol, a rich protein diet, and intake of hepatoprotectors. Undoubtedly, the most effective treatment for alcohol-induced liver disease is refusal to take ethanol in any form.
Keywords: medical and pharmaceutical care, alcoholic liver disease, diagnostic, treatment and rehabilitation algorithm
PEDAGOGICAL EDUCATION
Efficiency evaluation of traditional and distance learning formats at the faculty of dentistry of SSMU
Abolmasov N.N., Kovalyova I.A., Konoplyova E.L., Kovalyova Yu.D., Adaeva I.A., Dmitrieva E.V., Abolmasov I.N.
Abstract: Objective. To evaluate the effectiveness of distance and traditional learning formats based on the results of a survey of students of 3-5 courses of the Faculty of Dentistry and teachers of specialized departments of SSMU.
Methods. The study analyzed 378 questionnaires of dental students and 45 medical school teachers of SSMU. Questions about the feasibility of the distance format in clinical classes and lectures suggested two options ("yes" and "no"). When answering the questions about the real need for online training, the respondents chose a number from 1 to 10, where 1 is not needed, 10 is needed.
Results. Most students surveyed find the distance learning format demanded within the dental disciplines, while lecturers consider face-to-face classes to be an essential part of the learning process.
Conclusion. Nowadays medical school education is undergoing significant changes. Despite the fact that there is a number of advantages of distance learning, teaching medical students clinical disciplines is impossible without communication between teachers, students and patients in face-to-face learning format.
Keywords: distance learning, traditional teaching, educational process, medical universities, students, teaching format
Types and results of educational research and scientific research activities of residents at the institute of pharmacy of KazSMU in 2019-2022
Garifullina G.X., Muslimova N.N.
Abstract: Objective. Consideration of issues of educational and research, and scientific and research work of pharmacists-residents for the last 4 years.
Methodology. Conducting an experiment for a detailed analysis of the types, results of educational research and scientific research of pharmacists-organizers in KazSMU of their opinions and preferences.
Results. A sociological study was conducted with residents of the pharmaceutical profile, with 100% coverage (32 residents for the specified period). A questionnaire has been developed that includes questions about the preferred types of independent work, about previous research experience, about the prospects for possible use of research experience in professional activities, about the types of scientific activities carried out by residents during the specified period and satisfaction with this process. Indicators of sociological research are presented in the form of tables and diagrams.
Conclusion. As a result of the study, it was found that 18.75% of residents prefer independent work in the form of homework on writing abstract reviews and presentations; 37.5% had research experience in their student years and only 26% have the experience of presenting research results at conferences; 62.5% prefer to carry out research in a group; 68.75 see the positive experience of research in professional activity in the future, 81.5% are satisfied with scientific activity, 100% somehow presented the results of their research activities at different levels, 100% are sure that the results of this activity depend on the personal qualities of the resident, 87.5% claim that the role of the teacher is the main motivational factor in this activity.
Keywords: resident, professional training, extracurricular independent work, educational and research work, research work
VARIOUS
Influence of drinking water chemical substances on public health
Markova E.O., Koriakina Yu.P., Farashchuk N.F., Kigan M.A.
Abstract: Objective. To analyze the results of modern research on the influence of chemical substances in drinking water on public health.
Methods. Collection, systematization and analysis of theoretical, experimental and clinical data of modern scientific research of domestic and foreign scientists on the effect of chemical substances in drinking water on public health, presented in leading scientific publications over the past 15 years.
Results. The article shows the effect of inorganic and organic chemical substances on public health. The influence of transformation products formed during chlorination, ketones and aldehydes - during ozonation is noted. The article pays attention to the problem of the physiological usefulness of drinking water, reflects the relationship between the ions present in drinking water and the ratio of structural fractions of water that affect its quality.
Conclusions. As a result of the analysis of scientific works on the influence of the chemical composition of drinking water on public health over the past 15 years, generalized data on the effect of the organic and inorganic substances amount in drinking water on water quality and the development of certain diseases of the population are presented. The analysis of the data indicates a number of methodological and organizational problems related to providing the population with safe drinking water in terms of chemical composition: the problems of monitoring new or previously undetectable substances, the problems of water treatment safety, which allows to avoid the appearance of dangerous transformation products, the problems of supplying the population not only with purified drinking water, but also with water, which physiologically completes in chemical and fractional composition.
Keywords: chemical substances, quality of drinking water, public health
Results of a survey on satisfaction of medical university students with innovative techniques of medical examinations within implementation of an innovative project «Health of a freshman-health of a doctor-Health of a nation!»
Maslyanyi A.S., Nesmachnaya V.E., Zaitseva V.M., Dmitrieva E.V., Krikova A.V.
Abstract: Objective. The aim of our study was to assess medical students’ opinion on their satisfaction with medical examinations and to evaluate new free innovative techniques of medical examinations in the Medical University.
Methods. The survey was conducted in March 2021, using https://docs.google.com/forms. The questionnaire was developed by a working group to assess the efficiency of the Federal Innovation Project «HEALTH of a Freshman – HEALTH of a Physician – HEALTH of a Nation! » implemented in Smolensk State University. Totally, 460 respondents took part in the survey on a voluntary basis.
Results. The study has found that 58,7% 95% CI:(54,2-63,2), 270 of students were satisfied with a free medical examination organized within the Federal Innovation Platform. Only 12,0%, 95% CI: (9,0-14,9), 55 students were unsatisfied respondents. On survey, the majority of students (88.5%, 95% CI: (85,6-91,4), n=407) knew about their health problems before their examination within the project. However, certain health problems were identified in 10.4%, 95% CI: (7,6-13,2), 48 students for the first time on examination within the project. In the questionnaire, 15, 2%, 95% CI: (11,9-18,5), 70 students noted that on examination certain health problems had been disclosed. We consider, this result is a good indicator of the quality of the medical examination performed. We also identified certain risk groups. Students included into the risk groups are planned to be followed up by university doctors and professors throughout the next 5 years of the Project. Disorders of the musculoskeletal system and connective tissues as well as eye diseases were the leaders among disorders identified on the examination.
Conclusions. Information about students’ health obtained during the medical examination will help to maintain their health and avoid chronic forms of diseases. Identified risk groups will require further follow-ups and special care of university doctors involved into the project. In further course of the project, development and implementation of new models of individual approaches to keeping body health will be carried out. The principle of an integrated approach to prevention, early diagnosis of chronic non-infectious diseases will be executed with the involvement of highly qualified university specialists. It will create extra conditions for implementation of primary national health programs aimed at better health in younger generations.
Keywords: federal innovation platform, students, health, healthy lifestyle
ANNIVERSARY
TO The 100-th anniversary of the foundation of the department of children's diseases of the Smolensk State Medical University
Bekezin V.V., Sharobaro V.E., Vasilyeva I.A., Peresetskaya O.V., Druzhinina T.V., Muravyev A.A., Kozlova E.Yu., Koroleva A.E.
Abstract: The article is devoted to the 100th anniversary of the foundation of the Department of Children's Diseases at Smolensk State Medical University. The rich history of the department in the temporal aspect is described, the achievements of today and the prospects for the development of the department are presented.
Keywords: Smolensk State Medical University, Department of Children's Diseases, anniversary (100th anniversary)
The formation and development of the scientific student society at the department of propaedeutics of internal medicine of Smolensk State Medical University
Ivanishkina.V., Udovikova O.And., Osipova M.S., Osipenkova T.A. Nankiewicz I.N., Volk S.V. She's A Loser.S., Shevchenko R.V.
Abstract: Important role in the formation of clinical thinking and professional training of a future specialist is played by a scientific student circle (SSC). It is one of the first stages in the training of scientific and pedagogical personnel of the university, as well as qualified medical practitioners.