Vol 21, No 6 (2015)

Articles
Editorials
Aleksandrov O.V., Kolomoets N.M.
Medical Journal of the Russian Federation. 2015;21(6):4-4
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The prognostication and prevention of cardioembolic stroke in patients with atria fibrillation
Rubanenko O.A.
Abstract
The study was organized to discover along with common factors the factors associated with old disturbed cerebral blood circulation in patients with atria fibrillation and to detect rate of prescription of anticoagulant therapy. The examined sample included 768 patients with atria fibrillation. The patients were separated by two groups. The first group included 135 patients with old stroke or transitory ischemic attack. The second group included 633 patients without the given complications in anamnesis. The milti-factorial analysis established that ratio of chances of development of stroke for permanent form of atria fibrillation consisted 1.24 (confidence interval 95%, 1.06-1.45; p=0.007), for age 64 years and older - 1.1 (confidence interval 95%, 1.02-1.45; p=0.0001) and for diabetes mellitus - 1.2 (confidence interval 95%, 1.05-1.5; p=0.04). The anticoagulant therapy was prescribed to 52 patients (38.5%) from first group and 260 patients (41%) from second group. Out of anti-thrombocyte pharmaceuticals 38 patients (12%) were prescribed Rivaroxaban, 10 patients (3.2%) - Dabigatran etexilate and 264 patients (84.6 %) - antagonists of vitamin K. Along with common factors (female gender, age 64 years and older, arterial hypertension, diabetes mellitus, old myocardium infarction) in patients with atria fibrillation the risk of development of disturbed cerebral blood circulation is associated with permanent form of atria fibrillation, duration of atria fibrillation longer than 18 months, level of fibrinogen higher than 4.3 g/l. The anticoagulant therapy takes first place as mode of preventing of thromboembolic complications in patients with atria fibrillation. However, in practice rate of prescription of anticoagulant therapy consists less than 45%.
Medical Journal of the Russian Federation. 2015;21(6):5-8
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The condition of immunity and methods of its correction in patients with hernia of abdominal wall against the background of chronic clamidiosis
Isaev G.B., Dzhebrailova A.V.
Abstract
The article considers resulting materials of examination and treatment of 20 patients (main group) aged 22-45 years (5 males, 15 females) addressed to the Research center of surgery for application of herniaplasty and who were detected urogenital clamidiosis after bacterioscopic, cultural and serological analysis. The relapsing ventral hernia was diagnosed in 9 patients, relapsing inguinal hernia - in 3 patients and femoral hernia - in 1 female patient. The control group included 20 patients with hernia of anterior abdominal wall without any chronic infection. The analysis of indicators of cellular and humoral chain of immune system established that patients with chronic clamidiosis are characterized by occurrence of suppression in T-cell chain and imbalance of indicators of humoral immunity. The occurrence of clinical signs of immunodeficiency in patients with hernia of anterior abdominal wall is a direct indication for prescription of immune correctional therapy during preoperational period. In patients with chronic clamidiosis Imunofan provides significant immune correctional effect manifesting as positive dynamics of indicators of cellular and humoral immunity. At the same time, therapy by Imunofan combined with 0. 33% tincture of saffron is more effective method of immune correction.
Medical Journal of the Russian Federation. 2015;21(6):8-11
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The morbidity of children with intrauterine growth retardation at first year of life
Garaeva S.Z.
Abstract
The study was organized to investigate characteristics of health of newborns at first year of life depending on clinical alternative. The monitoring was applied to 315 newborns with intrauterine growth retardation born at 37-41 week of pregnancy. The diseases of nervous and respiratory systems turned out the most significant in structure of morbidity of children with intrauterine growth retardation aged not over one-year-old. In all nosologic groups of diseases the reliable difference between children with intrauterine growth retardation and the control group was established. The indicators of morbidity in children with symmetric modification of intrauterine growth retardation were higher than in children with asymmetric modification. The high rate of perinatal affection of central nervous system, birth trauma and respiratory disorders in neonatal period negatively effect on indicators of prevalence of diseases of nervous system and respiratory organs at the first year of life.
Medical Journal of the Russian Federation. 2015;21(6):12-14
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The importance of analysis of nonsaturation of lipids of blood plasma in newborns with low and extremely low body mass at birth
Turkina T.I., Scherbo S.N., Kolodiiy E.V., Degtyareva M.V., Kiseleva E.V., Vaganov P.D., Talitskiy V.V.
Abstract
For the first time the diagnostic significance of total nonsaturation of lipids of blood plasma (double bonds) was analyzed in 25 newborns, including small premature infants with extremely low body mass at birth. The detection of nonsaturation of lipids of blood plasma was implemented using quick-test of ozonization at the analyzer "ADS-5M". The comparison group included 7 examined healthy full-term newborns. The normal level double bonds for newborns was established for the first time on the basis of analysis of level of double bonds in healthy full-term newborns. The random sampled 18 children treated in the department of reanimation and intensive therapy of newborns were examined. The comparison of level of double bonds in ill newborns established that singled out groups of ill newborns with course of congenital infection of different degree of severity (down to sepsis) are differentiated reliably on degree of nonsaturation of lipids. This occurrence can be explained by alteration of structure of fatty acids both in free condition and composition of lipid complexes. The alterations should be considered in treatment because nonsaturation of fractions of lipids relate to stabilization of membranes and content of essential fatty acids in neutral lipids is related to mechanism of blood clotting. The presented materials demonstrate availability of further application of indicator of double bonds as an additional criterion in laboratory diagnostic and monitoring for adequate tactic of treatment of newborns being in the department of reanimation and intensive therapy of newborns (antioxidant, hypoglycemic and membrane-stabilized pharmaceuticals) and also with purpose of prognosis of complications.
Medical Journal of the Russian Federation. 2015;21(6):15-17
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The condition of large intestine under constipation in children
Artamonov R.G., Glazunova R.G., Gammel E.N., Polyakov M.V.
Abstract
The organic affections of intestine are the most prevalent cause of chronic constipations in children. The article presents data concerning 21 children suffering from constipations. The x-ray examinations established anomalies of development of intestine in 18 children. The authors consider that decisive role in diagnostic of chronic constipations plays irrigoradiography.
Medical Journal of the Russian Federation. 2015;21(6):18-20
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The possible relationships between caries disease and subjective indicators of stomatological health of children of school age
Kiselnikova L.P., Leus P.A., Boyarkina E.S.
Abstract
Within the framework of international pilot project in four cities - Minsk, Moscow, Novosibirsk and Samara - the stomatological examination and questionnaire survey was carried out concerning 850 children of key age groups, 12 and 15 years using the European indicators of stomatological health proposed by EGOHID, records of stomatological status and questionnaires of WHO-2013. The most of 15 applied indicators demonstrated high informativeness and specificity in detecting risk factors related to development of stomatological diseases and problems of inadequate effectiveness of community programs of dental caries prevention. The recommendation is substantiated concerning application of complex of subjective indicators as an addition to studies of stomatological status of children of school age.
Medical Journal of the Russian Federation. 2015;21(6):20-24
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The optimization of diagnostic of cervix cancer
Alyautdina O.S., Sinitsina O.V.
Abstract
The cervix cancer is one of the most prevalent oncological diseases. so far as viruses of human papilloma play determining role in development of this pathology the most important significance in their diagnostic acquire modern techniques of laboratory analyses. In the process of determination of algorithm of monitoring of female patients infected by virus of human papilloma such innovative diagnostic techniques were implemented as fluid cytology and identification of oncoprotein p16 ink4a. It is demonstrated that in female patients infected with virus of human papilloma the clinical picture very often had no equivalence to intensity of pathological process under cytological diagnostic. Thereupon, the algorithm was developed related to monitoring of female patients under different combined alternatives of clinical and cytological manifestation of cervix dysplasia.
Medical Journal of the Russian Federation. 2015;21(6):25-27
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The imbalance of fatty acids metabolism under obesity and diabetes mellitus type II in women with insulin resistance
Mikaelyan N.P., Nguien K.Z., Mikaelyan A.A.
Abstract
The results of study testify that in women obesity and diabetes mellitus type II are accompanied by dyslipidaemia of atherogenic character with activation of processes of lipid peroxidation and disorders of system of antioxidant defense. The diabetes mellitus type II conditioned by imbalance in system POL-AOA is accompanied by higher concentration of peroxided lipoproducts. decreasing of parameters of antioxidant systems and utilization of glucose by cells. The obesity and diabetes mellitus type II is accompanied by modification of content of free and esterified fatty acids of blood plasma. This occurrence can result in alterations of functional activity of cell membranes and therefore in decreasing of functional activity of insulin receptors and insulin-dependent glucose transporter. The results of study convincingly testify the important role of fatty acids and their metabolites in pathogenesis of obesity and diabetes mellitus type II. This is to be accounted in development and choosing of corresponding preventive and therapeutic activities targeted to prevention or elimination of detected disorders.
Medical Journal of the Russian Federation. 2015;21(6):28-32
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The curative diagnostic tactic under personality disorders in practice of penitentiary medicine
Spasennikov B.A.
Abstract
The article presents results of study of individuals with previous convictions (main group) and law-abiding citizen (control group). It is established that in individuals with previous convictions various personality disorders (psychopathies) that can play an important role in realization of criminal behavior are detected 5.5 times often as compared with control group. The dissocial disorder of personality is most prevailed in examined convicts. In most individuals with previous convictions disorder of mental activity as insufficient prognosis of aftermaths of one’s own actions was detected. These disorders favor thoughtless inclusion into criminal behavior. At that, patient only partially lack possibility of regulation of one’s own behavior. The analysis of data of polygraph psycho-physiological study in individuals with previous convictions revealed disorders of bio-electrical activity of brain in 46% of cases whereas in individuals without previous convictions only in 22% of cases. This data testifies that the convicts suffer more often from functional structural defects of brain. The criminal penalty specifying imprisonment provokes decompensation of personality disorders. It is demonstrated that convicts suffering of personality disorder of dissocial, schizoid, epileptic, paranoid type are needed in prescription of forced out-patient psychiatric treatment combined with serving one’s sentence that is targeted to amelioration of neurological psychiatric health of convict, increasing of life-quality, re-socialization.
Medical Journal of the Russian Federation. 2015;21(6):33-36
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The analysis of medical social condition of families with focus of respiratory chlamydiasis
Markina A.N., Kapustina T.A., Parilova O.V., Belova E.V.
Abstract
The issues of social characteristic of patients with urogenital chlamydiasis are covered rather sufficiently in actual scientific medical publications. However, the social aspects of respiratory chlamydiasis proper consideration is still to be given. The absence of information concerning characteristics of health and social characteristics of members of families in the focus of family respiratory chlamydiasis became a reason of targeted study of this problems. The article presents characteristics of medical social conditions of members of families of patients with diseases of upper section of respiratory tract associated with chlamydia infection. The sampling consisted of 87 families 44 out of them with verified chlamydia infection (main group) and 43 families of ENT-patients with unverified respiratory chlamydiasis (control group). The total number of composition of families made up to 245 individuals. The chlamydia infection was diagnosed using complex of such laboratory techniques as direct immune fluorescent and immune-enzyme analysis, polymerase chain reaction. The evaluation of medical social conditions of members of family was implemented using questionnaire survey technique. The originally developed questionnaire included sections reflecting health condition, health risk factors and social characteristic of members of families of ENT-patients. The study established high degree of contagiousness of chlamydia infection in focus of respiratory chlamydiasis. It is demonstrated that in family focuses of respiratory chlamydiasis there were more family members frequently and continuously sick with acute diseases and suffering from chronic pathology of different organs and systems. Also in these families chronic pathology of of ENT-organs was diagnosed at the expense of larger number of family members with throat diseases. In the focus of respiratory chlamydiasis families having "good diet" were in much less number and families evaluated their social well-being as low were in by far higher number. Therefore, results of study demonstrated that medical and social condition of families having focus of respiratory chlamydiasis s much worse than of families without the mentioned focus.
Medical Journal of the Russian Federation. 2015;21(6):37-40
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The fibrillation of atrium and stroke
Damulin I.V., Andreev D.A.
Abstract
The article considers fibrillation of atrium as one of the mostly frequent alternative of cardiac rhythm disturbance and its significance in genesis of development of cardio-embolic stroke. It is emphasized that stroke risk in patients with atrium fibrillation increases in case of occurrence of concurrent arterial hypertension, diabetes mellitus and increasing of age. It is marked that stroke developed against the background of atrium fibrillation proceeds as a rule in a more severe way and is accompanied with higher disability and lethality than stroke developed against the background of normal sinus rhythm or in case of valvar origin of emboli that is caused in average large size of emboli. The area of cerebral infarction developed because of embolism is commonly larger than in case of thrombolitic infarction and at affection of the same cerebral vessel. The main technique of diagnostic in case of cardio-embolic stroke is computer or magnetic resonance tomography of brain. These examinations mostly visualize neatly cuneiform delineated zone of ischemia at the border of white and gray substances of brain. The cardiological examination us implemented too (ECG, echoCG). Monitoring of patients with cardio-embolic stroke developed against the background of atrium fibrillation is carried out according general principles implemented in case of ischemic stroke. To prevent recurrent cardioembolism per oral anticoagulants are applied in most cases.
Medical Journal of the Russian Federation. 2015;21(6):41-45
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The laparoscopic transabdominal preperitoneal and total extraperitoneal inguinal hernioplasty: advantages and shortcomings
Sazhin A.V., Klimiashvili A.D., Kochiay E.
Abstract
Nowadays, the issue of choosing the mode of hernioplasty of inguinal hernia is to be actual. The proposed multiple alternatives of reconstruction of anterior or posterior walls of inguinal canal using local tissues are not quite effective ones. The reason is that under primary inguinal hernia relapses occur with rate of 10-30% and especially in case of such complex forms of inguinal hernia as sliding, combined, giant, relapsing and repeatedly relapsing. The number of relapses make up to 40-45%. The nonstrain modes of inguinal hernioplasty using mesh alloprothesis decreased rate of relapses up to 1-5%. However, aggression of operation, possibility of development of chronic pain syndrome and long term of physical and psychological rehabilitation served as an occasion for developing mini-invasive techniques of surgery. During last 15 years the laparoscopic techniques of surgery are applied in surgical practice. The laparoscopic transabdominal and preperitoneal and total extraperitoneal inguinal hernioplasties combine mini-invasive access and nonstrain prosthetics of posterior wall of inguinal canal. the both techniques are effective in view of decreasing of aggression of operative intervention, amelioration of aesthetic results and decreasing relapses up to 2% in case of both techniques. However, the well-formulated criteria of choice of laparoscopic technique are absent. There is not enough data concerning comparative results of treatment in remote post-operative period.
Medical Journal of the Russian Federation. 2015;21(6):46-49
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The case of severe diabetic ketoacidosis in female patient with communityacquired pneumonia
Pasechnik I.N., Berns S.A., Golikova A.A., Kolesnikova N.L., Krilov V.V., Zverev K.V., Tarasov V.S.
Abstract
The article presents a clinical case of severe diabetic ketoacidosis developed against the background of community-acquired pneumonia and accompanied with critical declinations of indicators of glycaemia and acid-base balance. The tactic of management of female patient is presented and discussed. against the background of applied treatment, diabetic ketoacidosis was successfully coped rather quickly. The development of metabolic alkalosis and hypernatremia was avoided.
Medical Journal of the Russian Federation. 2015;21(6):50-52
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The case of photodermatitis induced by inadequate application of glycolic peeling with following tan in conditions of tropics
Bronshtein A.M., Malishev N.A., Berenbeyn M.B., Davidova I.V.
Abstract
The article for the first time in Russia describes the case of extensive and long-course melanin-hyper-pigmentation in female patient with thyroid ectomy in anamnesis. The patient permanently takes euthyrox and carrying out on her own peeling with glycolic acid before her trip to Dominican Republic. The inflammatory reaction of skin underlaid pathogenesis of development of melanin-hyper-pigmentation. the inflammation was conditioned by interaction of glycolic acid and intensive ultraviolet radiation in the equatorial region against the background of substitutive hormone therapy. The problems of prevention of complications related to chemical peeling in tourists planning to visit tropical countries.
Medical Journal of the Russian Federation. 2015;21(6):52-56
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