Kazan medical journal

Medical peer-review journal for physicians and researchers.

Editor-in-Chief: Ayrat U. Ziganshin, MD, PhD, Professor.


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Published bimonthly since 1901, distributed by subscription.

About: the Kazan Medical Journal is a peer-reviewed journal for clinicians and medical scientists, practicing physicians, researchers, teachers and students of medical schools, interns, residents and PhD students interested in perspective trends in international medicine.

Missions of the Journal are to spread the achievements of Russian and international biomedical sciences, to present up-to-date clinical recommendations, to provide a platform for a scientific discussion, experience sharing and publication of original researches in clinical and fundamental medicine.







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Vol 101, No 5 (2020)

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Theoretical and clinical medicine
The effect of nitroglycerin on cardiac extrasystoles and heart rate variability in patients with ­stable angina pectoris class 1 and 2
Safronova E.A., Kuzin A.I., Kharlamova U.V., Shamaeva T.N., Ryabova L.V.

Aim. To study the effect of nitroglycerin on the heart rate and its variability in patients with stable angina pectoris class 1 and 2.

Methods. 85 men with stable angina pectoris class 1 and 2 pathologies were examined between 2007 and 2012 in the City Clinical Hospital No. 8 of Chelyabinsk (mean age 53.1±5.66 years). In addition to common methods, a rhythmocardiographic study was performed, which allows you to calculate heart rate variability. An electrocardiogram was recorded simultaneously with the rhythmocardiogram.

Results. After sublingual nitroglycerin, the number of ventricular extrasystoles decreased in the background test and during Valsalva maneuver, increased in the Ashner's test and an exercise stress tests and did not change in the orthostatic test. An increase in supraventricular extrasystoles after nitroglycerin administration occurred in 10.6% of patients. Nitroglycerin administration resulted in a decrease in the inter-systolic intervals, an increased in the proportion of slow low-frequency waves— statistically significant in the background and an exercise stress test. Spectral indicators of cardiac sympathetic modulation significantly increased in the Ashner’s test and decreased in the background test, while spectral indicators of cardiac parasympathetic modulation decreased in all samples except in exercise stress tests.

Conclusion. Under the influence of nitroglycerin, supraventricular arrhythmias increased in all vegetative tests except for orthostatic, the number/severity of ventricular extrasystoles ambiguously changed: decreased in Valsalva manoeuvre the background test, did not change in orthostatic and increased in Aschner's and an exercise stress tests; after nitroglycerin, the proportions of sympathetic influence (in Ashner's test) and slow low-frequency waves in the spectrum of the vegetative modulation increased with a decrease in parasympathetic.

Kazan medical journal. 2020;101(5):645-651
Predictive value of respiratory parameters in patients with obstructive sleep apnea and chronic heart failure with preserved ejection fraction
Yakovlev A.V., Mayanskaya S.D., Shilov S.N., Teplyakov A.T., Shirinsky I.V., Yakovleva N.F.

Aim. To study individual functional parameters of respiration in different phases of sleep in patients with obstructive sleep apnea (OSA) and chronic heart failure with preserved ejection fraction (HFpEF) and to assess their effect on the clinical course of the disease.

Methods. The study included 86 men with OSA [with an apnea-hypopnea index (AHI) ≥15 per hour]. Upon inclusion in the study, all patients underwent a polysomnographic study and echocardiography, the level of brain natriuretic peptide (NT-proBNP) was determined, a six-minute walk test was performed. After 12 months of prospective observation, the patients were divided into 2 groups according to the clinical course of chronic heart failure: with unfavorable (n=33) and favorable (n=53) clinical course. The prognostic significance of the studied parameters of respiration to the course of the disease was assessed by using logistic and linear regression.

Results. A significant role of the following respiratory parameters as predictors of chronic heart failure progression was established: obstructive apnea-hypopnea index for the entire night sleep [odds ratio (OR) 1.04, p=0.002] and in the phase of rapid eye movement sleep (REM) (ОR 1.24, p=0.001); the index of respiratory disorders for the entire sleep period (ОR 1.06, p=0.044) and in REM sleep phase (ОR 1.25, p=0.003). For hospital readmission, the predictive role was determined for obstructive apnea/hypopnea index for REM phase (ОR 1.07, p=0.044) and index of respiratory disorders for REM phase (ОR 1.13, p=0.040).

Conclusion. The prognostic value of the obstructive apnea-hypopnea index and the index of respiratory disorders for the entire night sleep and in the phase of REM sleep was revealed for patients with OSA and chronic heart failure with preserved ejection fraction, which allows considering these parameters as independent predictors of an unfavorable clinical course in this group of patients.

Kazan medical journal. 2020;101(5):652-660
Gastroesophageal reflux disease in residents of the Trans-Baikal Territory
Zhilina A.A., Lareva N.V., Luzina E.V.

Aim. To study the prevalence of gastroesophageal reflux disease (GERD) symptoms and lesions of the esophageal mucosa in residents of Zabaikalsky krai, taking into account ethnicity.

Methods. The first stage: 371 residents of Zabaikalsky krai over 18 years old, were door-to-door interviewed by using the GERD questionnaire (GerdQ). The respondents with 8 or more points were classified as having GERD symptoms. Additionally, we collected passport data, smoking status, alcohol and coffee consumption, anthropometric data and social status. The second stage: we analyzed 2130 upper gastrointestinal (GI) endoscopy reports from Regional Clinical Hospital in Chita.

Results. 48 (12.9%) of 371 respondents had GERD symptoms. 135 (36.4%) respondents were Buryats, and 236 (63.6%) were non-Buryats, with the latter more often had GerdQ total score of 8 or more [38 (16.1%) non-­Buryats and 10 (7.4%) Buryats, p=0.009]. The average age of non-Buryats respondents with GERD symptoms was 53.4±17.47 years and exceeded that in the group without symptoms (46.2±19.2 years), p=0.035. The age of Buryats with and without GERD symptoms did not differ (42.67±11.52 and 37.89±15.54 years, respectively, р=0.087). The prevalence of obesity, smoking, alcohol and coffee consumption of respondents with and without GERD symptoms, both among Buryats and non-Buryats was the same. Of the 2130 patients who underwent endoscopy, 164 (7.8%) had morphological changes in the esophagus, 105 (4.9%) had erosive esophagitis (EE). Catarrhal and erosive chan­ges in the esophagus were detected in 156 non-Buryats (91 men and 66 women) (7.7%), while EE was diagnosed in 97 (4.8%) patients. 6.5% (5 women and 3 men) Buryats had the esophagus pathology, which caused by erosion. It was found that in non-Buryats group EE develop more often in male respondents (p=0.0019). Only non-Buryats had catarrhal changes in the esophagus (37.8%, 59 people), p=0.0312. At the same time, the incidence of complica­ted disease course in groups with EE was the same (p=0.8934).

Conclusion. About 13% of residents of Zabaikalsky krai have weekly symptoms of GERD, male of a non-Buryat ethnic group are more likely to develop erosive esophagitis than women; the incidence of complications of esophagitis is the same in Buryats and non-Buryats respondents groups.

Kazan medical journal. 2020;101(5):661-668
The effect of the distance from the pyloric sphincter and size of the calibration tube on ­postoperative outcomes of the laparoscopic sleeve gastrectomy
Omarov T.I., Bayramov N.Y., Huseynova M.R., Zeynalov N.A.

Aim. To study of the effect of the diameter of the calibration tube and the distance from the pyloric sphincter on the outcomes of the laparoscopic sleeve gastrectomy.

Methods. The study included 945 (915 women) patients with a body mass index 51.5±9 kg/m2. The average age of the patients was 53.5±8.5 years. The patients were divided into 2 groups by the type of laparoscopic surgery: in the first group (n=463), a 36 Fr calibration tube was used, the distance from the pyloric sphincter was 4–6 cm; in the second group (n=482), a 32 Fr calibration tube was used, the distance from the pyloric sphincter was 2–3 cm. The main comparison criteria was the percentage of body weight loss in the first 6 and 12 months, and an additional comparison criteria was the of concomitant diseases progress in postoperative and the existence of complications.

Results. A comparative analysis showed that the first group in the first 6 months lost 59±3% of its initial body weight, while in 12 months — 71±4%; in the second group, 73±3 and 87±3% of the initial weight, respectively. Concomitant diseases in the first group decreased by 70–80% by the 6th month after surgery and by 85–96% by the 12th month. In the 2nd group, similar remission with improvement was between 84 and 94% at the 6th month, and remained the same at the 12th month.

Conclusion. The results of the study show that in laparoscopic sleeve gastrectomy with a calibration tube diameter 32 Fr and a distance of 2–3 cm from the pyloric sphincter, compared to a calibration tube diameter 36 Fr or more and a distance of 4–6 cm from the pyloric sphincter, a body weight loss faster and more effective with earlier remission of concomitant diseases, while the number of complications is comparable.

Kazan medical journal. 2020;101(5):669-676
Integrated approach for the preoperative correction of anemia for liver resection in patients with colorectal liver metastases
Alborov A.E., Hanevich M.D., Bessmeltsev S.S., Rozanova O.E., Glazanova T.V., Romanenko N.A.

Aim. To study the features of the pathogenesis of anemia in patients with colorectal cancer and metastatic liver damage, as well as to evaluate the effectiveness of etiological correction of anemia in the preoperative period.

Methods. 90 patients with colorectal liver metastases and anemia (hemoglobin content 75–95 g/L), who were observed at the City Clinical Oncological Center of St. Petersburg between 2014 and 2020, were included. The patients were divided into two groups. The first group consisted of prospectively assessed patients with the preoperative correction of anemia by iron supplements (intravenously 7 mg/kg once a week) and recombinant erythropoietin (subcutaneously 150 IU/kg 3 times a week). The second group included retrospectively assessed patients with the correction of anemia only by red blood cell (RBC) transfusion (1–3 doses). The groups were comparable for gender [sex ratio (male/female) was 17:31 and 16:26 for the first and the second groups, respectively; p >0.5], age (63.3±1.4 and 60.2±1.2 years, respectively; p >0.1) and hemoglobin content (87.4±1.0 and 86.7±0.9 g/l, respectively; p >0.2).

Results. In studying the causes of anemia, a decrease in the mean serum endogenous erythropoietin level was revealed in most patients (36.7±1.9 mIU/ml with the required 70 mIU/ml). A decrease in the concentration of serum iron (6.6±0.3 versus 15.1±0.8 μmol/l) and ferritin (15.5±1.9 versus 102.4±8.4 μg/ml) levels were revealed. At the same time, there was no difference in the concentration of pro-inflammatory cytokines in patients with anemia and healthy controls (tumor necrosis factor α, interleukin-1β, interleukin-6; p >0.2), which indicates a low activity of the immune system in response to a tumor, due to conducted chemotherapy. In the preoperative correction of anemia, a positive effect was achieved with both iron supplementation with erythropoietin preparation (the hemoglobin level increased from 87.6±1.0 to 108.1±0.9 g/l; p <0.01) and RBC transfusion (from 86.7±0.9 to 114.6±0.6 g/l; p <0.01).

Conclusion. In patients with colorectal liver metastases, the most common causes of anemia were low levels of erythropoietin and iron deficiency; also for this group of patients, the prescription of erythropoietin and intravenous iron preparations are effective for the preoperative correction of anemia.

Kazan medical journal. 2020;101(5):677-684
Analysis of postoperative prognostic factors in patients with long bones metastatic lesions
Wang J., Kharchenko N.V., Karpenko V.Y.

Currently, with the development of the concept of cancer treatment, the survival rate of patients has increased significantly, but the percentage of the frequency of various metastatic lesions remains high. The bones of the skeleton are one of the main parts of metastases. In cancer patients, bone metastases usually mean that the disease is at an advanced stage, and the prognosis is not good. These patients often suffer from many complications, including pain, decreased mobility, pathological fractures, etc. The quality of life of patients is seriously deteriorating. Therefore, the main goal of surgical treatment of patients with bone metastases is the earliest possible restoration the function of the affected limb, pain relief, prevention of pathological fractures and the improvement of the quality of life of patients after surgery. This literature review analyzes the incidence of bone metastases in patients, and the dependence of metastatic lesions of long tubular bones on localization incidence of bone metastases in different body parts. The domestic and foreign literature on the surgical treatment of patients with metastatic bone lesions was analyzed. The results of the analysis show that the features of surgical treatment are becoming the main factors influencing the prognosis in patients with metastatic lesions of the long bones.

Kazan medical journal. 2020;101(5):685-690
Spectrum and frequency of BRCA1, BRCA2, CHEK2, PALB2, RAD50 mutations in breast cancer patients in the Republic of Bashkortostan
Pushkarev A.V., Sultanbaeva N.I., Pushkarev V.A., Nasretdinov A.F., Menshikov K.V., Musin S.I., Minniakhmetov I.R., Gilyazova I.R., Izmailov A.A., Sultanbaev A.V.

Aim. To assess the spectrum and frequency of mutations in patients with hereditary breast cancer from the Republic of Bashkortostan.

Methods. The material for the study was sections of fresh frozen, formalin-fixed and paraffin-embedded tumor tissue from 100 unrelated patients with a histologically confirmed diagnosis of breast cancer. The study was carried out using two methods: real-time polymerase chain reaction and next-generation sequencing-NGS.

Results. By using real-time polymerase chain reaction (PCR), the 5382insC mutation in the BRCA1 gene was detected in 12 cases. By using a next-generation sequencing method (NGS), highly penetrant mutations in BRCA1, BRCA2, CHEK2, PALB2 and RAD50 were revealed in 16 patients. In total, these methods detected mutations in 28 patients. Out of a total of probands in the BRCA1 gene, mutations were detected in 13 patients, that included 12 patients with the 5382insC mutation, and 1 patient with c.3143delG. In the BRCA2 gene, mutations were revealed in 3 patients, of which c.6621_6622del in 2 patients and c.-39-1_-39delGA in 1 patient. Mutations in CHEK2 were detected in 5 patients: c.470T>C in 3 patients, c.444+1G>A in 2 patients. The 1592delT mutation in PALB2 was found in 4 patients. The c.2157delA mutation in RAD50 was detected in 3 patients.

Conclusion. Pathogenic mutations in BRCA1/2, CHEK2, PALB2 and RAD50 were found in 28 patients with a hereditary feature of the disease; the identification of highly penetrant mutations in probands allowed us to determine their relatives, probable carriers of mutations, which were referred for genetic counselling.

Kazan medical journal. 2020;101(5):691-697
Experimental medicine
Slc6a4, Tph2, Htr1b, Htr2a genes expression in the mouse spinal cord after microgravity exposure simulation on earth
Kuznetsov M.S., Lisyukov A.N., Davleeva M.A., Izmailov A.A.

Aim. To determine the level of gene expression of the serotonergic neurotransmission system (Slc6a4, Tph2, Htr1b, Htr2a) in the cervical and lumbar enlargement of the spinal cord for mice after 30-day microgravity exposure simulation by using the antiorthostatic unloading model by Morey-Holton et al. and a subsequent 7-dayrecovery period.

Methods. The experimental animals were divided into three groups: “Unloading” group with mice undergoes hindlimb-unloading procedure for 30 days (n=5); “Recovery” group with mice undergoes hindlimb-unloading procedure for 30 days, followed by readaptation within 7 days (n=5); “Control” group with mice kept at standard vivarium conditions (n=5). The expression level of genes encoding synaptic proteins in the central nervous system was estimated by a real-time polymerase chain reaction.

Results. There were no statistically significant differences between the studied groups regarding the Tph2, Htr1b, and Htr2a expressions in the cervical and lumbar enlargement of the spinal cord. Compared to the “Control” group, a statistically significant increase (6.3 times) in the level of Slc6a4 expression in the lumbar spinal cord was revealed after microgravity exposure simulation (“Unloading” group), followed by a 3-fold decrease during the readaptation period (“Recovery” group ).

Conclusion. The expression level of the Slc6a4 gene, which encodes carrier protein involved in the function of serotonergic synapses, may indicate the potential involvement of this neurotransmitter system in the pathogenesis of movement disorders after microgravity exposure simulation on earth.

Kazan medical journal. 2020;101(5):698-703
Assessment of the effect of exogenous fibrin monomer on post-traumatic bleeding in hypofibrinogenemia caused by administration of snake venom Agkistrodon rhodostoma
Vdovin V.M., Momot A.P., Orekhov D.A., Shakhmatov I.I., Lycheva N.A., Momot D.A.

Aim. To assess the effect of fibrin monomer on the rate of blood loss after controlled liver injury in hypofibrinoge­nemia induced by systemic administration of Malayan pit viper venom (Agkistrodon rhodostoma).

Methods. A placebo-controlled study of the hemostatic effect of fibrin monomer administered intravenously at 0.25 mg/kg, and coagulation parameters in the controlled liver injury with profound hypofibrinogenemia caused by administration of Malayan pit viper venom was conducted in 34 male Chinchilla rabbits. The distribution of the studied parameters was investigated by the Shapiro–Wilk test. Statistical differences between groups were tested by Student’s t-test, Mann–Whitney U test, or Wilcoxon test, as appropriate. Differences in mortality rate were exa­mined using Fisher's exact test.

Results. A model of experimental toxogenic disseminated intravascular coagulation was reproduced, manifested by high mortality of animals (50.0%), severe blood loss (increased blood loss by 1.78 times), hemolysis, a decreased platelet count (by 19.6% of median) and platelet dysfunction, fibrinogen consumption (protein content less than 0.9 g/l), hypocoagulation as well as intensive D-dimer production (increased concentration by 25.0 times of me­dian). A high level of the fibrin derivative demonstrated activation of fibrin formation and fibrinolysis in the bloodstream of the animals. Systemic prophylactic administration of exogenous fibrin monomer after receiving snake venom did not lead to a decrease in post-traumatic bleeding, whereas earlier, during reproduction of disseminated intravascular coagulation caused by streptokinase infusion, such a hemostatic effect of fibrin monomer was shown.

Conclusion. The absence of fibrin monomer effect (at a dose of 0.25 mg/kg) on the severity of blood loss in toxo­genic disseminated intravascular coagulation may be associated with more profound disseminated intravascular coagulation and a sharp 25-fold increase in D-dimer levels that can act as a fibrin monomer polymerization inhibitor.

Kazan medical journal. 2020;101(5):704-712
Dental morbidity in Russia
Salakhov A.K., Ksembaev S.S., Baykeev R.F., Silagadze E.M.

At present, the most common dental diseases in most regions of Russia are caries, periodontal diseases, and dentofacial anomalies. A literature review was carried out on the prevalence of major dental diseases in Russian adult. The study aimed to analyze the literature on dental morbidity in Russia in the following areas: assessment of the prevalence, intensity, and treatment need of major dental diseases, depending on regional particularities, age, and sex differences. Caries and periodontal diseases are a major medical and social problem. The results of recent epidemiological studies have shown that almost the entire Russian adult has signs of these diseases. There is also a high rate of dental anomalies in children. The high prevalence of dental diseases indicates the need to strengthen the role of preventive work in the doctor's work. In conducting prevention program, it is important to consider the prevalence and intensity of major dental diseases which have pronounced regional particularities. Dental practice in recent years has shown that as a result of a targeted and effective preventive program, you can significantly reduce the level of dental morbidity.

Kazan medical journal. 2020;101(5):713-718
Social hygiene and healthcare management
Medical and social indicators of the reproductive potential of the female population of the region (on the example of the Republic of Tatarstan)
Khabriev R.U., Mingazova E.N., Shigabutdinova T.N., Sadykova R.N.

Aim. To analyze the dynamic changes in medical and social indicators of the reproductive potential of the female popu­lation, markers of trends in the formation of the medical and demographic process in the region.

Methods. The study was conducted on the basis of an analysis of literary sources that determine the general trend in the demographic situation in the country, as well as information from statistical collections of the Federal State Statistics Service and the Ministry of Health of Russia and Tatarstan. The analytical and statistical methods (descriptive statistics, student criterion, trend analysis) were used in the study.

Results. It was revealed that the fertility rate of women living in rural areas decreased by dynamics (between 1991 and 2017, from 79.9 to 42.3 per 1000 women aged 15–49; p <0.05). Before 2014, the indicator for rural residents was higher than that for urban women. Since 2015, the trend has been reversed: among urban women it has become higher than among those living in rural areas, which correlates with the birth rate in urban and rural areas. Percentage of live births from 1991 to 2017 in women of early reproductive age (up to 20 years) decreased among urban women from 11.3 to 3.7% (p <0.05), among rural women from 10.0 to 5.8% (p <0.05); among urban women in the age group 20–24 years from 35.4 to 27.1% (p <0.05), among rural women of the same age from 40.9 to 34.2% (p <0.05). In the observed period, percentage of live births among women of the older reproductive age increased both among residents of cities and in rural areas. Percentage of births by birth order was changed: in urban areas accounted for 55.9% of the first child, in rural areas — 44.3%; for the second child — 35.1% and 34.2%, respectively; for third and more children — 9 and 21.5%.

Conclusion. The analysis of medical and social indicators of the reproductive potential of the female population and markers of trends in the formation of the medical and demographic process in the region suggests a decrease in ferti­lity rate (fertility) with an increase in the mean age of women at childbirth.

Kazan medical journal. 2020;101(5):719-726
Results of the perinatal audit of the Northwestern Federal District
Ivanov D.O., Shevtsova K.G., Moiseeva K.E., Harbedia S.D.

Aim. To assess the results of a perinatal audit of the Northwestern Federal District and to identify opportunities for a decrease in perinatal mortality.

Methods. The audit of perinatal loss was conducted in two stages: (1) remote audit — audit of perinatal mortality indicators; (2) medical history audit — audit of cases of perinatal death of a child based on medical documentation. Held the copy of the data from the 925 medical records for 220 cases of perinatal death. The perinatal audit of the Northwestern Federal District used the Nordic-Baltic perinatal death classification. The following statistical me­thods were used for statistical data processing: incidence rate of a trait was determined by using frequency tables, the statistical significance of differences was tested by using contingency tables, the Chi-square criterion, along with the Pearson correlation coefficient. The statistical significance of differences in quantitative indicators was assessed by using Student's t-Test. The significance level was set at p <0.05.

Results. It was found that in the Northwestern Federal District pregnancy losses III category of the Nordic-Baltic classification (gestational age newborn, more than 28 weeks, without congenital malformations and intraute­rine growth restriction) is 27.5%, intranatal losses VI category of the Nordic-Baltic classification (gestational age newborn, more than 28 weeks, without congenital malformations and intrauterine growth restriction) — 7.4%, the loss of newborns VIII–XI category of the Nordic-Baltic classification (gestational age newborn, more than 28 weeks, without congenital malformations and intrauterine growth restriction) — 16.9%. Among children who died during the perinatal period, children of gestational age over 28 weeks significantly predominate (p=0.003). In the nosological structure of stillbirth, most of the diseases are associated with respiratory disorders (85.9%), infectious complications are 14.1%. The main causes of death of newborns in the early neonatal period are respiratory disorders — 40.0% and infectious diseases specific to the perinatal period — 36.0%. The assessment of the sexual prevalence of pregnancy losses did not reveal a statistically significant difference (p=0.29). The assessment of the sexual characteristics of intranatal losses showed that boys significantly predominate (p=0.003).

Conclusion. The perinatal audit revealed that, in the Northwestern Federal District, the level of the mobile reserve of perinatal losses associated with managed causes is 51.8%.

Kazan medical journal. 2020;101(5):727-733
Prediction of temporary disability due to of circulatory system diseases in housing and communal services employees
Bendyuk G.Y., Grishina N.K., Dokhov M.A., Sidorov A.A.

Aim. To develop a prognostic model of incidence of temporary (short-term) disability due to cardiovascular diseases in a housing and communal services employees using the example of the State Unitary Enterprise (SUE) “Vodokanal of St. Petersburg”.

Methods. The study included 4634 people, observed in the departmental outpatient clinic of SUE “Vodokanal of St. Petersburg”, between 2015 and 2017 years. We calculated extensive indicators determining the disease patterns and intensive indicators characterizing the prevalence of the pathological process in the study of morbidity by the findings of periodic health examinations and incidence of short-term disability. The incidence of short-term disability was predicted by using the method of sequential analysis A. Wald modified by E.V. Gubler and the neural network.

Results. We found that based on the operational and statistical data of the medical and sanitary unit, using a neural network, relying on linear and nonlinear dependence of comorbidity, in particular, respiratory diseases, it is possible to predict (in 92.4% of cases) the incidence of temporary disability due to cardiovascular diseases in employees of the housing and communal services SUE “Vodokanal of St. Petersburg”. The high sensitivity (97.7%) and specificity (90.7%) of the method allows it to predict the need for treatment and prophylaxis measures in the contingent attached to the medical and sanitary unit.

Conclusion. The developed model allows to determine the main directions of preventive work to reduce the incidence of circulatory system diseases with temporary disability: prevention of high blood pressure and respiratory diseases.

Kazan medical journal. 2020;101(5):734-739
Clinical experiences
Bactericidal capacity of oral neutrophils as a marker for clinical course of inflammatory ­respiratory diseases in children
Pikuza O.I., Fayzullina R.A., Zakirova A.M., Suleymanova Z.Y., Rashitova E.L., Volyanyuk E.V.

Aim. To study the number of neutrophils in the oral cavity, their bactericidal potential, to assess as an indicator for predicting the course of recurrent bronchitis (J40) and community-acquired focal pneumonia in children.

Methods. 87 children between 5 and 10 years old, including 52 children with recurrent bronchitis and 35 with focal community-acquired pneumonia were observed. The control group consisted of 37 conditionally healthy children of a similar age. Viral antigens were studied by chemiluminescence immunoassay. Oral neutrophil counts and functional activity were determined. Antibacterial antibodies were measured by an enzyme-linked immunosorbent assay (ELISA).

Results. 70.11% of patients had a viral antigen, and 57.47% had immunoglobulins M and G against bacterial pathogens. Oral neutrophil counts increased in the main group compared to the control group: up to 163.8±26.5 cells (p <0.001) in recurrent bronchitis, to 110.9±25.5 (p <0.05) in community-acquired pneumonia. By the recovery period, the number of oral neutrophils counts decreased in recurrent bronchitis (1.7 times higher compared to the control group, p <0.01) and remained practically unchanged in community-acquired pneumonia (115.0±26.9, p <0.05). Myeloperoxidase level had opposite changes for the groups compared to the control group: with recurrent bronchitis, it was 1.61±0.09 to the level in the control group (p <0.05), with community-acquired pneumonia — 0.73±0.09 to the level in the control group (p <0.001). The level of lysosomal cationic proteins decreased to 0.77±0.09 to the level in the control group (p <0.05) in recurrent bronchitis, and to 0.80±0.09 (p <0.05) in pneumonia.

Conclusion. In inflammation of the respiratory tract, neutrophil migration to the oral cavity, as well as myelope­roxidase level, increases, indicators of spontaneous luminol-dependent chemiluminescence are activated, and a deficiency of lysosomal cationic proteins occurs; this prevents the penetration of the pathogen into the lower respiratory tract.

Kazan medical journal. 2020;101(5):740-748
Risk of long QT syndrome in novel coronavirus COVID-19
Oslopov V.N., Oslopova J.V., Hazova E.V., Sergienko K.S., Murzakhanova A.F., Boichuk J.M.

The article is devoted to the risk of cardiovascular disease in coronavirus infection. In March 2020, the World Health Organization announced the COVID-19 pandemic. The virus set many tasks for practicing doctors, inclu­ding the study of its pathogenesis and the creation of a therapy suitable for all patient groups. This paper presents information about cellular entry of the coronavirus, the development of cardiovascular diseases, in particular, the heart, and the latest data on experimental therapy with hydroxychloroquine. Coronavirus has been shown to affect the synthesis of angiotensin 2, which increase the QT interval. At the same time, the combination therapy ­using chloroquine and azithromycin caused a critical prolongation of the QT interval in some cases. On 4 July 2020, WHO accepted the Solidarity Trial’s International Steering Committee recommendation has stop the trial of these drugs. Cardiologists should review the latest information on the effects of coronavirus on the cardiovascular system and based on this, make recommendations the management and treatment of severe patients.

Kazan medical journal. 2020;101(5):749-753
Neuroimmune predictors of outcome after aneurysmal subarachnoid hemorrhage
Ermakov S.V., Karpov S.M., Вaturin V.A., Belokon O.S., Mozheiko R.A.

Aim. To determine the possibility of predicting the course and outcomes of aneurysmal subarachnoid hemorrhage (aSAH) by using the detection of autoantibody level to neurospecific proteins.

Methods. The autoantibody level to neurospecific proteins was detected in 65 people: 30 healthy volunteers and 35 with a confirmed diagnosis of aneurysmal subarachnoid hemorrhage. Autoantibodies to myelin basic protein (MBP), peripheral myelin, dopamine receptors, myosin, N-methyl-D-aspartate (NMDA) receptors and S100 protein detected by using an enzyme immunoassay. The severity of illness in dynamics was defined in all patients by using the following scales: Rivermead mobility index, Hunt–Hess, Graeb and others. Statistical analysis was performed using Statistica 10.0, with the consistent use of descriptive statistics methods, the Mann–Whitney, Kruskal–Wallis and Pearson tests, Spearman coefficient.

Results. At the first stage, neurospecific proteins characterized by a large increase in autoantibody titers were identified. Further, based on the data obtained, a statistically significant correlation between autoantibody ­titers to S100 protein (360.43±40.35 µg/ml, p <0.05), MBP (145.91±12.43 µg/ml, p <0.05), NMDA receptors (66.17±6.42 µg/ml, p <0.05) and aSAH outcome was established.

Conclusion. The study revealed an increase in autoantibody level to neurospecific proteins in the blood plasma of patients, depending on the severity of subarachnoid hemorrhage and the development of delayed cerebral ischemia due to cerebral vasospasm; high antibodies titers to S100 protein in subarachnoid hemorrhage are associated with cerebral vasospasm and the development of secondary (delayed) ischemic changes in the brain.

Kazan medical journal. 2020;101(5):754-759
Psychological characteristics of patients with primary dysmenorrhea
Makaricheva E.V., Burguvan M.S.

Aim. To study the psychological characteristics of women with primary dysmenorrhea.

Methods. We examined 77 women of childbearing age, divided into the main (40 women) and control (37 women) groups. The criterion for inclusion in the main group was a clinically confirmed diagnosis of “primary dysmenorrhea” with a regular menstrual cycle. The exclusion criteria were an organic gynecological pathology, a diagnosis of secondary dysmenorrhea and an irregular menstrual cycle. The criterion for inclusion in the control group was absolute painlessness of menstruation and the absence of gynecological diseases. The survey was conducted using psychodiagnostic techniques: a method for self-assessment of anxiety, rigidity, and extroversion; test “Express diagnosis of the level of self-esteem”; a technique for studying accentuation of personality traits; test-questionnaire of psychological defense mechanisms “Life Style Index”; questionnaire “Methods of coping behavior”, statistical methods. Also, a specially developed questionnaire was used, including questions related to socio-psychological parameters, as well as the nature and intensity of pain.

Results. Significant differences between the groups characterizing coping strategies were found: distance (p <0.002); escape-avoidance (p <0.029); psychological defenses: denial (p <0.006), regression (p <0.011). The subjects of the main group were characterized by significantly high anxiety levels (p <0.020) with the average score 47.2±1.15 corresponding to a hyperanxious and low self-esteem (p <0.001) with the average score 30.1±1.43 compared to women in the control group: 42.7±1.53 — average anxiety level and 27.4±1.31 — normal self-esteem.

Conclusion. The features of the relationship of the psychological characteristics of women with “primary dysmenorrhea” were revealed; it was proved that the subjects of the main and control groups differ in the features of coping behavior, psychological defenses and accentuation of personality traits, and also have reliably distinguishable levels of anxiety and self-esteem.

Kazan medical journal. 2020;101(5):760-767
History of medicine
On the activities of the Kazan Scientific Research Institute of Epidemiology and Microbiology during the Great Patriotic War of 1941–1945
Reshetnikova I.D., Isaeva G.S., Kulikov S.N., Gabidullina S.N.

The article was prepared for the 75th anniversary of Victory in the Great Patriotic War and the 120th anniversary of the Kazan Scientific Research Institute of Epidemiology and Microbiology. The paper presents the contributions of the Kazan Institute of Epidemiology and Microbiology staff in the sacred cause of victory over fascism to protect the health of soldiers and civilians of our homeland during the Great Patriotic War. The scientific research data and production activities of the institute are presented. The institute turned out to be practically the closest microbiological institution to the front, having the necessary laboratory equipment and a production base. The institute launched the production of medications, including 4 types of anti-gangrenous serums, anti-dysenteric tablets, te­tanus toxoid, anti-typhoid tablets, dysenteric dry bacteriophage, dysenteric subcutaneous vaccine, pentavacine, typhoid vaccine, antibiotic gramicidin and others.

Kazan medical journal. 2020;101(5):768-774
Problems and prospects of studying hemorrhagic fever with renal syndrome in the Republic of Tatarstan
Boyko V.A., Savitskaya T.A., Trifonov V.A., Serova I.V., Isaeva G.S.

The paper presents the history of the study of hemorrhagic fever with renal syndrome (HFRS) at the Kazan Research Institute of Epidemiology and Microbiology from the beginning of the 50s to the present. The accumula­ted information allows to draw up general conceptions about the main source of infection, the biological structure of natural foci of infection, nosoarea and the main clinical forms of the disease, the nature and seasonality of the disease, the sex and age composition of patients, and the types of natural foci of HFRS. The stages of improving the methods of laboratory diagnosis of HFRS, development of a specific immunoglobulin against the serum of the Puumala virus are described. A significant contribution to the study of HFRS was the landscape-epidemiological ranking of the territory of the Republic of Tatarstan and the Middle Volga endemic for HFRS, with the identification of zones of special risk of human infection and the main factors that form them. At present, a reference center for monitoring HFRS has been created based on the Kazan Research Institute of Epidemiology and Microbiology, and the study of the properties of HFRS pathogens at the current molecular-genetic level continues.

Kazan medical journal. 2020;101(5):775-785
The history of creation hospital surgery clinic in Kazan
Krasilnikov D.M., Karpukhin O.Y.

In 1860, the Department of hospital surgery was organized at Imperial Kazan university. The reform of medical education to Western standards supposed the training of students in faculty and hospital clinics. The main task of the faculty Department is to teach the classical clinical picture of the most common diseases, while the task of the hospital Department is focusing to variants of clinical manifestations of the disease and improvement of practical skills. The first head of the Department of hospital surgery at Imperial Kazan University was Professor Andrey Beketov. Professor A.N. Beketov is one of the pioneers of the use of inhalation anesthesia, which he recommended for widespread use in the clinic. Besides, Beketov is the author of priority works in the field of traumatology and orthopedics. In a short time, the hospital surgical clinic in Kazan became one of the leading clinics in the East of Russia, the Urals and Siberia.

Kazan medical journal. 2020;101(5):786-790
70 year to Academician Andrey Lvovich Zefirov

2 октября 2020 г. исполнилось 70 лет академику Российской академии наук, заслуженному деятелю науки Российской Федерации (РФ) и Республики Татарстан (РТ), вице-президенту Всероссийского физиологического общества им. И.П. Павлова, декану лечебного факультета, заведующему кафедрой нормальной физиологии, директору Института нейронаук Казанского государственного медицинского университета, доктору медицинских наук, профессору Андрею Львович

Kazan medical journal. 2020;101(5):791-793
Professor Anatoliy Pavlovich Tsibul'kin

2 сентября 2020 г. не стало Анатолия Павловича Цибулькина — доктора медицинских наук, профессора, заслуженного деятеля науки Республики Татарстан и Российской Фе­дерации.

Kazan medical journal. 2020;101(5):794-796
Cochrane Review Summaries
Quarantine alone or in combination with other public health measures to control COVID‐19: a rapid review

Не существует эффективного лечения или вакцины (лекарства, которое предотвращает заражение конкретным заболеванием) от COVID‐19, поэтому необходимы другие способы замедления (контроля) его распространения. Один из способов контролировать болезнь — карантин. Это означает отделение здоровых людей от других здоровых людей, которые могут иметь вирус после того, как они находились в близком контакте с заражённой персоной, или потому что они вернулись из области с высокими показателями инфекции. Аналогичные рекомендации включают изоляцию (как карантин, но для людей с положительным результатом теста на COVID‐19) и физическое дистанцирование (когда люди без симптомов физически держатся на расстоянии друг от друга).

Что мы хотели узнать? Мы хотели выяснить, останавливает ли и насколько эффективно останавливает карантин распространение COVID‐19 и предотвращает ли он смерть. Мы хотели узнать, было ли это более эффективным в сочетании с другими мерами, сколько это стоит.

Kazan medical journal. 2020;101(5):797-798
Antibody tests for identification of current and past infection with SARS‐CoV‐2

COVID‐19 — инфекционное заболевание, вызываемое вирусом SARS‐CoV‐2, которое легко распространяется между людьми подобно обычной простуде или «гриппу». Большинство людей с COVID‐19 имеют респираторные заболевания лёгкой и умеренной степени тяжести, а некоторые могут не иметь никаких симптомов (бессимптомная инфекция). У других развиваются тяжёлые симптомы, и они нуждаются в специализированном лечении и интенсивной терапии.

Иммунная система людей с COVID‐19 реагирует на инфекцию, вырабатывая белки (антитела), которые могут атаковать вирус в их крови. Тесты для обнаружения антител в крови людей могут показать, есть ли у них в настоящее время COVID‐19 или был он у них ранее.

Kazan medical journal. 2020;101(5):798-800

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