Vol 95, No 1 (2014)

Aim. To compare the prevalence of West’s syndrome in very preterm babies and in babies with prematurity of 1-2 degrees. Methods. Both retrospective and prospective study including 241 preterm babies who received out-patient or in-patient aid for different neurological disorders. Inclusion criteria for the first group were diagnosis of a neurological disorder, gestational age less than 31 weeks and birth weight not exceeding 1500 grams. Inclusion criteria for the second group were diagnosis of a neurological disorder, gestational age of 32-37 weeks and birth weight ranging from 1501 to 2500 grams. Results. Severe central nervous system damage, including such conditions as spastic quadriplegia (126 out of 157 1 stgroup babies, 80.3%, and 40 out of 84 2 ndgroup babies, 47.6%, р <0.001), developmental delay of cognitive functions (123 out of 157 1 stgroup babies, 78.3%, and 40 out of 84 1 stgroup babies, 47.6%, р <0,001) were more common in the first group. West’s syndrome was diagnosed in 22 (14%) of cases in 1 stgroup, in 3 (3.6%) of cases in 2 ndgroup (HR=4.4, 95% CI [1.28; 15.16], χ 2=6.42, р=0.01). In 21 (95.5%) of West’s syndrome cases, modified hypsarrhythmia was diagnosed by video electroencephalogram monitoring. Severe cerebral hypoxia of higher degrees, periventricular leukomalacia and hypoplasia of the corpus callosum were more common in 1 stgroup babies. Conclusion. Our study showed that the prevalence of West’s syndrome in very premature infants with neurological disorders was 4.4 times higher compared to babies with prematurity of 1-2 degrees. There was an association between West’s syndrome in preterm babies and such cerebral disorders as severe cerebral hypoxia of 3 rddegree, periventricular leukomalacia and hypoplasia of the corpus callosum.

Aim. To assess the bond strength of composite material to ceramic surface of metal-ceramic-fixed dental prosthesis depending on the type of restoration systems used for chipped porcelain restorations. Methods. Bond strength of restoration material to porcelain coating surface were studied according to ISO 10477 issued at 01.10.2004. The surface of the ceramic-metal plates was polished by different methods depending on the restoration system used. Restorative material was applied using a template. Prepared samples were placed in a testing machine and loaded at a constant crosshead speed of 1±0.3 mm/min before separation, the load F at break was registered by an automatic recorder. Results. Similar bond strength results were revealed for restoration systems not requiring acid pickling of porcelain surface («Cimara», «Ceramic Repair») and restoration system including 9.5% hydrofluoric acid «Porcelain etch & silane»: 17.993, 17.774 and 17.896 MPa respectively. Bond strength was much higher (25.278 MPa) if restoration system with 4% hydrofluoric acid was used. «Vertise™ Flow» restorative single-component material also provided significant bond strength - 24.315 MPa. Conclusion. The study showed the possibility of using a single-component restorative material to repair chipped porcelain tile coating metal-ceramic-fixed dental prostheses. For longer life of chipped porcelain tile coating restoration of dental prostheses, the use of restoration systems including 4% hydrofluoric acid is recommended.

Aim. To study the effect of phosphodiesterase type 5 inhibitors used to treat the erectile dysfunction in patients of different age groups with concomitant diabetes mellitus. Methods. The study included 293 patients with diabetes mellitus type I and II aged 17-60 years, with duration of diabetes varying from 6 months to 29 years, duration of erectile dysfunction - from 6 months to 12 years. To diagnose the erectile dysfunction, an international index of erectile function, together with routine and special methods were used. Patients were administered phosphodiesterase type 5 inhibitors: sildenafil, taladafil and vardenafil. The control group included men with the erectile dysfunction without diabetes. To identify the male hypogonadism, patients were examined depending on the age group: 18-29 years, 30-39 years, 40-49 years, 50-59 years. Patiens were tested for sex hormones level, male ageing questionnaires were administered. Results. The increased rate of hypogonadism (from 12.5 to 54%) was associated with older age in patients with diabetes mellitus. The androgen status index in patients with diabetes mellitus, according to the Aging Males’ Symptoms rating scale, was 37.1±1.4 points. Phosphodiesterase type 5 inhibitors were more effective in younger age groups (57.1-91.7%) compared to older (36.8-67.3%). When comparing the study drugs, vardenafil showed better effect and relatively few side effects. Conclusion. Androgen deficiency, developing with increasing age is accompanied by a decrease in phosphodiesterase type 5 inhibitors efficiency. The use of small doses of these drugs corresponding the circadian rhythm of testosterone in males with normal testosterone blood level has the same effect as large doses.

Aim. To study the functional state of endothelium in patients with chronic viral hepatitis and liver cirrhosis and impact of left and right ventricle diastolic malfunction and pulmonary hypertension on endothelial function. Methods. 74 patients with chronic viral hepatitis (group 1), 62 patients with cirrhosis (group 2) and 17 healthy volunteers were examined. Doppler echocardiography and brachial artery ultrasonography with endothelium-dependent vasodilation measurement were performed. Results. Endothelium-dependent vasodilatation was reduced in patients of the 1 stgroup (6.2%), and of the 2 ndgroup (2.2%) compared to the controls (13.8%, р <0.05). Sensitivity coefficient for the brachial artery was measured as 0.31 (0.19; 0.35) in patients with chronic viral hepatitis, 0.25 (0.09; 0.35) in patients with cirrhosis compared to 1.27 (0.72; 1.29) in control group, demonstrating the marked endothelial dysfunction in patients of the 1 stand 2 ndgroups (р <0.05). Moderate pulmonary hypertension was accompanied by a more pronounced endothelium-dependent vasodilation impairment in both groups (р <0.05). In patients with viral hepatitis, endothelial malfunction was less common (62%) compared with patients with liver cirrhosis (85%, p=0.002). Presence of left and right ventricle diastolic malfunction did not influence the endothelial function. Conclusion. In patients with viral hepatitis and cirrhosis, endothelium-dependent vasodilatation is affected depending on the severity of the disease and increased if pulmonary hypertension was present. Presence of left and right ventricle diastolic malfunction did not influence the endothelial function.

Aim. To perform the comparative analysis of clinical and criminological characteristics of patients with organic mental disorders who had repeatedly committed socially dangerous acts. Methods. 79 patients with diagnosed organic mental disorders who had committed socially dangerous acts, declared insane by the court and underwent compulsory treatment determined by the court as out-patients or in general or specialized mental hospital. Patients who had repeated socially dangerous acts after treatment, were included in the group A (19 patients), patients who had not committed any socially dangerous act after treatment, were included in the group B (60 patients). Results. Patients with organic delusional disorder (21 vs 11.6%) and non-psychotic organic disorders (10.5 vs 5%) were more commonly seen in group A compared to group B. The share of patients with dementia was higher in group B (23.3 vs 5.2%). 8 (42.1%) patients of group A were never prosecuted before, compared to 40 (66.7%) patients from group B. Some crimes were registered only in patients who repeatedly committed crimes: sexual crimes - 1 (5.2%), crimes against administrative order - 2 (10.5%), crimes against public security 5.2% (patient was convicted in illicit firearms manufacturing). Psychopathy-like syndrome was the leading syndrome in patients who committed a socially dangerous act in both A and B groups: 11 (57.9%) and 33 (55%) cases respectively. Hallucinatory delusion was diagnosed in 7 (36.8%) of group A patients and in 17 (28.3%) of group B patients. Majority of the group A patients had further committed only one crime after treatment - 11 (57.9%), 5 (26.3%) committed 2-3 crimes, 3 (15.8%) patients - over 3 crimes. The time gap between the first and further compulsory treatment was between 1 and 3 years in most of the cases (11 patients, 57.9%). 4 (21%) patients were readmitted for repeated compulsory treatment within 1 year, 3 (15.8%) were readmitted from 3 to 5 years and 1 (5.3%) from 5 to 8 years after the initial treatment. Conclusion. There are a number of factors influencing the criminal behavior and re-committing socially dangerous acts in future. Despite the small sample size, it should be noted that patients with dementia do not repeat socially dangerous acts.

A review of articles covering the modern views on the hepatobiliary system damage features in patients with clinical manifestations of metabolic syndrome. 196 original papers published over the last 6 years were found using PubMed, MEDLINE, E-library databases, from which 50 articles were picked out for the review. Considering high prevalence of metabolic syndrome, the studied problem seems important. The influence of obesity and associated insulin resistance at launching the systemic inflammation leading to activation of immunological cascade resulting in terget organs damage in such patients is highlighted. The pathogenesis of liver, gall bladder and bile ducts damage at presence of metabolic disorders is outlined. The role of inflammatory and anti-inflammatory cytokines in liver tissue damage is described. Based on the data of literature review and own data, it was shown that the lipid metabolism alterations are associated with liver functional damage, and liver in patients with metabolic syndrome is not only participating in atherogenic dislipoproteinemia development, but also damaged as the target organ. It was revealed that the key link in the gall bladder pathology in patients with metabolic syndrome is the lipid metabolism alterations that lead to the excess cholesterol bile excretion and cholesterol monohydrate crystals sedimentation. It was also shown that the functionally affected hepatocytes produce imperfect bile micelles with high cholesterol and low phospholipid levels, increasing the bile lithogenicity. High bile cholesterol level stimulating the mucin secretion by gall bladder wall, which is the important component of bile sediment and increases the bile crystalloids aggregation.

The review of clinical and immunologic studies of periodontal inflammatory diseases is presented. At present, the most effective tools for treatment of malocclusions are fixed orthodontic appliances (dental braces), but the use of fixed appliances complicates the oral hygiene, predisposes to periodontal and gum inflammation. The rate of complications diagnosed during orthodontic treatment stays high. The principles of periodontal inflammatory diseases (gingivitis, periodontitis) treatment are closely related with the causes and mechanisms of periodontal inflammation. Patients who receive orthodontic treatment using braces should be treated as a group with a high risk for inflammatory periodontal diseases. The orthodontic devices stimulate the directed reorganization of periodontal structures achieving optimal aesthetic and functional standards. Physiology of periodontium restructuring is largely determined by the local and general health before, during and after the orthodontic treatment. This article surveys the mechanisms of periodontal damage, highlighting the important role of immune response. So far, only anecdotal descriptions of immune response on the stages of orthodontic treatment are published.

P2 receptors are detected in different tissues and organs, which makes them a potential target of pharmacological action. A number of studies confirming the maturity of purinergic theory are currently published. Literature review focuses on P2 receptors characteristics, their main current agonists and antagonists, as well as on the possibilities of pharmacological action on these receptors. The most important studies addressing new chemical compounds important for studying P2 receptors and also compounds with potential for medical use are analyzed. Data on current successes of P2 receptors pharmacology and introduction of P2Y receptors antagonists into clinical practice are presented. Over the last decades a certain progress was observed in studying P2 receptors agonists and antagonists. There is a growing interest to pathophysiology and therapeutic potential of purinergic neurotransmission. Nevertheless, there is a need for developing new compounds acting selectively to these receptors both in vivo and in vitro. Despite the large number of P2 receptors agonists and antagonists, most of them have certain drawbacks, including incomplete of non-selective antagonism, or significant effect on ecto-ATPase activity. Thus, studying P2 receptors to find novel compounds acting on these receptors is of significant clinical value. Apparently, this trend of developing novel drugs — P2 receptors agonists and antagonists — is particularly promising.

Aim. Conduct a questionnaire survey of in private clinic patients to study the problems of ophthalmologic aid quality. Methods. The survey included 108 patients who filled in a specially designed questionnaire. Typological and variation analysis was performed, relative and mean statistical values were calculated; statistical significance of revealed differences was checked. Results. When choosing a private clinic, young people often rely on advertising, while the older patients - on the opinion of relatives and friends. Patients seek for paid services because they believe in a higher healthcare, with 59.3% of respondents believe that the quality of care is improved if they pay. Services of paid clinics are quite affordable for the majority of the interviewed patients (proposed service cost is moderate, transport accessibility, travelling time and admission queue time are quite acceptable). Generally, consumers gave a positive assessment of the clinic staff and its activities as a whole: the relationship with the doctor was characterized as trustful, attentive and respectful, involving a complete understanding of patient’s problems by the medical staff. Most respondents (92.6%) find their physician a specialist of high qualification. The main reasons for dissatisfaction with paid medical services are discrepancy between price and quality, low treatment effect, which is closely coupled with the staff competence and incorrect behavior of health workers. Conclusion. The conducted survey showed high satisfaction with medical services provided in a private clinic.

Aim. To identify trends of further development, priorities, challenges and vectors of further research in social pediatrics. Methods. Interpretive content analysis of dissertations in the field of public health and healthcare for the period from 1991 to 2012 was performed. 4194 items were analyzed. Results. At the first stage of the research, it was found that 14.8% of public health dissertations presented during the research period addressed pediatric problems. The next stage included qualitative and quantitative analysis of top-priority topics of social pediatrics in public health dissertations. The analysis of social pediatrics areas included the following categories: (1) studies of social (psychosocial) determinants of children’s health; (2) studies of health condition of children and adolescents in a stressful situation; (3) organization of medical and social aid to children. Studies of social (psychosocial) determinants of children’s health were the most common (35.9 %). Studies of health status of vulnerable children and adolescents had a share of 15% of all studies. 7.6% of studies were devoted to pediatric medical and social aid organization. Conclusion. It is important to facilitate the research in social pediatrics to optimize the scientific data and improve pediatric medical and social aid.

Thromboembolism is one of the dangerous complications of cerebrovascular endovascular surgeries, often resulting in severe disabilities. A clinical case of using stent retriever for treating iatrogenic cerebral thromboembolism occurred as a complication of diagnostic cerebral angiography is presented. Patient M., 49 years, was admitted in the department of neurology with referral diagnosis of subarachnoid hematoma. No pathologic changes of intracranial arteries were revealed on multi-spiral computed tomography, so cerebral angiography was administered. After administration of heparin (100 U/kg), selective cerebral angiography of all the intracranial vascular beds was performed using a diagnostic cerebral catheter with some technical difficulties. After the intervention was finished, the patient developed non-focal neurological symptoms, left-sided hemianopsia. Angiography of posterior circulation system was repeated immediately, left posterior cerebral artery occlusion was found. Stent retriever was used to restore the intracranial blood flow. An intracranial stent retriever Solitaire (EV3) was delivered to the occlusion and deployed with exposition of 5 minutes and further removal. Control angiography showed complete restoration of the intracranial blood flow without signs of distal embolism. The neurologic deficit had completely resolved during first 24 hours after the surgery. The presented clinical case illustrates the effect of stent retriever use to to restore the intracranial blood flow and stresses the need for such devices availability in departments performing cerebral surgeries in patients with cerebrovascular diseases.

The Zemstvo reform has set a start of changes in a number of spheres of the country’s life, including health-care. The development of zemstvo healthcare in Kazan Governorate took the way of increasing the number of healthcare workers and consolidating the healthcare facilities network. Kazan Governorate zemstvo managed to create a promoted healthcare in conditions of scarce resources and lack of medical professionals. At this period, a new form of medical and sanitary attendance — medical district — was created, replacing the old patrolling system. One of the advantages of zemstvo healthcare was introduction of free drug supplies. At the end of XIX century, a developed network of pharmacies was established. Almost in all uyezds of Kazan Governorate, medical depots were functioning, providing local pharmacies with the required medicines. At the beginning of zemstvo healthcare functioning, obstetrics was singled out as a separate branch of medicine. In XIX century, special maternity beds appeared in a number of zemstvo healthcare units. At the beginning of XX century, special maternity ward for obstetric aid appeared in zemstvo hospitals, maternity clinics opened. By the early XX century, a rural healthcare system, its legal groundwork, operations and funding were established. As a result of zemstvo self-government institutions functioning, an extensive network of uyezd hospitals, paramedic stations was established, providing medical aid to rural population; stationary zonal system of medical aid was created.