Vol 95, No 4 (2014)

Aim. To study the incidence of unpaired visceral arteries occlusive disease and clinical types of visceral ischemic syndrome in patients with persistent abdominal pain. Methods. The study included 326 patients with chronic atrophic gastritis and duration of abdominal pain over 3 months. The first group included 184 patients with inflammatory conditions. The second group consisted of 142 patients with visceral ischemic syndrome associated with visceral arteries stenosis. The mean age of patients with inflammatory conditions did not exceeded 60 years, and duration of abdominal pain syndrome was less than 6 months. In patients with visceral ischemic syndrome, patients’ age was over 60 years, and abdominal pain persisted for more than 12 months (p <0.01). All patients underwent an integrated ultrasonography and two-staged functional Doppler ultrasonography of visceral arteries. Results. At endoscopy, atrophic gastritis was associated with atrophic colitis and bowel motility disorders in 14.7-15.3% of patients with visceral ischemic syndrome and in 2.1% of patients with inflammatory conditions (p <0.001). On Doppler, 53.5% of patients with visceral ischemic syndrome had clinical picture of subcompensated celiac trunk arterial insufficiency (36.8%) or a combination of two visceral artery diseases (13.2-18.4%). 46.5% of patients with visceral ischemic syndrome had clinical signs of decompensated visceral arteries chronic arterial insufficiency caused by external compression (69.7%) or atherosclerosis (30.3%). The classification of ultrasonic stages of visceral ischemic syndrome was developed, which allows optimizing patients’ follow-up, treatment tactics and better assessing their effectiveness. Conclusion. Integrated ultrasound of visceral arteries revealed visceral arteries disease in 43.6% of patients with persistent abdominal pain, as well as the stage and degree of the disease. In 46.5% of visceral ischemic syndrome cases, arterial stenosis was diagnosed, and in 53.5% of cases - functionally reduced visceral blood flow.

Aim. To identify the prevalence of main phenotypes of polygenic heritable connective tissue diseases in patients with internal diseases and to assess the prevalence of different internal diseases in such patients. Methods. The study involved 600 patients (254 males, 346 females) aged 18 to 64 years. Average age of males was 52±3.8 years, females - 47±2.2 years. Patients were examined to reveal the signs of different phenotypes of heritable connective tissue diseases in patients with internal diseases, as well as the severity of connective tissue diseases, and possibilities for it screening using the wrist and thumb hypermobility tests. Results. Signs of heritable connective tissue diseases were revealed in 147 (24.5%) patients with internal diseases. In females, those signs were observed in 104 (30.0%) cases, of which 44 (42.3%) were graded as mild, 35 (33.7%) - moderate, 25 (24.0%) - severe. In males, signs of heritable connective tissue diseases were revealed in 43 cases (16.9%), including mild - 17 (39.5%), moderate - 14 (32.5%) and severe - 12 (28.0%). Ehlers-like phenotype was the most common (52.0%), Marfan-like phenotype was observed in 14.0% of cases, primary mitral valve prolapse was diagnosed in 7.0% of patients, unclassifiable phenotype was observed in 11.0% of cases. Joint hypermobility syndrome was revealed in 31.0% of patients, presenting both as specific phenotypes (Marfan-like, Ehlers-like) and as a self-phenotype (31.9% of all the patients with heritable connective tissue diseases phenotype). Benign joint hypermobility was observed in 6.1% of cases. Symptoms of heritable connective tissue diseases were more frequent in patients with gastrointestinal and musculoskeletal diseases. Conclusion. The most common phenotype of heritable connective tissue diseases is Ehlers-like with skin, bone and systemic manifestations. Presence of heritable connective tissue diseases was most commonly associated with gastrointestinal and musculoskeletal diseases.

Aim. To study the expression of Fas-receptor on peripheral blood monocytes and lymphocytes in women who have given birth to children with low birth weight. Methods. Population-based study recruited 242 women who have given birth at the gestation term of more than 35 weeks. Group 1 (n=108) included mother-newborn pairs with low birth weight of newborns, group 2 (n=134) - mother-newborn pairs with normal birth weight for the gestational age. Peripheral blood lymphocytes and monocytes total count and subpopulations, CD95 (Fas-receptor) apoptosis receptor expression level (using four- and five-parametric phenotypic test) were determined, using a combination of monoclonal antibodies to differentiation and activation markers. Results. CD3+CD95+ cells levels were significantly higher in women who delivered of low birth weight children. In T-cell subpopulation of group 1 women, there was a statistically significant increase in relative values of Fas-receptor expression on T-helpers and T-cytotoxic lymphocytes - by 1.6 (p <0.001) and 6.3 (p <0.001) times, respectively, and by 2.9 (p <0.001) and 2.6 (p <0.001) times, respectively, in absolute values. There was a reduction in absolute counts of CD3+CD4+ and CD3+CD8+ T-lymphocyte subpopulations in women who delivered of low birth weight children compared to controls. The ratio of CD95+-expressing T-lymphocyte subpopulations in group 1 women was the following: CD4+CD95+/CD8+CD95+ ratio was 4.9 times higher compared to the second group (p <0.001). Increased absolute and relative Fas-receptor expression on B-lymphocytes [by 63.9% (p <0.001) and 33.3% (p=0.002), respectively] was found in women who delivered of low birth weight children compared to women who delivered of children with normal birth weight. CD14+CD95+ expression analysis revealed increased absolute and relative counts of Fas-receptor expressing monocytes. Conclusion. Marked expression of CD95+ in circulating monocytes and raised CD4+CD95+/CD8+CD95+ ratio in women who delivered of low birth weight children may be a laboratory test for detecting higher chance for fetal growth restriction.

Aim. To study the features of ophthalmic disorders in patients with chronic alcoholism. Methods. Sixty patients (120 eyes) with chronic alcoholism (the main group), including 20 people (40 eyes) with the first stage, and 40 people (80 eyes) with the second stage of chronic alcoholism. Control group consisted of 30 healthy volunteers aged 18 to 46 years. All patients underwent ophthalmologic examination, which included visual acuity test, refractometry, biomicroscopy, biomicroophthalmoscopy, visual field test using chromatic and achromatic colors, color vision test using the tables by E.B. Rabkin (1972), tonometry, flicker fusion rate, and bulbar conjunctiva microcirculation examination. Results. In patients of the control group, eye condition complied with a person’s age, a few changes of the conjunctiva microcirculation were revealed, perivascular changes index was assessed as 1.26±0.05 points, vascular changes index - 1.2±0.05 points, capillary changes index - 1.28±0.05 points, intravascular changes index - 2.3±0.05 points, total conjunctival index - 5±0.13 points. Patients with chronic alcoholism showed reduction of central vision in 26% of cases; white color perception visual field decrease - in 80% of cases, red color - in 40%, green - in 13% of cases. Color perception change was an acquired one in 88% of cases, inherited - in 22% of cases; unilateral reduction of visual flicker fusion rate to red light was observed in 35% of cases, bilateral decrease - in 23% of cases. All patients with chronic alcoholism had bulbar conjunctiva microcirculation disorders: perivascular changes index was assessed as 3.48±0.06 points, vascular changes index - 11.25±0.32 points, capillary changes index - 10.51±0.06 points, intravascular changes index - 2.36±0.06 points, total conjunctival index - 27.61±0.48 points. Conclusion. Alcohol intoxication causes profound pathological changes in the eye seen as visual field decrease, color vision disorders, reduced flicker fusion rate, presence of perivascular, intravascular and vascular disorders of bulbar conjunctiva microvasculature, which should be considered at main process monitoring and choosing the appropriate treatment.

Aim. To assess serum lipid spectrum profile as a potential tool for differential diagnosis of gastroenteritis associated with salmonellosis and acute alcoholic gastroenteritis. Methods. Serum lipid profile was examined in 50 healthy volunteers, 50 patients with acute alcoholic gastroenteritis and 50 patients with gastroenteritis associated with salmonellosis of moderate severity. Lipids were extracted by Folch method and fractionated by a modified method; the percentage of separate lipid fractions was determined by densitometry using the «Shimadzu CS-9000» scanner. General lipid level was determined by Marsh method. Total serum lipid level and their fractions: phospholipids total level, free cholesterol, free fatty acids, triglycerides and cholesterol ethers levels were measured. Results. Total serum lipid level was almost 2 times higher in patients with acute alcoholic gastroenteritis compared to patients with gastroenteritis associated with salmonellosis. Relative total level of phospholipids was significantly higher in patients with gastroenteritis associated with salmonellosis compared to patients with acute alcoholic gastroenteritis. However, difference in absolute levels of phospholipids was not significant between the patients with gastroenteritis associated with salmonellosis and patients with acute alcoholic gastroenteritis. Absolute level of free cholesterol was significantly higher in patients with acute alcoholic gastroenteritis than in patients with gastroenteritis associated with salmonellosis. Free fatty acids levels in patients with gastroenteritis associated with salmonellosis did not differ from a respective parameter in patients with acute alcoholic gastroenteritis. Relative level of cholesterol ethers in patients with gastroenteritis associated with salmonellosis was significantly lower compared to patients with acute alcoholic gastroenteritis. Absolute and relative levels of triglycerides in patients with acute alcoholic gastroenteritis were significantly higher, compared to patients with gastroenteritis associated with salmonellosis. Conclusion. Lipid profile detection can be used as an additional test for differential diagnosis of gastroenteritis associated with salmonellosis and acute alcoholic gastroenteritis.

Aim. To assess clinical and epidemiological features of bacterial dysentery caused by Shigella Flexneri 2а in children with severe neurologic comorbidities. Methods. 27 case histories of children with the clinical picture of shigellosis were analyzed. All patients were admitted to the pediatric ward of the hospital of infectious diseases from specialized neuropsychiatric care home in October-November 2013. Results. Clinical picture of bacterial dysentery in examined children was classic. 22 out of 27 children (81.5%, CI 66.9-96.1) had mild disease, 3 (11.1%, CI -0.7-22.9) - moderate, 2 (7.4%, CI -2.5-17.3) - severe form of the disease. In majority of cases, intestinal involvement was manifesting as enterocolitis - in 20 out of 27 patients (74.1%, CI 57.6-90.6). In 3 patients (11.1%, CI -0.7-22.9), shigellosis was manifesting as gastroenterocolitis. In 4 cases (14.8%, CI 1.4-28.2) clinical signs of hemorrhagic colitis were observed. Severe dehydration (2nd and 3rd degree) was registered in 4 out of 27 patients, (14.8%, CI 1.4-28.2), moderate - in 2 (7.4%, CI -2.5-17.3). In 4 out of those 6 patients (66.7%, CI 29-104.4) dehydration was isotonic, in 2 (33.3%, CI 0.4-75) - hypotonic. Conclusion. The infectious disease did not influence the clinical course of concomitant neurologic disorder and did not lead to development of neurologic complications in the admitted patients. In most of the cases shigellosis was mild, and patient’s condition was mostly determined by a concomitant disease.

Aim. To improve the results of surgical treatment for patients with postoperative ventral hernia by improving complex preoperative physical examination and better prevention of wound complications. Methods. Results of surgical treatment of 160 patients [mean age - 64 years, females - 120 (75%), males - 40 (25%)] with postoperative ventral hernia treated from 2003 to 2012 were analyzed. The surgeries were performed routinely. All patients were distributed to 2 groups depending on postoperative wound complications prevention. The main group included 60 patients who underwent a vacuum therapy (authors’ technology) during postoperative period for preventing wound complications. Perioperative management of patients with large and huge hernias in this group was performed according to recommendations of the European Society of Cardiologists and All-Russian Scientific Cardiologic Society for cardiovascular risk assessment at surgeries excluding heart surgery. Comparison group included 100 patients who underwent surgery for postoperative ventral hernias using a conventional vacuum drainage and common methods of patient examination according to recommended standards. Results. Using vacuum therapy in patients of the main group limited the number of Redon-drainage procedures, reduced the rate of local pyoinflammatory complications by 4.2 times (p <0.05). Cardiovascular risk identification and proper preoperative preparation allowed avoiding unfavorable outcomes associated with cardiovascular complications in patients with high cardiovascular risk. Conclusion. High efficiency of a complex approach in preventing postoperative complications after ventral hernias surgical treatment allows to recommend its use in clinical practice.

Aim. To study the hypoglycemic effect of the Medicago Sativa leaves extract in intact rats and in rats with a glucose load. Methods. At the first stage, hypoglycemic effect of Medicago Sativa leaves extract was determined in intact rats. 50 mg/kg of metformin and 18 mg/kg of herbal anti-diabetic «Arfazetin» tea were used as comparator drugs. At the second stage, hypoglycemic effect of Medicago Sativa leaves extract was determined in rats with glucose load. Blood samples for glucose analysis were taken before and in 15, 30, 60 and 120 minutes after loading. Blood glucose level was determined by glucose oxidase method. Results. Medicago Sativa leaves extract showed hypoglycemic effect both in intact animals and in animals with glucose load. 25 mg/kg of Medicago Sativa leaves extract decreased blood glucose level in intact animals at 4, 6 and 8 hours by 1.04, 1.14 and 1.11 times compared to the baseline level; the effect was comparable with herbal anti-diabetic «Arfazetin» tea and was inferior to metformin. A single 25 mg/kg dose of Medicago Sativa leaves extract showed hypoglycemic effect in animals with glucose load and significantly reduced blood glucose level in 15, 30, 60 and 120 minutes compared to control. Conclusion. The findings suggest that 25 mg/kg of Medicago Sativa leaves extract can be used as a herbal medication in the complex treatment of type II diabetes mellitus for its hypoglycemic properties.

Aim. To study the changes in prevalence of diabetes mellitus in the Republic of Azerbaijan in 1994-2012 and to predict the changes by 2030. Methods. The data of the number of patients with diabetes mellitus in the Republic of Azerbaijan were gained by analyzing official statistics of Ministry of Healthcare of the Azerbaijan Republic. The population of Azerbaijan in 1994-2012 was also analyzed. Microsoft Excel software package was used for prognosis calculation and graphical representation. Results. In 1994 40 438 patients with diabetes mellitus were registered in the Republic of Azerbaijan, in 2003 - 49 083 pa-tients, and in 2012 the number of patients with diabetes mellitus has reached 151 667 which was 375.06% compared to 1994 and 309.00% compared to 2003. Mid-annual change of the country’s population was calculated, with the gained data used for population prediction for 2030. According to the calculations, the number of officially registered patients with diabetes mellitus should reach 3.73% of the Azerbaijan Republic population by 2030. Conclusion. Statistical data show considerable growth in diabetes mellitus prevalence in the Republic of Azerbaijan. The prediction based on the last 9 years data allows to predict the increase of the number of officially registered patients with diabetes mellitus up to 380 178 patients by 2030, which will make 3.73% of the country’s population.

The main component of the treatment of patients with HIV infection is highly active antiretroviral therapy (HAART), which can help to control the disease. The main goal of HAART is to increase the life duration and to maintain the quality of patients’ life. Improved survival among HIV-infected patients receiving highly active antiretroviral therapy is achieved mainly by a decrease of HIV RNA viral load, which increases CD4 lymphocytes count. However, some patients may present with discordant response to treatment, when there is no CD4 lymphocyte count elevation associated with the virus disappearing from the blood. Such patients retain immunodeficiency, despite long-term treatment. The risk of opportunistic infections on the background of insufficient immunological response, despite viral replication suppression, is higher than in patients with good immunological response to treatment. Consistently low CD4 cell counts are associated with an increased risk of AIDS diagnosis. Furthermore, this group of patients shows a slight increase in mortality not associated with AIDS-defining illnesses. The reasons for the low CD4 lymphocytes count increase in some patients achieving virologic response to HAART remain unclear. The immunological efficacy of treatment depends on many factors: baseline CD4 count, duration of HIV infection prior to HAART initiation, age, co-infection with HCV, presence of secondary diseases and comorbidities, HAART regimens, IL-2 use and others. Literature review covers the phenomenon of immunological «non-response» to HAART, factors leading to its development, and possible methods of correction. Currently, there are more questions than answers in the area of immunological non-effectiveness of HAART in HIV-infected patients.

Article is devoted to the jubilee of V.V. Chirkovsky, who headed the Department of Ophthalmology of the Kazan University from 1922 to 1929, and was a rector of the University from 1923 to 1925. He was also the director of the wWorld’s first Trachoma Research Institute named after E.V. Adamyuk (Kazan). The article outlines his outstanding organizational skills, resulting in creating ophthalmologic departments and scientific schools of ophthalmology in Tomsk, Irkutsk, Perm, Kazan and Leningrad (Saint Peterburg). During his work in Kazan, V.V. Chirkovsky was elected as a rector of the Kazan University, in this position he served until 1925. He led the university during a harsh period: the country experienced economic collapse, university professors led a beggarly life, but he managed to preserve the two most important faculties of the university - medical and physic-mathematical, and to keep the professors of the university. The creation of Trachoma Research Institute allowed not only to strengthen the fight against trachoma in Tatarstan, but also to completely eliminate it in our and neighboring regions (Republic of Mari El, Bashkortostan, Udmurtia, etc.). In 1929 professor V.V. Chirkovsky moved to Leningrad, where he headed the Department of Ophthalmology of the 1st Leningrad Medical Institute and headed the Leningrad Research Institute of Ophthalmology named after Girschman until 1952. During his active life, professor V.V. Chirkovsky authored about 100 scientific papers on various aspects of ophthalmology. His main publications were related to the study of trachoma, the disease that he has defeated.

The aim of the research - to evaluate complex documentary archives stored in the Museum of History of Kazan State Medical University as a source providing evidence needed for the reconstruction of various historic events linked to high medical education in Kazan. Source-classification methods, as well as external and internal criticism of historical documentary sources were applied. The article discusses the features of the documentary sources study analysis of the documentary archives stored at the Museum of History of the Kazan State Medical University. Stages of forming of a number of documentary collections that became the product of faculties, institute and later university clinical and theoretical departments’ activities, are characterized. While structuring an array of written sources, the decision to allocate three fundamental stages that determined the particular characteristics of documentary collections creation was made. The features of numerous documents were considered; their value for reconstruction of separate aspects of national medical science development in general, as well as the activities of the Kazan medical schools in particular, were defined. As a result of the source-study analysis of the written sources deposited in the Museum of History of Kazan State Medical University five independent groups were allocated. These are collection of business documents; collection of state certification documents; collection of personal papers; collection of official documents reserving copyrights; collection of manuscripts of scientific researches of scientists-physicians. Results of research allow to determine the source value and information potential of documentary archives of the Museum of history of the Kazan State Medical University. Written sources fund is an important historical source for studying the history of the Kazan medical schools, in general, and individual medical scientists, in particular. From the source-study point of view, an extensive array of documents that were not previously included in the scientific examination and require comprehensive analysis, are of considerable interest. Among them there are documents of healthcare manager V.V. Treiman, internist V.F. Bogoyavlenskiy, neurologist L.I. Omorokov, etc. Thus, documentary collections contribute to the expansion of the source base for researches.