HERALD of North-Western State Medical University named after I.I. Mechnikov
Journal: Рeer-review medical academic journal
History: publishes from 2009
The target audience of a peer-reviewed journal "HERALD of North-Western State Medical University named after I.I. Mechnikov" is faculty members of medical universities and institutions of additional professional education, for research staff, as well as for practitioners of various specializations.
The "HERALD of North-Western State Medical University named after I.I. Mechnikov" publishes original articles written by experts of different fields of clinical and preventive medicine, public health, biomedical and pharmaceutical sciences, scientific lectures, scientific reviews and discussions, as well as highlights various issues concerning the advanced training of practitioners.
The Editorial board cooperates with the faculty members of the leading research institutes and medical schools of Russia.
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Vol 16, No 2 (2024)
- Year: 2024
- Published: 03.07.2024
- Articles: 11
- URL: https://journals.eco-vector.com/vszgmu/issue/view/8760
Reviews
Prospects for using machine learning to improve coronary angiography
Abstract
Cardiovascular diseases pose the main threat to the population health of the Russian Federation and rank the first among the causes of death. Coronary heart disease has the highest standardized mortality rates among the population of the Russian Federation. Comprehensive diagnosis of coronary artery disease includes assessment of coronary atherosclerosis using both non-invasive methods, such as multispiral computed tomography of the coronary arteries, and invasive ones, including coronary angiography, and sometimes intravascular imaging. First two methods are the two most important diagnostic methods for coronary heart disease.
The widespread use of medical technologies based on artificial intelligence in recent years has led to the emergence of new diagnostic and therapeutic opportunities. Artificial intelligence has bridged the gap between massive datasets and useful information by processing and analyzing important data at an unprecedented rate.
The review identifies five potential cases with machine learning having significant prospects in the field of coronary angiography: improving quality and effectiveness, determining plaque characteristics, assessing hemodynamics, predicting disease outcomes and diagnosing non-atherosclerotic lesions of the coronary arteries. While machine learning has transformative potential in the field of coronary angiogram analysis, careful consideration of limitations, including data exchange protocols and interpretability of models is essential to fully exploit its potential and ensure optimal diagnosis and treatment of patients.
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Multimorbid pathology at psoriasis (scientific review)
Abstract
Chronic auto-inflammatory process in psoriasis is associated with the involvement of internal organs and systems, as well as the development of several systemic disorders: heart failure, psoriatic arthritis, diabetes, obesity, etc. In this regard, the purpose of our study is to integrate information about comorbid and concomitant pathology in patients with psoriasis. Data on the biological aspects of the increased risk of occurrence and adverse cardiovascular outcome of myocardial infarction, stroke and cardiovascular mortality in patients with psoriasis are supported by clinical observations on the relationship of the course of coronary heart disease with the area of skin lesion. The association between the presence of obesity and an increased level of proinflammatory cytokines has been confirmed, which may be one of the triggers for the development of psoriatic arthritis associated with early disability of patients with psoriasis. There was a greater incidence of non-response to psoriasis treatment among obese patients. Cardiovascular complications are the most common cause of death for patients with psoriasis. Identifying common combinations of comorbid and concomitant diseases in the main chronic disease can serve as a basis for the development of tactics and criteria for patient management in order to optimize treatment.
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The role of selenium in the pathogenesis and therapy of inflammatory bowel diseases
Abstract
In recent decades, Russia, as well as around the world, has recorded a steady increase in the incidence of inflammatory bowel diseases, which include ulcerative colitis and Crohn’s disease. The incidence of inflammatory bowel diseases in Russia accounts for 4.1 per 100 thousand of the population for ulcerative colitis and 0.8 per 100 thousand – for Crohn’s disease. The prevalence of inflammatory bowel diseases in Russia is 19.3–29.8 cases per 100 thousand of the population for ulcerative colitis and 3.0–4.5 per 100 thousand – for Crohn’s disease.
In recent years, selenium has attracted the attention of researchers due to its anti-inflammatory and antioxidant properties as well as its ability to influence the intestinal flora. There is evidence that inflammatory bowel diseases has deficiency of trace elements, which is more often detected during active period of the disease than during remission.
The purpose of the review is to summarize and analyze current literature data on the relationship between selenium and inflammatory bowel diseases, with special emphasis on the mechanism and function of selenium in intestinal inflammation as well as to discuss the possible therapeutic use of selenium in inflammatory bowel diseases. The authors conducted a search for publications in the electronic databases PubMed and eLibrary. After the selection procedure, 87 studies were included in the review.
Due to its anti-inflammatory and antioxidant properties, the concentration of selenium can be crucial in the occurrence and development of inflammatory bowel diseases. Dietary recommendations with the inclusion of selenium gradually improve the quality of life of patients with inflammatory bowel diseases. The development and use of selenium drugs have also provided new therapy strategies. In the future, a large number of experimental and clinical studies are still needed to confirm the relationship between selenium and inflammatory bowel diseases, which, in turn, will mark a new turn in the prevention and treatment of these severe chronic diseases.
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Original research
The effect of Streptococcus mutans, Candida albicans and other cariesogenic factors on the concentration of cathelicidin LL-37 in oral fluid in children with early childhood caries
Abstract
BACKGROUND: Human antimicrobial peptides play a significant role in innate immunity. In the oral cavity salivary glands and mucosal epithelium produce human antimicrobial peptides, including defensins and cathelicidin LL-37. Cathelicidin is the most significant peptide protecting against different types of infections, controls the activity of commensal bacteria and prevents colonization and growth of pathogenic bacteria.
AIM: To determine the concentration of cathelicidin LL-37 in the oral fluid of children 2–5 years old and the oral hygiene index depending on some of the parameters and intensity of the carious process in the oral cavity.
MATERIALS AND METHODS: The study was conducted in a group of children aged 2-5 years old; the concentration of catelicidine in the oral fluid was determined by enzyme immunoassay. Moreover, the concentration of Streptococcus mutans in saliva, the presence of Candida albicans in dental plaque, oral hygiene index and the concentration of 25-hydroxycalciferol in venous blood were assessed in these children.
RESULTS: The stydy revealed the dependence of the concentration of cathelicidin in the oral fluid on the intensity of the carious process in children as well as on the concentration of Streptococcus mutans in saliva, the presence of Candida albicans in plaque and poor oral hygiene.
CONCLUSIONS: It was found that in children with high intensity of caries, the concentration of antimicrobial peptide LL-37 is twice lower than in children with low and medium intensity of early childhood caries.
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Periostin as a marker of eosinophilic inflammation in patients with asthma and chronic obstructive pulmonary disease
Abstract
BACKGROUND: Asthma and chronic obstructive pulmonary disease are common chronic respiratory diseases. Given their heterogeneity, the study of periostin is a relevant area for establishing the endotypes of airway inflammation and determining further therapy tactics.
AIM: To evaluate periostin levels and determine its significance as a marker of eosinophilic inflammation in patients with asthma and chronic obstructive pulmonary disease.
MATERIALS AND METHODS: The study included 59 patients with asthma and 33 patients with chronic obstructive pulmonary disease. The control group consisted of 37 apparently healthy people, comparable in age and sex, without allergic and bronchial obstructive diseases in anamnesis. The anamnesis data, the number of peripheral blood eosinophils and induced sputum, indices of external respiratory function were evaluated. Levels of specific immunoglobulin E to allergens, periostin level were determined in blood serum by immunoenzyme method. The obtained data were processed using STATISTICA 13 and SPSS Statistic 27 software systems.
RESULTS: The maximum serum periostin concentration 22.5 (17–38) ng/ml was recorded in the patients with asthma, which was significantly higher than in the chronic obstructive pulmonary disease group [16 (12–21) ng/ml; p = 0.006] and control group [20.1 (14.6–24.8) ng/ml; p = 0.044]. The level of periostin in induced sputum in the patients with asthma was significantly higher than in the chronic obstructive pulmonary disease group — 0.05 (0.03–0.6) ng/ml vs 0.03 (0.02–0.04) ng/ml (p = 0.008). The study revealed the correlation between serum periostin level and eosinophil level (r = 0.406; p < 0.05) and with forced expiratory volume in the first second after bronchodilator test (r = 0.366; p < 0.05) as well as with forced expiratory volume in the first second divided by forced vital capacity after bronchodilator test (r = 0.572; p < 0.05).
CONCLUSIONS: Periostin is a promising marker of eosinophilic inflammation in patients with asthma, which can be considered as an indicator of fixed bronchial obstruction and a molecule linking T2-inflammation and airway remodelling. In a group of chronic obstructive pulmonary disease patients, the use of periostin for diagnostic and prognostic purposes requires further investigation and larger studies.
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Registry of patients with autoimmune liver diseases in St. Petersburg: clinical and epidemiological data
Abstract
BACKGROUND: The problem of autoimmune liver diseases, which include autoimmune hepatitis, primary biliary cholangitis, primary sclerosing cholangitis and their overlap syndromes is an urgent problem of modern medicine. This is associated with an increase in the incidence and prevalence of these nosologies in different regions of the world. Absence of an established etiological factor, prolonged asymptomatic or low-symptomatic course, lack of pathognomonic clinical picture, imperfect diagnostic criteria, insufficient awareness of physicians lead to late diagnosis of autoimmune liver diseases and, accordingly, untimely initiation of treatment, which often reduces its effectiveness, affecting the further prognosis and survival rate for this group of patients. Patients with autoimmune liver diseases require long-term, often lifelong therapy and dispensary observation. Epidemiological registries along with autoimmune liver diseases registries, including various nosologies of autoimmune liver diseases, form an important database on the incidence, clinical features, development and course of the disease, variants of therapy and response to therapy, presence of extrahepatic manifestations as well as allow analysis of all data in dynamics.
AIM: To analize data on various nosologies of autoimmune liver diseases, demographics, clinical symptoms, timing of the first symptoms, timing of diagnosis, and the nature of extrahepatic manifestations.
MATERIALS AND METHODS: This article presents data from the autoimmune liver diseases Register of the North-West Hepatology Centre (North-West Autoimmune Liver Diseases Register) of the North-Western State Medical University named after I.I. Mechnikov.
RESULTS: The study obtained data on the nosological structure, demographic characteristics, timing of diagnosis verification, clinical symptoms and extrahepatic manifestations of autoimmune liver diseases.
CONCLUSIONS: Establishing registers of autoimmune liver diseases, providing information about patients with these diseases, will help to assess the effectiveness of examination and treatment methods, factors affecting the course and prognosis of the disease. Analysis of the data obtained will help to develop screening programs, diagnostic algorithms and differential diagnostics of autoimmune liver diseases, which, in turn, will facilitate the diagnostic process, shorten the time of diagnosis, make it possible to start therapy earlier and, consequently, improve the prognosis and survival rate for this group of patients.
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Registration of jaw centric relation with different deprogramming devices
Abstract
BACKGROUND: There are several methods to register jaw centric relation for diagnosis and therapy of dysfunctional disorders of the temporomandibular joint. However, there is insufficient information in the literature regarding the choice of the optimal way to determine this indicator.
AIM: To compare different methods for recording jaw centric relation according to the data of the computed tomography of temporomandibular joint.
MATERIALS AND METHODS: The study includes participants with increased abrasion of hard tooth tissues and symptoms of musculoskeletal dysfunction of the temporomandibular joint. The main group (80 people) has been recorded jaw centric relation using deprogramming devices (Lucia jig — 1st subgroup, Kois deprogrammer — 2nd subgroup, sheet calibrator — 3rd subgroup, deprogrammer in combination with M. Rocаbado kinesiotherapy elements — 4th subgroup). The control group included 20 participants, who had not had deprogramming before registration of jaw centric relation. The results were monitored using computed tomography of temporomandibular joint and subsequent assessment of the sizes of the TMG articular gap in the coronary and sagittal sections at 3 stages of the study: diagnostic, after registration of jaws central relation and prosthetic treatment and 6 months after prosthetic rehabilitation. Since there were no more than 50 observations in each group, the Shapiro–Wilk W-test was used to verify compliance with the norm.
RESULTS: According to the data obtained, the parameters of the temporomandibular joint gap have changed in the main group of the 1th subgroup, where indicators are approaching the physiological norm (98% of cases). In the 2nd subgroup, 90% of the participants show a tendency to conform to the physiological norm. The exception is 10% of the participants with no tendency of improvement. The smaller part (75%) of the participants of the 3rd subgroup observed compliance of the parameters of the articular gap with the criteria of the norm. The dimensions of the anterior part of the articular gap of the temporomandibular joint exceed the dimensions of the distal part, which indicates the anterior position of the temporomandibular joint. Some patients in this group (25%) showed no positive results of computed tomography measurements after jaws centric relation registration. In the 4th subgroup, the patients returned to normal values (100% of the cases). The positive effect of prosthetic treatment and restoration of the position of the articular heads of the temporomandibular joint were obtained in 45 % of the participants in the control group. However, in 55% of the participants the location of the articular gap of the temporomandibular joint did not improve.
CONCLUSIONS: Lucia jig in combination with the M. Rokabado’s complex of cranial-postural kinesiotherapy is the most effective method to register jaw centric relation within this study. The remaining methods are also applied among prosthetic dentists and gnathologists. However, in each clinical situation, it is necessary to consider temporomandibular joint pathology indications, type and degree of severity as well as the technical and financial capacity of both doctor and patient.
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Morphological features of the synovial membrane in patients with osteoarthritis after knee arthroplasty
Abstract
BACKGROUND: Inflammation of the synovial membrane is a common manifestation in osteoarthritis which plays a role in complex pathophysiology of osteoarthritis. Synovitis leads to complications during knee replacement.
AIM: To give clinical and morphological characteristics of the knee joint condition by histological assessment of the synovial membrane.
MATERIALS AND METHODS: In the clinic of traumatology and orthopedics of North-Western State Medical University named after I.I. Mechnikov in 2022, 187 total knee arthroplasty operations were performed in patients with osteoarthritis. For morphological study of the synovial membrane of the knee joint biopsy specimens were taken from 30 patients (19 women and 11 men) by randomized sampling method. The age of patients: from 40 to 76 years, the average age was 59,3 ± 6,7 years. Immunohistochemical reactions were performed to characterize the cellular composition of the inflammatory infiltrate; antibodies to CD68, CD3, CD20, CD138, Ki-67 were used. Morphometry was performed at ×400 magnification.
RESULTS: Only 48 (25.7%) patients had at least one course of inpatient conservative or minimally invasive surgical treatment for osteoarthritis of the knee joint before total knee arthroplasty. 18 (9.6%) patients had intraoperative and postoperative complications. Among 30 morphological studies conducted, 3 (10%) patients had verified stage I osteoarthritis of the knee joint, 8 (26.7%) were diagnosed with stage II osteoarthritis, and 19 (63.3%) — stage III osteoarthritis. Significant correlation was obtained between cells stained with antibodies to CD3 and CD20 (r = 0.69; p < 0.05), CD68 and CD138 (r = 0.66; p < 0.05). Cluster analysis identified three groups of patients with severe (10%), moderate (30%) and weak/absent infiltration (60%).
CONCLUSIONS: To correct the treatment strategy for patients with osteoarthritis of the knee joint, it is advisable to strengthen the role of arthroscopic methods in the diagnostic and treatment processes.
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Intrahepatic cholestasis of pregnancy: current clinical and treatment and diagnostic approaches
Abstract
BACKGROUND: The article is devoted to the current problem of intrahepatic cholestasis of pregnancy. This disease complicates the course of pregnancy, worsens the quality of life of patients and is a predictor of obstetric and perinatal complications.
AIM: To analyze clinical features, epidemiology, treatment, and diagnosis of patients with verified intrahepatic cholestasis of pregnancy, to study the relationship between the level of bile acids and the severity of skin itching and the development of complications in newborns.
MATERIALS AND METHODS: Using a retrospective analysis technique, medical histories of patients with intrahepatic cholestasis of pregnancy were studied.
RESULTS: Verified intrahepatic cholestasis of pregnancy was found to be associated with the age over 30 years old, high baseline body mass index (more 25 kg/m2), and with consecutive pregnancy. Most patients (64%) were diagnosed with intrahepatic cholestasis after 36 weeks of pregnancy. Skin itching is the main clinical symptom of intrahepatic cholestasis of pregnancy, which in most cases (46.7%) was pronounced. Meanwhile, the intensity of itching, depended on the level of bile acids (p = 0.00000000001). There is a relationship between the degree of increased levels of bile acids and the appearance of various respiratory disorders in newborns (p = 0.003).
CONCLUSIONS: The topic under consideration will be of interest to specialists in the field of obstetrics and gynecology, gastroenterology, hepatology, and therapy. The issue of diagnosis and treatment of intrahepatic cholestasis of pregnancy requires further study.
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Prevention and correction of micronutrient deficiencies. What do we know about it?
Abstract
BACKGROUND: Micronutrient deficiencies, including deficiencies of vitamins and microelements, are a major public health concern worldwide. They are highly prevalent, particularly in developing countries, and have significant health consequences, including anemia, impaired immune function, cognitive impairment, and growth retardation. Micronutrient deficiencies can also contribute to the development of chronic diseases, such as cardiovascular disease and diabetes. Micronutrient deficiencies can also contribute to the development of chronic diseases.
AIM: To study the knowledge, interest and motivation of different population groups regarding vitamin and micronutrient intake.
MATERIALS AND METHODS: The original questionnaire with 45 questions was completed by 344 respondents: 141 (41%) without medical education, 91 (25.4%) with higher medical education, 112 (32.6%) by students of medical unvesities.
RESULTS: Only 100 (29.4%) respondents considered their nutrition balanced. 180 (52.3%) people did not consume vegetables and fruits on a daily basis, 82 (23.3%) respondents almost never consumed fish and seafood. Almost all respondents [335 (97.4%)] took some vitamin and mineral complex at least in one of the periods of their life, 284 (82.6%) — did it without a doctor’s prescription. Female respondents demonstrated a higher level of knowledge about the problem under study: 115 (41.9%) women and only 17 (24.2%) men had checked vitamin D levels (p = 0.006), while 187 (68.2%) women and only 33 (47.1%) men had taken vitamin D (p = 0.006). Those receiving/having higher medical education were more likely to take vitamin D (4.4 times), vitamin B6 (3.8 times), selenium (3 times), and zinc (2.8 times) than non-medical respondents.
CONCLUSIONS: The nature of nutrition indicates potential risks of micronutrient imbalance in the respondents. Knowledge about the problem of micronutrient imbalances among the study participants is not systematized. Men and people without medical education have less knowledge on this topic and are less likely to take various micronutrients.
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Case report
Clinical cases of vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA vasculitis) induced by COVID-19
Abstract
COVID-19 is similar to immunoinflammatory rheumatic diseases in clinical manifestations, immune responses and pathogenetic mechanisms. Specific autoantibodies as markers of autoimmune diseases can be detected in patients with coronavirus infection. Most often, after COVID-19, antinuclear antibodies, antibodies to phospholipids, to cardiolipin, to β2-glycoprotein, to cytoplasmic antigens SS-A and SS/B, and cyclic citrulline-containing peptide are detected. In moderate and severe cases of COVID-19 infection with pulmonary-renal syndrome, cytokine storm, antineutrophil cytoplasmic antibodies, antibodies to myeloperoxidase and to proteinase 3 have become more frequent, which can trigger neutrophil NETosis with the formation of extracellular neutrophil traps — networks and induce the development of autoimmune processes and the appearance of de novo immunoinflammatory rheumatic diseases: arthritis , systemic lupus erythematosus, vasculitis associated with antineutrophil cytoplasmic antibodies (ANCA vasculitis). Our study presents 4 clinical cases of patients with ANCA vasculitis with a history of recent coronavirus infection, chronologically verified. The average time after COVID-19 and the onset of ANCA vasculitis was about 3 months; damage to the upper respiratory tract, lower respiratory tract, skin and renal syndromes were observed. The severity of ANCA vasculitis did not depend on the severity of coronavirus infection: a mild course of COVID-19 infection did not exclude a severe course of ANCA vasculitis. It is recommended that all patients during and after coronavirus infection with post-COVID syndrome in the presence of damage to the ENT organs, kidneys, and skin are screened the presence of antineutrophil cytoplasmic antibodies to exclude the onset of ANCA vasculitis.
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