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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Current Issue

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Vol 15, No 4 (2023)

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Reviews

Impact of urate-lowering therapy on the course of chronic kidney disease in patients with asymptomatic hyperuricemia: a meta-analysis of randomized controlled trials
Mazurov V.I., Sayganov S.A., Martynov A.I., Bashkinov R.A., Gaydukova I.Z., Sapozhnikov K.V., Tolkacheva D.G., Sableva N.A., Tsinzerling A.Y.
Abstract

The presented study has been carried out to identify the effect of urate-lowering therapy with xanthine oxidase inhibitors on glomerular filtration rate and serum uric acid in patients with asymptomatic hyperuricemia and chronic kidney disease. A systematic review of randomized controlled trials has been conducted; its results based on meta-analysis has been evaluated.

A systematic search and selection of publications in Embase, PubMed, Cochrane Library, and eLibrary databases has been performed. The studied drugs were xanthine oxidase inhibitors: allopurinol and febuxostat. The study considered the following parameters such as efficacy endpoints, namely, glomerular filtration rate and serum uric acid after 3–15 months of follow-up. Clinical and methodological heterogeneity of the included randomized controlled trials has been assessed as well as publication bias and risk of systematic error. Synthesis has been performed using bivariate meta-analysis assessing residual statistical heterogeneity.

7 selected randomized controlled trials (1203 patients) have been included in the meta-analysis. This analysis revealed that medication urate-lowering therapy (allopurinol or febuxostat) was associated with higher glomerular filtration rate (+3.0 ml/min/1.73 m2; 95% confidence interval +0.4 to +5.6; p = 0.022) compared with the controls (placebo/no urate-lowering therapy) at 3–15 months of follow-up. Along with this, medication urate-lowering therapy (allopurinol or febuxostat) has been found to result in lower serum uric acid (−3.3 mg/dl; 95% confidence interval −3.8 to −2.8; р < 0.001) compared to the controls (placebo / no urate-lowering therapy) at 3–15 months of follow-up.

The results of the meta-analysis have demonstrated a positive role of allopurinol and febuxostat in increasing glomerular filtration rate and decreasing serum uric acid in patients with chronic kidney disease and asymptomatic hyperuricemia. The presented data suggest that therapeutic measures aimed at the elimination of asymptomatic hyperuricemia, including the use of xanthine oxidase inhibitors, may be important in slowing the progression of chronic kidney failure and may be additional factors of nephroprotection.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2023;15(4):5-18
pages 5-18 views
Enamel and dentin of human teeth. Fatigue strength
Silin A.V., Satygo E.A., Maryanovich A.T.
Abstract

The article provides a brief overview of the studies regarding changes in the structure and composition of teeth after eruption. The factors of degenerative changes in tooth structures and their relationship with non-carious lesions have been analyzed. The study makes emphasis on the tooth durability and the factors influencing tissue fatigue, explaining increased tissue wear due to local factors. Understanding mechanisms of metabolism of teeth hard tissues is the key to the stability of restorative treatments and occurrence of non-carious tooth lesions. The evolution of views on this problem is noteworthy. The literature review reveals the initial predominance of mechanical actions, abrasion, and mineralization. It is later complemented by a detailed analysis of the influence of destructive stresses and deformation due to mechanical factors. All the leading works of the 2000s are dedicated to analyzing the ultrastructural features of enamel that affect its mechanical characteristics and can explain both the characteristics of the shape and intensity of mechanical tooth wear during the functioning of the stomatognathic system, as well as the durability of the performed restorations. The literature review covers 74 sources over the past 15 years.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2023;15(4):19-29
pages 19-29 views

Original research

Strategy of stage treatment for patients with perforated diverticulitis: first experience
Bezmozgin B.G., Poryvaeva E.V., Pirozhkova E.A., Babkov O.V., Yastrebov I.P., Batyrshin I.M., Surov D.A., Demko A.E.
Abstract

BACKGROUND: The results of surgical treatment of patients with perforative diverticulitis of the colon are still unsatisfactory today. Since the majority of patients undergo Hartmann surgery, the main problem is a large number of stoma patients. Three quarters of them live with a stoma for a long time, which negatively affects their quality of life and increases the cost of treatment.

AIM: The purpose of this research work is to improve the immediate results of treating patients with perforative diverticulitis and peritonitis by using staged surgical tactics.

MATERIALS AND METHODS: The reaserach included 14 patients with perforative diverticulitis Hinchey grade II-III. The average value of the Mannheim peritoneal index is 18.9 ± 6.3 points. At the first stage of surgical treatment, all the patients underwent colon resection with a zone of perforation of the diverticulum and leaving its muffled ends in the abdominal cavity. After lavage and drainage, temporary closure of the anterior abdominal wall was performed. After 24–48 hours, all the patients underwent colon reconstraction.

RESULTS: The average age of the patients was 52.3 ± 12.4 years with 4 women (28.6%) and 10 men (71.4%). The average duration of the first stage was 105.7 ± 27.2 minutes, the second one — 113.2 ± 40.5 minutes. The average hospital-stays were 16.4 ± 7.2 days. There were no anastomosis failures and no lethal outcomes. Complications were noted in 9 patients (64.3%), grade I according to Clavien – Dindo — 83.4%.

CONCLUSIONS: The tactics of early surgical treatment is a promising concept for patients with perforative diverticulitis. It provides rapid elimination of the septic focus during the first surgical operation, assumes early reconstruction of the intestine without increasing the number of complications and mortality, and can be used in patients with peritonitis.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2023;15(4):31-40
pages 31-40 views
Factors of stroke misdiagnosis at the onset of myastenia gravis
Alibekov A.R., Goldobin V.V., Yuldashev H.F., Klocheva E.G., Lubenets I.A., Nurmakhanbetova A.Z.
Abstract

BACKGROUND: Myasthenia gravis is a rare autoimmune disease,which is difficult to diagnose mainly in the initial stages, when there are single symptoms of the disease or an atypical course. Diagnostic errors are associated with the fact that myasthenia gravis and other diseases of the nervous system have similar symptoms. The most common misdiagnosis in the onset of myasthenia gravis is a stroke. However, the reasons for a false diagnosis remain unspecified and poorly understood.

AIM: To determine the factors leading to misdiagnosis of a stroke in the onset of myasthenia gravis.

MATERIALS AND METHODS: 133 patients diagnosed with myasthenia gravis were divided into two groups. Patients with misdiagnosed stroke at the onset of myasthenia gravis formed the first group, the rest of the patients – the second group. A comparative assessment was performed according to the age of myasthenia onset, the clinical variant of the onset, primary symptoms, the duration of diagnosis, and the severity of the disease at the time of the correct diagnosis, with the percentage of misdiagnosis calculation.

RESULTS: Stroke as misdiagnosis was established more often than others (in 23% of all cases and in 44% of incorrect diagnoses). In the 1st group, complaints of dysarthria and dysphagia were significantly higher, myasthenia gravis began acutely more often, the age of myasthenia onset in patients of the 1st group was statistically higher than in the 2nd. There was no difference between the groups in terms of diagnosis duration, the disease severity, and the history of previous stroke.

CONCLUSIONS: Factors leading to stroke misdiagnosis at the onset of myasthenia are advanced age and acute onset with bulbar disorders.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2023;15(4):41-50
pages 41-50 views
The influence of comorbid diseases on the profiles of signaling biomarkers (macrophage-derived chemokine, interferon-γ-induced protein 10 kD, soluble CD40 ligand, vascular endothelial growth factor) and severity in patients with COVID-19: clinical studies
Anisenkova A.Y., Mazurov V.I., Apalko S.V., Popov O.S., Sushentseva N.N., Mamaeva O.P., Mosenko S.V., Sarana A.M., Shcherbak S.G.
Abstract

BACKGROUND: Analysis of the effect of comorbid diseases on the concentration of biomarkers will help to deepen the understanding of the pathogenetic mechanisms of the impact of comorbid diseases on the course of COVID-19 and adjust prognostic models for its therapy.

AIM: To study the impact of comorbid diseases on the severity and outcomes of COVID-19. In addition, an analysis of the levels of macrophage-derived chemokine, interferon-γ-induced protein 10 kD, soluble CD40 ligand, vascular endothelial growth factor has been carried out in 472 patients with COVID-19, depending on the presence of various forms of comorbid pathology.

MATERIALS AND METHODS: To study the concentration of biomarkers an analysis has been conducted in a group of 1648 patients with confirmed COVID-19. The study assessed intergroup differences (disease outcome/severity of disease) in the general group (1648 patients) and in the group of patients without comorbidity (343 patients) — Charlson index less than 2 points. 472 medical histories of patients with COVID-19 have been analyzed, including with certain concentrations of the studied biomarkers and comorbid pathology included in the Charlson Index. For comparison, two samples have been formed: an experimental group consisting of patients with COVID-19 and the presence of a certain comorbid disease and a control group consisting of patients suffering from COVID-19 without a specified comorbid disease.

RESULTS: For the first time, data has been obtained indicating that patients with COVID-19 have comorbid conditions with the levels of the studied biomarkers differing significantly from the indicators of the control group. Thus, in patients with arterial hypertension (I10–I15 according to the International Classification of Diseases, 10th revision), chronic heart failure (I50.0), diseases of the vascular system (I70–I79), cerebrovascular diseases (I60–I69), chronic kidney disease (N17–N19), the level of the macrophage-derived chemokine biomarker was significantly lower than in the patients without these diseases. At the same time, in the COVID-19 patients with respiratory diseases (J40–J47), the levels of interferon-γ-induced protein 10 kD and vascular endothelial growth factor were significantly lower than in the patients who did not have lung diseases.

CONCLUSIONS: The study findings obtained have confirmed the role of signaling biomarkers in the development of severe forms and death in patients with COVID-19. Significant influence of comorbid pathology on the course of the new coronavirus infection has been shown.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2023;15(4):51-63
pages 51-63 views

Case report

Surgical aspects of the treatment of a patient with actinomycosis of the colon complicated by the formation of a colovesical fistula
Sigua B.V., Kurkov A.A., Lataria E.L., Kozlova O.P., Gurzhiy D.V., Vinnichuk S.A., Efimov A.L., Chizhov G.V., Khvatov A.A., Zemlianoi V.P.
Abstract

Actinomycosis is a chronic bacterial infection caused by bacteria from the Actinomycetaceae family. The causes of abdominal actinomycosis are usually destructive appendicitis, prolonged presence of an intrauterine contraceptive or perforation of the colon. Of the internal organs, the left colon and sigmoid colon are most often affected, which often leads to surgical complications. At the same time, diagnosis is significantly difficult due to the nonspecific nature of the clinical presentation, which is similar to that of oncological diseases, and verification of the process is possible only with microscopic examination in a specialized institution.

A clinical case demonstrating the difficulties of diagnosis and treatment of widespread abdominal actinomycosis complicated by the development of a colovesical fistula is presented.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2023;15(4):65-72
pages 65-72 views
Pulmonary artery thrombosis. Clinical cases
Porembskaya O.Y., Tsaplin S.N., Lobastov K.V., Ilina V.A., Kravchuk V.N., Sayganov S.A.
Abstract

Accumulating evidence supports the need to consider pulmonary artery thrombosis the separate thrombotic complication, which requires its own treatment algorithms.

The aim of the work is to demonstrate the pulmonary artery thrombosis clinical aspects and the effect of the standard thrombotic prophylactic algorithms with clinical examples.

Clinical cases of patients with pulmonary artery thrombosis are presented. Pulmonary artery thrombosis is considered to be the thrombotic obstruction of the pulmonary artery branches in the absence of venous and cardiac chambers thrombosis.

Patient S. with COVID-19 and 75% of lung involvement was treated in the accordance with the actual COVID-19 treatment recommendations. Enoxaparin sodium 6000 IE once a day followed by the increasing dosage of 8000 IE twice a day was used. To prevent exacerbation tocilizumab was infused, and systemic thrombolytic therapy was performed. On the 6th day after systemic thrombolytic therapy patient died. Examination revealed thrombi in the pulmonary artery branches.

Patient P. with continued growth of cerebral left frontoparietal region glioblastoma was hospitalized. Surgical tumor removal was performed a year ago. Conservative therapy, dexamethasone injections and anticoagulant prophylaxis (enoxaparin sodium 4000 IE once a day) were prescribed. After the patient death thrombi were found in the pulmonary artery segmental branches.

Outpatient D. had a history of four episodes of dyspnea during the acute respiratory diseases. Computed tomography performed at the time of the third and fourth episodes revealed thrombi in the pulmonary artery segmental branches. The fourth episode occured despite anticoagulant prophylaxis with rivaroxaban (10 mg once a day). Patient was recommended to switch to low molecular weight heparins in case of any disease. There have been no recurrent episodes over the past 8 months.

Distinctive features of pulmonary artery thrombosis pathogenesis determine the development of the complication despite anticoagulant prophylaxis. Preventive effect of anti-inflammatory drugs on the pulmonary artery thrombosis development has not been demonstrated.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2023;15(4):73-79
pages 73-79 views
Retroperitoneal synovial sarcoma
Lisitsyn A.A., Zemlyanoy V.P., Kotkas I.Е., Bekhtereva I.A.
Abstract

Synovial sarcoma of the retroperitoneum is a rare and aggressive tumor. In some cases, differential diagnosis between retroperitoneal sarcoma and adrenocortical cancer is difficult due to the similar clinical and intrascopic manifestations of these neoplasms. The final diagnosis is established based on the results of histological, immunohistochemical and genetic studies. The most important step in the treatment of synovial sarcoma is complete removal of the tumor. However, despite the radical nature of the intervention, the incidence of local relapse and metastasis remains high.

AIM: to conduct a retrospective analysis of the parameters of operated patients with synovial sarcoma of the retroperitoneum.

This study is aimed at studying the results of examination and surgical treatment of patients with synovial sarcoma of the retroperitoneal space who were hospitalized in the E.E. Eichwald Clinic surgical department of the North-Western State Medical University named after. I.I. Mechnikov.

The patients were assessed for hormonal status using an immunoassay to determine the levels of adrenocorticotropic hormone, cortisol, aldosterone, renin, normetanephrine and metanephrine in the blood, and a dexamethasone suppression test has been performed at a dose of 1 mg. High-performance liquid chromatography has determined 6 glucocorticoids in the blood serum: cortisol, cortisone, corticosterone, 11-deoxycorticosterone, 11-dehydrocorticosterone, 11-deoxycortisol. The urine steroid profile was studied in all the patients using gas chromatography-mass spectrometry. All the patients underwent computed tomography of the abdominal organs and retroperitoneal space with contrast, morphological and immunohistochemical examination of the removed material. The material was fixed in 10% neutral buffered formalin. The pieces were then subjected to standard wiring followed by embedding in paraffin. Sections 2–3 microns thick were prepared from the resulting blocks and stained with hematoxylin and eosin. Immunohistochemical studies were performed on paraffin sections. A panel of monoclonal antibodies was used: protein S-100 (poly), pancytokeratin (AE1/AE3), EMA, cytokeratin-8, -18, chromogranin A, synaptophysin, α-inhibin, SOX-10, CD99, TLE-1, bcl- 2, GATA-3. Postoperative outcomes and follow-up were assessed according to the information in the medical records and data obtained from a telephone conversation with each patient. Statistical processing of the results has not been out due to rare cases of the disease.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2023;15(4):81-88
pages 81-88 views


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