Vol 12, No 1 (2020)


Inflammatory bowel diseases during the coronavirus pandemic: potential risks and ways to reduce them

Bakulin I.G., Skalinskaya M.I., Skazyvaeva E.V., Zhuravleva M.S.


This review is devoted to the current issues on management of the patients with inflammatory bowel diseases during the new coronavirus SARS-CoV-2 pandemic. Since March 2020, the World Health Organization with the support of international gastroenterological associations has launched a project for monitoring and reporting outcomes of COVID-19 occurring in inflammatory bowel diseases patients — SECURE-IBD aimed to define the impact of COVID-19 on patients with inflammatory bowel diseases and how factors such as age, comorbidities, and inflammatory bowel diseases treatments influence COVID outcomes (www.covidibd.org). According to the data of this Registry, no higher incidence of SARS-CoV-2 in patients with inflammatory bowel diseases compared to the general population has been reported. However, active inflammation, severe disease course, the induction period of immunosuppressive therapy and the use of systemic steroids are unfavorable predictors of severe COVID-19 infection course in case of inflammatory bowel diseases.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):5-10
pages 5-10 views

MicroRNA regulatory mechanisms in atherosclerosis

Gareev I.F., Beylerli O., Alyshov A.B.


Atherosclerosis is a chronic inflammatory disease of the arterial wall, characterized by a change in the intima of the arteries in the form of focal lipid deposits and the formation of a fibrous lid. Atherosclerosis is considered as the main cause of myocardial infarction, ischemic stroke and chronic lower limb ischemia. The pathogenesis of atherosclerosis is complex, and genetic mechanisms of atherosclerosis have not been fully investigated. The recent studies have shown that microRNAs (miRNAs) can play a role in the development of atherosclerosis. MiRNAs are short, non-coding RNA molecules 18–22 nucleotides in length that suppress gene expression at the post-transcriptional level by binding to the 3ʹ-untranslated region of mRNA targets. MiRNAs are involved in virtually all biological processes, including cell proliferation, apoptosis, and cell differentiation. MiRNAs control aging and dysfunction of endothelial cells, proliferation and migration of vascular smooth muscle cells, as well as cytokine synthesis and polarization of macrophages. In this paper, we focus on how miRNAs can influence the pathogenesis of atherosclerosis.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):11-20
pages 11-20 views

Original research

The comparison of revalcularization outcomes in acute coronary syndrom following primary coronary angioplasty

Abramova O.V., Saiganov S.A.


Purpose. To compare clinical and morphofunctional outcomes of revascularization in patients after primary coronary angioplasty with different degree of coronary arteries damage and type of myocardial infarction.

Material and methods. The research involved 258 patients after myocardial infarction who underwent coronary balloon angioplasty with stenting infarct-related artery. By electrocardiographic and angiographic picture all patients were divided into 4 groups: Q-wave myocardial infarction and without Q-wave myocardial infarction with single-vessel and multivessel disease.

Results. The study found that the patients with non Q-wave myocardial infarction and single-vessel disease had no adverse clinical outcomes during a year. The wall motion index and the ejection fraction almost recovered completely (wall motion index varied from 1.18 ± 0.02 to 1.05 ± 0.02 and ejection fraction — from 57.4 ± 0.5% to 63.3 ± 0.6%; р < 0.001). All the patients with Q-wave myocardial infarction revealed similar clinical outcomes and morphofunctional characteristics. The group of patients with non Q-wave and multivessel disease had the highest rate of adverse clinical outcomes with progressing left-ventricular disfunction according to echocardiography (wall motion index varied from 1.15 ± 0.01 to 1.19 ± 0.04 and ejection fraction — from 53.9 ± 0.5% to 55.1 ± 0.6%; р < 0.001).

Conclusion. The degree of coronary arteries damage in the patients with Q myocardial infarction did not influence postinfarction remodeling and long-term cardiac outcomes. The patients with non-Q myocardial infarction and single-vessel disease had fewer signs of postinfarction remodeling and complications in postinfarction period. The worst prognosis was revealed by patients with similar forms of myocardial infarction and multivessel disease.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):21-30
pages 21-30 views

The influence of tocilizumab immunogenicity markers on the effectiveness of treating rheumatoid arthritis

Nazarov V.D., Lapin S.V., Tulenko K.V., Samigullina R.R., Mazurov V.I.


Purpose. The study assesses the impact of tocilizumab immunogenicity markers on clinical response to conducted treatment in patients with rheumatoid arthritis.

Materials and methods. A total of 17 patients with the confirmed diagnosis of RA receiving tocilizumab therapy for more than 1 year were enrolled into the study. Blood serum samples were collected once every six months before every drug injection during 2.5 years of treatment. The concentration of antibodies to tocilizumab and level of tocilizumab was determined using the ELISA. Additionally, DAS28 values were measured at the first and the last patient visit during the course of study, whereas levels of C-reactive protein (CRP), white blood cells, platelets, rheumatoid factor, and circulating immune complexes were only measured at the last examination.

Results. Positive correlations between the antibodies to tocilizumab and the last point DAS28 values were found, as well as a negative correlation of tocilizumab level and the level of DAS28.

Conclusions. The data obtained indicate a significant effect of serum levels of tocilizumab, as well as of the concentration of antibodies to tocilizumab on the effectiveness of RA treatment. A routine study of these biomarkers might be useful for individualizing treatment approaches for RA patients and determining the causes of tocilizumab resistance.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):31-36
pages 31-36 views

Gallbladder microbiota in patients with gallstone disease

Simanenkov V.I., Suvorov A.N., Tikhonov S.V., Ermolenko E.I., Dekkanova V.D., Goncharov A.E., Tkachev P.V., Bakulina N.V.


The article presents the results of investigating 20 patients with cholelithiasis. The bile and a piece of the gallbladder were taken to analyze microbiota during a scheduled laparoscopic cholecystectomy. The study of microbiota was carried out with the cultural method and real-time PCR. Bifidobacterium spp., Bacteroides spp., Lactobacillus spp., E. coli prevailed in the taxonomic structure of isolated bacteria. Isolated Enterococcus spp. had a lot of genes encoding various factors of pathogenicity.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):37-44
pages 37-44 views

Application of nanostructured carbon implants in surgical treatment of transverse flat feet

Savintsev A.M., Sorokin I.V.


This article discusses the modern method of treatment of transverse flat feet using carbon nanostructured implants. The characteristic features of the installation, recovery period, features of consolidation, cosmetic and functional results are analyzed. Based on the research, the disadvantages of the method, its characteristics and features were identified, and the results were compared with the data stated by the implant manufacturer

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):45-52
pages 45-52 views

Use of breath testing in gastrointestinal disorders

Plavnik R.G., Nevmerzhitsky V.I., Butorova L.I., Bakulina N.V.


The article presents the data and review of the North American Consensus (2017) recommendations on the use of hydrogenmethane breathing test in diagnosing gastrointestinal disorders accompanied by excessive bacterial growth in the small intestine. On May 16, 2015, 17 leading scientists specializing in breathing tests took part in a consensus meeting in Washington (DC, USA). By a voting method, 28 consensus statements were identified and recommendations were given on the following issues regarding the use of the hydrogen-methane the procedure itself test in gastroenterological practice: 1) preparation for a breathing test; 2) indications for a breathing test; 3) the procedure itself; 4) interpretation of results; 5) gaps in the knowledge and unresolved issues.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):53-62
pages 53-62 views

Pathomorphological characteristics of myocardial infarction complicated by rupture

Kovalchuk E.Y., Povzun A.S.


The report presents the results of a pathoanatomical study of 81 cases of postinfarction cardiac rupture. The terms of development of cardiac rupture and comorbid background of patients are specified. Inconsistences of in vivo diagnostics of both ischemic heart disease and comorbid diseases, the results of autopsies were revealed.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):63-70
pages 63-70 views

Anti-parietal cell antibodies seroconversion in patients with autoimmune atrophic gastritis: a prospective study

Sablina A.O., Aleksanin S.S., Sablin O.A.


The purpose of the study was to evaluate the atrophic changes of body and antrum gastric mucosa, the occurrence of Helicobacter pylori infection and the possibility of seroconversion in patients with autoimmune gastritis throughout 10 years.

Material and methods. 203 Chernobyl nuclear power plant accident recovery workers were included in the prospective study. Blood levels of anti-parietal cell antibodies, basal gastrin-17, pepsinogens I and II were evaluated in all the patients to diagnose autoimmune gastritis and to assess gastric mucosa non-invasively.

Results. Anti-parietal cell antibodies were found in 34.5% of the patients. Eradication rates were low (32.8–50.0%) in the patients with atrophy of gastric mucosa in the first 3 years of observation. Statistically significant decrease in pepsinogen I and gastrin-17 serum levels was observed in the patients with H. pylori-associated autoimmune gastritis throughout first 4–6 years. In the next 7–10 years pepsinogen I and gastrin-17 serum levels were increasing possibly due to positive effect of H. pylori eradication therapy. Successful eradication leads to disappearance of anti-parietal cell antibodies in 33.4% of the patients by the 10th year of the observation.

Conclusion. The obtained results show that H. pylori eradication therapy is effective in reducing atrophic changes of gastric mucosa in the patients with autoimmune gastritis. Against the background of successful treatment the levels of pepsinogen I and gastrin-17, the markers of body and antrum gastric mucosa atrophy, were increasing. In the patients with autoimmune gastritis but without H. pylori infection the following trend was not noticed.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):71-78
pages 71-78 views

Case report

New modification of the Albrecht–Staveley operation for treating aorto-mesenteric compression of the duodenum

Sigua B.V., Zemlyanoy V.P., Kachiuri A.S., Fetisov K.V., Zakharov E.A., Melnikov V.A.


Aorto-mesenteric compression of the duodenum (Wilkie syndrome, upper mesenteric artery syndrome) is one of the causes of chronic duodenal obstruction. This condition is caused by compression of the horizontal branch of the duodenum between the abdominal aorta and the superior mesenteric artery, departing from the aorta at an acute angle. Among the causes of this pathological condition, an asthenic physique, pronounced weight loss in a short period of time, and others are distinguished. Currently, the main component of eliminating aorto-mesenteric compression is surgical intervention. Among other surgical methods, the most optimal is duodeno-jejunostomy according to Albrecht–Staveley. However, when this surgical intervention is associated with a high risk of developing a ‘vicious circle’ syndrome. The developed modification of the Albrecht–Staveley operation aims to minimize the risks of developing the ‘vicious circle’ syndrome.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):79-84
pages 79-84 views

Successful treatment of patient with thoracoabdominal injury with heart and esophageal trauma (clinical case).

Babich A.I., Tulupov A.N., Taniya S.S., Demko A.E.


The article presents a case of treating the patient with extrapleural thoracoabdominal injury with heart and esophageal trauma. Examination of the patient in a shock trauma operating room, the use of minimally invasive technologies (thoracoscopy, laparoscopy) allowed to choose the right treatment tactics, timely identify all injuries and eliminate them. The presented clinical observation demonstrates the feasibility of using video thoracoscopy and video laparoscopy in hemodynamically stable patients with penetrating thoracoabdominal wounds to detect damage to the heart and esophagus.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):85-87
pages 85-87 views

On the question of differential diagnosis of multifocal motor neuropathy

Sokolova M.G., Lobzin S.V., Zuev A.A., Pustozerov V.G., Aleksandrov N.Y., Gavrichenko A.V.


Differential diagnostics of multifocal motor neuropathy (MMN) has many difficulties associated with a number of factors: rare nature of disease, polymorphic clinical forms and a phenotypic picture similar to peripheral motor neuron diseases. Such diseases also include rare nosological forms: amyotrophic lateral sclerosis, hereditary myopathies and neuropathies; their general phenotypic picture has a form of progressive flaccid paralysis, age of the disease onset and the nature of its course. However, different pathogenesis of these diseases requires a differentiated approach to therapy.

This article deals with differential diagnostics of multifocal motor neuropathy, gives examples of modern diagnostic criteria necessary for diagnosing multifocal motor neuropathy and analyzes a clinical case with an incorrect diagnosis of multifocal motor neuropathy.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):89-96
pages 89-96 views

Diagnosis and surgical treatment of acute intestinal obstruction caused by extragenital form of endometriosis

Zemlyanoy Z.P., Sigua B.V., Syomin D.S., Gurzhiy D.V., Qalandarova D.H.


Damage to the gastrointestinal tract with extragenital endometriosis is a very rare pathology. According to the literature, the frequency of damage to the gastrointestinal tract in endometriosis, after previously performed gynecological operations, is less than 1%. At the same time, involvement in the pathological process of the intestine is noted in 3–37% of women of childbearing age with diagnosed genital endometriosis. In most clinical cases extragenital endometriosis occurs intraoperatively due to the complexity of early diagnosis.

This article presents a clinical case of successful surgical treatment of a 43-year-old patient admitted to a surgical department with signs of intestinal obstruction. According to the anamnesis the patient had been suffering from recurrent pains in the lower abdomen in the right mesogastrium and constipation. The day before hospitalization, the above mentioned symptoms become worse with additional nausea, vomiting, lack of gases and feces. Based on the clinical laboratory and instrumental data the diagnosis of acute intestinal obstruction was established; and the urgent surgical treatment was carried out. Two formations were revealed intraoperatively (in the terminal ileum and in the elongated loop of the sigmoid colon). Both formations circularly narrowed the intestinal lumen, however the ileum was the cause of obstruction. Due to the lack of histological verification and the inability to exclude the malignant nature of the formation, the surgical treatment was carried out taking into account oncological standard in the amount of ileum resection and obstructive resection of the sigmoid colon with lymphadenectomy and small intestine intubation. Pathohistological examination confirmed intestinal endometriosis. The course of the postoperative period revealed no complications. The patient was discharged on the 12th day for outpatient treatment under the supervision of a surgeon and a gynecologist at the place of residence with recommendations and subsequent planned hospitalization in order to conduct reconstructive surgery to restore intestinal patency.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2020;12(1):97-101
pages 97-101 views

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