Open Access Open Access  Restricted Access Access granted  Restricted Access Subscription or Fee Access

Vol 13, No 4 (2021)

Cover Page

Full Issue

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access


Drug-induced pleural diseases

Ostroumova O.D., Smetneva N.S., De V.A.


The problem of differential diagnosis of pleural diseases involves a large number of pathological conditions causing its damage, which physicians are not aware about. Drug-induced (DI) lesion occupies a special place in the structure of pleural diseases, both due to the relatively low prevalence and due to insufficient awareness of doctors about the presence of such adverse reactions in drugs. At the same time, thanks to modern information about the morphology, physiology and pathophysiology of the pleura and pleural cavities, the diagnosis and treatment of pleural diseases are becoming more and more effective. The article presents the data of modern literature and electronic databases of The Drug-Induced Respiratory Disease Website about DI lesions of the pleura. This review provides information about the main types of DI lesions of the pleura and the scope of drugs that cause these reactions. Ultimately, doctors’ awareness of drug-induced pleural diseases can ensure timely diagnosis of these conditions, correct therapy, and ultimately improve the quality of medical care.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(4):5-14
pages 5-14 views

Stimulation of bone regeneration using bone morphogenetic proteins: modern concepts

Mukhametov U.F., Lyulin S.V., Borzunov D.Y., Gareev I.F.


It is known that the restoration of fractures or bone defects after trauma is one of the urgent problems of modern orthopedics and traumatology. Bone morphogenetic proteins (BMPs) are a group of growth and differentiation factors that are a large subfamily of the transforming growth factor-β (TGF-β) superfamily. To date, more than 20 types of different BMPs have been identified based on structural similarities, and it has been found that some of them, like BMP-2, -4, -6, -7, and -9, have the most pronounced osteogenic properties. BMPs induce migration, proliferation, and differentiation of undifferentiated mesenchymal stem cells to form osteoblasts and chondroblasts. BMPs have significant inductive effects on various stages of the bone healing process, such as inflammation, angiogenesis, callus formation, and bone remodeling. It is known that recombinant (rh) rhBMP-2 and rhBMP-7 (approved for clinical use in humans by the USA Food and Drug Administration (FDA)), together with the use of bone grafts, they are used to activate reparative osteogenesis in injuries and to replace bone defects in spinal surgery. Therefore, due to its unique properties, the use of BMPs in bone tissue regeneration is one of the most promising and rapidly developing directions in practical medicine. This review discusses the most important concepts regarding the use of BMPs in stimulating bone regeneration, including their mechanisms of action, modes of use, efficacy, and their advantages and disadvantages.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(4):15-30
pages 15-30 views

Angiotensin converting enzyme inhibitors and angiotensin II receptor blockers: which class of drugs should be preferable for patients with cardiovascular pathology?

Stolov S.V., Privalov K.A.


The article presents a comparative analysis on the effectiveness of two classes of drugs — angiotensin converting enzyme inhibitors (ACE inhibitors) and angiotensin II type 1 receptor blockers (ARB II) for patients with cardiovascular diseases: arterial hypertension, heart failure, coronary heart disease, ischemic brain disease. The advantage of ACE inhibitors over ARB II in reducing the risk of general and cardiac mortality, myocardial infarction, cerebral strokes, chronic heart failure, chronic kidney disease has been established. The positive effect of ACE inhibitors on the course of a new coronavirus infection is also demonstrated. The mechanisms of action of both classes of drugs are proposed for discussion, which substantiate the advantage of ACE inhibitors over ARB II from the standpoint of pathophysiology in relation to controlling major cardiovascular risks.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(4):31-46
pages 31-46 views

Original research

Gender peculiarities of critical lower limb ischemia

Glushkov N.I., Puzdriak P.D., Agurbash A.N., Razepin A.V., Ivanov M.A.


BACKGROUND: Development of critical ischemia of lower limbs in patients with atherosclerosis causes negative consequences due to the high probability of detecting multilevel changes, as well as identifying coronary and carotid pools.

АIM: The aim of the study was to investigate gender differences in critical lower limb ischemia of atherosclerotic genesis following reconstructive interventions.

MATERIALS AND METHODS: Arterial reconstructions have been performed in 261 patients with peripheral atherosclerosis (95 women and 166 men). The specific features of reconstructive interventions have been taken into account; complications and the number of amputations have been analyzed in the early period.

RESULTS: Higher pulse pressure has been registered in the female group; tibial arteries have been affected significantly more frequently (p < 0,05). Thrombosis of the operated segment has been observed more frequently in the male patients at the stage of critical ischemia; in the case of claudication the complications were sporadic.

CONCLUSIONS: The best results of reconstructive care in men and women with peripheral atherosclerosis at the claudication stage determine the vector of active tactics in the absence of conservative treatment results.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(4):47-52
pages 47-52 views

Reductive annuloplasty with autopericardium in surgical treatment of mitral insufficiency

Sotnikov A.V., Melnikov M.V., Bitieva A.M., Kolmakov E.A.


BACKGROUND: Despite the widespread usage of all-type rings in the surgical treatment of patients with mitral valve insufficiency (MV) and dilatation of its fibrous annulus, the researches on this topic are in progress.

AIM: To study the short- and long-term results of narrowing annuloplasty of the MV utilizing an autopericardium strip of calculated length.

MATERIALS AND METHODS: The study group consisted of 21 patients (average age 60.9 ± 4.3 years, women 23.8 %) with MV insufficiency of non-rheumatic ethiology. The narrowing of the fibrous annulus during valve reconstruction has been performed along with the posterior 2/3 of their circle using interrupted horizontal sutures. With those sutures, an autopericardial strip of the calculated length has been secured to the annulus. The length of the strip has been calculated according to the original method, according to the data obtained during preoperative transesophageal echocardiography. The length of the strip was 2/3π ∙ D (mm), where D — the existing length of the anterior leaflet of the MV in the middle portion from the fibrous annulus to the free edge in the zone of the A2 segment. The control group consisted of 38 patients with non-rheumatic MV insufficiency (average age 59.1 ± 3.5 years, women 23.7 %); the strengthening and narrowing of the fibrous annulus have been performed using a strip made from a wicker vascular prosthesis. The length was 55 mm, equal for all the patients. In both groups, in addition to the narrowing of the fibrous annulus, other types of mitral valve-sparing surgery (partial resection of MV leaflets, suture leaflets techniques, their combination) and combined procedures (coronary bypass surgery, left ventricle reconstructions for postinfarction aneurysms) have been also performed.

RESULTS: In the studied groups, the safety and reliability of the performed restrictive MV annuloplasty procedures have been demonstrated. During the follow-up period up to 8 years (average 3.5 ± 0.7 years), there was no recurrence of significant mitral regurgitation, which would require repeated surgery in both groups. Narrowing annuloplasty of the fibrous annulus of MV with a strip from the autopericardium of an individual calculated length allows to perform a more accurate anatomical correction of the valve compared with the control group. The existing methods of mitral annuloplasty, their advantages and disadvantages are discussed.

CONCLUSIONS: The proposed method of restrictive annuloplasty of the MV with an autopericardial strip of the calculated length allows to perform a reliable and safe correction of the dilated fibrous annulus in patients with mitral insufficiency during valve-preserving operations.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(4):53-64
pages 53-64 views

Effect of arterial hypertension on quality of life and anxiety in middle-aged patients with breast cancer

Poroshina E.G., Vologdina I.V., Zhabina R.M., Krasilnikova L.A.


BACKGROUND: Arterial hypertension is one of the key risk factors for the development of cardiotoxicity in cancer patients. The importance for patients with left breast cancer is due to the possibility of the heart getting into the radiation area during treatment. The use of a method for assessing the quality of life and symptoms of anxiety can help improve treatment in such patients by increasing the interaction between a physician and a patient.

AIM: The aim of the study is to assess the quality of life and the level of anxiety in patients with breast cancer, depending on the presence of arterial hypertension.

MATERIALS AND METHODS: 67 patients with HER2neu negative cancer of the left breast have been examined. The average age is 42 (47; 63). All the patients after radical mastectomy and a course of chemotherapy with the inclusion of doxorubicin in a cumulative dose of no more than 360 mg/m2 have been hospitalized for 3D conformal radiation therapy. The first group included 32 patients with grade I–II comorbid hypertension; the second group included 35 patients without hypertension. The examination included an assessment of the status of an oncological patient according to the ECOG scale, echocardiography with an assessment of diastolic function, determination of the level of reactive and personal anxiety according to the Spielberger – Khanin scale and quality of life using the SF-36 questionnaire.

RESULTS: In the group of the patients with combined hypertension, left ventricular hypertrophy has been detected in 48 % of cases. In the patients of both groups with preserved ejection fraction, type I diastolic dysfunction has been detected (E/A < 1): in the patients of the first group — in 59.4 % of cases, in the patients of the second — 31.4 % of cases. The difference obtained is due to the effect of hypertension on the left ventricular relaxation disorder. The level of reactive anxiety was significantly higher in the patients of the first group and amounted to 43.8 (41.2; 46.2) versus 38.4 (32.7; 42.6) points in the second group. The level of personal anxiety was high in the patients of both groups, which can be explained by the predominant influence of cancer. In the patients of both groups, there was a decrease in indicators according to the SF-36 questionnaire on all scales. The most significant changes have been obtained on the scales of physical functioning, role-based physical functioning, pain, vitality and general health. Cancer patients with concomitant hypertension rated their health status lower, while they are more likely to note a decrease in daily role activity as a result of their emotional state.

CONCLUSIONS: The data obtained indicate that arterial hypertension has a significant negative effect on the level of reactive anxiety and quality of life indicators of breast cancer patients, which is of great importance in the formation of a patient-oriented approach to the therapeutic support of specific treatment in such patients.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(4):65-70
pages 65-70 views

Features of endothelial function and autonomic regulation of heart rhytm in patients with vasospastic angina

Guzeva V.M., Yarmosh I.V., Evdokimov D.S., Serdukov S.V., Ermolov S.Y., Boldueva S.A.


BACKGROUND: The clinical features of vasospastic angina are well known, but pathogenesis remains a subject of discussion. Changes in the autonomic regulation of coronary artery tone and endothelial function that contribute to the development of vasospasm are not well understood. The data on the subject from the published studies are contradictory.

AIM: To evaluate features of endothelial function and autonomic regulation of heart rhythm in patients with vasospastic angina.

MATERIALS AND METHODS: The study included 16 patients with proven vasospastic angina. All the patients have been evaluated for the heart rate variability at rest and vegetative tests (deep breathing, and active standing tests). Endothelial function has been assessed in terms of reactive hyperemia index by peripheral arterial tonometry using an Endo-PAT 2000 device.

RESULTS: The baseline of the total heart rate variability was borderline with the normal parameters SDNN 50 (32.5; 50) ms in the patients with vasospastic angina. There were 14 patients who have demonstrated an imbalance of the autonomic nervous system at rest, mainly due to an increase of parasympathetic influences. The appropriate reaction of the autonomic nervous system, characterized by an increase of vagal influences, has been determined in 13 patients in the deep-breathing test. A paradoxical reaction, characterized by an increase of vagal influences on the heart rhythm, has been registered in 13 patients in the active standing tests. Endothelial dysfunction has been observed in half of the studied patients. Furthermore, a combination of both pathophysiological mechanisms, i.e., endothelial and autonomic dysfunctions have been observed in all the patients with a reduced reactive hyperemia index.

CONCLUSIONS: According to the results of our study, the parasympathetic influences of the autonomic nervous system on the heart rhythm were predominant in the patients with vasospastic angina, which is not typical for coronary heart disease. All the patients had autonomic or endothelial dysfunction. A combination of both pathophysiological mechanisms has been observed in half of the examined patients.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(4):71-78
pages 71-78 views

N-acetyl-p-benzoquinonimine metabolite as a factor of possible neurotoxicity of paracetamol

Vlasova Y.A., Zagorodnikova K.A.


BACKGROUND: Currently, the possible negative effects of paracetamol on the central nervous system are widely discussed in the modern scientific literature. The relationship between the intake of paracetamol during pregnancy by women and the risk of autism spectrum disorders in their children is being studied. However, such conclusions are often met with serious criticism as there are many questions about the methods of assessing behavioral disorders and processing research results. Therefore, experimental data obtained on neuronal cells may be a sufficient ground to confirm or refute assumptions about the neurotoxicity of paracetamol and its metabolites.

AIM: To study the effect of paracetamol and its metabolite N-acetyl-p-benzoquinonimine (NAPQI) on the neurons of the cerebral cortex of fetal rats.

MATERIALS AND METHODS: The study of the effect of paracetamol and its metabolite NAPQI on cell viability has been carried out by a method based on the reduction of 3-(4,5-dimethylthiazole-2-yl)-2,5-tetrazolium bromide (MTT).

RESULTS: It has been shown that during preincubation of neurons in the cerebral cortex of the rats with paracetamol at a concentration of 1 mg/ml for 24 hours and subsequent incubation with 0.3 mM hydrogen peroxide, both hydrogen peroxide and paracetamol itself reduce the viability of neurons. Joint incubation with paracetamol and hydrogen peroxide also reduces the viability of neurons. The same effect of paracetamol and its metabolite is observed with the joint preincubation of paracetamol or NAPQI and hydrogen peroxide.

CONCLUSIONS: Paracetamol as well its metabolite NAPQI reduce the viability of neurons in the fetal cortex of rats.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(4):79-84
pages 79-84 views

Case report

Case of lactacidosis in acute kidney damage and metformin therapy

Alekseenko O.V., Kovalchuk E.Y., Risev A.V., Sergeeva A.M., Lapickiy A.V.


Тhe article provides a clinical observation of the development of a rare pathological condition of lactic acidosis in a patient with acute kidney injury while taking metformin and confirms the need for timely determination of blood lactate.

Тhe clinical case confirms that the development of lactic acidosis in a patient with diabetes mellitus may have a mixed etiology and be associated not only with the use of metformin, but also with the presence of tissue hypoxia, exposure to an infectious process, and impaired renal function.

The development of lactic acidosis is associated with an increase in secretion and / or a decrease in the rate of excretion of lactate, which is expressed in a state of metabolic acidosis and severe cardiovascular insufficiency. The development of lactic acidosis is most often associated with the presence of renal and / or hepatic insufficiency, diabetes mellitus, lung pathology, macromicrocirculation disorders, and hemoglobin function defects, the treatment with biguanide drugs (metformin). Diagnosis of lactic acidosis is based on the data from a biochemical blood test and electrolyte parameters – the concentration of blood plasma lactate, the study of acid-base state of the blood and anion gap.

HERALD of North-Western State Medical University named after I.I. Mechnikov. 2021;13(4):85-90
pages 85-90 views

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies