Vol 9, No 3 (2017)

Reviews
CLINICAL AND IMMUNOLOGICAL CORRELATIONS IN PATIENTS WITH SYSTEMICLUPUS ERYTHEMATOSUS WITH ANTIPHOSPHOLIPID ANTIBODY SYNDROME
Belolipetskaia E.A., Beliaeva I.B., Mazurov V.I., Trofimov E.A., Lapin S.V.
Abstract
Antiphospholipid antibodies (aPL): lupus anticoagulant (LA), anticardiolipin antibodies (aCL) and anti-β2-glycoprotein I antibodies (anti-β2GPI) are found in 12 to 44% of systemic lupus erythematosus (SLE) patients. On average, antiphospholipid antibody syndrome (APS) develops in50% of aPL-positive patients with SLE. The seronegative APS is characterized by the absence of the diagnostic levels of "classical" aPL and by the presence of non-criteria aPL: antibodies against pro- thrombin (aPT), antibodies against annexin V, antibodies against phosphatidylethanoamine (aPE), antibodies to phosphatidylserine/prothrombin complex (aPS-PT) and antibodies against negatively charged phospholipids. The presence of four antibodies (LA + aCT + anti-β2GPI + aPT) is associated with a threefold increase in the risk of thrombosis. The presence of aCL and anti-β2GPI in SLE patients with APS and recurrent thromboses is associated with the HLA dRB1 * 0402.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):7-11
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EVALUATION OF NONCARDIAC CHEST PAIN
Dorofeev V.I., Monashenko D.N., Svirido D.A., Savelev A.A.
Abstract
In the presented review of the current literature a lot of information about differente diagnostic approaches for patients management with a syndrome of noncardiac chest pain were system- atized and generalized.These patients have a diverse set of disease that requires the physician applying a wide range of ad- ditional surveys. In General, doctors need to exclude heart disease in patients who were treated with chest pain. If chest pain is noncardiac, then empirical treatment for gastro-intestinal reasons and the cor- responding assessment of psychogenic causes of chest pain are important for the symptomatology of pa- tients. In particular, primary care physicians should consider - besides the cardiac causes as a possible causes of thoracalgia - possible mental disorders, impaired motility of the upper gastrointestinal tract, problems with the thoracic spine - as a possible causes of thoracalgia. It would be beter to find out the rea- sons of thoracalgia with all available diagnostic tools and then - choose and assign appropriate adequate etiotropic therapy for most effectively cupping the patient's symptoms and reducing health care costs.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):12-23
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NEURORETINOPROTECTION IN TREATMENT AND REHABILITATIONOF EYE DISEASES IN CHILDREN’S AGE
Saidasheva E.I.
Abstract
Presented of own long-term experience and the generalized results of the researches devoted to use of domestic drugs of peptide structure in complex therapy of a number of diseases of an optic nerve and a retina at patients of children's age. Clinical efficiency of a retinalamin as retinoprotector and cortexin as neuroprotector in treatment and rehabilitation the disabling diseases shown: atrophy of the optic nerve, retinopathy of prematurity and degenerative myopia.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):24-31
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CUSTODIOL CARDIOPLEGIA: WHICH PROTOCOL TO PREFER?
Istomin T.A., Kurapeev I.S., Mihaleva Y.B., Suborov E.V., Domanskaya I.A., Vasilieva G.N.
Abstract
In this review we presented data about the basic Custodiol cardioplegia techniques and protocols, adverse site effects and warnings. National and international articles on the use of Custodiol cardiople- gia in cardiopulmonary bypass surgery were analyzed. Based on the previous research data, we are criti- cally reflected the current state of anti-ischemic protection of the myocardium, in particular cardiople- gia. Possible future directions for further scientific research in this field of medicine were identified. In this review we discussed the ways to further improve Custodiol cardioplegia.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):32-39
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HYPERMNESIA EUPHORIA OR ANY OTHER DESIRABLE FROM THE POINT OF VIEW OF THE CONSUMER, A PSYCHOTROPIC EFFECT - FIRST AND LEADING ELEMENT IN THE OCCURRENCE AND PRESERVATION OF THE BODY’S DEPENDENCE ON PSYCHOACTIVE FACTORS
Baitubayev D.G., Baitubayeva M.D.
Abstract
The work shows the role of the vegetative nervous system (VNS) in the functioning of long-term memory, identity mechanisms of long-term memory in the human evolutionary adaptation and substance dependence. It is shown that, depending on the substance of the body are states like pro- gressive adaptation, that the bodycondition, depending on the chemical and psychogenic psychoactive- factors state of the same circle. It proposed the creation of a branch of medicine that combines study of the dependence of the organism, both on the chemical and psychoactive psychogenic factors. Given the classification of psychoactive factors.Onomastics formulated definitions of terminology changes and additions to be used in a new branch of medicine. Proposed allocation of the International Classifica- tion of diseases separate chapter for the classification of states like progressive adaptation of the body depending on psychoactive factors.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):40-46
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MULTIPLE SCLEROSIS. JUSTIFICATION OF GEROPROTECTIVE THERAPY
Lobzin S.V., Golovkin V.I., Kamynin Y.F., Onischenko L.S., Garyshina Y.O., Sagiyan A.S.
Abstract
Results of immunological blood count and liquor test taken from 76 patients with multiple sclerosis aged 33,6±2,7 were studied to determine genetic markers of locus HLA-drB1and asynchronous intrathecal synthesis ratio of immunoglobulin free light chain (К ƙ/ƛ), as well as state of mitochondrial electron transport chain and density of neurotransmitter receptors of brain cells. 12 laboratory Guinea pigs with experimental allergic encephalomyelitis were taken to conduct electron microscopy of ultrathin brain sections collected from animals at the peak of the disease. Weak association of immunological and genetic indicators and statistically significant morphofunctional abnormalities of mitochondrial appara- tus of brain cells as well as neurotransmitter deviations towards nociceptive processes with simultaneous weakening of central antinociceptive mechanisms was found. The conclusion is that patients with mul- tiple sclerosis have early pathologic aging so early geroprotective therapy is required.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):47-52
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ABOUT VALUE OF CONSCIOUS AND UNCONSCIOUSEMOTIONAL PROCESSES AT MULTIPLE SCLEROSIS
Reznikova T.N., Seliverstova N.A.
Abstract
Research of conscious and unconscious emotional processes at 167 patients with multiple sclerosis in a condition of remission was conducted. The conscious and unconscious alarm (according to tests Taylor and Lusher), conscious and unconscious aggression (according to Bass-darky test and Hand test) in comparison to indicators of personal scales on the Standardized multidimensional personal questionnaire and the clinical and anamnestic of data was studied. At most of patients the high level of conscious and unconscious anxiety, the increased unconscious aggression at standard values of the general conscious aggression is revealed. The correlation analysis between indicators of emotional pro- cesses of the personality and clinical and anamnestic data revealed reliable interrelation of conscious and unconscious alarm, and also a depression (according to the test of Zung) with the phenomena of personal disadaptation and disease severity while conscious and unconscious aggression (on the general indicators) such relationship was no that is important for psychological diagnostics and rehabilitation.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):53-58
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CHARACTERISTICS OF METABOLISM OF GLUCOCORTICOID HORMONESIN PATIENTS WITH PHEOCHROMOCYTOMA
Ivanushko M.A., Vorokhobina N.V., Velikanova L.I., Shafigullina Z.R.
Abstract
The article performs analysis of glucocorticoid hormones data and their metabolites in- vestigated by methods of high-performance liquid chromatography and gas chromatography - mass- spectrometry in 47 patients with pheochromocytoma (РНЕО) and 28 patients with hormone-inactive adenoma of the adrenal cortex. We revealed increased blood levels оf biologically active glucocorticoids and elevation of urine excretion of their tetrahydrometabolites in patients with PHEO. 6 patients with PHEO showed biochemical signs of the autonomous cortisol production. A positive correlation of free normetanephrine excretion with blood cortisol, corticosterone and 11-deoxycortisol and urine excretion of tetrahydrometabolites and cortols and a negative correlation with the urine excretion of tetrahydro-11-dehydrocorticosterone were detected. An increase of the THF/THE and (THF+alloTHF+cortol)/ (THE+allo-THE+ cortolone) ratios may indicate a decrease of 11β-hydroxysteroiddehydrogenase type 2 activity in patients with РНЕО.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):59-64
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PROSPECTS OF ULTRASONOGRAPHY APPLICATION FOR PARATHYROID GLANDS ASSESSMENT IN PATIENTS WITH SECONDARY HYPERPARATHYROIDISM
Zotova I.S., Kholin A.V.
Abstract
Literature analysis was performed data on possibilities of ultrasonic examination (uS) of the para- thyroid glands (PTG) in the differential diagnosis and determining treatment strategy of secondary hyperparathyroidism. It was indicated that the current PTG hyperplasia can be diagnosed by using a variety of methods, at the same time as the most promising considering ultrasound. The literature data suggests that ultrasonography is a highly informative method for assessing the PTG state in secondary hyperparathyroidism, allowing early detection of changes in the glands, to determine the severity of hy- perplasia, assess variants of morphological changes to select the treatment. uS can also be used to moni- tor and control changes identified in gland state during the therapy. uS is recognized method of choice due to its non-invasiveness, harmless and availability, while computed tomography, magnetic resonance imaging and scintigraphy may become further diagnostic step in the cases of unidentified glands and a suspected ectopic PTG. The use of uS allows additional qualitative and quantitative information about PTG state that can be used to select an adequate method of medical or surgical treatment. Further research is needed to assess the possibilities of applying the uS method in the differential diagnosis of secondary hyperparathyroidism.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):65-73
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PERCUTANEOUS REMOVING OF KIDNEY STONE UNDER ONLY ULTRASONIC CONTROL
Guliev B.G., Stetchik E.O.
Abstract
The study included the outcome of percutaneous treatment for nephrolithiasis in 176 patients, who were divided in two groups. Ninety patients (Group 1) underwent PNCL with combined ultrasound and radiological guidance, 86 patients (Group 2) underwent surgery with only ultrasound guidance. The inclusion criteria were the cases with renal pelvis stones larger than 2,0 cm diameter. Postoperative complications (exacerbation of chronic pyelonephritis, macrohematuria) were observed in 13 (14,4%) patients in Group 1 and in 6 (7,0%) in Group 2. There was no significant differences in effectiveness of PCNL, the volume of blood loss and duration of hospitalization. In Group 1 and Group2 the effectiveness of PCNL was 94,4% and 93,0% respectively. In Group 1, 5 (5,6%) required additional intervention. In Group 2, 6 (7,0%) patients required additional intervention. The efficiency of ultra- sound guided PCNL is comparable with this of conventional PCNL. In addition, the radiation exposure of patients and medical staff is reduced during ultrasound guided PCNL.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):74-79
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ANALYSIS OF THE STRUCTURE OF CARIES MORBIDITY IN CHILDRENWITH VARIOUS SOMATIC PATHOLOGIES
Catygo E.A., Reutskaya K.V.
Abstract
This study found, that the lowest intensity of dental caries in children 2-5 years old with allergic diseases, and the highest intensity of caries in children with NET disorders. Also, the research has demonstrate, that in 4-5 years there is a significant increase in tooth decay in children.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):80-83
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PECULIARITIES OF DEVELOPMENT OF BEHAVIORAL FUNCTION IN CHILDREN WITHDIFFERENT TYPES OF FEEDING UNDER STRESSFUL CONDITIONS
Ershova I.B., Shirina T.V., Goncharova T.A.
Abstract
The aim of the research is to study the state of behavioral function in infants who were born and living in the Lugansk and donetsk during the military conflict.A dynamic clinical examina- tion was made. Also it was made the assessment of the rate of behavioral development in 68 children in the area of military conflict. Among them 32 children were breast-fed, forming Ia (the main) group of children, and 36 children who were bottle-fed, forming the comparison group Ib.The control groups of our study consist of 88 children who were outside the zone of military conflict. Among them there were 47 children who were breast-fed (IIa group), and 41 children who were bottle-fed (IIb group).The assessment of the level of behavioral function development in children was carried out using a standard- ized clinical-psychological techniques "Gnome".Conclusions: The development of behavioral functions in infants and toddlers depends on the sur- rounding stressful conditions and the type of feeding. The level of formation of these functions in chil- dren who were bottle-fed and under stress of war was the lowest. The greatest delay in children of this group were the indicators of social development. From biological indicators much more suffered the functions associated with eating behavior. Children who were bottle-fed in the stress of military actions in infancy and early childhood are in need of rehabilitation activities.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):84-88
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ASSESSMENT OF THE CURRENT ECONOMIC EFFICIENCY OF TREATMENTOF PATIENTS WITH OSTEOARTHRITIS IN SAINT-PETERSBURG AND ITS PERSPECTIVES
Povzun A.S., Mazurov V.I., Povzun K.A., Kostenko V.A.
Abstract
The article analyzed the features of the existing system of treatment’s payment in patients with osteoarthritis. The main features of the billing during the transition of the patients hospitalization pay- ment to the system using diagnostic-related groups defines. The main advantages and disadvantages of these systems are analyzed, ways of the economic results optimization of osteoarthritis patients treat- ment are determined with in connection with the planned transition to payment using the clinical- statistical groups. Presented method of the economic efficiency evaluation of paying for treatment can be recommended for use in any other nosological forms of diseases.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):89-96
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MEDICAL PERSONNEL OF POLYCLINIC AS AN INDICATOROF THE QUALITY OF HUMAN RESOURCES IN THE HEALTH CARE
Panov V.P., Avdeeva M.V., Logunov D.L., Filatov V.N.
Abstract
The article presents the main characteristics of the medical personal of a typical city polyclinic, on the basis of which it is possible to get an idea about the quality of medical resources in primary health care. It was found that more than half of the physicians «treatment group» working in primary health care, do not have qualifying category (53,1%), despite the big experience of medical practice (14,7±12,1 years). The presence of the qualifying category does not always objectively reflect the quality of medical resources, as most physicians have great experience of practical work and highly appreciate their individual professional level. Activities of the medical personnel of polyclinics associ- ated with intense working conditions, due to the excessive number of the attached population for the primary health care, work without help of a nurse, remoteness of district territories and high need of the population of primary health care. The main factors that adversely affecting the preventive work with the population should include the intensity of outpatient reception, remoteness of district territories, insufficient study of the medical literature and rare visits to scientific conferences.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):97-101
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PEDIATRIC ASPECTS OF RENDERING THE EMERGENCYMEDICAL SERVICE IN THE RUSSIAN FEDERATION
Barsukova I.M.
Abstract
Questions of the organization of rendering an emergency medical service to the children's population of the Russian Federation are considered. They are connected with a demographic situation in the country - growth of the children's population, decrease in indicators of infantile and maternal mortality. Against common problems of system of rendering an emergency medical service in the country its pediatric link looks rather safe. Protection of motherhood and the childhood was and remains the priority direction of a state policy of our country.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):102-109
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CLINICAL AND Х-RAY PATTERNSOF DESMOPLASTIC FIBROMAOF MANDIBULAR BONE
Muzykin M.I., Iordanishvili A.K., Rybakova M.G., Bugera V.N., Vasiliev S.V.
Abstract
This article presents the results of the clinical examination of the patient at the age of 41, who has been hospitalized according to the principle of OMC to the department of oral surgery and multi- specialized hospital of stomatology with a rare bone disease which affects the lower jaw -desmoplastic fibroma. The surveillance has been conducted for three years. Clinical characteristics and Хray patterns of the disease were revealed and the results of instrumental and histological studies were shown.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):110-113
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CLINICAL CASE OF MENTAL DISORDERS IN THE DEBUTOF MULTIPLE SCLEROSIS
Zhulev S.N., Toropova A.A., Nemykin O.N., Fomintseva M.V., Garyshina Y.O., Kula I.I., Mirzaeva L.M.
Abstract
In a course of multiple sclerosis neurologic deficit could be overshadowed by psychotic signs such as catatonia, depression and dementia. Thus, ignoring these clinical manifestations can pre- vent early diagnosis of multiple sclerosis. Subsequently, an appropriate treatment will be delayed. In our article we report a case of multiple sclerisos in patient presented initially with catatonia, depression and dementia. Psychiatric, neurological, MRI picture and treatment impact thoroughly throughout the whole observation period are described. This case illustrates that catatonia can be dominating feature in the clinical course of multiple sclerosis and can overshadow other neurologic signs.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):114-120
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THE MEDICAL AND LEGAL ASPECTS OF EFFECTIVENESS EVALUATIONOF THE EXAMINATION AND TREATMENT OF COMPLICATED FORMS OF DIABETICFOOT IN PATIENTS DISSATISFIED WITH THE QUALITY OF MEDICAL CARE PROVIDED
Movchan K.N., Iskhakov R.B., Kovalenko A.V., Rusakevich K.I.
Abstract
Medical care quality assessment in patients suffering from ulcerous-necrotic forms of diabetic foot is a rather problematic question, especially in cases of negative disease outcome. Patients fighting against diabetes mellitus and its complications for saving their lives occasionally not only criticize the healthcare organization without a good cause but use civil law procedures, bringing in an indictment accusing healthcare practitioners of unsuitable medical care. The article discusses deonto- logical aspects of providing medical care to patients with diabetic foot dissatisfied with the quality of examination and treatment in healthcare providing institutions. It also demonstrates the medical and legal conflict which arose due to medical care quality assessment in a patient with complicated form of diabetic foot who regularly was consulted and was under the care of different health care practitioners as an in-patient so as an out-patient. The article illustrates that important factors in successful treat- ment of patient with diabetes mellitus are professional engagement and interaction between healthcare providers of specialized centres and healthcare practitioners at the out-patient stage as well as case follow-up with suitable and well-timed correction of glucemia. Special attention should be given to doctor-patient cooperation. Only a multidisciplinatory approach offers the possibility to improve the quality of medical care provided to patients with complicated forms of diabetic foot and to reduce the frequency of complaints to different medical, social and politico-administrative authoritative bodies.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2017;9(3):121-126
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