DENTAL SERVICE PROVISION UNDER GENERAL ANESTHESIA TO PHYSICALLY DISABLED PATIENTS WITH COMORDIDITIES IN THE REPUBLIC OF TATARSTAN

ABDRASHITOVA ALENA B., C. Med. Sci., associate professor of the Department of paediatric dentistry of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: egorova-alena@mail.ru

GAYNULLINA DILYA K., maxillo-facial surgeon of City Clinical Hospital No 7, Russia, 420130, Kazan, Chuykov str., 54, e-mail: dilya.gainullina@mail.ru

Abstract. Aim. Comparative analysis of dental service provision under general anesthesia to physically disabled patients with comorbidities has been performed. Material and methods. Oral cavity was sanitized under general anesthesia in physically disabled patients with concomitant diseases aged from 15 to 37 years in city clinical hospital No 7 for 3 years during the period from 2014 to 2017. Before the general anesthesia the patients underwent the necessary medical examinations. Before the oral cavity sanitation, the dental status was assessed. Then the order of oral manipulations was determined. Results and discussion. Dental status analysis of physically disabled patients indicates that the majority of the patients had high intensity caries, low oral uid pH and low caries resistance. It has revealed that the majority of the examined patients have low oral uid pH, low caries resistance and very high caries intensity compared to other dental diseases, thus demonstrating a high incidence of caries among physically disabled patients. Conclusion. General anesthesia makes oral cavity sanitizing possible in physically disabled patients. It has allowed increasing the number of teeth preserving manipulations.

Key words: dentist, dentistry, general anesthesia, oral cavity sanitation, physically disabled patients.

For references: Abdrashitova AB, Gaynullina DK. Dental service provision under general anesthesia to physically disabled patients with comorbidities in the Republic of Tatarstan. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (6): 7—11. DOI: 10.20969/VSKM.2017.10(6).7-11.

References

 DISABILITY IN PATIENTS WITH TUBERCULOSIS IN MODERN CONDITIONS

УДК 616.24-002.5-036.86(470.43)

BORODULINA ELENA A., ORCID ID: orcid.org/0000-0002-3063-1538; SCOPUS Author ID: 7801342837; D. Med. Sci., professor, Head of the Department of phthisiology and pulmonology of Samara State Medical University, Russia, 443099, Samara, Pionerskaya str., 48, tel. 8(846)332-57-35, e-mail: Borodulinbe@yandex.ru

DOMNITSKIY OLEG A., physician of the Main Disability board of review in Samara Region, assistant of professor of the Department of phthisiology and pulmonology of Samara State Medical University, Russia, 443099, Samara, Pionerskaya str., 48

BORODULINA ELVIRA V., postgraduate student of the Department of public health and health management with a course of economics of Samara State Medical University, Russia, 443099, Samara, Michurin str., 125, tel. 8(846)312-55-18

Abstract. The problems of disability examination are an important part of doctor’s work in the course of treatment of patients with tuberculosis. Aim. Disability indicators related to tuberculosis have been analyzed in the period of improvement and stabilization of epidemiological situation on tuberculosis in the Samara region. Material and methods. The data of the Disability board of review of the Samara region for 2014—2016 was analyzed. Standard forms were used. Analysis of newly acquired and recurrent disability in adult population was performed. The indicators were assessed in dynamics by year. The data on disability for HIV was taken into account. The patient was considered disabled according to the Decree No 95 of the Government of the Russian Federation from February 20, 2006 «On the procedure and conditions for recognition of a person as disabled». The data on the adult population was studied. Results and discussion. There was more than 50% of disability in persons under 45 years old in the group disability structure in 2014—2016, while in persons over 55 years of age it was less than 5%. 10 time increase in disability for HIV in 3 years has been noted. The main disability group is the 2nd. It contains the individuals with an active disease that require continuous treatment. Conclusion. It is necessary to stratify the causes of disability in order to create scienti cally-based measures on improvement of the effectiveness of treatment and social burden reduction.

Key words: tuberculosis, disability board of review, disability, disability evaluation.

For reference: Bоrоdulinа EA, Domnitskiy OA, Borodulina EV. Disability in patients with tuberculosis in modern conditions. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (6): 11—15. DOI: 10.20969/VSKM.2017.10(6).11-15.

References

1. Abol’ AV. Osobennosti kontingenta povtorno priznannyh invalidami vsledstvie tuberkuleza v Rostovskoj oblasti v 2009-2013 gg [Features of the contingent re-recognized by people with disabilities due to tuberculosis in the Rostov Region in 2009-2013]. Mediko-social’naja jekspertiza i reabilitacija [Medicosocial examination and rehabilitation]. 2015; 18 (1): 32-33.

2. Orlova VM. Analiz invalidnosti vsledstvie tuberkuleza v Novgorodskoj oblasti v dinamike za 2010-2014 gg [The analysis of disability due to tuberculosis in the Novgorod region in the dynamics for 2010-2014]. Mediko-social’naja jekspertiza i reabilitacija [Medicosocial examination and rehabilitation]. 2016; 19 (2): 86-88.
3. Zakirova JeM, Stepanov AA, Iksanov HV, Marchihin VI. Analiz pervichnoj i povtornoj invalidnosti vsledstvie tuberkuleza v respublike Tatarstan za 2004—2008 gg [Analysis of primary and secondary disability due to tuberculosis in the Republic of Tatarstan for 2004-2008]. Mediko-social’naja jekspertiza i reabilitacija [Medicosocial examination and rehabilitation]. 2012; 3: 22-25.
4. Grishina LP, Abol’ AV. Sravnitel’nyj analiz pervichnoj invalidnosti vsledstvie tuberkuleza v juzhnom federal’nom okruge v 2009-2013 gg [Comparative analysis of primary disability due to tuberculosis in the Southern Federal District in 2009-2013]. Mediko-social’naja jekspertiza i reabilitacija [Medicosocial examination and rehabilitation]. 2014; 17 (4): 28-30.
5. Borodulina EA, Matkina TN, Vdoushkina ES. Prichiny smerti bol’nyh VICh-infekciej i tuberkulezom [Causes of death of patients with HIV infection and tuberculosis]. Tuberkulez i bolezni legkih [Tuberculosis and lung diseases]. 2015; 5: 44-45.
6. Kolomiec VM, Konorkina EA, Shpak AV. Social’no- psihologicheskaja reabilitacija psihicheski bol’nyh kak metod nespeci cheskoj pro laktiki tuberkuleza [Socio-psychological rehabilitation of mentally ill patients as a method of nonspecific prevention of tuberculosis]. Mediko-social’naja jekspertiza i reabilitacija [Medicosocial examination and rehabilitation]. 2013; 3: 19-22.
7. Borodulin BE, Borodulina EA, Vdoushkina ES, Matkina TN. Prichina smerti –komorbidnost’ VICh-infekcii i tuberkuleza [Cause of death-co-morbidity of HIV infection and tuberculosis]. Pul’monologija [Pulmonology]. 2015; 25 (4): 461-465.
8. Bazaeva EA, Marusheva LG, Trifonova OB, German SV. Regional’nye osobennosti struktury pervichnoj invalidnosti vzroslogo naselenija Nizhegorodskoj oblasti s uchetom grupp invalidnosti [Regional features of the structure of primary disability of the adult population of the Nizhny Novgorod region, taking into account disability groups]. Mediko-social’naja jekspertiza i reabilitacija [Medicosocial examination and rehabilitation]. 2011; 2: 37-41.
9. Postanovlenie Pravitel’stva RF ot 20 fevralja 2006 goda No 95 «O porjadke i uslovijah priznanija lica invalidom» [Resolution of the Government of the Russian Federation of February 20, 2006 No 95 «On the procedure and conditions for the recognition of a person with a disability»].

 THE FEATURES OF MICROECOLOGICAL DISTURBANCES IN GASTRODUODENAL AND BILIARY SYSTEMS IN CHILDREN

DOI: 10.20969/VSKM.2017.10(6).15-20.

KAZAKOVA MARIA A., postgraduate student of the Department of introduction into children’s diseases and intermediate level pediatrics with the course of childhood diseases for the faculty of general medicine of Kazan State Medical University, Russia, 420012, Kazan, Tolstoy str., 4, tel. (843)236-71-72, e-mail: k-a-z-a-k@yandex.ru

Abstract. The data on assessment of the nature of microbial association contents of biliary tract in children with complex gastric, duodenal, hepatic and bile system disorders is presented. Aim. Тo study the frequency of H. pylori detection in bile tract in children in Kazan, as well as to evaluate the nature of microbial associations of bile tract content, as well as their possible involvement in pathogenesis of hepatic and bile system diseases. Material and methods. 69 biopsies of duodenal mucosa obtained during esophagogastroduodenoscopy and 106 bile samples obtained by fractional duodenal catheterization in 106 children were the studied materials. Indication and identi cation of aerobic and facultative anaerobic microorganisms were performed via inoculation on 5% blood agar, Endo and Ploskireva mediums and bile-alkaline agar with following biochemical identi cation. H. pylori infection rate was determined by complex respiratory screening method «Helic-test» followed by bacteriological and molecular biological genetic sample test methods. Results and discussion. It was proved, that children with isolated forms of chronic gastritis, duodenitis and biliary tract dysfunction rarely have positive H pylori test comparing to the children with organic bile system disease, such as cholecystitis and cholangitis. Conclusion. That means that primary diagnosis requires H. pylori infection veri cation in children, with possible subsequent correction of treatment.

Key words: Helicobacter pylori, bacteriological method, polymerase chain reaction, chronic gastroduodenitis, combined pathology, children.

For reference: Kazakova MA. The features of microecological disturbances in gastroduodenal and biliary systems in children. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (6): 15—20. DOI: 10.20969/VSKM.2017.10(6).15-20.

1. Bohr UR, Annibale B, Franceschi F, Roccarina D, Gasbarrini A. Extragastric manifestations of Helicobacter pylori infection — other Helicobacters. Helicobacter. 2007; 1: 45-53.

2. Suzuki H, Matsuzaki J, Hibi T. Lifestyle related diseases and H pylori. Nippon Rinsho. 2009; 12: 2366–2371.

3. Gasbarrini G, Racco S, Franceschi F, Miele L, Cammarota G, Grieco A, Gasbarrini A. Helicobacter pylori infection: from gastric to systemic disease. Recenti Prog Med. 2010; 101 (1): 27-33.

4. Dorofeychuk VG, Potekhin PP, Zakomernyy AG. Neinva- zivnyj sposob diagnostiki piloricheskogo helikobakterioza [Noninvasive diagnostic method for H pylori infection]. Klinicheskaja laboratornaja diagnostika [Clinical Laborato- ry Diagnostics]. 1997; 8: 42-44

5. Zhebrun AB, Alexandrova VA, Goncharova LB et al. Diagnostika, profilaktika i lechenie zabolevanij, associirovannyh s Helicobacter pylori- infekciej: posobie dlja vrachej [Diagnosis, prevention and treatment of diseases associated with Helicobacter pylori-infection: A guide for physicians]. St. Petersburg: NIIJeM. 2002; 44 p.

6. Hofmann AF. Biliary secretion and excretion; The hepatobiliary component of the enterohepatic circulation of bile acids; Physiology of the Gastrointestinal Tract: LR Johnson ed. New York: Raven Press. 1994; 3: 1555-1557.

7. Zimmerman YS. Klinicheskaja gastrojenterologija: izbrannye razdely [Clinical Gastroenterology: Selected section]. Moskva [Moscow]: Geotar Media. 2009; 416 p.
8. Shutov YM, Shornikov YV, Tomilov IN, Shutova MZ Numerical and analytical researches of biliary systems of human liver at norm and pathology [Chislenno- analiticheskie issledovanija zhelcheproduktivnoj i zhelchevyvodjashhej sistemy pecheni cheloveka v norme i patologii]. Medicina i obrazovanie v Sibiri [Journal of Siberian Medical Sciences]. 2014: 2: 19.

 FOCUSED ULTRASOUND ABLATION UNDER THE GUIDANCE OF MAGNETIC RESONANCE IMAGING IN TREATMENT OF LOCALIZED PROSTATE CANCER

УДК 616.65-006.6-089:615.837.3

NASRULLAYEV MARAT M., C. Med. Sci., Head of the Department of oncology No 6 of Tatarstan Regional Clinical Cancer Center, Russia, 420029, Kazan, Sibirskiy tract, 23, e-mail: msh.avia@yandex.ru

NASRULLAYEV MURAD M., C. Med. Sci., physician of the Department of oncology No 2 of Tatarstan Regional Clinical Cancer Center, Russia, 420029, Kazan, Sibirskiy tract, 23

NASRULLAYEV MAGOMED N., D. Med. Sci., professor of the Department of surgery of Kazan State Medical Academy — Branch of the FSBET APE RMACPE MON, Russia, 420012, Kazan, Mushtari str., 11

Abstract. Aim. The possibilities of focused ultrasound ablation method under the guidance of magnetic resonance imaging in treatment of patients with prostate cancer have been studied. Material and methods. Analysis of the results of treatment of 67 patients with prostate cancer using the focused ultrasound ablation method with the Exablade 2000 machine by Insightec (Israel) under the guidance of magnetic resonance imaging GESigna (USA) was carried out. The mean age of the patients was (68,9±6,9) years. PSA values were (10,7±5,1) ng/ml. The volume of prostate gland was (27,7±8,1) сm3. Results and discussion. All patients were under observation after treatment (16±1,5) months. In the rst 3 weeks 7 (12,3%) patients had frequent urination. I degree urine incontinence was seen in 1 patient (1,5%). It became normal after 2,5 months of conservative therapy. 1 patient (1,75%) had haematuria that disappeared after conservative treatment in the 1st week. PSA values after 3 months of treatment were (0,5±1,7) ng/ml, after 6 months — (0,7±1,7) ng/ml, after 9 months — (0,6±1,7) ng/ml, after 12 months — (0,4±1,5) ng/ml and after 16 months — (1,0±1,5) ng/ ml. The volume of prostate gland after 2 weeks of treatment was (47,1±7,9) cm3, after 1 month — (36,3±6,7) cm3, after 3 months — (19,3±2,3) cm3, after 6 months — (14,6±1,9) сm3, after 9, 12 and 16 months, respectively, it was (14,1±1,5) cm3, (14±1,5) сm3 and (12,7±1,3) cm3. Magnetic resonance imaging 3, 6 and 9 months after the treatment has revealed that the area of pathological lesion were visualized as hypo intensive locus in T2-weighted images, which did not contrast. Conclusion. Focused ultrasound ablation with the usage of Exablade 2000 machine (Insightec Company) under the guidance of magnetic resonance imaging is an effective, safe, non-invasive method of treatment for patients with prostate cancer. After focused ultrasound ablation under the guidance of magnetic resonance imaging patients do not require hospitalization and are able to continue their normal life.

Key words: prostate cancer, focused ultrasound ablation, haematuria, urine incontinence.

For reference: Nasrullaev MM, Nasrullaev MM, Nasrullaev MN. Focused ultrasound ablation under the guidance of magnetic resonance imaging in treatment of localized prostate cancer. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (6): 20—24. DOI:10.20969/VSKM.2017.10(6).20-24.

1. Alyaev UG, Amosov AV, Grigoryan VA, et al. Rak predstatel’noj zhelezy i HIFU — terapija [Prostate Cancer and the VIFA — therapy]. Urologija [Urology]. 2007; 6: 32-38.

2. Shaplygin LV, Solovov VA, Vozdvizhenskiy MO, Khametov RZ. Vysokointensivnaja fokusirovannaja ul’trazvukovaja abljacija raka predstatel’noj zhelezy: 5-letnie rezul’taty [High-intensity focused ultrasonic ablation of prostate cancer: 5-year results]. Urologija [Urology]. 2013; 1: 70-72.

3. Alyaev UG, Krupinov GE, Grigoryan VA et al. Vyso- kointensivnyj fokusirovannyj ul’trazvuk v lechenii raka predstatel’noj zhelezy [High-intensity focused ultrasound in the treatment of prostate cancer]. Onkourologija [Oncourology]. 2007; 2: 42-51.

4. Argawal PK et al. Treatment failure after primary and salvage therapy for prostate cancer likelihood, patterns of care, and outcomes. Cancer. 2007; 112 (2): 307–314.

5. Blana A, Murat FJ, Walter et al. First analisys of the long- term result with High-intensity focused ultrasound with localised prostate cancer. Eur Urol. 2008; 53: 1194–1201.

6. Chaussy C et al. Technology Insight: high-intensity focused ultrasound for urologic cancers. Nat Clin Pract Urol. 2005; 2 (4): 191–198.

7. Kaprina AD, Stalinskogo VV, Petrova GV. Zlokachestven- nye novoobrozovanija v Rossii v 2016 godu (zabolevae- most’ i smertnost’) [Malignant novoobrazovany in Russia in 2016 (morbidity and mortality)]. Moskva [Moscow]. 2017; 250 p.

8. Krupinov EG. Lechenie bol’nyh rakom predstatel’noj zhelezy vysokointensivnym fokusirovannym ul’trazvukom [Treatment of patients with prostate cancer high-intensity focused ultrasound]. Moskva [Moscow]. 2010; 40 p.

9. Manakov DM, Shaplygin LV. Abljacija predstatel’noj zhelezy vysokointensivnym fokusirovannym ul’trazvukom pri pervichno-mnozhestvennyh zlokachestvennyh zabolevanijah [Ablation of the prostate high-intensity focused ultrasound in multiple primary malignant diseases]. Aktual’nye problemy okazanija specializirovannoj medicinskoj pomoshhi [Actual problems of specialized medical care]. 2009; 103-104.

10. Chaussy CG et al. Robot-assisted high-intensity focused ultrasound in Prostate Cancer. J Endourol. 2010; 245: 843–847.

11. Solovov VA, Thuroff S, Rossi K, Vozdvizhenskiy MO et al. Fokusirovannaja vysokointensivnaja ul’trazvukovaja abljacija pri lechenii pacientov s rakom predstatel’noj zhelezy: STATUSQUO 2014 [High-intensity focused ultrasound ablation in the treatment of patients with prostate cancer: website STATUSQUO 2014]. Zlokachest- vennye opuholi [Malignant tumor]. 2014; 3 (10): 52-56.

12. Chaussy C, Thuroff S. Transrectal high-intensity focused ultrasound for local treatment of prostate cancer: current role. Arch Esp Urol. 2011; 64 (6): 493–506.

13. Crouzet S et al. Locally recurrent prostate cancer after initial radiation therapy: early salvage high intensity focuse ultrasound improves oncologic outcomes. Radiotherapy and Oncology. 2012; 125 (2): 198–202.

14. Thuroff S, Chaussy C, Vallancien G et al. High-intensity focused ultrasound and localized prostate cancer: eficacy results from the European multricentric study. J Endourol. 2003; 17 (8): 673–677.

 THE FIRST EXPERIENCE OF PERSONAL ECG MONITORING IN PATIENTS AFTER THORACOSCOPIC ABLATION OF THE LEFT ATRIUM

УДК 616.12-008.313.2-089.168.1-07:616.12-073.97

DOI: 10.20969/VSKM.2017.10(6).24-30.

PIDANOV OLEG YU., C. Med. Sci., cardiovascular surgeon of the Department of cardiovascular surgery of Clinical Hospital of the President Administration, Russia, 107150, Moscow, Losinoostrovskaya str., 45, e-mail: 9681@mail.ru

Abstract. Aim. CardioQVARK portable device has been assessed as a tool for cardiovascular system monitoring in patients after thoracoscopic ablation for atrial brillation. Material and methods. 8 patients operated for symptomatic type of atrial brillation (EHRA III-IV) were incorporated in the research. All patients have undergone thoracoscopic fragmentation of the left atrium according to the Dallas Lesion Set chart with standard set of radio-frequency appliance. 5 minute ECG recording with CardioQVARK device has been performed in hospital patients from the 1st to the 5th day after the surgery. CardioQVARK system provided data transmission to CardioQVARK Doctor app. by mobile internet via cloud service. Results and discussion. Signi cant difference in cardiac rhythm veri cation between CardioQVARK data and bedside monitor indication was not observed. CardioQVARK personal device has demonstrated convenience and ease of use when monitoring patients in the period after surgical treatment for atrial brillation in hospital setting. One patient experienced an episode of typical atrial brillation in the early postoperative period. This episode was veri ed by the personal portable monitor CardioQVARK. Conclusion. The 1st experience of personal ECG monitoring using CardioQVARK system has demonstrated device reliability in hospital setting. Remote monitoring performed by CardioQVARK allows observing patients continuously. Nevertheless, the effectiveness of distant method is meant to be evaluated on a larger number of patients.

Key words: atrial brillation, thoracoscopic ablation of the left atrium, electrocardiogram.

For reference: Pidanov OYu. The rst experience of personal ECG monitoring in patients after thoracoscopic ablation of the left atrium. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (6): 24—30. DOI: 10.20969/ VSKM.2017.10(6).24-30.

1. Lloyd-Jones DM, Wang TJ, Leip EP, et al. Lifetime risk for development of atrial brillation: The Framingham Heart Study. Circulation. 2004; 110: 1042–1046.
2. Thom T, Haase N, Rosamond W, et al. Heart disease and stroke statistics—2006 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2006; 113: 85–151.
3. Wolf PA, Abbott RD, Kannel WB. Atrial brillation as an independent risk factor for stroke: the Framingham Study. Stroke. 1991; 22: 983–988.
4. McLellan AJ, Ling LH, Azzopardi S, Lee GA, Lee G, Kumar S, Wong MC, Walters TE, Lee JM, Looi KL, Halloran K, Stiles MK, Lever NA, Fynn SP, Heck PM, Sanders P, Morton JB, Kalman JM, Kistler PM. A minimal or maximal ab- lation strategy to achieve pulmonary vein isolation for paroxysmal atrial brilla- tion: a prospective multi-centre randomized controlled trial (the Minimax study). Eur Heart J. 2015; 36: 1812–1821
5. Revishvili ASh, Serguladze SYu., Ezhova IV, Kvasha BI, Sopov OV, Shmul AV. Rezul’taty hirurgicheskogo lechenija izolirovannyh form fibrilljacii predserdij s ispol’zovaniem modi cirovannoj operacii «labirint» [Results of Surgical Treatment of Isolated Atrial Fibrillations with the Use of Modi ed Maze Procedure]. Annaly aritmologii [Arrhythmology annals]. 2012; 9 (3): 31-39.
6. Monitoring for atrial brillation in discharged stroke and transient ischemic attack patients: recommendations. Ottawa: CADTH. 2016; 5: 2c.
7. Kishore A, Vail A, Majid A, Dawson J, Lees KR, Tyrrell PJ, Smith CJ. Detection of atrial brillation after ischemic stroke or transient ischemic attack: a systematic review and meta-analysis. Stroke. 2014; 45: 520–526.
8. Gladstone DJ, Spring M, Dorian P, Panzov V, Thorpe KE, Hall J, Vaid H, O’Donnell M, Laupacis A, Cote R, Sharma M, Blakely JA, Shuaib A, Hachinski V, Coutts SB, Sahlas DJ, Teal P, Yip S, Spence JD, Buck B, Verreault S, Casaubon LK, Penn A, Selchen D, Jin A, Howse D, Mehdiratta M, Boyle K, Aviv R, Kapral MK, Mamdani M. Atrial brillation in pa- tients with cryptogenic stroke. N Engl J Med. 2014; 370: 2467–2477.
9. Thijs VN, Brachmann J, Morillo CA, Passman RS, San- na T, Bernstein RA, Diener HC, Di Lazzaro V, Rymer MM, Hogge L, Rogers TB, Ziegler PD, Assar MD. Predictors for atrial brillation detection after cryptogenic stroke: Results from CRYSTAL AF. Neurology. 2016; 86: 261– 269.
10. Van Laar C, Kelder J, van Putte BP. The totally thoracosco- pic maze procedure for the treatment of atrial brillation. Interactive CardioVascular and Thoracic Surgery. 2017; 24: 102–111.
11. Tieleman RG, Plantinga Y, Rinkes D, Bartels GL, Posma JL, Cator R, Hofman C, Houben RP. Validation and clinical use of a novel diagnostic device for screening of atrial brillation. Europace. 2014; 16: 1291–1295.
12. Barrett PM, Komatireddy R, Haaser S, Topol S, Sheard J, Encinas J, Fought AJ, Topol EJ. Comparison of 24-hour Holter monitoring with 14-day novel adhesive patch electrocardiographic monitoring. Am J Med. 2014; 127: 95–97.
13. Quinn FR, Gladstone D. Screening for undiagnosed atrial brillation in the community. Curr Opin Cardiol. 2014; 29: 28–35.

 GENDER, SOCIAL AND MEDICAL ASPECTS OF COMBINED TUBERCULOSIS WITH THE DISEASES OF UROGENITAL SYSTEM IN CHILDREN

УДК [616-002.5:616.6]-053.2(571.13) 

DOI: 10.20969/VSKM.2017.10(6).30-34

ROMANOVA MARIA A., assistant of professor of the Department of therapeutical and surgical phthisiology of Omsk State Medical University, Russia, 644050, Omsk, Khimikov str., 8a, tel. 8-906-992-74-24, e-mail: rmari1@mail.ru

TURITSA ANNA A., C. Med. Sci., associate professor of the Department of childhood diseases with the course of outpatient pediatrics of Omsk State Medical University, Russia, 644099, Omsk, Lenin str., 12, tel. 8-913-968-76-30, e-mail: turi8282@mail.ru

MORDYK ANNA V., D. Med. Sci., professor, Head of the Department of therapeutical and surgical phthisiology of Omsk State Medical University, Russia, 644050, Omsk, Khimikov str., 8a, tel. 8(3812)95-68-24, e-mail: amordik@mail.ru

IVANOVA OLGA G., C. Med. Sci., associate professor of the Department of therapeutical and surgical phthisiology of Omsk State Medical University, Russia, 644050, Omsk, Khimikov str., 8a, tel. 8(3812)95-68-24, e-mail: olga-ivanova1969@mail.ru

TSYIGANKOVA ELENA A., C. Med. Sci., Head of the Department of Specialized Сhildren’s Tuberculosis of Clinical Hospital, Russia, 644510, Omsk, Krylovskaya str., 52, tel. 8-913-634-14-13

Abstract. Aim. The types of tuberculosis combined with the diseases of the genitourinary system in children, comorbidities with typical somatic diseases, gender and social components of these combinations have been revealed and evaluated in a large sample of pediatric patients with tuberculosis. Materials and methods. The data obtained from 1165 children with active tuberculosis was retrospectively gathered and analyzed by dividing them into groups: the 1st group — children with diseases of genitourinary system (n=157) and the 2nd — with no disease of genitourinary system (n=1008). Results and discussion. Gender differences were revealed. 63 (40,1%) boys were observed in the 1st group and 541 (53,7%) boys in the 2nd group (χ2=9,907; p=0,002). As for respiratory tuberculosis structure, the most common was tuberculosis of intrathoracic lymph nodes both in the 1st (85 children, 54,1%) and in the 2nd (641 children, 63,6%) groups (χ2=4,773; p=0,029) as well as primary tuberculosis complex — 11,5% (18 children) and 18,2% (183 children) (χ2=3,803; p=0,051). Children from socially safe families made 35,7% in the 1st group and 34,9% in the 2nd group (χ2=0,009; p=0,926). The remaining children in both groups were brought up in socially maladjusted or sociopathic families. Conclusion. Thus, there are diseases that correspond to the trends common for general population of children among the patients with active tuberculosis. More than 30% of the cases of tuberculosis in children are classi ed as socially safe. The presence of the diseases of the genitourinary system does not depend on the social status of the child’s family. Extrapulmonary types of tuberculosis were more often recorded in children with diseases of the genitourinary system. Diseases of the genitourinary system in children with tuberculosis are often combined with cardiovascular and endocrine disorders.

Kew words: tuberculosis, children, the social status of the family, extrapulmonary tuberculosis, diseases of the genitourinary system.

For reference: Romanova MA, Turica AA, Mordyk AV, Ivanova OG, Cygankova EA. Gender, social and medical aspects of combined tuberculosis with the diseases of urogenital system in children. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (6): 30—34. DOI: 10.20969/VSKM.2017.10(6).30-34.

1. Kul’chavenja EV, Zhukova II. Vnelegochnyj tuberkulez — voprosov bol’she, chem otvetov [Extrapulmonary tuberculosis — more questions than answers]. Tuberkulez i bolezni legkih [Tuberculosis and lung diseases]. 2017; 2: 59-63.
2. Kul’chavenja EV, Krasnov VA, Mordyk AV. Al’manah vnelegochnogo tuberkuleza [Almanac of extrapulmonary tuberculosis]. Novosibirsk: Sibprint [Novosibirsk: Sibprint]. 2015: 247.
3. Mordyk AV, Jakovleva AA, Nikolaeva IN, Leont’ev VV. Aktual’nost’ problemy vnelegochnogo tuberkuleza v sovremennyh jepidemiologicheskih uslovijah [The urgency of the problem of extrapulmonary tuberculosis in modern epidemiological conditions]. Tihookeanskij medicinskij zhurnal [Paci c Medical Journal]. 2015; 3: 19-21.
4. Mordyk AV, Puzyreva LV, Desenko AS, Rusanova NN. Tuberkulez central’noj nervnoj sistemy i mozgovyh obolochek v Omskoj oblasti za 2009-2012 goda [Tuberculosis of the central nervous system and meninges in the Omsk region for 2009-2012]. Medicina i obrazovanie v Sibiri [Medicine and Education in Siberia]. 2013; 5: 10.
5. Mordyk AV, Turica AA. Urogenitel’nyj tuberkulez u detej [Urogenital tuberculosis in children]; v knige: Al’manah vnelegochnogo tuberkuleza [in the book: Almanac of extrapulmonary tuberculosis]. Novosibirsk: Sibprint. 2015: 102-126.
6. Puzyreva LV, Safonov AD, Lebedev OI, Mordyk AV. Tuberkulez glaz [Tuberculosis of the eye]. Vestnik oftal’mologii [Herald of Ophthalmology]. 2016; 3: 103-107.
7. Mordyk AV, Cygankova EA, Podkopaeva TG, Puzyreva LV, Turica AA. Faktory riska razvitija tuberkuleza u detej (obzor literatury) [Risk factors for development of tuberculosis in children (literature review)]. Zhizn’ bez opasnostej; Zdorov’e; Pro laktika; Dolgoletie [Life without danger; Health; Prevention; Longevity]. 2014; 1: 92-95.
8. Cygankova EA, Mordyk AV, Turica AA. Vnelegochnye formy tuberkuleza u detej rannego vozrasta v 1985-2010 godah [Extrapulmonary forms of tuberculosis in young children in 1985-2010]. Tuberkulez i social’no-znachimye zabolevanija [Tuberculosis and socially significant diseases]. 2014; 3: 9-12.
9. Turica AA, Velichko KA, Baryshnikova DV, Ivanova OG, Mordyk AV. Patologija pochek u detej, in cirovannyh mikobakterijami tuberkuleza [Kidney pathology in children infected with mycobacteria tuberculosis]. Tuberkulez i bolezni legkih [Tuberculosis and lung diseases]. 2015; 7: 140.

 COMPARATIVE ANALYSIS OF THE DENTAL STATUS OF THE STUDENTS OF KAZAN STATE MEDICAL UNIVERSITY

УДК 616.31-057.875-07(470.41-25)

SALEEV RINAT A., D. Med. Sci., professor of the Department of prosthodontics of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: rinat.saleev@gmail.com

ABDRASHITOVA ALENA B., C. Med. Sci., associate professor of the Department of pediatric dentistry of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: egorova-alena@mail.ru

MAKHMUTOVA ALIYA I., 5-year student of dental faculty of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: a_maxmutova@mail.ru

Abstract. Aim. Comparative analysis of dental status of the 2nd year students of Kazan State Medical University has been conducted. Material and methods. The dental status evaluation of 116 2nd year students of the dental faculty has been carried out according to the results of preventive examination (June 2016) and to the dental patient medical card records (preventive examination, September 2015) on the basis of the dental clinic of Kazan SMU. The sampling was performed by simple randomization. The dental status has been assessed by primary and additional methods upon readings. Results and discussion. Analysis of preventive examination results has showed that the prevalence of dental caries among the students is quite high with the average level of (94,02±0,46)%. The intensity of the caries has reached the average of (6,83±0,31)%. Hygienic condition was assessed on average as satisfactory. In ammatory diseases of periodontal tissues were determined in (21,1±0,58)% of the cases (according to the PMA index). The oncological screening has showed the following results: according to the past medical history 8 people — the carriers of herpes simplex virus with the changes at the border of the oral mucosa and vermillion border demonstrate 1—2 point glow. 3—4 point luminescence intensity was seen in 3 patients with diagnosed chronic trauma of the cheek mucous membrane along the line of occlusion. Non-nuclear epithelial cells with keratohyalin nuclei inclusion in the cytoplasm have been discovered in the histological material (3—4 degrees of differentiation). Conclusion. 2nd year students of the dental faculty have demonstrated the high prevalence and activity of caries, which indicates the need in secondary and tertiary prevention. Comparison with the results of 2015 and 2016 has revealed that the number of affected teeth in the students increases, which may be associated with deterioration of individual oral hygiene.

 SURVIVAL PROGNOSIS IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE PHENOTYPE IN COMBINATION WITH ARTERIAL HYPERTENSION

УДК [616.24-036.12:616.12-008.331.1]-037 

DOI: 10.20969/VSKM.2017.10(6).41-48

SHPAGIN ILYA S., C. Med. Sci., assistant of professor of the Department of internal medicine, hematology and transfusiology of Novosibirsk State Medical University, Russia, 630084, Novosibirsk, Polzunov str., 21, tel. (383)279-99-45, e-mail: doctor_ilya@mail.ru

GERASIMENKO OKSANA N., D. Med. Sci., professor of the Department of internal medicine and medical rehabilitation of Novosibirsk State Medical University, Russia, 630051, Novosibirsk, Polzunov str., 21, tel. (383)279-99-45, e-mail: mkb-2@yandex.ru

POSPELOVA TATYANA I., D. Med. Sci., professor, pro-rector for scientific work, Head of the Department of internal medicine and hematology of Novosibirsk State Medical University, Russia, 630084, Novosibirsk, Polzunov str., 21, tel. +7(383)279-99-45, e-mail: mkb-2@yandex.ru

SHPAGINA LUBOV A., D. Med. Sci., professor, Head of the Department of internal medicine and medical rehabilitation of Novosibirsk State Medical University, Russia, 630051, Novosibirsk, Polzunov str., 21, tel. (383)279-99-45, e-mail: mkb-2@yandex.ru

DROBYSHEV VICTOR A., D. Med. Sci., professor of the Department of internal medicine and hematology of Novosibirsk State Medical University, Russia, 630084, Novosibirsk, Polzunov str., 21, e-mail: doctorvik@yandex.ru

SUKHATERINA NATALYA A., C. Med. Sci., assistant of professor of the Department of internal medicine and medical rehabilitation of Novosibirsk State Medical University, Russia, 630051, Novosibirsk, Polzunov str., 21, tel. (383) 279-99-45, e-mail: mkb-2@yandex.ru

Abstract. Aim. The objective of the study was to evaluate the prognosis and to determine the most signi cant predictors of the overall and cardiovascular survival in patients with chronic obstructive pulmonary disease phenotype in combination with arterial hypertension based on the clinical functional and molecular marker assessment. Material and methods. Single site prospective cohort observational study of 360 patients carried out during 2011—2016 included patients with COPD comorbid with AH (n=135), COPD without AH (n=108), patients with AH without COPD (n=117) and control group of relatively healthy individuals (n=99). Diagnosis of COPD was made according to GOLD criteria, 2016. Diagnosis AH was made based on ESH/ESC criteria, 2013. COPD symptoms and exacerbation frequency were evaluated. Spirography, blood gas analysis, bioimpedanceometry, echocardiography, 24-hour BP monitoring, ultrasound study of carotid vessels, in ammatory molecule, oxidative stress and endothelial dysfunction marker evaluation have been performed. Correlation and regression analysis has been carried out in order to determine the most signi cant survival predictors in patients with comorbid phenotype. Survival analysis was performed using Kaplan-Mayer method. The level of signi cance was p=0,05. Results and discussion. The lowest overall survival rate determined by the presence of cardiovascular diseases was observed in patients with COPD phenotype combined with arterial hypertension with frequent exacerbations. Among the most important predictors of the overall 5-year survival observed in patients with COPD phenotype combined with AH were the parameters characterizing hypoxemia, microcirculation disorders, renin-angiotensin-aldosterone system hyperactivation and systemic in ammation, such as 6 minute walk test, mMRC, active cellular mass, pulmonary residual volume, pulmonary residual volume/total lung capacity, mean pulmonary artery pressure, pulmonary vascular resistance, right front wall ventricle thickness, isovolumetric relaxation time of the right ventricle, oxygen partial pressure in alveoli, urotensin 2, angiotensin 1, angiotensin 2 and angiotensin converting enzyme inhibiting factor, MCP-1, MIP-1β, MMP-9 and lipid peroxidation product 8-iso-PGF2α. Conclusion. Evaluation of the mean pulmonary pressure, the structure and function of the right heart chambers, parameters of pulmonary hyperin ation and basal microcirculation and the frequency of COPD exacerbations is important in terms of 5-year cardiovascular survival prediction in COPD patients with AH.

Key words: chronic obstructive pulmonary disease, arterial hypertension, phenotype, prognosis, survival.

For reference: Shpagin IS, Gerasimenko ON, Pospelova TI, Shpagina LA, Drobyshev VA, Sukhaterina NA. Survival prognosis in chronic obstructive pulmonary disease phenotype in combination with arterial hypertension. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (6): 41—48. DOI: 10.20969/VSKM.2017.10(6).41-48.

1. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. 2017: URL: http://www.goldcopd.com (date accessed: 27.05.2017)

2. Nekrasov AA, Kuznetsov AN, Melnichenko OV, Kabanova TI. Remodelirovanie serdca pri hronicheskoj obstruktivnoj bolezni legkih s raznoj stepen’ju legochnoj gipertenzii pri primenenii ingibitorov APF [Cardiac Remodeling in chronic obstructive pulmonary disease with different degree of pulmonary hypertension with the use of ACE inhibitors]. Pulmonology [Pul’monologija]. 2012; 2: 52-55.

3. Agusti A, Bel E, Thomas M et al. Treatable traits: toward precision medicine of chronic airway diseases. Eur Respir J. 2016; 47: 410-441.

4. Negewo NA, Gibson PG, McDonald VM. Itscomorbidities and COPD: Impact, measurementandmechanisms. Respirology. 2015; 20 (8): 1160-1171.

5. Chazova IE, Chuchalin AG, Zykov KA et al. Diagnostika i lechenie pacientov s arterial’noj gipertoniej i hronicheskoj obstruktivnoj bolezn’ju legkih (Rekomendacii Rossijskogo medicinskogo obshhestva po arterial’noj gipertonii i Rossijskogo respiratornogo obshhestva) [The Diagnosis and treatment of patients with arterial hypertension and chronic obstructive pulmonary disease (Recommendations of the Russian medical society on arterial hypertension and Russian respiratory society)]. Systemic Hypertension [Sistemnye Gipertenzii]. 2013; 10: 5–34.

6. Caramori G, Adcock IM, Di Stefano A, Chung KF. Cytokine inhibition in the treatment of COPD. Int J Chron Obstruct Pulmon Dis. 2014; 28; 9: 397-412.

7. Teng N, Maghzal GJ, Talib J et al. The roles of myeloperoxidase in coronary artery disease and its potential implication in plaque rupture. Redox Rep. 2016; 25: 1-23.

8. Avdeev SN, Asanov ZR, Belevskiy AS. Perspektivy farmakoterapii hronicheskoj obstruktivnoj bolezni legkih: vozmozhnosti kombinirovannyh bronhodilatatorov i mesto ingaljacionnyh gljukokortikosteroidov. Zakljuchenie Soveta jekspertov [Prospects for pharmacotherapy of chronic obstructive pulmonary disease: possibilities of combined bronchodilators and inhaled glucocorticosteroids place: the conclusion of the Council of experts. Pulmonology]. Pulmonology [Pul’monologija]. 2016; 26 (1): 65-72.

9. Cooper LL, Palmisano JN, Benjamin EJ et al. Microvascular Function Contributes to the Relation Between Aortic Stiffness and Cardiovascular Events: The Framingham Heart Study. Circ Cardiovasc Imaging. 2016; 9 (12): e00497. doi: 10.1161/CIRCIMAGING.116.004979

10. Shaw JG, Vaughan A, Dent AG, O’hare PE et al. Biomarkers of progression of chronic obstructive pulmonary disease (COPD). J Thorac Dis. 2014; 6 (11): 1532-1547.

 TACOTSUBO SYNDROME IN THE COURSE OF INTERNAL DISEASES

УДК [616.127:616.124.2]-008.6(048.8) 

DOI: 10.20969/VSKM.2017.10(6).49-60

ABDRAKHMANOVA ALSU I., C. Med. Sci., associate professor of the Department of clinical medicine fundamental basis of Institute of fundamental medicine and biology of Kazan Federal University, Russia, 420012, Kazan, Karl Marx str., 74, tel. 8-917-922-66-29, e-mail: alsuchaa@mail.ru

TSIBULKIN NIKOLAY A., C. Med. Sci., associate professor of the Department of cardiology, roentgen-endovascular and cardiovascular surgery of Kazan State Medical Academy — Branch of the FSBEI APE RMACPE MON, Russia, 420012, Kazan, Butlerov str., 36, e-mail: kldkgma@mail.ru

AMIROV NAIL B., ORCID ID: orcid.org/0000-0003-0009-9103; SCOPUS Author ID: 7005357664; D. Med. Sci, professor of the Department of general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: namirov@mail.ru

GALIMZYANOVA LILYA A., Head of the Department of cardiology of Interregional Clinical Diagnostic Center, Russia, 420089, Kazan, Karbyshev str., 12а

SAIFULLINA GUSALIA B., physician of the Laboratory of radioisotope diagnostics of Interregional Clinical Diagnostic Center, Russia, 420089, Kazan, Karbyshev str., 12а

OSLOPOVA JULIYA V., C. Med. Sci., associate professor of the Department of clinical medicine fundamental basis of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, Karl Marx str., 74

Abstract. Aim. Analysis of the latest publications on the prevalence, the features of the course, diagnosis and treatment of takotsubo syndrome has been performed. Material and methods. Review of scienti c and medical publications devoted to takotsubo syndrome has been carried out. Results and discussion. The prevalence of takotsubo syndrome among patients with acute coronary syndrome is 1,7—2,2%. Catecholamines play a key role among the pathophysiological links of this syndrome. There are several distinct anatomical types of the primary and secondary takotsubo syndrome. Diagnostic criteria of the tacotsubo syndrome are: transient violation of local contractility of the left or right ventricle of the myocardium, which is often, but not always, preceded by a stressor factor (emotional or physical); the violation of local contractility usually corresponds to the areas of the myocardium, which is supplied by more than 1 epicardial coronary artery, and it often leads to circular dysfunction of the left ventricular segments; the absence of atherosclerotic lesions of the coronary arteries; First developed and reversible pathological changes on the ECG (increase or decrease of the ST segment from the isoelectric line, left bundle branch blockade, changes in T wave and prolongation of Q—Tc interval, clinically signi cant increase in concentration of natriuretic peptides during the acute phase of the disease; positive troponin (discrepancy between increased levels of troponin in the blood and myocardial dysfunction with symptoms), ventricular systolic function restoration according to the imaging (for 3—6 months). The main complications are: acute heart failure and arrhythmias. The frequency of relapse within 5 years can reach 5—22%. The estimation of the prognosis should be individual depending on the probability of relapse, the nature of the provoking factor and on the comorbidities. Takotsubo syndrome requires urgent hospitalization in intensive cardiology department. Randomized studies of the effect of various drugs in takotsubo syndrome are lacking. The treatment is supportive in the majority of cases. Conclusion. Doctors should consider the likelihood of takotsubo cardiomyopathy in patients with typical dynamics of clinical manifestations and data of instrumental studies. It will minimize the overdiagnosis of coronary heart disease.

Key words: takotsubo syndrome, acute coronary syndrome, coronary angiography, myocardial infarction.

For reference: Abdrahmanova AI, Tsibulkin NA, Amirov NB, Saifullina GB, Galimzyanova LA, Oslopova JB. Takotsubo syndrome in the course of internal diseases. The Bulletin of Contemporary Clinical Medicine. 2017; 10 (6): 49—60. DOI: 10.20969/VSKM.2017.10(6).49-60.

1. Sato H, Tateishi H, Uchida T. Takotsubo-type cardio- myopathy due to multivessel spasm; In: Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure; Kodama K, Haze K, Hon M, eds. Tokyo: Kagakuhyouronsya Co. 1990; 56-64 p.

2. Shao Y, Redfors B, Lyon AR et al. Trends in publications on stress-induced cardiomyopathy. Int J Cardiol. 2012; 157: 435-436.

3. Tranter MH, Wright PT, Sikkel MB Lyon AR. Takotsubo cardiomyopathy: the pathophysiology. Heart Fail Clin. 2013; 9: 187-196.

4. Lyon AR, Rees PS, Prasad S, et al. Stress (Takotsubo) cardiomyopathy — a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008; 5: 22-29.

5. Tornvall P, Collste O, Ehrenborg E et al. A case-control study of risk markers and mortality in Takotsubo stress cardiomyopathy. J Am Coll Cardiol. 2016; 67: 1931-1936.

6. Schneider B, Athanasiadis A, Stollberger C et al. Gender differences in the manifestation of tako-tsubo cardiomyopathy. Int J Cardiol. 2013; 166: 584-588.

7. Santoro F, Ieva R, Spennati G et al. Tako-Tsubo cardiomyopathy in a teen girl with pheochromocytoma. Int J Cardiol. 2012; 160: 48-49.

8. Lyon AR, Bossone E, Schneider B et al. Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2016; 18: 8-27.

9. Redfors B, Shao Y, Ali A et al. Are the different patterns of stress-induced (Takotsubo) cardiomyopathy explained by regional mechanical overload and demand: supply mismatch in selected ventricular regions? Med Hypothe- ses. 2013; 81: 954-960.

10. Eitel I, Von Knobelsdorff-Brenkenhoff F, Bernhardt P et al. Clinical characteristics and cardiovas- cular magnetic resonance ndings in stress (takotsubo) cardiomyopathy. JAMA. 2011; 306: 277-286.

11. Litvinenko RN, Shulenin SN, Kulikov AN et al. O differencial’noj diagnostike tranzitornoj ishemii mio- karda — takocubo-kardiomiopatii [On differential diagnosis of transient myocardial ischemia — tacotubo- cardiomyopathy]. Vestnik Rossijskoj voenno- medicinskoj akademii [Bulletin of the Russian Military Medical Academy]. 2013; 1 (41): 1-10.

12. Citro R, Rigo F, Previtali M et al. Differences in clinical features and in-hospital outcomes of older adults with tako- tsubo cardiomyopathy. J Am Geriatr Soc. 2012; 60: 93- 98.

13. Harina TP, Tarjanik PV, Gerashhenko EV i dr. Sindrom «razbitogo serdca» ili stress — inducirovannaja kar- diomiopatija (sindrom takocubo) [Syndrome of «broken heart» or stress-induced cardiomyopathy (takotsubo syndrome]. Zdorov’e; Medicinskaja jekologija; Nauka [Health; Medical ecology; The science]. 2016; 1 (64): 55-60.

14. Ahmed KA, Madhavan M, Prasad A. Brain natriuretic peptide in apical ballooning syndrome (Takotsubo/stress cardiomyopathy): comparison with acute myocardial infarction. Coron Artery Dis. 2012; 23: 259-264.

15. Frohlich GM, Schoch B, Schmid F et al. Takotsubo cardiomyopathy has a unique cardiac biomarker pro le: NT-proBNP/myoglobin and NT-proBNP/troponin T ratios for the differential diagnosis of acute coronary syndromes and stress induced cardiomyopathy. Int J Cardiol. 2012; 154: 328-332.

16. Paur H, Wright PT, Sikkel MB et al. High levels of circulating epinephrine trigger apical cardiodepression in a beta2- adrenergic receptor/Gi-dependent manner: a new model of Takotsubo cardiomyopathy. Circulation. 2012; 126: 697-706.

17. Jaguszewski M, Osipova J, Ghadri JR et al. A signature of circulating microRNAs differentiates takotsubo cardiomyopathy from acute myocardial infarction. Eur Heart J. 2014; 35: 999-1006.

18. Johnson NP, Chavez JF, Mosley WJ et al. Performance of electrocardiographic criteria to differentiate Takotsubo cardiomyopathy from acute anterior ST elevation myocardial infarction. Int J Cardiol. 2013; 164: 345-348.

19. Delgado GA, Truesdell AG, Kirchner RM et al. An angiographic and intravascular ultrasound study of the left anterior descending coronary artery in takotsubo cardiomyopathy. Am J Cardiol. 2011; 108: 888-891.

20. Giljarevskij SR. Kardiomiopatija takocubo: Podhody k diagnostike i lecheniju [Cardiomyopathy takotsubo: Approaches to diagnosis and treatment]. Moskva [Moscow]: MEDpress-inform, 2013; 184 p.

21. Bossone E, Lyon A, Citro R et al. Takotsubo cardiomyo- pathy: an integrated multi-imaging approach. Eur Heart J Cardiovasc Imaging. 2014; 15: 366-377.

22. Meimoun P, Clerc J, Vincent C et al. Non-invasive detection of tako-tsubo cardiomyopathy vs acute anterior myocardial infarction by transthoracic Doppler echocardiography. Eur Heart J Cardiovasc Imaging. 2013; 14: 464-470.

23. Citro R, Rigo F, D’Andrea A et al. Echocardiographic correlates of acute heart failure, cardiogenic shock, and in-hospital mortality in tako-tsubo cardiomyopathy. JACC Cardiovasc Imaging. 2014; 7: 119-129.

24. Thavendiranathan P, Walls M, Giri S et al. Improved detection of myocardial involvement in acute infammatory cardiomyopathies using T2 mapping. Circ Cardiovasc Imaging. 2012; 5: 102-110.

25. Iacucci I, Carbone I, Cannavale G et al. Myocardial oedema as the sole marker of acute injury in Takotsubo cardiomyopathy: a cardiovascular magnetic resonance (CMR) study. Radiol Med. 2013; 118: 1309-1323.

26. Friedrich MG, Sechtem U, Schulz-Menger J et al. Cardiovascular magnetic resonance in myocarditis: a JACC White Paper. J Am Coll Cardiol. 2009; 53: 1475- 1487.

27. Fejshanova LI, Malov AA, Bashirov RA. Rol’ perfuzionnoj scintigra i v diagnostike kardiomiopatii Takocubo [The role of perfusion scintigraphy in the diagnosis of Takotsubo cardiomyopathy]. Prakticheskaja medicina [Practical medicine]. 2015; 4: 169-170.

28. Christensen TE, Bang LE, Holmvang L et al. Cardiac Tc sestamibi SPECT and F FDG PET as viability markers in takotsubo cardiomyopathy. Int J Cardiovasc Imaging. 2014; 30: 1407-1416.

29. Redfors B, Vedad R, Anger s O et al. Mortality in takotsubo syndrome is similar to mortality in myocardial infarction—A report from the SWEDEHEART1 registry. Int J Cardiol. 2015; 185: 282-289.

30. Singh K, Carson K, Shah R et al. Meta-analysis of clinical correlates of acute mortality in takotsubo cardiomyopathy. Am J Cardiol. 2014; 113: 1420-1428.

31. Haghi D, Athanasiadis A, Papavassiliu T et al. Right ventricular involvement in Takotsubo cardiomyopathy. Eur Heart J. 2006; 27: 2433-2439.

32. Pant S, Deshmukh A, Mehta K et al. Burden of arrhythmias in patients with Takot- subo Cardiomyopathy (apical ballooning syndrome). Int J Cardiol. 2013; 170: 64-68.

33. Murakami T, Yoshikawa T, Maekawa Y et al. Characterization of predictors of in-hospital cardiac complications of takotsubo cardiomyopathy: multi-center registry from Tokyo CCU Network. J Cardiol. 2014; 63: 269-273.

34. Kim J, Laird-Fick HS, Alsara O et al. Pericarditis in takotsubo cardiomyopathy: a case report and review of the literature. Case Rep Cardiol. 2013; 2013: 5.

35. Yeh RW, Yu PB, Drachman DE. Takotsubo cardiomyopathy complicated by cardiac tamponade: classic hemodynamic findings with a new disease. Circulation. 2010; 122: 1239-1241.

36. Santoro F, Ieva R, Musaico F et al. Lack of ef cacy of drug therapy in preventing takotsubo cardiomyopathy recurrence: a meta-analysis. Clin Cardiol. 2014; 37: 434-439.

37. Singh K, Parsaik A, Singh B. Recurrent takotsubo cardiomyopathy: variable pattern of ventricular involvement. Herz. 2014; 39: 963-967.

38. Palla AR, Dande AS, Petrini J et al. Pretreatment with low-dose beta-adrenergic antagonist therapy does not affect severity of Takotsubo cardiomyopathy. Clin Cardiol. 2012; 35: 478-481.

39. Santoro F, Ieva R, FerrarettiA et al. Safety and feasibility of levosimendan administration in takotsubo cardiomyopathy: a case series. Cardiovasc Ther. 2013; 31: 133-137.

40. Karvouniaris M, Papanikolaou J, Makris D et al. Sepsisassociated takotsubo cardiomyopathy can be reversed with levosimendan. Am J Emerg Med. 2012; 30: 832-837.

41. Shao Y, Redfors B, Scharin Tang M et al. Novel rat model reveals important roles of beta-adrenoreceptors in stress-induced cardiomyopathy. Int J Cardiol. 2013; 168: 1943-1950.

42. Donker DW, Pragt E, Weerwind PW et al. Rescue extracorporeal life support as a bridge to reflection in fulminant stress-induced cardiomyopathy. Int J Cardiol. 2012; 154: e54-e56.

43. Gowdar S, Chhabra L. Takotsubo Cardiomyopathy Outcomes Should Be Stratified Based on the Triggering Etiology. JACC. 2016; (68) 15: 1705-1711

44. Templin C, Napp C, Ghadri J. Takotsubo Syndrome. Journal of the amtrican college of cardiology. 2016; (67) 16: 1937-1940.

 CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND TUBERCULOSIS: THE LATEST PROBLEM IN REAL CLINICAL PRACTICE (review)

УДК 616.24-036.12:616.24-002.5(048.8)

KHANIN ARKADIY L., D. Med. Sci., professor, honored doctor of Russian Federation, Head of the Department of phthisiology and pulmonology of Novokuznetsk state institution of complementary professional education — of branch of the FSBET APE RMACPE MON, Russia, 654005, Novokuznetsk, Stroiteley ave., 49, e-mail: prof.khanin@yandex.ru, tel. +7-384-345-48-73

KRAVETS SVETLANA L., phthisiatrician of the Prokopyevsky tuberculosis dispensary, Russia, 653024, Prokop’evsk, Serov str., 6, e-mail: kompasha@mail.ru, tel. +7-904-963-21-02

Abstract. Aim. Current data on the problem of combined chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) has been studied. Material and methods. Review of national and foreign literature on the prevalence of bronchial obstructive syndrome in TB and in combined COPD with TB is presented. Results and discussion. There are 3 clinical types of COPD and pulmonary TB combination. Those are: TB progressing in patients with COPD; both diseases progressing simultaneously or secondary COPD as a consequence of pulmonary TB. Combination of COPD and TB is one of the common comorbid conditions in medicine, because both diseases have similar risk factors. Those are smoking, professional and ecological problems related to health. Moreover, continuous smoking increases the risk of TB by 15 times in relation with non-smoking people. COPD is diagnosed in 23—35,5% of patients with newly diagnosed pulmonary TB. Every 5th patient has an extremely severe stage of disease according to GOLD criteria. In case of COPD and pulmonary TB combination there is a syndrome of mutual burdening. TB is characterized by signi cant clinical symptoms. In majority of the cases it is cavity decay formation with massive bacterial excretion, more frequent respiratory and heart failure, adverse outcome of pulmonary TB or severe COPD. Conclusion. It is noted that the pathogenesis of obstructive disorders related to the combination of these diseases is not studied properly. The diagnostic criteria and the features of COPD phenotypes in TB patients are not suf cient. Neither there are standards for treatment of patients with concomitant disease. There are few works showing the advantage of Tiotropium bromide and prolonged beta-2-agonist in combination with inhaled corticosteroids. Several studies have shown that inhaled corticosteroid administration in patients with COPD 2,04 times, periodical use 4,31 times increases the risk of tuberculosis. Challenging TB situation and increase in COPD prevalence is the problem that acquires an important scienti c and practical value.

Key words: COPD, tuberculosis, bronchial obstructive syndrome, diagnostics, treatment.

For reference: Khanin AL, Kravets SL. Chronic obstructive pulmonary disease and tuberculosis: the latest problem in real clinical practice (review). The Bulletin of Contemporary Clinical Medicine. 2017; 10 (6): 60—70. DOI: 10.20969/ VSKM.2017.10(6).60-70.

1. Avdeev SN. Profilaktika obostreniy khronicheskoy obstruktivnoy bolezni legkikh [Prevention of chronic obstructive pulmonary disease exacerbations]. Pulmo- nologiya [Pulmonology]. 2016; 26 (5): 101-108.

2. Bilichenko TN, Bystritskaya YeV, Chuchalin AG, Belevskiy AS, Batyn SZ. Smertnost ot bolezney organov dykhaniya v 2014-2015 godah i puti ee snizheniya [Mortality from respiratory diseases in 2014-2015 and ways for its reduction]. Pulmonologiya [Pulmonology]. 2016; 26 (4): 23-28.

3. Va n AYu, Vizel AA, Sherputovskiy VG et al. Zabolevaniya organov dykhaniya v Respublike Tatarstan: mnogoletniy epidemiologicheskiy analiz [Respiratory diseases in the Republic of Tatarstan: long-term epidemiological analysis]. Vestnik sovremennoy klinicheskoy meditsiny [Journal of modern clinical medicine]. 2016; 9 (1): 24-31.

4. Makarov IA, Potapova IA, Makeeva NV. Osobennosti dinamiki professionalnoy khronicheskoy obstruktivnoy bolezni legkikh u rabochikh pylevykh professiy [Peculia- rities of the dynamics of COPD among workers of dust professions]. Pulmonologiya [Pulmonology]. 2017; 27 (1): 37-40.

5. Nauchno-issledovatelskiy proekt Fonda «Kachestvo zhizni»: «Sotsialno-ekonomicheskie poteri ot bronkhialnoy astmy i khronicheskoy obstruktivnoy bolezni legkikh v Rossiyskoy Federatsii» [Scientific research project of “Quality of life” Fund: “Social and economic losses from bronchial asthma and COPD in Russian Fede- ration”]. 2013; http://www.qualityo ife.ru/ru/taxonomy/ term/2/all

6. Starodubov VI, Leonov SA, Vaysman DSh. Analiz osnovnykh tendentsiy izmeneniya zabolevaemosti naseleniya khronicheskimi obstruktivnymi boleznyami legkikh i bronkhoektaticheskoy boleznyu v Rossiyskoy Federatsii v 2005–2012 godakh [Analysis of the main trends of morbidity of COPD and bronchiectasis disease in Russian Federation in 2005-2012]. Meditsina [Medicine]. 2013; 4: 1-31.

7. Chuchalin AG et al. Khronicheskaya obstruktivnaya bolezn legkikh i soputstvuyushchie zabolevaniya [COPD and comorbidities]. Pulmonologiya [Pulmonology]. 2008; 18 (2): 5-14.

8. Chuchalin AG, Aysanov ZZ, Avdeev SN. Natsionalnye klinicheskie rekomendatsii po diagnostike i lecheniyu khronicheskoy obstruktivnoy bolezni legkikh: algoritm prinyatiya klinicheskikh resheniy [National clinic guidelines for the diagnosis and treatment of COPD: an algorithm for decision making in the clinical sphere]. Pulmologiya [Pulmonology]. 2017; 27 (1): 13-20.

9. Shprykov AS. Klinicheskie osobennosti tuberkuleza legkikh u kuryashchikh bolnykh [Clinical features of pulmonary TB among smoking patients]. Tuberkulez i bolezni legkikh [Tuberculosis and lung disease]. 2011; 9: 24- 28.

10. Chenry P. Quend les aconomistes s’emparent de la santy. J damocr sanit. 2002; 143: 25-28.

11. Global Initiative for Chronic Obstructive Lung Diseases (COLD-2011). Global strategy for diagnosis, management, and prevention of chronic obstructive pulmonary disease. NHLBI/WNO workshop report. 2011; GOLD website: www.goldcopd.com.

 CARDIAC X SYNDROME: THE POSSIBILITIES OF THERAPY

УДК 616.12-085.22 

DOI: 10.20969/VSKM.2017.10(6).71-74

CHEPURNENKO SVETLANA A., D. Med. Sci, cardiologist of the Department of cardiology outpatient of Cardiosurgery Center of Rostov Regional Clinical Hospital, Russia, 344015, Rostov-on-Don, Blagodatnaya, str., 170; assistant of professor of the Department of general medical practice (family medicine) with the courses of geriatrics and physiotherapy of Rostov State Medical University, Russia, 344022, Rostov-on-Don, Nakhichevanskiy lane, 29, e-mail: ch.svet2013@yandex.ru

SHAVKUTA GALINA V., D. Med. Sci, professor, Head of the Department of general medical practice (family medicine) with the courses of geriatrics and physiotherapy of Rostov State Medical University, Russia, 344022, Rostov-on-Don, Nakhichevanskiy lane, 29 

BULGAKOVA NATALIA M., C. Med. Sci., cardiologist of the Department cardiology outpatient of Cardiosurgery Center of Rostov Regional Clinical Hospital, Russia, 344015, Rostov-on-Don, Blagodatnaya str., 170 

Abstract. The article presents clinical observation of a patient with a special type of coronary heart disease — cardiac X syndrome. Prognosis of this disease is currently not so favorable and it seriously worsens the quality of patient life. Therefore, a great importance is attached to the choice of adequate treatment. Aim. Assessment of patient management tactics in coronary X syndrome has been performed. Material and methods. Clinical observation of a patient with cardiac X syndrome, which refers to a particular type of coronary heart disease, is described in detail. Diagnostic criterion of the disease is the absence of hemodynamic signi cant stenoses of the coronary arteries against the background of ongoing signs of myocardial ischemia, with recorded ST-segment depression of more than 1,5 mm and duration of more than 1 minute, established with a 48-hour monitoring of the electrocardiogram. Results and discussion. Atypical character of the pain syndrome was seen in the patient. The use of the late current inhibitor of sodium ions ranolazin has led to an increase in exercise tolerance by 55% and to a decrease in ischemia duration by 48%. The number of episodes of depression decreased in 2 times according to the holter ECG monitoring compared to the results of standard therapy. The ATP-dependent potassium channel activator nicorandil has reduced the duration of ischemia by 11% and the number of depression episodes — by 16,6% according to holter ECG monitoring. Conclusion. Both drugs in combination with standard therapy have demonstrated a positive effect in cardiac X syndrome. To a greater extent, it was expressed against the background of taking ranolazine.

1. Zakharova OV, Boldueva SA, Leonova IA et al. Voz- mozhnosti optimizacii lekarstvennoj terapii u bol’nyh s kardial’nym sindromom X [Possibilities to optimize drug therapy in patients with cardiac syndrome X]. Original’nye issledovanija [Original Research]. 2016; 8: 33-38.

2. Demirkol S, Balta S, Unluoy M et al. Lymphocytes ratio in patients with cardiac syndrome X and its association with carotid intima–media thickness. Clinical and Applied Thrombosis/Hemostasis. 2014; 20: 250-255.

3. Alekseeva OP, Dolbin IV. Kardial’nyj sindrom X: patogenez, diagnostika, lechenie [Cardiac Syndrome X: pathogenesis, diagnosis, treatment]. Kazanskij medicinskij zhurnal [J Kazan Medical]. 2009; 90: 769-775.

4. Rydoi AS, Zagashvili IV. Mikrovaskuljarnaja stenokardija [Microvascular angina]. Voennaja medicina: nauchno- prakticheskij recenziruemyj zhurnal [J Military medicine: scienti c and practical peer-reviewed]. 2012; 1: 143-148.

5. Chepurnenko SA, Mikashinovich ZI, Bulgakova NM. Vozmozhnosti rannej diagnostiki narushenij metaboliz- ma kostnoj tkani v postmenopauze [Possibilities of early diagnosis of disorders of bone metabolism in postmenopausal women]. J of Modern Clinical Medicine. 2016; 9 (1): 71-74.

6. Chepurnenko SA, Shavkuta GV. Deficit vitamina D i ego vzaimosvjaz’ s markerom kostnoj rezorbcii v postmenopauzal’nom periode [Vitamin D deficiency and its relationship with the bone resorption marker in the postmenopausal period ]. Rostov-na-Donu [Rostov-on-Don]: Uluchshenie kachestva pervichnoj medicinskoj pomoshhi cherez prizmu podgotovki vysokoprofessional’nyh vrachebnyh kadrov: akcenty na profilaktiku, rannjuju diagnostiku i racional’nuju lekarstvennuju terapiju: sbornik statej V Kongressa vrachej pervichnogo zvena zdravoohranenija Juga Rossii, XI Konferencii vrachej obshhej praktiki (Semejnyh vrachej) Juga Rossii [Improving the quality of primary health care through the prism of training highly professional medical staff: emphasis on prevention, early diagnosis and rational drug therapy: Proceedings of the V Congress of Primary Health Care Professionals of the South of Russia, XI Conference of General Practitioners (Family Physicians) in the South of Russia]. 2016; 299-306.

7. Sarkisyan OG, Mikashinovich ZI, Chepurnenko SA. Mehanizmy formirovanija atroficheskogo kol’pita u zhenshhin postreproduktivnogo perioda [Mechanisms of atrophic vaginitis in women postreproductive period]. Medicinskij vestnik Juga Rossii [Medical bulletin of the South of Russia]. 2016; 1: 67-71. 

8. Galin PU, Gubanova TG, Erov NC. Kardial’nyj sindrom X kak projavlenie nekoronarogennoj ishemii miokarda [Cardiac syndrome X as a manifestation noncoronary myocardial ischemia]. Fundamental’nye issledovanija [Fundamental research]. 2015; 1: 634-641.

9. Gurevich MA. Kardial’nyj sindrom X [Cardiac Syndrome X]. Medical Alphabet. 2016; 1: 46-47.

10. Oslopov VN, Oslopova JV, Borisov DV. Kardial’nyj sindrom X; Pato ziologicheskie mehanizmy razvitija i vozmozhnost’ ego skriningovoj veri kacii putjom izuchenija aktivnosti Na+ -Li+ -protivotransporta v membrane jeritrocita [Cardiac Syndrome X; The pathophysiological mechanisms of development and the possibility of screening veri cation by examining the activity of Na + -Li + -protivotransporta in the erythrocyte membrane]. Kazanskij medicinskij zhurnal [J Kazan Medical]. 2013; 94: 355-361.

11. Gurevich MA, Agababyan DA, Kuzmenko NA. Mehanizm dejstvija i primenenija ranolazina pri ishemicheskoj bolezni serdca i brilljacii predserdij [The mechanism of action and the use of ranolazine in patients with coronary heart disease and atrial brillation]. Russkij medicinskij zhurnal [J Russian Medical]. 2014; 31: 2196-2199.

12. Horovenko II, Boltachev AV, Dragun JV et al. Klinicheskie aspekty primenenija nikorandila [Clinical aspects of nicorandil]. Voennaja medicina [Military medicine]. 2015; 4: 129-132.

 ANALYSIS OF THE QUALITY OF MEDICAL SERVICE FOR THE POPULATION OF THE RUSSIAN FEDERATION: REFINEMENT OPTIONS

УДК 614.2(470+571):616-082:005.6 

DOI: 10.20969/VSKM.2017.10(6).75-80

TAIROVA RAISA T., ORCID ID: orcid.org/0000-0002-4174-7114; senior researcher of National Research Institute
of Cerebrovascular Pathology and Stroke, N. Pirogov Russian National Research Medical University, Russia, 117997, Moscow, Ostrovitianov str., 1, tel. +7(926)226-59-88, e-mail: tairova-r@mail.ru

BERSENEVA EVGENIA A., ORCID ID: orcid.org/0000-0003-3481-6190; SCOPUS Author ID: 55554758300; D. Med. Sci., Head of the Center for Higher and Additional Professional Education, N.A. Semashko National Research Institute of Public Health, Russia, 105064, Moscow, Vorontsovo Pole str., 12, build. 1, tel. +7(916)216-84-59, e-mail: eaberseneva@gmail.com

USHENIN VASILY V., ORCID ID: orcid.org/0000-0002-1800-4195; D. Med. Sci., Head of the Center for Higher and Additional Professional Education, N.A. Semashko National Research Institute of Public Health, Russia, 105064, Moscow, Vorontsovo Pole str., 12, build. 1, tel. +7(915)288-88-27, e-mail: vasiliy.ushenin@gmail.com

Abstract. Aim. Analysis of imperfections in medical care quality in the Russian Federation and assessment of effectiveness of the primary examination of the quality of care has been performed. The goal was to select strategic solutions to improve the quality of care, to select the factors that affect the number of errors in medical records in healthcare institutions. Material and methods. Analysis of monitoring and expert activity of the territorial compulsory health insurance funds for the period from 2013 to 2015 has been performed. 8 903 199 cases have been reviewed during the examination. Dynamics in medical documentation errors has been studied in the subjects of the Russian Federation. The relative share of the contribution to the total number of medical care quality imperfections has been analyzed in accordance with the total population by subject of the Russian Federation. Results and discussion. In the course of the study the total number of imperfections involving primary and repeated ones for 3 years has reached 1 141 246, which is 12,8% of the errors. At the same time, 192 779 cases of medical documentation errors were revealed, which is 16,8% of the total number of imperfections. Analysis of the distribution of the number of imperfections related to medical records has showed the absolute validity and reliability of the expert on the quality of medical service; as well as the steady increase of the medical documentation errors with each year. Conclusion. The results of evaluation and expert analysis demonstrate general negative dynamics in the quality of medical service resulting as an increase in imperfection total number, as well as the increase in the number of identi ed medical documentation errors by 16,1% by the end of 2015. Re nement options are proposed in order to prevent a number of factors and to reduce medical record errors in healthcare institutions timely.

1. Lindenbraten AL, Savel’ev VN, Dunaev SM, Vinogradova TV. Kachestvo medicinskogo obsluzhivanija naselenija Udmurtskoj Respubliki na sovremennom jetape [The quality of medical care for the population of the Udmurt Republic at the present stage]. Izhevsk. 2011; 3-11.

2. Shhepin OP. Fundamental’nye osnovy politiki zdravo- ohranenija [Fundamental foundations of health policy]. Moskva: Jeski [Moscow: Eski]. 2001; 352 p.

3. Najgovzina NB, Astoveckij AG. Kachestvo medicinskoj pomoshhi i ego jekspertiza [Quality of medical care and its expertise]. Jekonomika zdravoohranenija [Health Economics]. 1998; 1: 7-14.

4. Lindenbraten AL, Shhepina OP ed. Sovremennye ocherki ob obshhestvennom zdorov’e i zdravoohranenii [Modern essays on public health and public health]. Moskva [Moscow]: Medicina [Medicine]. 2005; 41 p.

5. Dejo RA, Contr P, Trials C. Vosproizvodimost’ i otkrytost’ ocenki sostojanija zdorov’ja: statistika i strategija razvitija [Reproducibility and openness of health assessment: statistics and development strategy]. Klinicheskie issledovanija [Clinical research]. 1991; 12: 142-158.

6. Starodubov VI. Problemy vnedrenija OMS v Rossii [Problems of introduction of compulsory medical insurance in Russia]. Terapevticheskih arhiv [Therapeutic archive]. 1993; 65: 4-5.