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ORIGINAL RESEARCH
UDC 616-002.5. 5:579.873.21 DOI: 10.20969/VSKM.2022.15(1).7-16
GX TECHNOLOGIES FOR RAPID DIAGNOSIS OF TUBERCULOSIS IN GENERAL HEALTHCARE NETWORK
BORODULINA ELENA A., ORCID ID: 0000-0002-3063-1538, Author ID: 651365, SPIN-code: 9770-5890, Dr. Med. Sci., Professor, Head of the Department of Phthisiology and Pulmonology, Samara State Medical University, address: Russia, 443020, Samara, Pionerskaya street, 48, tel.: +7-917-958-34-82; e-mail: borodulinbe@yandex.ru
SHUBINA ANASTASIA T., ORCID ID: 0000-0002-8096-7611, Author ID: 1009823, SPIN-code: 2706-7833, postgraduate student of the Department of Phthisiology and Pulmonology, Samara State Medical University, Russia, 443020, Samara, Pionerskaya street, 48, tel.: +7-927-737-73-08; e-mail: doc.inkova@gmail.com
GERASIMOV ANDREY N., ORCID ID: 0000-0003-4549-7172, Author ID: 141741, SPIN-code: 4742-1459, Dr. Phys.-Math. Sci., Professor, Head of the Department of Medical Informatics and Statistics, Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after I.M. Sechenov, Ministry of Health of Russia, Russian Federation, 119991, Moscow, Trubetskaya st., 8, building 2, tel.: +7-905-550-50-84; e-mail: andr-gerasim@yandex.ru
KUZNETSOVA ALENA N., ORCID ID: 0000-0001-7634-0106, Author ID: 1037619, SPIN-code: 6331-3600, postgraduate student of the Department of Phthisiology and Pulmonology, Samara State Medical University, address: Russia, 443020, Samara, Pionerskaya street, 48, tel.: +7-937-064-94-25, e-mail: alena-suetina@mail.ru
KUDLAY DMITRY A., ORCID ID: 0000-0003-1878-4467, Dr. Med. Sci., Leading Researcher, Laboratory of Personalized Medicine and Molecular Immunology, Federal State Budgetary Institution «SSC Institute of Immunology», Federal Medical and Biological Agency of Russia, 115522, Moscow, Kashirskoe shosse, 24; Professor of the Department of Pharmacology, Institute of Pharmacy, Federal State Autonomous Educational Institution of Higher Education First Moscow State Medical University named after I.M. Sechenov, Ministry of Health of Russia, Moscow, 119991, Trubetskaya st., 8, building 2, e-mail: D624254@gmail.com
Abstract. Introduction. There is still a high percentage of tuberculosis detection by the number of complaints to the general medical network. Di erential diagnosis is often performed in pulmonology departments using a standard diagnostic minimum. Reducing the time of diagnosis of tuberculosis is possible with the introduction of molecular genetic methods in the standards of primary examination. Aim. The aim is to determine the possibility of improving the detection of pulmonary tuberculosis using molecular genetic methods by the example of GeneXpert MTB/RIF cartridge technology in the pulmonology department of the general treatment network of healthcare. Material and methods. GeneXpert MTB/ RIF cartridge technology (MGM) was used in 159 patients with high risks of tuberculosis, characteristic changes on the X-ray image in addition to the standard study for the search for M. tuberculosis in biological material (sputum or bronchoalveolar uid). Аccording to veri ed diagnoses, two groups were formed: 1st - tuberculosis (n = 119), second - pneumonia (n = 40). Statistical processing was carried out using the IBM SPSS Statistics 22.0 statistical software package.Results and discussions. In the di erential diagnosis of tuberculosis in patients of the pulmonology department, there is a commonality of criteria for age (p=0.066), gender (p=0.249), unemployment (p=0.452), HIV infection (p=0.115), drug addiction (p=0.066), hepatitis (p=0.076). Positive results were on smear microscopy with sputum staining by Ziehel-Neelsen 18.9%, bronchoalveolar uid 31%. The method of GeneXpert MTB/RIF cartridge technology showed a high sensitivity of 100% and speci city of 99% in all cases of a veri ed diagnosis of «tuberculosis» using culture methods.Conclusion. In patients with pneumonia who have risk factors for tuberculosis, when the GeneXpert MTB/RIF cartridge technology for M. tuberculosis search is included in the standard diagnostic minimum in the general medical network, the e ectiveness of tuberculosis detection increases while reducing the time of diagnosis.
Key words: tuberculosis, HIV infection, laboratory diagnostics, GeneXpert MTB/RIF.
For reference: Borodulina EA, Shubina AT, Gerasimov AN, Kuznetsova AN, Kudlay DA. GX technologies for rapid diagnosis of tuberculosis in general healthcare network. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1):7–16. DOI: 10.20969/VSKM.2022.15(1).7-16
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UDC: 616.155.35:616.516.5:612.017.1 DOI: 10.20969/VSKM.2022.15(1).17-25
EVALUATION OF CULTUROMA OF THE DISCHARGE OF THE UPPER RESPIRATORY TRACT AND THE CONTENTS OF THE COLON IN PATIENTS WITH ATOPIC DERMATITIS
ZHESTKOV ALEXANDER V., ORCID ID: 0000-0002-3960-830X, MD, D. Med. Sci., Professor, Chief of the Department of Clinical Microbiology, Allergology and Immunology, Samara State Medical University. 443079, Russia, Samara, Gagarina Str., 18, e-mail: avzhestkov2015@yandex.ru
LYAMIN ARTEM V., ORCID ID: 0000-0002-5905-1895, MD, D. Med. Sci., Associate Professor, Department of Clinical Microbiology, Allergology and Immunology, Samara State Medical University. 443079, Russia, Samara, Gagarina Str., 18, e-mail: avlyamin@rambler.ru
POBEZHIMOVA OLGA O., ORCID ID: 0000-0001-9593-4807, Postgraduate student, Department of Clinical Microbiology, Allergology and Immunology, Samara State Medical University. 443079, Russian Federation, Samara, Gagarina Str., 18, e-mail: ImmunologSamara888@yandex.ru
Abstract. Aim. The aim of the study is to study the species diversity of the micro ora of the discharge of the nose, oropharynx and the contents of the colon in atopic dermatitis. Material and methods. The study included 80 patients with atopic dermatitis. Patients are divided into 3 groups depending on the severity of AD (Focusing on the SCORAD scale). The patients underwent collection of biomaterials from the oral and nasal cavities and intestines. Sowing of the material was carried out on an extended list of nutrient media. As a result of the MALDI-ToF mass spectrometry on the Micro ex LT (Bruker, Germany), the resulting microorganisms were recognized by direct and extended deposition using formic acid. Results and discussion. When seeding feces patients from all groups, statistically signi cant di erences were revealed for the following microorganisms, depending on the severity: Enterococcus faecium (61%), Streptococcus anginosus (16.7%), Parabacteroides distasonis (22.2%) were found in remission; at the stage of exacerbation with exacerbation of atopic dermatitis in the form of a limited form - Enterococcus faecalis (39.3%), Lactobacillus fermentum (16.1%), Streptococcus parasanguinis (9%);with a common form of exacerbation, Klebsiella pneumonia (50%), Klebsiella oxytoca (50%), Enterococcus mundtii (16.7%), Echerichia vulneris (16.7%), Lactobacillus salivarius (83.3%), Raoultella ornithinolytica(16.7%), Enterococcus avium (50%), Enterobacter asburie (16.7%), Citr obacter braaki (33.3%), Bacteroides vulgates (33.3%), Bi dobacterium adolescentis(16.7%), Enterococcus durans (16.7%), Lactobacillus crispatus (16.7%), Corynebacterium amycolatum (33.3%), Streptococcus sanguinis (16.7%). Inoculation of oropharyngeal discharge from patients with atopic dermatitis revealed statistically signi cant di erences for the following microorganisms, depending on the severity: Streptococcus australis (11.1%) was detected in remission; in the stage of exacerbation with a limited form of atopic dermatitis, Rothia mucalaginosa (19.6%), Streptococcus saliverius (39.3%) were identi ed; in the stage of exacerbation with a widespread form of atopic dermatitis, Streptococcus anginosus (16.7%;), Candida albicans (33.3%), Streptococcus gordonii (16.7%), Staphylococcus haemolyticus (16.7%), Neisseria oralis (33.3%), Corynebacterium amycolatum (16.7%), Kocuria rhizophila (33.3%), Lactobacillus rhamnosus (16.7%). Inoculation of nasal discharge from patients with atopic dermatitis revealed statistically signi cant di erences for the following microorganisms, depending on the severity: Staphylococcus haemolyticus (16.7%), Staphylococcus lugdunensis (11.1%), Staphylococcus copitis (11.1%) were found in remission. At the stage of exacerbation with a widespread form of atopic dermatitis, Proteus mirabilis (16.7%), Streptococcus vestibularis (16.7%), Streptococcus sobrinus (16.7%), Staphylococcus warneri (16.7%), Corynebacterium coyleae (16.7%), Lactobacillus plantarum (16.7%). Conclusion. Our results indicate enzymatic de ciency and signi cant changes in the qualitative composition of the microbiota in people with atopic dermatitis, which violates the body's immunomodulating function.
Key words: atopic dermatitis, microbiota, oral cavity, nose, intestines, immunopathogenesis.
For reference: Zhestkov AV, Lyamin AV, Pobezhimova OO. Evaluation of the culturoma of the discharge of the upper respiratory tract and the contents of the colon in patients with atopic dermatitis. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1):17–25. DOI: 10.20969/VSKM.2022.15(1).17-25
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UDC 616.981.21/958.7 DOI: 10.20969/VSKM.2022.15(1).26-33
ONGOING SYMPTOMATIC COVID-19 – PHARMACOTHERAPY POSSIBILITIES
ZAITSEV ANDREY A., ORCID ID: 0000-0002-0934-7313, Doctor Medical Sciences, Professor, Honored Doctor of the Russian Federation, Chief Pulmonologist of the Main Military Clinical Hospital named after Academician N.N. Burdenko, Russia, 105094, Moscow, Hospital pl., 3, tel. 8-916-588-32-12, e-mail: a-zaicev@yandex.ru
TERNOVSKAYA NINA A., Pulmonologist, Main Military Clinical Hospital named after Academician N.N. Burdenko, Russia, 105094, Moscow, Hospital pl., 3, tel. 8-903-175-89-29, e-mail: nina.vishna@yandex.ru
CHELAN EKATERINA A., Pulmonologist, Main Military Clinical Hospital named after Academician N.N. Burdenko, Russia, 105094, Moscow, Hospital pl., 3, tel. 8-963-641-69-80
KULAGINA IRINA TS., ORCID ID: 0000-0002-5387-5244, Candidate of Medical Sciences, Head of the 20th Pulmonology Department of the Main Military Clinical Hospital. Academician N.N. Burdenko, Russia, 105094, Moscow, Hospital pl., 3, e-mail: irina-kulagina@mail.ru
SIDOROV YURI A., Pulmonologist, Main Military Clinical Hospital named after academician N.N. Burdenko, Russia, 105094, Moscow, Hospital pl., 3
LIKHODIY VYACHESLAV I., Candidate of Medical Sciences, Head of the 30th Pulmonology Department, Main Military Clinical Hospital named after Academician N.N. Burdenko, Russia, 105094, Moscow, Hospital pl., 3, tel. 8-916-520-21-77
Abstract. Introduction. The medical community continues to search for modern methods of treating the ongoing symptomatic COVID-19 and post-COVID syndrome. Among all symptoms of ongoing symptomatic COVID-19, respiratory disorders are the most challenging and leading not only to impaired quality of life, but also to patient's disability. Thus, it seems relevant to study various options for the treatment of ongoing symptomatic COVID-19, including drugs with adaptogenic e ects. Aim. The aim of the study was to seek the e ects of the drug Trecresan on the recovery of patients who had COVID-19 (reduction of the severity of asthenia, restoration of lung function and other indicators) in comparison with standard (real practice) therapy of patients who incurred a new coronavirus infection COVID-19. To evaluate and conduct a comparative analysis of the safety of the treatment regimens used for "ongoing symptomatic COVID-19" with patients who have moderate and severe case of a new coronavirus infection. Material and methods. The study included 103 patients with ongoing symptomatic COVID-19 who were hospitalized in a pulmonology department. The rst group included 53 patients who were treated with the drug Trecresan, the 2nd group included 50 patients. During the examination of patients, the following was performed: A comprehensive study of lung function, including the designation of the di usion capacity of the lungs - DLCO, the level of SpO2 (saturation), a 6-minute walking test, an assessment asthenia severity on the MFI-20 (Multidimensional Fatigue Inventory) scale. The clinical e ciency of complex therapy was analyzed after 8-10 days of treatment. The endpoints necessary for subsequent analysis were the timing of COVID-19 symptoms resolution (severity of asthenia, performance, etc.) and adverse events developed during treatment. Results and discussion. The inclusion of the drug Trekrezan in the treatment of patients with ongoing symptomatic COVID-19 led to an improvement in overall well-being. There was a signi cant decrease in the severity of asthenia on the MFI-20 scale, a statistically signi cant decrease in the degree of shortness of breath and improvement in the patient’s quality of life were revealed, a decrease in the inpatient period was noted. Conclusion. It has been established that medium-term therapy using the adaptogen Trekrezan with patients with ongoing symptomatic COVID-19 and post-COVID syndrome reduces the severity of symptoms of the disease, increases exercise tolerance, reduces the severity of asthenia on the MFI-20 scale, reduces the inpatient period.
Keywords: adaptogen therapy, ongoing symptomatic COVID-19 and post-COVID syndrome, asthenia, oxygen saturation.
For reference: Zaitsev AA, Ternovskaya NA, Chelan EA, Kulagina Its, Sidorov YA, Likhodiy VI. Ongoing symptomatic COVID-19 – pharmacotherapy possibilities. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1): 26–33.DOI: 10.20969/VSKM.2022.15(1).26-33
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Лещенко И.В., Глушкова Т.В. О функциональных нарушениях и развитии фиброза легких у больных, перенесших новую коронавирусную инфекцию // Пульмонология. - 2021. – No 31 (5). – С.653-662. [Leshchenko IV, Glushkova TV. O funkcional’nyh narusheniyah i razvitii broza legkih u bol’nyh, perenesshih novuyu koronavirusnuyu infekciyu [On functional disorders and the development of pulmonary brosis in patients who have undergone a new coronavirus infection]. Pul’monologiya [Pulmonology]. 2021; 31 (5): 653-662. (In Russ.)]. DOI: 10.18093/0869-0189-2021-31-5-653-662
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UDC: 616.12+616.98 DOI: 10.20969/VSKM.2022.15(1).34-42
SARS-COV-2 VIRUS AND THE CARDIOVASCULAR SYSTEM INTERACTION: CLINICAL CHARACTERISTICS AND PATHOGENESIS
ISHMURZIN GENNADY P., ORCID ID: 0000-0002-0962-5790; C. Med. Sci., associate professor, Department of internal medicine, Kazan State Medical University; 420012, Russia, Tatarstan, Kazan, Butlerov Str., 49,
e-mail: ishm08@mail.ru
SEREBRYAKOVA OLGA A., ORCID ID: 0000-0002-2608-7904; student, Kazan State Medical University; 420012, Russia, Tatarstan, Kazan, Butlerov Str., 49
SYUZEV KIRILL N., ORCID ID: 0000-0003-3061-3150; junior researcher, Department of general pathology, Kazan State Medical University; 420012, Russia, Tatarstan, Kazan, Butlerov Str., 49
GAINULLINA AIGUL KH., ORCID ID: 0000-0001-5196-2566; student, Kazan State Medical University Ministry; 420012, Russia, Tatarstan, Kazan, Butlerov Str., 49
DOLGANOVA DARIA A., ORCID ID: 0000-0001-5444-6145; student, Kazan State Medical University; 420012, Russia, Tatarstan, Kazan, Butlerov Str., 49
Abstract. Introduction. The coronavirus disease 2019 (COеVID-19) caused by the SARS-CoV-2 virus led to the global pandemic, and by the beginning of August 2021, more than six million people fell ill in Russia. The study of the interaction between the SARS-CoV-2 virus and the cardiovascular system has great importance for the e ective treatment of patients with this disease. Aim. The aim of the study was to identify the frequency of cardiovascular complications, based on the analysis of the patient’s medical histories with viral pneumonia caused by SARS-CoV-2 virus. And to compare the results obtained with the data of literary sources and justify their pathogenetic occurrence. Material and methods.70 medical histories of patients with viral pneumonia caused by the SARS-CoV-2 virus who were admitted to the temporary infectious diseases hospital in Kazan were analyzed. The comorbidity, routine methods of laboratory (Complete blood count, qualitative and quantitative troponin test), and instrumental (ECG, Echo) diagnostics were studied. Descriptive statistics were calculated: median and interquartile range, categorical variables were presented in quantity and percentage. An unpaired t-test was used for the analysis of statistical signi cance. The critical value was assumed to be p≤0.05. Literature in eLIBRARY.ru, PubMed, GoogleScholar, Web of Science in recent years, mainly in 2020-2021, were analyzed. Results and discussion. Among the comorbidity: hypertension – in 31 (44%) patients, chronic heart failure – in 14 (20%) patients, coronary heart disease – in 10 (14.2%), diabetes mellitus – in 8 (11.4%), and 16 (22%) patients su ered from obesity. The most frequent complications were regurgitation on the valves (57,14%), cardiac arrhythmias (35,7%), of which supraventricular arrhythmias were the most common. There was no dependence of the increased level of Tr I on the degree of respiratory failure. Among patients with elevated Tr I levels, a chronological association with a previous infection with speci c symptoms was revealed in all patients with high reliability of the presence of myocarditis in 12 (17,14%) patients. Conclusion. COVID-19 a ects not only the respiratory system but also has a signi cant impact on the cardiovascular system because of the patient's immune response and the probable cytopathic e ect of the virus.Key words: coronavirus, COVID-19, SARS-CoV-2, myocarditis, arrhythmia, angiotensin.
For reference: Ishmurzin GP, Serebryakova OA, Syuzev KN, Gainullina AKh, Dolganova DA. SARS-CoV-2 virus and the cardiovascular system interaction: clinical characteristics and pathogenesis. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1): 34–42. DOI: 10.20969/VSKM.2022.15(1).34-42
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UDC 616.12-008.331.1-089 DOI: 10.20969/VSKM.2022.15(1).43-51
PULMONARY HYPERTENSION INFLUENCE ON OUTCOMES OF SECONDARY TRICUSPID INSUFFICIENCY CORRECTION IN PATIENTS FOR VALVULAR HEART DISEASE
KAIPOV ARTUR E., ORCID ID: 0000-0001-8531-1315, Cardiovascular Surgeon, Interregional Clinical Diagnostic Center, 420101, Kazan, st. Karbysheva, 12a, e-mail: turik4martn@mail.ru, cell. tel.: 89377703642.
GEORGIKIA ROIN K., ORCID ID: 0000-0003-0309-7605, Professor, Doctor of Medical Sciences, Head of the Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, 420101, Kazan, st. Butlerov 49 , e-mail: roink@mail.ru
ABDULYANOV ILDAR V., ORCID ID: 0000-0003-2892-2827, Associate Professor, Candidate of Medical Sciences, Cardiovascular Surgeon, Interregional Clinical Diagnostic Center, 420101, Kazan, st. Karbysheva, 12a., the Head of the Department of cardiology, roentgen-endovascular and cardiovascular surgery of Kazan State Medical Academy – the branch of Russian Medical Academy of Postgraduate Education, Russia, 420012, Kazan, Butlerov str., 36, e-mail: ildaruna@mail.ru,
MUKHARYAMOV MURAT N., ORCID ID: 0000-0001-5814-7177, Associate Professor, Candidate of Medical Sciences, Interregional Clinical Diagnostic Center, 420101, Kazan, st. Karbysheva, 12a, e-mail: murat. mukharyamov@med.uni-jena.de,
VAGIZOV ILDAR I., ORCID ID: 0000-0002-3511-3211, Head of the Department of Cardiothoracic Surgery, Interregional Clinical Diagnostic Center, 420101, Kazan, st. Karbysheva, 12a, e-mail: i_vagizov@mail.ru
BIKCHURIN RUSLAN R., ORCID ID: 0000-0002-2174-1831, Interregional Clinical Diagnostic Center, 420101, Kazan, st. Karbysheva, 12a, e-mail: ruslan_radikovich89@mail.ru
SHORNINA ANNA S., ORCID ID: 0000-0001-9902-881X, Bashkir State Medical University, 450008, Ufa, st. Lenin, 3, e-mail: a.shornina@mail.ru
Abstract. Aim. The aim of the study is to compare the e ect of pulmonary hypertension on the outcome of tricuspid valve plasty in the groups with moderate and signi cant pulmonary hypertension. Material and methods. The results of surgical treatment of 620 patients with cardiac valve diseases were analyzed. Pulmonary artery systolic pressure (PASP) measured by echocardiography. Two groups were distinguished: Group 1 – pulmonary artery systolic pressure ˂ 50 mmHg. – 250 patients, Group 2-systolic pulmonary artery pressure ≥50 mm Hg. – 370 patients. Depending on the method of tricuspid insu ciency correction, subgroups were identi ed in each group: subgroup A – suture plasty was used, subgroup B – annuloplasty ring. Mann-Whitney U test was used to compare two independent samples. Chi-square test was used to compare the percentages in the groups. Results and discussion. In group I (PASP up to 50 mmHg) pressure in the PA decreased in the postoperative period, however in the long-term period in the suture plasty subgroup (subgroup A) PASP increased (p=0.01), in the annuloplasty ring subgroup (subgroup B) PASP after surgery and in the long-term period has not changed signi cantly. The mean value of tricuspid regurgitation (TR) was 1.27±0.4 in subgroup B and 2.1±0.6 in subgroup A (p=0.0227). In group II (signi cant pulmonary hypertension), postoperative PASP decreased to 50.5±13.2 (subgroup A) and 53.4±8.0 (subgroup B) mm Hg, however in the long-term follow-up there was an increase of pressure in PA to 58.3±10.7 and 56.4±11.8 mm Hg, respectively. In subgroup B, the long-term results were better in terms of TR degree, 1.6±0.5, in contrast to subgroup A, where the average degree was 2.6±0.7 (p=0.001). Tricuspid valve (TV) plasty with a annuloplasty ring preserved coaptation of the TV cusps and prevented residual tricuspid insu ciency despite the intensity of pulmonary hypertension. Conclusion. Surgical treatment of mitral and aortic heart diseases leads to decrease or normalization of pulmonary artery pressure. Pulmonary hypertension in the postoperative period is a factor that in uences the intensity of TR. All patients with signi cant functional TR as an outcome of left heart valve pathology should undergo TV annuloplasty. Correction with annuloplasty ring only is recommended for patients with signi cant pulmonary hypertension and signi cant TR.
Keywords: acquired heart diseases, pulmonary hypertension, tricuspid insu ciency, tricuspid valve plasty.
For reference: Kaipov AE, Dzhordzhikiya RK, Abdulyanov IV, Mukharyamov MN, Vagizov II, Bikchurin RR, Shornina AS. Pulmonary hypertension in uence on outcomes of secondary tricuspid insu ciency correction in patients for valvular heart disease. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1): 43–51. DOI: 10.20969/VSKM.2022.15(1).43-51
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UDC 616.24-007.63; 616-097 DOI: 10.20969/VSKM.2022.15(1).52-61
THE ROLE OF IMMUNOLOGICAL FACTORS IN THE UNFAVORABLE OUTCOME OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE
KARZAKOVA LOUISE M., ORCID ID: 0000-0002-5899-6352; SCOPUS Author ID: 56916027300, D. Med. Sci, Professor, Head of the Department of Internal Medicine, Chuvashskii State University, 428015 Russia, Cheboksary, Moskovskii' pr., 15, +7 (903) 358-82-89, e-mail: luizak58@mail.ru.
ALEKSEEVA EVGENIYA P., ORCID ID: 0000-0002-3799-4278; Assistant Professor, Department of Internal Medicine, Chuvashskii State University, 428015 Russia, Cheboksary, Moskovskii' pr., 15, +7 (961) 340-05-80, e-mail: evgenia010307@mail.ru
KUDRYASHOV SERGEY I., ORCID ID: 0000-0003-2277-9425; C. Med. Sci., Associate Professor, Department of Internal Medicine, Chuvashskii State University, 428015 Russia, Cheboksary, Moskovskii' pr., 15,
+7 (917) 652-34-99, e-mail: medicpro21@mail.ru
ZHURAVLEVA NADEZHDA V., ORCID ID: 0000-0001-6470-7724; C. Med. Sci., Associate Professor, Department of Internal Medicine, Chuvashskii State University, 428015 Russia, Cheboksary, Moskovskii' pr., 15,
+7 (903) 358-71-78, e-mail: zhuravlevanv@mail.ru
UKHTEROVA NADEZHDA D., ORCID ID: 0000-0003-1808-6845; C. Med. Sci., Associate Professor, Department of Internal Medicine, Chuvashskii State University, 428015 Russia, Cheboksary, Moskovskii' pr., 15,
+7 (906) 136-73-41; e-mail: 55dd@mail.ru
ANDREEVA NATALIA P., ORCID ID: 0000-0002-1989-3334; SCOPUS Author ID: 21733375100, C. Med. Sci., Allergist/Immunologist, City Children's Clinical Hospital, Russia, 428015, Cheboksary, Traktorostroiteley str., 12, +7 (903) 358-27-02; e-mail: Nataliutt@ya.ru
Abstract. Aim. The aim of the research was to study the role of immunological mechanisms in the unfavorable outcome of chronic obstructive pulmonary disease (COPD). Material and methods. The research included 116 patients hospitalized in 2005-2006 in the pulmonology department of patients with the exacerbation of mild and moderate COPD. Research protocol: general clinical and special (immunological) methods of examination were performed in patients with COPD. Instrumental research methods included: spirography, ECG, EchoCG, brobronchoscopy, chest X-ray. After diagnostic bronchoscopy, bronchoalveolar uid (BAF) was taken for cytological and immunological examination. On the rst and second days of inpatient treatment, patients underwent immunological studies: immunophenotyping of mononuclear cells (MNC), assessment of phagocytic activity of leukocytes (latex test, nitroblue tetrazolium (NBT) test) in blood and BAF, determination of the content of immunoglobulins in blood serum and BAF, study of cytokine levels in blood serum, BAF and MNC culture supernatant under conditions of their spontaneous production and activation in the mitogen-stimulated (phytohemagglutinin "Difco" 5 mg/ml) proliferation. Statistical data processing was carried out using the Statistica 10.0 program. In 2020, the long-term survival of COPD patients was assessed. The cohort of patients was divided into two groups. Survivors were included in the rst group (n=44), and patients who died by 2020 were included in the other group (n=72). The retrospective comparison of the studied indicators was determined at the time of COPD exacerbation in 2005-2006 in these patient groups. Results and discussion. In the surviving patients, the BAF cytogram was distinguished by the higher macrophage content and the increased number of NBT-positive cells in this population with the reduced neutrophil content in both blood and BAF. The deceased had elevated levels of IgM and IgA in the blood serum and BAF. The results of the study of cytokine production in MNC cultures in vitro indicate that the ratio of IFN-γ/IL-4 in the conditions of spontaneous cytokine production was higher in the deceased compared with the indicators of the surviving patients. This fact indicates the polarization of the immune response of the deceased in the direction of the cell type mediated by Th1 cells, which is con rmed by the peculiarities of the BAF cytokine pro le in the deceased – the signi cant increase in the value of IFN-γ/IL-4 relative to the indicators in the survivors. Conclusion. The unfavorable outcome of COPD is associated with the increase in the number of neutrophil cells in BAF, in the blood, with the predominance of Th1-type activation of adaptive immunity at the local level and activation of both cellular and humoral mechanisms of adaptive immunity at the systemic level. The increased activity of innate immunity in COPD exacerbation, manifested by the increase in the number and metabolic activity of macrophages, is associated with the long-term survival of patients.
Key words: chronic obstructive pulmonary disease, mortality, disease outcome, cytokines, Th1 cells.
For reference: Karzakova LM, Alekseeva EP, Kudryashov SI, Zhuravleva NV, Ukhterova ND, Andreeva NP. The role of immunological factors in the unfavorable outcome of chronic obstructive pulmonary disease. The Bulletin of Contemporary Clinical Medicine. 2022;15(1):52– 61. DOI: 10.20969/VSKM.2022.15(1).51-62.
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21.Lee SH, Goswami S, Grudo A, Song LZ, Bandi V, Goodnight-White S, Green L, Hacken-Bitar J, Huh J, Bakaeen F, Coxson HO, Cogswell S, Storness-Bliss C, Corry DB, Kheradmand F. Antielastin autoimmunity in tobacco smoking-induced emphysema. Nat Med. 2007; 13 (5): 567-569. DOI: 10.1038/nm1583.
22.Ravindran M, Khan MA, Palaniyar N. Neutrophil Extracellular Trap Formation: Physiology, Pathology, and Pharmacology. Biomolecules. 2019; 9 (8): 365. DOI: 10.3390/biom9080365.
23. Castanheira FVS, Kubes P. Neutrophils and NETs in modulating acute and chronic in ammation. Blood. 2019; 133 (20): 2178-2185. DOI: 10.1182/ blood-2018-11-844530.
24.Dicker AJ, Crichton ML, Pumphrey EG, Cassidy AJ, Suarez-Cuartin G, Sibila O, Furrie E, Fong CJ, Ibrahim W, Brady G, Einarsson GG, Elborn JS, Schembri S, Marshall SE, Palmer CNA, Chalmers JD. Neutrophil extracellular traps are associated with disease severity and microbiota diversity in patients with chronic obstructive pulmonary disease. J Allergy Clin Immunol. 2018; 141 (1): 117-127. DOI: 10.1016/j. jaci.2017.04.022.
25.Ma A, Wen L, Yin J, Hu Y, Yue X, Li J, Dong X, Gupta Y, Ludwig RJ, Krauss-Etschmann S, Riemekasten G, Petersen F, Yu X. Serum Levels of Autoantibodies Against Extracellular Antigens and Neutrophil Granule Proteins Increase in Patients with COPD Compared to Non-COPD Smokers. Int J Chron Obstruct Pulmon Dis. 2020; 15: 189-200. DOI: 10.2147/COPD.S235903.
UDC: 616.235:616-052 DOI: 10.20969/VSKM.2022.15(1).62-67
CLINICAL AND FUNCTIONAL PORTRAIT OF A PATIENT WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE PHENOTYPE WITHOUT FREQUENT EXACERBATIONS
KULIK EKATERINA G., SPIN-код: 7661-1946; ORCID ID: 0000-0002-6059-1813; C. Med. Sci., associate professor, Department of Internal Medicine, Amur State Medical Academy, 675006, Russia, Amur Region, Blagoveshchensk, st. Gorky, house 95, e-mail: rybas_katya@mail.ru
PAVLENKO VALENTINA I., SPIN-код: 1172-1390; ORCID ID: 0000-0001-8794-9929; Dr. med. Sci., associate professor, professor, Department of Internal Medicine, Amur State Medical Academy, 675006, Russia, Amur Region, Blagoveshchensk, st. Gorky, building 95.
NARYSHKINA SVETLANA V., SPIN-код: 3909-2850; ORCID ID: 0000-0003-0587-456X; Dr. med. Sci., Professor, Head of the Department of Internal Medicine, Amur State Medical Academy, 675006, Russia, Amur Region, Blagoveshchensk, st. Gorky, building 95.
Abstract. Introduction. According to current data, the COPD phenotype without frequent exacerbations is frequently encountered and requires close attention. However, in the course of a literary search, it was possible to nd only isolated scienti c works with a generalized description of the features of this phenotype. Aim. The aim of the study is to compile a typical clinical portrait of a patient with the COPD phenotype without frequent exacerbations based on the analysis of clinical, laboratory and functional parameters. Material and methods. The study included 45 patients aged 57.2±1.1 years with a diagnosis of COPD without frequent exacerbations in age. In all patients, the concentration of proin ammatory cytokines, C-reactive protein in blood serum was determined by immunoferment analysis. Results and discussion.Males (93.3%) with a smoker index of 33.7± 2.5 packs/years and a disease duration of more than 10 years dominated the studied cohort. The average score on the CAT test was 10.32±0.05 points, on the mMRC scale more than two points. The post - bronchodilation value of FEV1 corresponded to the average severity of obstructive disorders in 91.1% of individuals. Among the examined patients, persons with bronchitic type of COPD predominated (53.3%). The concentration of in ammatory biomarkers determined in the blood serum signi cantly exceeded the levels of the reference values. Also, patients with COPD with the studied phenotype was found to have low adherence to treatment and dispensary observation and late visit to the doctor. Conclusions. The obtained results of the study made it possible to draw up a clinical portrait of the patient with the COPD phenotype without frequent exacerbations.
Key words: phenotype, chronic obstructive pulmonary disease without frequent exacerbations, rare exacerbations.
For reference: Kulik EG, Pavlenko VI, Naryshkina SV. Clinical and functional portrait of a patient with chronic obstructive pulmonary disease phenotype without frequent exacerbations. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1):62–67. DOI: 10.20969/VSKM.2022.15(1).62-67.
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UDC 611.813.1 DOI: 10.20969/VSKM.2022.15(1).68-75
EFFECT OF TRANSPLANTATION OF HUMAN UMBILICAL CORD BLOOD MONONUCLEAR CELLS OVEREXPRESSING GLIAL NEUROTROPHIC FACTOR ON THE STATE OF MICROGLIA AND ASTROCYTES IN TRANSGENIC MICE WITH ALZHEIMER'S DISEASE MODEL
PETUKHOVA ELENA O., ORCID ID: 0000-0002-9100-815X; Researcher, Institute of Neuroscience, Kazan State Medical University, 49 Butlerova str., Kazan, 420012, Russia, tel: +7-843-292-72-99, e-mail: petukhovaeo@mail.ru
MUKHAMEDSHINA YANA O., ORCID ID: 0000-0002-9435-340X; C. Med. Sci., Associate Professor, Department of Histology, Cytology and Embryology, Kazan State Medical University, 420012, Russia, Kazan, 49 Butlerova Str., Leading Researcher of Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 18 Kremlevskaya Str., Kazan, 420008, Russia, tel: +7-843-292-76-19, e-mail: yana.k-z-n@mail.ru
TIMOFEEVA ANNA V., ORCID ID: 0000-0002-3393-6775; laboratory assistant-researcher of Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan, Kremlevskaya str. 18, 420008, Russia, tel: +7-843-292-76-19, anua_tima@mail.ru
RIZVANOV ALBERT A., ORCID ID: 0000-0002-9427-5739; Doctor of Biological Sciences, Chief Researcher of Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, Kazan,
Kremlevskaya str. 18, 420008, Russia, tel: +7-843-293-43-07, e-mail: rizvanov@gmail.com
MUKHAMEDYAROV MARAT A., ORCID ID: 0000-0002-0397-9002; Doctor of Medical Sciences, Professor of the Department of Normal Physiology, Kazan State Medical University, 49 Butlerova str., Kazan, 420012, Russia, tel: +7-843-292-72-99, e-mail: marat.muhamedyarov@kazangmu.ru
Abstract. Introduction. Alzheimer's disease is a neurodegenerative disease characterized by a progressive decline in cognitive functions. Alzheimer’s disease is the most common form of dementia and one of the main causes of disability in older people. Neuroin ammation is an important factor in the pathogenesis of Alzheimer's disease. The neuroin ammatory reaction observed in Alzheimer's disease is primarily caused by resident immune cells of the central nervous system, including microglia and astrocytes. Aim. The aim of this work was to study the e ect of transplantation of human umbilical cord blood mononuclear cells (UCBMC) overexpressing glial neurotrophic factor (GDNF) on the state of microglia and astrocytes in APP/PS1 transgenic mice with Alzheimer's disease model. Material and methods. Xenotransplantation of gene-cell structures to experimental animals was carried out retroorbitally, once in the amount of 2 million cells. Immuno uorescence examination of cryostatic sections of the brain was carried out by applying antibodies to ionized calcium-binding adaptive molecule 1 (Iba1, marker of microglia and macrophages) and antibodies to glial brillar acid protein (GFAP, marker of astrocytes) and subsequent imaging on a confocal scanning microscope LSM 510-Meta (Carl Zeiss). Results and discussion. It was found that transplantation of UCBMC overexpressing GDNF reduced the severity of microgliosis in the parietal cortex and dentate gyrus of the hippocampus, and also reduced the severity of astrogliosis in the CA3 zone of the hippocampus of the brain of APP/PS1 mice. Transplantation of UCBMC overexpressing enhanced green uorescent protein (EGFP) only reduced the severity of microgliosis in the parietal cortex of APP/PS1 mice.Conclusion. The data obtained indicate a high therapeutic potential of transplantation of UCBMC overexpressing GDNF in Alzheimer's neuropathology.
Keywords: Alzheimer's disease, neuroin ammation, microglia, astrocytes, gene-cell therapy.
For reference: Petukhova EO, Mukhamedshina YO, Timofeeva AV, Rizvanov AA, Mukhamedyarov MA. The e ect of transplantation of human umbilical cord blood mononuclear cells overexpressing glial neurotrophic factor on the state of microglia and astrocytes in transgenic mice with Alzheimer's disease model. // Вестник современной клинической медицины. – 2022. – Т. 15, вып. 1. – С.68–75. DOI: 10.20969/VSKM.2022.15(1).68-75.
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9. Петухова Е.О., Мухамедшина Я.О., Ризванов А.А., и др. Трансплантация мононуклеарных клеток пуповинной крови человека улучшает пространственную память у APP/PS1 трансгенных мышей с моделью болезни Альцгеймера // Гены и клетки. – 2014. – Вып. 9, No 3. – С.40-45. [Petuhova EO, Mukhamedshina YO, Rizvanov AA, Mukhitov AR, Ze rov AL, Islamov RR, Mukhamedyarov MA. Transplantaciya mononuklearnyh kletok pupovinnoj krovi cheloveka uluchshaet prostranstvennuyu pamyat’ u APP/ PS1 transgennyh myshej s model’yu bolezni Al’cgejmera [Transplantation of mononuclear cells of human umbilical cord blood improves spatial memory in APP/PS1 transgenic mice with Alzheimer’s disease model]. Geny i kletki [Genes and Cells]. 2014; 9 (3): 40-45. (In Russ.)].
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THE MAIN TRENDS OF TOBACCO SMOKING AMONG RUSSIAN TEENAGERS FOR 20 YEARS OF THE XXI CENTURY
SKVORTSOVA ELENA S., ORCID ID: 0000-0003-2723-4029; SCOPUS Autor ID: 57213394865, D. Med. Sci, professor, Chief Researcher of the Department of Public Health and Demography, Federal Research Institute for Health Organization and Informatics, Russia, 127254, Moscow, Dobrolyubov str., 11, e-mail: scvortsova@mednet.ru
LUSHKINA NINA P., ORCID ID: 0000-0002-4861-2773; SCOPUS Autor ID: 57225233709; Candidate of Economic Sciences, Leading Researcher of the Department of Public Health and Demography, Federal Research Institute for Health Organization and Informatics, Russia, 127254, Moscow, Dobrolyubov Str., 11.
Abstract. Introduction. To this day, the problem of tobacco smoking among the population remains relevant throughout the world. Since the majority of smokers (about 90%) acquire this habit before the age of 18, WHO believes that special attention should be paid to protecting the younger generation from smoking and the harmful e ects of tobacco. For this, it is necessary to conduct research to study the behavior of school-age children. Aim. The aim is to identify the main trends of tobacco smoking among urban teenagers-schoolchildren in the Russian Federation for the period from 1999-2000, 2010-2011 and 2019-2020. Material and methods. A sample of adolescents in each subject of the Russian Federation was formed by multi-stage selection with alternating typological, random and continuous examination. In 1999-2000, 12912 urban teenagers were interviewed, of which 5939 boys and 6973 girls, in 2010-2011 - 15323, of which 6961 boys and 8362 girls, in 2019-2020 - 14084 teenagers, of which 6535 boys and 7549 girls. Statistical development of materials was carried out using the computer program "Risk factors". The Pearson criterion 2 was used to calculate the statistical signi cance of the di erences in indicators. Results and discussion. During the period under review, the prevalence of smoking and daily smoking tended to decrease, both among boys (4.5 times) and among girls (3.2 times). At the same time, if the prevalence of boys who smoked over girls also decreased and by 2019-2020 the proportion of boys and girls who smoked was equal, then among teenagers who smoked daily, the proportion of boys remained, as before, higher than the proportion of girls (1,2 times). The proportion of teenagers who smoked for reasons of emerging addiction ("like", "out of habit", "I can't quit") tended to increase, both among boys and girls. During the period under review, the motive of the rst smoking test "curiosity", both boys and girls, retained its primacy. The age interval for introducing urban teenagers-schoolchildren to tobacco smoking has not changed either (from 10 years to 17 years inclusive). However, the "peak" of initiation to smoking in boys moved from the age range up to 10 years inclusive in 1999-2000 and, starting from 2010-2011. and in 2019-2020, for the age range of 13-14 years, for girls, the age range of 13-14 years retained its position as the "peak" of initiation to smoking. Conclusion. A comparative analysis showed a signi cant decrease in the prevalence of smoking among urban teenage schoolchildren in the Russian Federation.
Key words: Russia, urban adolescents, tobacco smoking, prevalence, motives, dynamics.
For reference: Skvortsova ES, Lushkina NP. The main trends in tobacco smoking among Russian adolescents over the 20 years of the XXI century. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1):76–87. DOI: 10.20969/ VSKM.2022.15(1).76-87.
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UDC 616.24-002.52 DOI: 10.20969/VSKM.2022.15(1).88-94
IRON METABOLISM IN DISSEMINATED PULMONARY TUBERCULOSIS AND PNEUMOCYSTIS PNEUMONIA IN PATIENTS WITH HIV INFECTION
YAKOVLEVA ELENA V., ORCID ID: 0000-0003-1858-5206, SPIN ID: 5682-6180, Postgraduate student, Department of Phthisiology and Pulmonology, Samara State Medical University, st. Chapaevskaya 89, Samara, 443099, Russia; e-mail: elena130894@mail.ru
Abstract. Introduction. The main disease that complicates HIV is Pneumocystis pneumonia. It often requires di erential diagnosis with tuberculosis. Aim. The aim of the study was to conduct a comparative analysis of the clinical features and main indicators of iron metabolism in HIV infection with disseminated pulmonary tuberculosis and Pneumocystis pneumonia and to identify potential di erential diagnostic markers of tuberculosis. Material and methods. The study included two groups of patients with HIV infection: 42 patients with disseminated pulmonary tuberculosis and 44 patients with Pneumocystis pneumonia. The clinical and laboratory data was carried out, the main indicators of iron metabolism were determined: iron concentration, hepcidin, ferritin. Statistical data processing was performed using the MedCalc 19.2.6 statistical software. Results and discussions. In the group of patients with Pneumocystis pneumonia, the proportion of patients with a severe condition is greater, the level of CD4-lymphocytes is signi cantly lower - 5 times less than in tuberculosis (p <0.001). Statistically signi cant di erences between the groups were found for hepcidin and serum. The median for hepcidin is 1.4 times higher in group 1 than in group 2 (p <0.001), for serum - 1.5 times less in group 1 than in group 2 (р<0,001). In patients with HIV and pulmonary dissemination, a higher probability of tuberculosis was revealed with hepcidin more than 13810 pg/ml (sensitivity 80.95%, speci city 75%, ROC AUC 0.854) and with an iron concentration less than 10 μmol / L (sensitivity 85.7%, speci city 59.1%, ROC AUC 0.733). Conclusion. When examining patients with HIV infection and pulmonary dissemination syndrome who have a common anamnesis, clinical and radiological, laboratory data and a high degree of suspicion of tuberculosis, it was established by the analysis of ROC curves that the peptide hormone hepcidin has the greatest practical value for its further comprehensive study as a potential and a promising marker for the diagnosis of tuberculosis.
Key words: HIV infection; disseminated tuberculosis; pneumocystis pneumonia; pulmonary dissemination; hepcidin.
For reference: Yakovleva E.V. Iron metabolism in disseminated pulmonary tuberculosis and pneumocystis pneumonia in patients with HIV infection. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1): 88–94. DOI: 10.20969/ VSKM.2022.15(1).88-94.
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REVIEW
UDC 616-08.:-036.-039.81 DOI: 10.20969/VSKM.2022.15(1).95-106
HYPERURICEMIA: CLINICAL CONSEQUENCES, CARDIOVASCULAR RISK, MODERN APPROACH TO THERAPY
AMIROV NAIL B., ORCID ID: 0000-0003-0009-9103; D. Med. Sci., professor of the Department of outpatient therapy and general medical practice of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49; tel. +7-843-291-26-76, e-mail: namirov@mail.ru
NAUMOVA ASEL YA., ORCID ID: 0000-0002-9963-9466; 6th year student of the medical Faculty, Department of outpatient therapy and general medical practice of Kazan State Medical University, Russia, 420012, Kazan, st. Butlerova, 49, tel. +7-996-952-51-22, e-mail: vahitovaasel@gmail.com
FATYKHOV RENAT G., ORCID ID: 0000-0001-5651-8341; the Head of the Clinical Hospital of the Medical Care unit of the Ministry of Internal Affairs of Russia in the Republic of Tatarstan, Russia, 420000, Kazan, Orenburgskiy tract str., 132, tel. +7(843)291-26-84, e-mail: fatyhov.renat2011@yandex.ru
AMIROVA RENATA N., ORCID ID: 0000-0001-6867-3648; head of the personal insurance programs support department, doctor-expert of the Kazan branch of SOGAZ JSC, Russia, Kazan, тел. +7-903-307-99-47; e-mail: renata1980@mail.ru
Abstract. Introduction. In recent decades, increased attention has been paid to hyperuricemia due to the widespread prevalence of this pathology in the population (16.8%), the presence of a connection with the risk of developing cardiovascular diseases, as well as the variety of its clinical consequences. Aim. A review of current data on the causes of hyperuricemia, clinical aspects, the e ect of hyperuricemia on cardiovascular risk, and the current view of therapy, including asymptomatic hyperuricemia. Material and methods. The review carried out topical medical publications in foreign and domestic literature on this issue, accumulated at the present time. Results and discussion. An increase in uric acid level can occur as a result of inaccuracies in the diet, taking certain medications, impaired excretion of uric acid due to impaired renal function and other reasons. Hyperuricemia is the main cause of gout, which can manifest itself as acute gouty arthritis, chronic topical arthritis, urate nephropathy, and other diseases. Modern research shows that an increase in serum uric acid concentration is associated with an increased cardiovascular risk. Acting as an independent predictor of arterial hypertension, coronary heart disease, chronic heart failure, chronic kidney disease. Treatment with xanthine oxidase inhibitors (allopurinol, febuxostat) can a ect hyperuricemia, gout, and various forms of ischemic and vascular damage. As evidence of the e cacy of urate-lowering therapy remains controversial, these drugs are not currently indicated for routine prophylactic treatment in patients without gout symptoms. In 2018, specialists in the eld of hyperuricemia proposed an algorithm for the management of patients with asymptomatic hyperuricemia. However, the algorithm is not recommended for everyday practice due to further research's need to verify it. Conclusion. Classic manifestations of hyperuricemia such as gout and kidney damage remain the main indications for urate-lowering therapy. At the same time, the increased cardiovascular risk in hyperuricemia, proven by numerous studies, requires special attention in treating patients with comorbid pathology. Diet and lifestyle changes remain an integral part of therapy. The nal decision on the need for pharmacological treatment of patients with asymptomatic hyperuricemia with xanthine oxidase inhibitors is made individually. The development of algorithms and indications for the appointment of urate-lowering therapy continues. Recommendations for drug therapy for hyperuricemia are only possible after large, double-blind, placebo-controlled, randomized trials.
Key words: hyperuricemia; the risk of cardiovascular disease; gout, urate-lowering therapy; xanthine oxidase inhibitors.
For reference: Amirov NB, Naumova AYa, Fatykhov RG, Amirova RN. Hyperuricemia: clinical consequences, cardiovascular risk, modern approach to therapy. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1): 95–106.DOI: 10.20969/VSKM.2022.15(1).95-106.
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UDC 616.1-092:577.121.7 DOI: 10.20969/VSKM.2022.15(1).107-117
THE ROLE OF OXIDATIVE STRESS IN THE PATHOPHYSIOLOGY OF CARDIOVASCULAR PATHOLOGY
DEMKO IRINA V., ORCID ID: 0000-0001-8982-5292, Researcher ID: O-9740-2015, SPIN-код: 6520-3233, Author ID: 608300; D. Med. Sci., Professor, Head of Department of Advanced Internal Medicine and Immunology with Postgraduate Physician Training Course, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, st. Partizana Zheleznyaka 1, Krasnoyarsk, 660022, Russia; Head of Pulmonology and Allergology Center, Krasnoyarsk State Territorial Clinical Hospital: st. Partizana Zheleznyaka 3A, Krasnoyarsk, 660022, Russia; tel: +7 (913) 507 84 08; e-mail: demko64@mail.ru
SOBKO ELENA A., ORCID ID: 0000-0002-9377-5213, Researcher ID: AAG-7668-2019, SPIN-код: 9132-6756, Author ID: 720783; D. Med. Sci., Professor, Department of Advanced Internal Medicine and Immunology with Postgraduate Physician Training Course, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, st. Partizana Zheleznyaka 1, Krasnoyarsk, 660022, Russia; Head of the Department of Allergology, Krasnoyarsk State Territorial Clinical Hospital: st. Partizana Zheleznyaka 3A, Krasnoyarsk, 660022, Russia; tel: +7 (923) 327 11 92; e-mail: sobko29@mail.ru
SOLOVYEVA IRINA A., ORCID ID: 0000-0002-1999-9534, Researcher ID: M-3771-2014, SPIN-код: 8713-5470, Author ID: 716541; D. Med. Sci., Associate Professor, Department of Advanced Internal Medicine and Immunology with Postgraduate Physician Training Course, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, st. Partizana Zheleznyaka 1, Krasnoyarsk, 660022, Russia; Pulmonologist, Krasnoyarsk State Territorial Clinical Hospital: st. Partizana Zheleznyaka 3A, Krasnoyarsk, 660022, Russia; tel: +7 (391) 220 04 95; e-mail: acad-prorector@krasgmu.ru
KRAPOSHINA ANGELINA YU., ORCID ID: 0000-0001-6896-877X, Researcher ID: L-5636-2016, SPIN-код: 8829-9240, Author ID: 608302; C. Med. Sci., Associate Professor, Department of Advanced Internal Medicine and Immunology with Postgraduate Physician Training Course, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, st. Partizana Zheleznyaka 1, Krasnoyarsk, 660022, Russia; Pulmonologist, Krasnoyarsk State Territorial Clinical Hospital: st. Partizana Zheleznyaka 3A, Krasnoyarsk, 660022, Russia; tel: +7 (391) 228 34 69; e-mail: angelina-maria@inbox.ru
GORDEEVA NATALYA V., ORCID ID: 0000-0002-0586-8349, Researcher ID: AAN-1580-2020, SPIN-код: 7914-7630, Author ID: 815871; C. Med. Sci., Associate Professor, Department of Advanced Internal Medicine and Immunology with Postgraduate Physician Training Course, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, st. Partizana Zheleznyaka 1, Krasnoyarsk, 660022, Russia; Pulmonologist, Krasnoyarsk State Territorial Clinical Hospital: st. Partizana Zheleznyaka 3A, Krasnoyarsk, 660022, Russia; tel: +7 (913) 199 06 53; e-mail: natagorday@yandex.ru
ANIKIN DMITRY A., ORCID ID: 0000-0002-7418-897X, Researcher ID: AAH-8919-2021, SPIN-код: 3045-8493, Author ID: 1019131; Assistant Professor, Department of Advanced Internal Medicine and Immunology with Postgraduate Physician Training Course, Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, st. Partizana Zheleznyaka 1, Krasnoyarsk, 660022, Russia; General Practitioner, Krasnoyarsk State Territorial Clinical Hospital: st. Partizana Zheleznyaka 3A, Krasnoyarsk, 660022, Russia; tel: +7 (983) 140 27 37; e-mail: anikin27111994@mail.ru
Abstract. Introduction. In the pathogenesis of a number of diseases, a signi cant role is played by redox imbalance, which is referred to as oxidative (oxidative stress) stress. Aim. The aim of the study is to review current information on the pathophysiological mechanisms of the in uence of oxidative stress on the development of cardiovascular pathology.Material and methods. A review of current published studies on the e ect of oxidative stress on the development and course of cardiovascular pathology was carried out. Results and discussion. Oxidative stress, disorders of the antioxidant system, and in ammation are considered the leading links in the pathogenesis and progression factors of atherosclerotic cardiovascular diseases, heart failure, arterial hypertension, and others. Conclusion. By maintaining the physicochemical parameters of biological membranes regulating intracellular homeostasis and protein kinase activity, free radicals take part in key biological reactions, such as di erentiation, proliferation, and apoptosis. Strengthening reactions of free radical oxidation of lipids leads to damage to membranes and enzymatic systems, acting as a trigger factor for hidden genetically determined changes. In ammation is a pathological process inextricably linked with oxidative stress, which develops in tissues in response to their damage due to the action of agents of an infectious and non-infectious nature. Maladaptive in ammation leads to systolic and diastolic dysfunction through cardiovascular remodeling. Oxidative stress due to damage to the endothelial lining leads to the formation of endothelial dysfunction. The combination of the described pathological processes leads to cardiovascular diseases.
Key words: oxidative stress, in ammation, heart failure, atherosclerosis.
For reference: Demko IV, Sobko EA, Solovyeva IA, Kraposhina AY, Gordeeva NV, Anikin DA. The role of oxidative stress in the pathophysiology of cardiovascular pathology. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1): 107–117. DOI: 10.20969/VSKM.2022.15(1).107-117.
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UDC: 616.381-089.85-084-089.168.1-06:616-089.5-031.84 DOI: 10.20969/VSKM.2022.15(1).118-124
THE ROLE OF LOCAL ANESTHESIA OF A LAPAROTOMIC WOUND IN THE PREVENTION OF POSTOPERATIVE COMPLICATIONS
KONTOREV KONSTANTIN V., ORCID ID: 0000-0002-0641-5720; Researcher ID: AAK-1749-2021; postgraduate student, Department of General Surgery named after professor Yu.M.Lubensky, Krasnoyarsk State Medical University named after professor V.F. Voino-Yasenetsky, 660022, Russian Federation, Krasnoyarsk, Partizana Zheleznyaka St., 1, e-mail: kkontorev@mail.ru
ZDZITOVETSKY DMITRII E., ORCID ID: 0000-0002-2498-3844; AuthorID: 242540; ResearcherID: Q-5439-2016; D. Med. Sci., Associate Professor, Head of the Department of General Surgery named after professor Yu.M.Lubensky, Krasnoyarsk State Medical University named after professor V.F. Voino-Yasenetsky, 660022, Russian Federation, Krasnoyarsk, Partizana Zheleznyaka St., 1, 660022, Krasnoyarsk, Partizana Zheleznyaka St., 1, e-mail: zdz64@mail.ru
BORISOV ROMAN N., ORCID ID: 0000-0001-9670-9476; AuthorID: 543149; C. Med. Sci., Associate Professor, Department of General Surgery named after professor Yu.M.Lubensky, Krasnoyarsk State Medical University named after professor V.F. Voino-Yasenetsky, 660022, Russian Federation, Krasnoyarsk, Partizana Zheleznyaka St., 1, 660022, Krasnoyarsk, Partizana Zheleznyaka St., 1, e-mail: boron-5@yandex.ru
Abstract. Introduction. Wound pain and postoperative complications are a leading problem for patients operated on abdominal organs. In most cases, these two issues are interrelated; that is why their management requires a comprehensive modern approach. Aim. The aim of the study is to evaluate the literature data to identify a causal relationship between wound pain and some complications after abdominal surgeries and to determine the advantages of local anaesthesia of a laparotomic wound, taking into account its additional favourable features. Material and methods. Based on the analysis of Russian and foreign articles, the review presents the structure of the main wound, intra- and extra-abdominal complications after laparotomy, and their producing factors. Moreover, the role of pain during the postoperative period with its multiorgan e ect is clearly demonstrated. We considered characteristics of local anaesthetics with their non- standard e ects, as well as a comparison of publications regarding the advantages of local anaesthesia in the wound with the systemic administration of parenteral (narcotic and non-narcotic) analgesics, where side e ects were also analyzed.Results and discussion. Wound, intra- and extra-abdominal complications after laparotomy are very common today. Pain in the wound area is important in developing each of the complications: it provokes hypodynamia in the postoperative period, develops intestinal paresis, reduces the chest excursion and, as a result, worsens the life quality. All this provokes an increase in intra-abdominal pressure, impaired blood circulation of abdominal organs, wound ischemia in the suture area, lung congestion, which worsens hemodynamics and leads to the systemic consequences. Local anaesthetics are devoid of the well-known side e ects of narcotic analgesics and non-steroidal anti-in ammatory drugs. However, they have additional positive local e ects. Conclusion. Scienti c data analysis has shown that continuous infusion of local anaesthetics into the preperitoneal space of a median laparotomic wound is a promising method for relieving wound pain and preventing postoperative intra- and extra-abdominal complications.
Key words: midline laparotomy, postoperative complications, local anesthetics, wound pain.
For reference: Kontorev KV, Zdzitovetsky DE, Borisov RN. The role of local anesthesia of a laparotomic wound in the prevention of postoperative complications. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1):118–124.DOI: 10.20969/VSKM.2022.15(1).118-124.
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UDC:616-001-089.5-031.83-083.98 DOI: 10.20969/VSKM.2022.15(1).125-130
REGIONAL ANALGESIA METHODS FOR TRAUMA PATIENTS
SHARIPOVA VISOLATKHON H., ORCID ID: 0000-0003-2517-1183; D. Med. Sci, Head of the Department of Anesthesiology and Intensive Care, Republican Research Center of Emergency Medicine, Tashkent, Uzbekistan, 100107, Farhad str.2; E-mail: visolat_78@mail.ru.
ESHBOYEV ABDULKHAKIM T., ORCID ID: 0000-0003-4260-4155; Director of the Surkhandarya branch of the Republican Research Center of Emergency Medicine, Termez, Uzbekistan 190100, Zavqi str, 19; Phone: +998937986758; E-mail: termez9111@rambler.ru
ESHMURODOV DILSHODBEK B., ORCID ID: 0000-0002-3858-3163; Anesthesiologist and Intensive Care Physician, Surkhandarya branch of the Republican Research Center of Emergency Medicine, Termez, Uzbekistan 190100, Zavqi str, 19; Phone: +998901129200; E-mail: anestezolog@mail.ru.
Abstract. Introduction. Trauma patients are a special group in which pain control is often a challenge for the anesthetist and resuscitator. In recent years, the role of regional anesthesia in the anesthesia of patients with injuries has been growing and the methods of regional blockades have been improved. Aim. Analysis of scienti c medical literature on the pain relief of patients with traumatic injuries. Material and methods. The review and analysis of modern scienti c data about the problem of pain relief in patients with trauma in the search databases PubMed and Google Scholar is carried out. Results and discussion. Multimodal anesthesia consisting of ultrasound guided regional anesthesia methods contributes to better pain relief. Good quality pain relief for traumatic injuries reduces the body's stress response to trauma, reduces the opioid consumption and consequently their side e ects, signi cantly reduces the risk of development of chronic pain and improves the quality of life. Therefore, today, regional anesthesia methods are integrated into the protocols of Enhanced Recovery after Surgery (ERAS). This review highlights the literature data on the possibilities of using current regional anesthesia methods for injuries, in particular, combined and multiple traumas. The advantages and disadvantages of various regional blocks in trauma patients are described. Along with the methods of regional anesthesia of the extremities, relatively new methods of fascial blocks which are successfully used for anesthesia of the chest and abdomen are discussed. Conclusion. Personalized multimodal pain therapy aimed at the area of injury using ultrasound navigation is a promising direction in the treatment of pain in trauma patients.
Key words: pain, pain relief, multimodal analgesia, regional analgesia, trauma pain management.
For reference: Sharipova VH, Eshboyev AT, Eshmurodov DB. Regional analgesia methods for trauma patients. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1): 125–130. DOI: 10.20969/VSKM.2022.15(1).125-130.
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CRITICAL REVIEWS
UDC 614.2:364.614.8(049.3) DOI: 10.20969/VSKM.2022.15(1).131-138
THE JUSTICE AND EQUALITY IN HEALTHCARE: A REVIEW AND CRITICAL ANALYSIS OF THE 2016-2017 SOCIOLOGICAL PROJECT - MONOGRAPHS BY ZH.V. SAVELYEVA, L.M. MUKHARYAMOVA AND I.B. KUZNETSOVA
OSLOPOV VLADIMIR N., ORCID ID: 0000-0003-2901-0694; SCOPUS Author ID: 6602523658: Dr. Med. Sci., professor of the Department of Introduction to Internal Diseases named after Professor S.S. Zimnitsky, Kazan State Medical University, 420012, st., Butlerova 49, Kazan, Russia, tel. 8 (905)316-25-35,
e-mail: voslopov1845@gmail.com
MISHANINA YULIANA S., pediatric faculty student, Kazan State Medical University, 420012, st., Butlerova 49, Kazan, Russia, tel. 8-906-321-21-23, e-mail: mishanina.1998@list.ru.
OSLOPOVA JULIA V., ORCID ID : 0000-0002-9752-8703, C. Med. Sci., associate professor of the Department of the Fundamentals of Clinical Medicine, Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008, st., Kremlevskaya 18, Kazan, Russia, tel. 8 (917) 287-94-56,
e-mail: oslopovajul@mail.ru
Abstract. Introduction. The study of social justice and equality in health care is presented in the context of scienti c, expert and media conceptualizations of this phenomenon. Opinions and social perceptions of justice are characterized in terms of the liberal, socialist model of equitable health care and the modern concept of equality of opportunity in access to system resources. Aim. Conduct a critical analysis of the social project “Fairness and Equality in Health Care”, described in the monograph “Fairness and Equality in Health Care. Opinions of patients, experts and media discourse” by Zh.V. Saveleva, L.M. Mukharyamova, I.B. Kuznetsova. Material and methods. The article provides a review and critical analysis of the social project “Fairness and Equality in Health Care”, described in the monograph “Fairness and Equality in Health Care. Opinions of patients, experts and media discourse” by Zh.V. Saveleva, L.M. Mukharyamova, I.B. Kuznetsova.Results and discussion. The purpose of the project under review was to show how, through the analysis of the incidence in two Russian republics - the industrialized Republic of Tatarstan, and the predominantly agrarian Republic of Mari El - the cause of justice and equality in healthcare is presented and how contradictions can be resolved. Di erent positions, expectations regarding health care reforms and models of social justice are compared. The method of triangulation was used [lat. triangulum - triangle] quantitative and qualitative research methods. Semi-structured surveys of the population, experts, focus groups were conducted, and a mass survey was conducted. From the results obtained by the authors, 2 conclusions stand out: 1) an integrated approach to the analysis of equity in healthcare is needed; 2) actions are needed to equalize the accessibility of medical care to the population. Conclusion. Monograph “Fairness and equality in healthcare. Opinions of patients, experts and media discourse” by Zh.V. Saveleva, L.M. Mukharyamova, I.B. Kuznetsova, touches on one of the most burning issues that arise in modern Russian healthcare, issues that concern almost every inhabitant of Russia - "justice and equality". It is impossible to solve them in isolation from the global social policy in the state. The authors of the monograph literally keep their nger on the pulse of this important problem - as they say, they do it here and now. I hope that the authors will not con ne themselves to one monograph on this vitally important topic (raising the question) and that the next monograph will be devoted to solving this most important problem.
Keywords: justice, equality, healthcare, population studies, review, critical analysis.
For reference: Oslopov VN, Mishanina YuS, Oslopova YuV. The Justice and Equality in Healthcare: a Review and Critical Analysis of the 2016-2017 sociological project - monographs by Zh.V.Savelyeva, L.M.Mukharyamova and I.B.Kuznetsova. Bulletin of Contemporary Clinical Medicine. 2022; 15 (1): 131–138. DOI: 10.20969/VSKM.2022.15(1).131-138.
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WHEN THE ISSUE WAS MADE UP
UDC: 575.224.22:[616-009.7: 615.211] DOI: 10.20969/VSKM.2022.15(1).139-144
THE ROLE OF POLYMORPHISM OF THE MDR1 GENE FOR THE APPOINTMENT OF NONSTEROIDAL ANTI-INFLAMMATORY DRUGS IN PAIN SYNDROME
ABDASHIMOV ZAFAR BAKHTIYAROVICH, ORCID ID: 0000-0002-7807-9463, C. Med. Sci., doctoral student of the Department of subjects of therapeutic direction No. 2, Tashkent State Dental Institute, Uzbekistan, 100047, Tashkent, Yashnabad district, Taraqqiyot street, 103, tel. +99-871-2302073, e-mail: zafar_abdashimov@mail.com
Abstract. Introduction. One of the key roles in the excretion of a number of drugs, in particular nonsteroidal anti- in ammatory drugs, has a transport protein glycoprotein P, encoded by the MDR1 gene. In this connection, the in uence of genetic polymorphism of glycoprotein P on the pharmacokinetics of these drugs contributes to the prediction of clinical consequences. Aim. The aim of the current study was to study the associations of polymorphic markers C1236T and C3435T of the MDR1 gene encoding glycoprotein P with the development of undesirable drug reactions in patients with pain syndrome. Material and methods. The study included 69 patients with pain syndrome and were divided into 2 groups depending on the presence of adverse drug reactions: NLR+ - 20 patients and NLR - - 49 patients with pain syndrome. The association of the polymorphic marker C3435T of the MDR1 gene was also studied among 22 patients with adverse drug reactions (ADR+) and 47 patients with pain syndrome without the presence of adverse drug reactions (ADR-). Molecular genetic studies were carried out on the basis of the Laboratory of medical genetics of NIIG and the PC of the Ministry of Health of the Republic of Uzbekistan. Results and discussion. During the genotyping, it was found that the occurrence of alleles and genotypes of the polymorphic marker C3435T of the MDR1 gene had signi cantly signi cant di erences among the patients of the examined groups, depending on adverse drug reactions. Conclusion. The association of the polymorphic marker C3435T of the MDR1 gene with the development of undesirable drug reactions in pain syndrome, the TT genotype and the T allele may be genetic risk factors (OR=4.0 and 8.25; 95% CI 1.78-9.09 and 2.56-26.57, respectively) predisposing to the development of undesirable drug reactions in patients with pain syndrome. Therefore, further study is necessary in order to carry out genotyping of the polymorphic marker C3435T of the MDR1 gene to increase the e ectiveness and safety of therapy of nonsteroidal anti-in ammatory drugs.
Key words: adverse drug reactions, MDR1 gene, polymorphic marker C3435T, nonsteroidal anti-in ammatory drugs, NSAIDs.
For reference: Abdashimov ZB. The role of polymorphism of the mdr1 gene for the appointment of nonsteroidal anti-in ammatory drugs in pain syndrome. The Bulletin of Contemporary Clinical Medicine. 2022; 15 (1):139–144.DOI: 10.20969/VSKM.2022.15(1).139-144
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