Vol 36, No 5 (2019)

Cover Page
Clinical studies
Obesity and hypovitaminosis D3 as risk factor for puerperal complications
Makarova E.L., Padrul M.M.

Abstract

Aim. To study the puerperal complications in women with disturbance of fat metabolism associated with hypovitaminosis D3.

Materials and methods. One hundred and two puerperal women were examined after giving birth to a child at the City Perinatal Center.

Results. The number of puerperal complications in the group of women with obesity and hypovitaminosis D occurred twice as more often than in women with normal body mass. From all complications, there prevailed lactostasis and hypogalactia. Only in the group of puerperas with high body mass index and low vitamin D content combined, there were detected subinvolution and puerperal endometriosis.

Conclusions. Patients with obesity and low vitamin D3 content need more thorough preparation to delivery and lactation at “The Mother’s School” when they are observed during pregnancy. Personnel of maternity hospital and patient’s relatives ought to take an active part in puerperal care and promote early activation of puerpera with obesity to reduce possible complications.

Perm Medical Journal. 2019;36(5):5-10
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Gender abdominal features, determining depth of incisional wound in abdominal surgeries
Amarantov D.G., Zarivchatsky M.F., Alkhamaidh A.A., Gorst N.K., Zheleznitskikh O.V., Zhuravlev O.S.

Abstract

Aim. To determine the mean values of the anterior abdominal wall thickness and abdominal cavity depth for men and women with different types of constitution and reveal the mechanisms, allowing the surgeon to predict these parameters in the preoperative period.

Materials and methods. One hundred twenty male and female computer tomograms of the abdominal cavity were studied.

Results. The anterior abdominal wall thickness and abdominal cavity depth values for men and women with different types of constitution at different levels of measurement were determined. The depth of laparotomy wound was found to be dependent on the distance between the anterior upper iliac spines.

Conclusions. The gender features of the anterior abdominal wall thickness and abdominal cavity depth were revealed. There were determined the coefficients, permitting to predict the depth of laparotomy wound in the preoperative period.

Perm Medical Journal. 2019;36(5):11-20
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Methods of diagnosis and technologies
Role of magnetic resonance tomography in diagnosis of genital endometriosis among women of reproductive age
Sandakova E.A., Chistyakova D.M., Vaganova A.F., Rakitina Y.V.

Abstract

Aim. To estimate the informativity of the technique of magnetic resonance tomography (MRT) of pelvic organs in diagnosis of genital endometriosis in women of reproductive age.

Materials and methods. The results of pelvic organs MRT from 415 women aged 18–45 years were analyzed. The examination was implemented using the apparatus Philips Intera 1.5 Tl. The method of copying the results of MR-investigations was used to receive the data on localization, degree of dissemination of endometriosis foci and concomitant diseases of female reproductive system, which were later compared with the results of the existing echographic studies of pelvic organs.

Results. The study demonstrated higher informativity of magnetic resonance tomography in diagnosis of different forms of endometriosis and gynecological pathology associated with it, unlike echography. Out of 415 women, who underwent magnetic resonance tomography of pelvic organs, endometriosis was diagnosed in 20 % of the examined women, while echographic study – only in 4 %. When implementing ultrasound, the signs of malignant neoplasms of the uterine neck and ovaries were not detected in a part of patients, whereas revealed with MRT of pelvic organs and further confirmed by the results of histological studies.

Conclusions. Application of magnetic resonance tomography permits to improve significantly diagnosis of endometriosis that is important for determination of adequate tactics of treatment, taking into account the existing concomitant gynecological pathology.

Perm Medical Journal. 2019;36(5):21-26
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Hepatic syndromes and cytokine indices in patients with hepatic cirrhosis
Schekotova A.P., Bulatova I.A., Paducheva S.V.

Abstract

Aim. To analyze the clinical manifestations of hepatic cirrhosis (HC) of different etiology and their correlation with proinflammatory cytokine level – interleukin-6 and tumor necrosis factor-alpha (TNF-α).

Materials and methods. Fifty patients with viral hepatic cirrhosis (as a result of chronic hepatitis C), 20 patients with alcoholic HC, 16 persons with mixed etiology HC (viral and alcoholic) with the mean age 53 ± 13.01 years were examined. Hepatic cirrhosis was diagnosed using complex data of clinicolaboratory and instrumental studies. The levels of IL-6 and TNF-α were determined with the kits of “VectorBest” company (Russia, Novosibirsk) using the method of enzyme immunoassay and registration of results on photometer “Stat-Fax” 2100 (USA).

Results. No reliable differences in clinical manifestations and cytokine level in HC of different etiology were detected. The levels of cytokine concentration median significantly elevated as HC progressed. Interleukin-6 demonstrated moderate correlations with lethargy and hepatocellular insufficiency as a whole (Ki = 0.673 and Ki = 0.607, respectively).

Conclusions. Clinical syndromes of HC practically do not depend on etiology of disease. Increase in production of IL-6 and TNF-a demonstrates pathogenetic significance of proinflammatory cytokines in the lesion of the liver. IL-6 level correlates with the severity of liver lesion and, thus, objectifies clinical symptoms in HC patients, especially those based on patients’ complaints.

Perm Medical Journal. 2019;36(5):27-34
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Urinary and blood procalcitonin concentration in healthy persons
Sosnin D.Y., Nenasheva O.Y., Zubareva N.A., Renzhin A.V., Gal'kovich K.R.

Abstract

Aim. Blood serum and urinary procalcitonin (PCT) concentration in healthy persons was studied.

Materials and methods. A single-stage observational study of “case-control” type was performed. The study included 32 men and 37 women of middle age (53.4 ± 16.4 years) with normal renal function. PTC concentration was determined with the method of solid-phase enzyme immunoassay using test-system (Procalcitonin IFA-BEST, Russia).

Results. Blood serum PCT concentration in the examined persons was 0.029 ± 0.016 ng/ml (M ± SD). The number of blood serum samples with PTC level > 0.05 ng/ml was 5.8 % (4 from 69). The mean urinary PTC concentration by 72.59 times exceeded the mean blood serum PTC content and was 2.12 ± 1.832 ng/ml (р < 0.000001).

Coefficient of variation of results for the urine by 1.57 times exceeded the analogous index for the blood serum. When comparing the results of blood serum and urine analyses, no statistically significant differences between men and women were revealed. When estimating the coefficients of linear correlation between PTC content in the blood serum and urine, a weak positive dependence was established (R = 0.302782).

Conclusions. High PTC concentration in the urine permits to suppose that one of the ways of procalcitonin removal from the blood plasma is its elimination by kidneys in unchanged type by means of glomerular filtration.

 

Perm Medical Journal. 2019;36(5):35-43
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Preventive and social medicine
Assessment of immune status in children with functional respiratory system disorders, living in aerogenic aluminium exposure zone
Dolgikh O.V., Alikina I.N., Guselnikov M.A.

Abstract

Aim. To assess the immune status in children of primary school age with functional disorders of the respiratory system, who live in the territory with location of industrial enterprise, producing aluminium.

Materials and methods. Fifty-two children aged 7–11 years with respiratory system disorders, who live in the zone of exposure of aluminium-producing enterprise were examined. Cellular differentiation marker CD127, protein Bcl-2 and TNFR receptor expression levels were identified using the method of flow cytometry. Phagocytic activity of the cells was studied using formalinized sheep erythrocytes; IgG content was determined with radial immunodiffusion method; beta2-microglobulin level – with enzyme immunoassay. Functional status of respiratory system was assessed using spirometry, rhinomanometry methods but functional reserves – with calculated Skibinskaya index.

Results. The prevalence of allergic diseases in the examined children was 2,4 times higher and allergic rhinitis was diagnosed 3,2 times more often than in the group of comparison. The prevalence of bronchial asthma, clinical signs of chronic lympho-proliferative diseases reliably exceeded the level observed in children of comparison group (29.4 %, р = 0.001). There were established the changes in immune reactivity versus the comparison group, manifested by increase in percentage of phagocyting cells, beta2-microglobulin protein, IgG, CD127, TNFR and specific IgG to aluminium by 1.1, 1.2, 1.0, 1.7, 2.5 and 1.2 times, respectively; suppression of protein

Bcl-2 expression by 2,6 times (p < 0.05) was registered.

Conclusions. Among children aged 7–11 years, who live in the territory with localized aluminium-producing enterprise, the diseases of respiratory organs with allergic component, reliably associated with aluminium compound contamination, were diagnosed more often than in children of comparison group. Immunologic study detected imbalance between humoral and cellular components of immunity: hyperproduction of specific IgG to aluminium, excess expression of proteins and beta2-microglobulin receptors, IgG, CD127, TNFR and deficit of Bcl-2.

Perm Medical Journal. 2019;36(5):44-51
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Conditions, determining timeliness of newborn vaccination at perinatal center
Kuznetsova O.A., Golubkova A.A., Bashmakova N.V.

Abstract

Aim. To assess the volume of immunopreventive work at the perinatal center.

Materials and methods. In the cohort prospective controlled study, the coverage of newborn vaccination at maternity hospitals and the reasons of parents’ refusals from vaccination were evaluated

Results. The specific features of vaccination of the newborns born from women with gestational diabetes mellitus and fetoplacental insufficiency were determined; sociological questioning was carried out to assess parents’ attitude to vaccination,

Conclusions. The results of the study showed that the process of vaccination at perinatal center has its peculiar features. Each infant needs individual approach. The role of medical personnel in formation of loyalty to vaccination is undoubtful.

Perm Medical Journal. 2019;36(5):52-57
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Thyroid tumors in iodine deficiency region
Styazhkina S.N., Idiatullin R.M.

Abstract

Aim. To analyze the epidemiological indices of thyroid tumors in iodine deficiency region.

Materials and methods. The morbidity and mortality of thyroid cancer in Udmurt Republic was analyzed using the data of state statistical accounting documentation of Republican Information Analytical Center and “Republican Clinical Oncological Dispensary named after S.G. Primushko” for 10 years (2007–2018).

Results. In 2018, one hundred thirty two persons in Udmurt Republic were diagnosed thyroid cancer for the first time, 40 (30.6 %) of them had advanced process. Thyroid cancer morbidity in Udmurt Republic increased from 5.39 cases per 100 000 in 2007 to 8.7 cases per 100 000 in 2018. A twenty-year gain was 61.4%. According to prognosis, thyroid cancer morbidity in Udmurt Republic in 2023 will reach 10.23 cases per 100 000 of the population.

Conclusions. According to prognosis, during the next 5 years the level of thyroid cancer morbidity in Udmurt Republic will be growing. Middle-aged women more often suffer from thyroid cancer. It should cause oncologic alarm in this group of the population, especially in iodine deficiency regions.

Perm Medical Journal. 2019;36(5):58-64
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Features of formation of biliary dysfunctions in children consuming drinking water with high nitrate content
Tolmacheva O.G., Ustinova O.Y., Maklakova O.A., Ivashova Y.A., Vandisheva A.Y.

Abstract

Introduction. In recent years, there is more and more information about the global distribution of nitrates in soil, water, food.

Purpose. To study the features of the formation of biliary dysfunction in children with drinking water with high nitrate content.

Materials. 124 school-age children consuming drinking water with high nitrate content (1.3 MPC) were examined. The comparison group included 52 children living in areas where the nitrate level in drinking water was 4.7 times lower. Results. In children of the observation group, the concentration of N-nitrosodimethylamine in the blood was 3.3 times higher than in the comparison group, and the concentration of nitrates in urine was 1.8 times higher. Every second child with a pathology of the gastrointestinal tract consuming drinking water with a high content of nitrates was diagnosed with biliary dysfunction manifested by hepatocellular dysfunction (increased activity of AST) and a violation of motor-tonic function of the gallbladder by hyperkinetic type against the background of hemolysis of erythrocytes (increased total bilirubin) with a stable level of hemoglobin.

Perm Medical Journal. 2019;36(5):65-70
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Polyclinic doctors’ knowledge of clinical recommendations regarding indications to administration of antihypertensive drugs
Sandakov Y.P., Kochubei V.V.

Abstract

Aim. To study the knowledge of clinical recommendations of the Ministry of Healthcare of the Russian Federation, acquired by doctors providing dispensary observation regarding contraindications to administration of antihypertensive drugs.

Materials and methods. Questioning of 146 doctors, providing dispensary observation of adults using the standard questionnaire, containing 14 questions-tests. There was implemented the frequency analysis, calculation and comparison of the mean score, Median, Mode in relation to all the group and groups, singled out by the following two signs: work at the hospital for the recent 5 years and awareness of the content of clinical recommendations of the Ministry of Healthcare of RF. Correlation analysis between scores and age was conducted.

Results. The mean score was 3.6 ± 3.3 with maximum 14, Median 1, Mode 1. Nobody from respondents got the maximum score, the best result 12 scores was received by 0.7 % of respondents, 0 scores – 3 %. No correlation between scores and age (r = –0.1, p = 0.4) was revealed. In the group of doctors, working at the hospital for the recent 5 years, during half a year the mean score 5.4 ± 3.5 was significantly higher (t = 3.8, p = 0.001) than in the group of those who did not work 2.9 ± 2.7. In the group of respondents, who indicated their knowledge of the content of clinical recommendations, the mean score 3.6 ± 3.4 (t = –0.4, p = 0.89) did not significantly differ from the mean score 3.5 ± 3.3 in the group of doctors who were not aware of clinical recommendations on arterial hypertension in adults.

Conclusions. The knowledge of clinical recommendations, confirmed by the Ministry of Health of the Russian Federation, should be regularly estimated among the doctors, providing dispensary observation. Practice-oriented training of clinical recommendations is also needed.

 

Perm Medical Journal. 2019;36(5):71-75
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Risk factors for development of prenosological and nosological forms of health care-associated infections in puerperas
Agarev A.E., Zdol'nik T.D., Kovalenko M.S.

Abstract

Aim. To reveal the risk factors for the development of prenosological and nosological forms of health care-associated infections in puerperas.

Materials and methods. To reveal the factors of risk, experimental and control groups were formed: the experimental group 1 – 154 puerperas with nosological forms; the experimental group 2 – 181 puerperas with prenosological forms; the control group – 303 puerperas. It was a retrospective study of “case – control” type.

Results. According to the results of the study, the following risk factors for the development of nosological forms were stated: pregnancy-caused hypertension, prenatal hospitalization longer than 1 day, first labor, disturbances of labor activity, minor obstetric operations, cervical rupture, deep vaginal mucosa rupture, 2–4 degree perineal rupture, anhydrous period longer than 4 hours, separate stay; risk factors for the development of prenosological forms: unregistered marriage, irregular observation at antenatal clinic during pregnancy, onset of sexual life before 18, absence of education, extragenital pathology, prenatal hospitalization longer than 1 day, preeclampsia and placental disturbances during pregnancy, first labor, preeclampsia in labor, hydramnios, disturbances of labor activity, anhydrous period longer than 4 hours, augmentation of labor, cesarean section, especially urgent, deep vaginal mucosa rupture, postnatal anemia, separate stay.

Conclusions. Most factors, elevating the risk for the development of both nosological and prenosological forms, are connected with the period of labor. Risk factors for the development of prenosological forms are characterized by a great variety and enclose a vast majority of risk factors for the development of nosological forms.

Perm Medical Journal. 2019;36(5):76-82
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Medicosocial problems of pupils’ health according to survey results
Dymova I.A., Karoyan A.A.

Abstract

Aim. To reveal the regional features and causes of worsening of health among pupils using the results of survey.

Materials and methods. The method of questioning was used to study the prevalence of the factors, conditioned by the mode of life, educational process, informativity of pupils regarding the main risk factors, their loyality to healthy way of life. The study included 247 pupils of the 8–9 forms from 12 secondary schools of the city.

Results. The paper is devoted to the study of the causes of worsening of health among pupils, living in small cities of Russia. There is singled out and presented a group of unfavorable factors, conditioned by pupils’ way of life: malnutrition, intensive educational load, long use of computers and prevalence of bad habits, which negatively influence the development and health of the growing organism.

Conclusions. To preserve pupils’ health in modern conditions, it is necessary to optimize the conditions of training and way of life taking into account regional features. First of all, the manageable factors ought to be used, which do not need additional financial costs: observation of hygienic regime and nutrition at school and at home; improvement of internal environment, perfection of curriculum, health-improving measures, training of healthy way of life.

Perm Medical Journal. 2019;36(5):83-87
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Review of literature
Modern prospects for using polyene unsaturated fatty acids in obstetrics and gynecology
Kiselev M.A., Repina N.B., Kiseleva J.S.

Abstract

Unsaturated fatty acids is the key block of cellular membranes, they determine the specificity of high-differentiated cells and are the precursors of eicosanoid synthesis (prostaglandins, thromboxanes, leukotrienes). A marked antiinflammatory, antisclerotic, antiarrhythmic, anticoagulant, neuroprotective and other effects of omega-3 polyunsaturated fatty acids, established in biochemical and experimental studies, stimulated implementation of a large number of epidemiological and clinical investigations. Successful application of polyunsaturated fatty acids in cardiology, neurology and other fields of therapy focuses on such spheres as obstetrics and gynecology.

Perm Medical Journal. 2019;36(5):88-95
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Anniversaries
October 24 marks the 75th anniversary of the birth of Academician Chereshnev Valery Alexandrovich
 

Abstract

October 24 marks the 75th anniversary of the birth of Academician Chereshnev Valery Alexandrovich

Perm Medical Journal. 2019;36(5):96-99
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