Vol 36, No 6 (2019)

Cover Page
Clinical studies
Clinicopathogenetic features of cardiovascular system affection in influenza patients with hypertensive reaction revealed for the first time
Vorobеva N.N., Okishev M.A., Semerikov V.V., Khlynova O.V., Nikolenko V.V., Symlivaya O.N.

Abstract

Aim. To study the state of central hemodynamics, oxygen metabolism and tissue blood flow in patients with influenza who suffered from hypertensive reaction detected for the first time, in dynamics of infectious process.

Materials and methods. At Perm Regional Clinical Infectious Hospital, 65 patients with influenza underwent a deepened study of cardiovascular system: central hemodynamics and local blood flow.

Results. While studying the central hemodynamics, there was detected the increased general peripheric vascular resistance without normalization during the follow-up period. Investigation of gas exchange showed decrease in tissue oxygenation, vasodilatation and tissue blood flow.

Conclusions. Among patients with influenza, the oxygen transport system functions in a tense regime. In dynamics of infectious process and after the disease, the following is observed: development of tissue hypoxia, decrease in local blood flow tempo and elevation of general peripheric vascular resistance.

Perm Medical Journal. 2019;36(6):5-11
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Correlation between severity of health status in extremely premature newborns on third day of life and clinicolaboratory indices
Furman E.G., Nikolenko A.V., Kulizhnikov G.V.

Abstract

Aim. To detect the correlation between the severity of health status in extremely premature newborns and the changes in clinical and laboratory indices.

Materials and methods. The study included small premature newborn infants with extremely low body mass and very low-birth-weight infants with clinical picture of respiratory distress syndrome. To carry out the study, patients were divided into 2 groups depending on the health status severity index on the third day of life using NEOMOD scale. Group I enclosed infants with health status severity on the third day of life from 0 to 2 scores, group II – patients with health status severity on the third day from 3 and more scores by NEOMOD scale.

Results. The patients with more severe health status according to NEOMOD scale had lower blood erythrocyte index on the first day of life as compared to the patients with less severe health status (U = 64; р = 0.034). There was revealed a direct relationship between health status severity on the third day and health status severity on the first day (U = 56.5; р = 0.014), stab neutrophil number (U = 57; р = 0.016) and neutrophil nuclear shift index (NNSI) (U = 61; p = 0.025) on the twenty eighth day.

Conclusions. The lower number of erythrocyte on the first day of life is interconnected with more severe health status on the third day of life. The initial severity of respiratory failure in case of respiratory distress syndrome influences the duration of infectious processes, in particular, pneumonia with high indices of infectious markers.

Perm Medical Journal. 2019;36(6):12-18
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Methods of diagnosis and technologies
Nosologic independence of pediatric protracted bacterial bronchitis in real clinical practice: single-stage continuous cross-sectional study
Mazunina E.S., Furman E.G., Evseenkova T.G., Valiulov I.M.

Abstract

Aim. To study the clinical and paraclinical features of protracted bacterial bronchitis (PBB), stated according to “clinical” definition of disease in children with relapsing course of respiratory diseases and a symptom of wet cough for more than 4 weeks.

Materials and methods. The study included 68 children with relapsing course of respiratory diseases, who have a symptom of wet cough for more than 4 weeks. Group 1 enclosed 30 (44 %) children, who corresponded to “clinical definition of PBB”. Group 2 – 38 (56 %) children without PBB manifestations.

Results. Bronchial asthma (46.6%, p < 0.05), degree 2-3 tracheobronchomalacia (30 %, p < 0.05) were more common in the group of children with “clinical” PBB. No any allergic pathology was observed in 13 (44.8 %) children with PBB. Among the main clinical features of PBB there were observed the following: the presence of night cough (73.3 %, p < 0.05), fine moist rales in the lungs (76.6 %), bronchoscopically – the presence of diffuse catarrhal-purulent endobronchitis (86.6 %).

Conclusions. Physicians should bear in mind one of the most frequent causes of protracted wet cough (more than 4 weeks), namely, PBB. When suspecting PBB, a patient should be sent to pulmonologist, undergo bronchoscopy and BAL by indications so as to assess microbial landscape in children with protracted productive cough and rales for a timely diagnosis of PBB and administration of antibacterial therapy.

Perm Medical Journal. 2019;36(6):19-26
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Characteristic features of functional status of lymphocytes in premature newborns
Maiden I.V., Spivak E.M.

Abstract

Aim. To characterize the functional properties of peripheral blood lymphocytes in association with peculiarities of the period of neonatal adaptation of premature newborns.

Materials and methods. Sixty-one conditionally healthy premature infants with gestation period of 28-37 weeks and their mothers as well as 12 full-term newborns were examined. The functional status of small lymphocytes was assessed by the activity of chromatin of their nuclei. For this purpose, there were used cytochemical and fluorometric methods with acridine orange staining of the smears obtained from leukocytic suspension that was followed by measuring intensity of luminescence in the light wave diapason of 530-580 nm. The study was implemented thrice – on the days 6th, 16th, and 26th of infants’ life.

Results. During the neonatal period, premature infants demonstrated the growth of the absolute and relative number of lymphocytes. The mentioned indices have an inverse dependence on the period of gestation. Activity of chromatin of small lymphocyte nuclei in newborns is significantly higher than in adults. Its maximum values are registered in prematurely born infants. Newborn small lymphocytes are characterized by marked functional heterogeneity. Unfavorable course of neonatal period in these patients is accompanied by lower values of the absolute number of lymphocytes and activity of their nuclei chromatin.

Conclusions. The index of activity of small lymphocyte nuclei chromatin can be used to predict the course of neonatal period in prematurely born infants.

Perm Medical Journal. 2019;36(6):27-32
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Prevalence and structure of foot deformities in primary school children
Averyanova N.I., Pristupova V.V., Semerikova A.I., Starkova I.L.

Abstract

Aim. To study the prevalence and structure of deformity of the foot in primary school children (pupils of the 1st- 4th grades).

Materials and methods. The study involved 277 children aged 7-10 years. The main method of investigation used was computed plantography by means of electronic baropodometer PadProfessional.

Results. Deformity of the foot was detected in 58% of children – 65.3% of boys and 52.3% of girls (p < 0.05). The following pathology was revealed: platypodia, increase in the load on the calcaneal part of the foot and malposition of the foot. The most common pathology was platypodia diagnosed in 28.2% of children.

Conclusions. High prevalence of foot deformities requires their early diagnosis and correction as well as improvement of parents’ knowledge regarding this problem.

Perm Medical Journal. 2019;36(6):33-40
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Preventive and social medicine
Features of psychological status in women with functional ovarian cysts
Sandakova E.A., Zhukovskaya I.G., Vaganova A.F.

Abstract

Aim. To analyze the psychological status indices in women with functional cysts of the ovaries.

Materials and methods. The group of observation (group I) included 35 women with functional ovarian cysts (follicular and yellow body cysts), the group of comparison (group II) – 34 patients with no cysts available and normal ovarian volume. The mean age of the patients examined was 28.7 ± 5.2 and 29.3 ± 4.8 years, respectively. The methods used included registration of complaints and anamnesis data, standard general clinical and gynecological studies, ultrasound scanning of pelvic organs using apparatus Sonoscape 6000, survey with Beck Depression Inventory, Spielberger-HaninScale, MOS SF-36.

Results. Health status of women with functional cysts of the ovaries is characterized by abdominal pain syndrome (91.3 % and 14.7 ± 6.0%; p < 0.001), mastodynia in the second phase of cycle (37.1 % and 8.8 ± 4.9 %; p < 0.01), dysmenorrhea (37.1 % and 14.7 ± 6.0 %; p < 0.05) that undoubtedly influences the indices of psychoemotional status. It is worth noting that the prevalence of smoking among women of group I is high (26.5 % and 2.9 % respectively; p < 0.01). The characteristic features of psychological status of group I patients are the following: high level of reactive anxiety (Spielberger-Hanin Anxiety Scale – 45.7 ± 1.9 and 35.8 ± 0.9 scores; p < 0.001), elevated level of depression (Beck scale – 18.9 ± 3.4 and 9.5 ± 5.3 scores; p < 0.01) and, as a result, decrease in the quality of life, especially with the Role Functioning Scale (25.71, 61.79 scores, p < 0.01) and Social Functioning Scale (26.60 and 62.93 scores, p < 0.05).

Conclusions. Improvement of health among women with functional ovarian cysts should be complex and include modification of the way of life (refusal from smoking), anti-inflammatory therapy, correction of hypothalamic-pituitary dysfunction and psychological status.

Perm Medical Journal. 2019;36(6):41-47
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Practical experience of using pneumococcal thirteen-valent conjugate vaccine among premature infants
Zubova E.S., Semerikov V.V., Sofronova L.V.

Abstract

Aim. To ground the necessity of premature infants’ vaccination against pneumococcal infection and estimate the reactogenicity and immune activity of pneumococcal 13-valent conjugate vaccine when vaccinating infants with different degree of prematurity.

Materials and methods. The clinical study enclosed 88 children including 16 (18.2 ± 0.25 %) infants with extremely low birth body mass (ELBM) and 28 infants (31.8 ± 0.32 %) with very low body mass (VLBM). The mean gestation age was 31 ± 0.41 weeks. The mean birth weight was 1530 ± 66.58 grams. Bronchopulmonary dysplasia was diagnosed in 27 ± 0.25 % of infants. Thirty one infants underwent assessment of the concentration of the total level of specific blood serum IgG antibodies to S. Pneumonia antigens contained in vaccine. The mean age of these infants was 9.71 ± 0.74 months, the mean gestation age at birth – 30 ± 0.41 weeks (25 to 41 weeks). The mean birth weight – 1441 ± 66.58 grams, ELBM – 14 infants, VLBM – 18 infants.

Results. The mild general postvaccinal reactions were noted in 11.3 ± 1.24% of infants, which were arrested for 2 days with no drugs used. The moderate and severe reactions were observed in 2.27 ± 0.62 % of infants. No local postvaccinal reactions were registered. When studying the concentration of the total level of specific IgG antibodies to S. Pneumonia antigens, there was revealed a more than 4- fold increase in geometric mean of pneumococcal antibody titer that proves a high immunogenicity of this vaccine in premature infants. A high level of pneumococcal antibodies after vaccination was reached in 24 infants (75 ± 1.24 % of infants).

Conclusion. The necessity of immunization of premature infants against pneumococcal infection was scientifically grounded. The application of conjugate 13-valent pneumococcal vaccine among premature infants confirmed a high profile of its safety and high immunogenicity. Improvement of communicative habits between parents and medical personnel regarding the necessity of vaccination of premature infants against pneumococcal infection, as an advanced technology, will permit to provide a timely coverage of infants with immunization (98 %).

Perm Medical Journal. 2019;36(6):48-56
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Assessment of type i diabetes mellitus compensation degree in children and adolescents of Perm Krai
Khudorozhkova O.M., Smirnova E.N.

Abstract

Aim. To assess the dependence of carbohydrate metabolism state in children and adolescents with type I diabetes mellitus (DM) in Perm Krai on patients’ age, disease duration, way of insulin administration (regimen of multiple insulin injections or insulin pump therapy), complications available.

Materials and methods. The study enclosed 451 children and adolescents, living in Perm Krai, who were hospitalized for type 1 DM to Endocrine Unit of Regional Children’s Clinical Hospital during 2016-2017. Glycated hemoglobin level (HbA1c), daily insulin requirement, availability and character of complications were assessed in these patients.

Conclusions. The state of decompensation more often is connected with the disease duration for more than 5 years and adolescent age. There was detected a feedback between the physical development level and the duration of disease and number of chronic complications. The period of development of type 1 DM chronic complications depends on patient’s age, sex and compensation of disease. The degree of compensation of the disease is higher when using insulin pump therapy or regimen of multiple injections of ultrashort analogs of insulin in combination with basal analogs.

Perm Medical Journal. 2019;36(6):57-63
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Influence of some socio-behavioral and medical factors on probability of developing gonococcal infection
Rumyantseva M.A., Isaeva N.V.

Abstract

Aim. To analyze and assess the influence of some socio-behavioral and medical factors on probability of developing gonococcal infection

Materials and methods. The study was carried out among the patients of State Budgetary Institution of Healthcare of Perm Krai “Regional Clinical Dermatovenerologic Dispensary”. It involved 292 persons. To evaluate the influence of socio-behavioral and medical factors on gonococcal infection sickness rate, the ratio of odds to 95% confidence interval was calculated. Multinominal logit and multi-factor correlation regression analysis were used. Nonparametric criteria χ² were applied to compare quantitative signs.

Results. The factors, influencing the development of gonococcal infection were determined. Socio-behavioral factors – absence of work, early onset of sexual life, use of psychoactive substances – elevate the risk of gonococcal infection development by 2.4–4.8 times. The most significant medical factors – untimely visit to a doctor, full elimination of causative agent after treatment – the first dispensary examination, on the day 14th after full elimination of causative agent – the second dispensary examination that increases risk for development of gonococcal infection by 1.15–7.65 times. Significance of the following factors was stated: age and family status; the younger is respondent, the higher is morbidity risk; the same situation is observed when there is no a constant sexual partner. When comparing persons with a single episode of disease and those who were ill twice and more frequently, the most essential factors were registration at detmatovenerologic dispensary, elimination of causative agent, deregistration on the day 42nd after elimination of causative agent, indication of source of disease, examination of sexual partners, treatment of sexual partners, examination and treatment of partners.

Conclusions. The priority risk factors were the following: socio-behavioral – nonworking persons, who started their sexual life early (under 16) and use psychoactive substances. Medical risk factors: full elimination of causative agent after antibiotic therapy (Clinical Recommendations of Russian Society of Dermatovenerologists and Cosmetologists) – the first dispensary examination, and the day 14th after confirmed full elimination of causative agent – the second dispensary examination.

Perm Medical Journal. 2019;36(6):64-71
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Biology and experimental medicine
Polymeric synthetic materials as basis for biofilm formation by staphylococci
Stepanov M.S., Kobzarenko E.E., Godovalov A.P.

Abstract

Aim. To study and compare the features of formation of biofilms S. aureus and S. epidermidis on synthetic materials from polyvinylchloride and polystyrene.

Materials and methods. In the experiments, S. aureus and S. epidermidis strains as well as polymeric synthetic materials were used. Expression of biofilm formation of these strains on polystyrene and polyvinylchloride was studied. Biofilm formation was determined in sterile flat-bottomed tablets. Into a part of tablet holes, pieces of polyvinylchloride measuring 5×5×1 mm were placed. They were cultivated at the temperature 37 ºC for 24–48 hours.

Results. On polyvinylchloride, biofilm-forming ability of staphylococci was practically absent. S. aureus is more active in formation of biofilms as compared with S. epidermidis. As incubation period is increased, S. aureus elevates biofilm-forming activity but S. epidermidis does not.

Conclusions. It was established that one and the same microorganisms are different in manifestation of biofilm-forming activity on polystyrene and polyvinylchloride that can be conditioned by various chemical structure of these materials.

Perm Medical Journal. 2019;36(6):72-75
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Clinical case
Case of development of Gottron’s carcinoid papillomatosis of skin against a background of protracted psoriasis
Kobernik M.Y., Elkin V.D., Sedova T.G., Zhukova A.A.

Abstract

The paper presents information regarding a rare skin disease – Gottron’s carcinoid papillomatosis, for the first time described in 1932 by German dermatologist H.A. Gottron. Its development is associated with the preceding chronic dermatoses and disturbance of circulation in the lower extremities. Morphologically, Gottron’s carcinoid papillomatosis of the skin is characterized by the development of pseudoepitheliomatous hyperplasia of epidermis. Clinical picture, dermatoscopy, ultrasound and histological studied were used for diagnosis. This disease should be differed from high differentiated squamous cell carcinoma of the skin, chronic ulcerous pyodermavegetans, lupus verrucosis, chromomycosis. We described our own clinical observation of Gottron’s carcinoid papillomatosis of the skin, developed against a background of psoriasis.

Perm Medical Journal. 2019;36(6):76-82
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Clinical case of invasive candidiasis in phthisiatrician’s practice
Shurygin A.A., Shirinkina A.E., Makarova E.A., Sergeev A.V., Marusich I.A.

Abstract

The paper presents a case of generalized candidomycosis in a 67-year old woman. Literature data regarding the cases of respiratory mycoses and candida sepsis are summarized. This case is interesting from the point of view of difficulty of differential diagnosis in patients with respiratory mycosis and tuberculosis, choice of adequate treatment.

Perm Medical Journal. 2019;36(6):83-94
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Stage treatment of patient with gunshot shin wound possessing bone and soft tissue defects in conditions of osteomyelitis
Belokrylov N.M., Belokrylov A.N., Antonov D.V., Schepalov A.V.

Abstract

The paper presents a case of severe gunshot wound of the shin in a 16-year-old adolescent as a result of gunshot from a small distance. Comminuted fracture of the tibia, damage of the anterior tibial artery, defect of the soft tissue in the injured area were detected. When admitted to the hospital, the patient underwent surgical treatment of the wound and fixation of fragments in carboxylic rod apparatus of external transosseous fixation. Osteomyelitis was developed. Ten days later, reosteosynthesis was performed. The first stage of bilocal osteosynthesis of the right shin was implemented, necrotized soft tissues and bone fragments and detritus were removed, initial purulent process was arrested. There was started distraction of the distal fragment of the tibia obtained as a result of its corticotomy in the lower third into the bone defect measuring 5 cm, which occurred when implementing surgical treatment of the wound. Twenty-eight days after, open alignment of tibial fragments in the upper third and reinstallation of Ilizarov apparatus was performed. The site of fragment junction was closed with unfree skin flap on the pedicle measuring 4 ´ 6 cm, the transplant bed was closed with full-layer skin graft using Parin’s technique. The further consolidation of fragments was reached simultaneously with maturation of the bone regenerate. The total period of fixation in Ilizarov apparatus lasted for 8 months. The bone and soft tissue structural integrity was restored, full function of the lower limb and adjacent joints was reached. Ilizarov apparatus is indispensable in multistage treatment of gunshot fractures and provides dynamic correction in changeable conditions; it permits to preserve the limb and its functionality.

Perm Medical Journal. 2019;36(6):95-101
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