Vol 37, No 1 (2020)

Cover Page

Original studies

Epidemiological features of multiple sclerosis in the republic of Bashkortostan

Novikova L.B., Akopyan A.P., Sharapova K.M.


Aim. To conduct a retrospective study of the prevalence of multiple sclerosis (MS) and use of "drugs that change the course of multiple sclerosis" in the Republic of Bashkortostan (RB) for 2014–2018.

Materials and methods. The analysis of the prevalence of MS in the Republic of Bashkortostan according to annual reports of neurological service of outpatient and inpatient hospitals of cities and districts of the Republic of Bashkortostan for 2014–2018 years. The data on dispensary examination of patients with a confirmed diagnosis of MS as well as those received from Medical Information and Analytical Center (MIAC) were analyzed.

Results. The prevalence of MS in Bashkortostan during the study period ranged from 47.9 to 61.9 cases per 100 thousand of the population that was recorded mostly in the Central and Eastern regions of the Republic. According to gender features, women predominated in relation to men – about 2:1. The mean age of patients ranged from 42.21 ± 0.61 years to 47.6 ± 10.83 years. The majority of patients (71.8 %), who were prescribed the drugs that change the course of multiple sclerosis, had a remitting form of the disease and 28.2 % had a secondary progressive form. Pathogenetic therapy of MS for the analyzed period of 2014-2018 was used for all MS patients on the basis of preferential drug provision.

Conclusion. Improvement of the quality of care, rendered to MS patients, is closely related to early diagnosis of the disease, the optimization of pharmacotherapy on the basis of modern approaches to the treatment of various forms of this disease according to clinical guidelines and standard management of MS patients. The solution of this problem requires systemic organizational approaches and formation of specialized service for MS patients.

Perm Medical Journal. 2020;37(1):5-13
pages 5-13 views

Study of urogenital tract and gut microbiota in women with stage III and IV ovarian endometriosis

Kalinkina O.B., Tezikov Y.V., Lipatov I.S., Aravina O.R., Morozova O.N.


Aim. To confirm that dysbiosis of the urinary tract or gut may be associated with endometriosis course.

Materials and methods. We analyzed the samples of vaginal, cervical and intestinal epithelial cell scrapes in 32 patients with a confirmed intraoperative diagnosis of stage III and IV endometriosis and 25 healthy patients as a control group. A wide range of pathogenic and opportunistic microorganisms was evaluated using polymerase-chain reaction (PCR) method to determine real-time results. We found fundamental differences between the samples of microflora in the investigated group and the control group. The lack of opportunistic gram-positive Atopobium vaginae in the vaginal and cervical secretions of women with stage III–IV endometriosis was statistically significant (p < 0.05). In the samples of cervical canal of epithelial scrapes of patients with stage III–IV endometriosis, there were detected clinically significant amounts (more than 104 million copies of DNA/ml) of opportunistic and pathogenic microorganisms Gardnerella vaginalis, Porphimonas spp. Opportunistic strains Gardnerella vaginalis, Prevotella bivia, Escherichia colli, Streptococcus spp. dominated in the rectal scrapes of the patients of the investigated group. On the basis of the obtained data of microbiota studying, individual correction of the detected dysbiosis was carried out.

Results. The obtained data demonstrated an altered microflora of the urogenital tract and gut in patients with stage III and IV endometriosis. After therapy, the groups ceased to differ in the frequency of detection of normocenosis, moderate dysbiosis and severe dysbiosis that testifies to the normalization of urogenital tract and intestinal microflora in patients with moderate and severe courses of ovarian endometriosis. Further research is needed to examine whether dysbiosis is a consequence of the development of moderate and severe endometriosis or dysbiosis is a concomitant background pathology that contributes to the formation of endometriosis of this degree of severity.

Perm Medical Journal. 2020;37(1):14-21
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Validity of studying by residents procedure of referring persons for high-tech medical care

Sandakov Y.P., Kochubey V.V., Dorofeev A.A.



Aim. To substantiate the relevance of studying by residents the procedure of referring persons for high-tech medical care rendered in the framework of the discipline “Healthcare Management”.

Materials and methods. Survey of 385 first and second year residents with the specialty "medical business", "pediatrics". The percentage and average values were calculated and analyzed.

Results. The average score is 1.2 ± 0.5 out of the maximum possible 13, Mode 1. There is no significant difference in the average score for persons with different basic specialties (t = 1.3), experience in practical healthcare (t = 0.2), first or second year of study in residency (t = 1). There is a weak direct correlation between the average score and the age of respondents r = 0.2 (with critical values 0.1 for p <0.05).

Conclusions. The lack of residents’ awareness regarding the procedure of referring persons to get a high-tech medical care proves the relevance of including this topic in the program of the discipline “Healthcare Management”.

Perm Medical Journal. 2020;37(1):22-26
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Factors associated with myocardial damage during transcutaneous coronary intervention in patients with acute coronary syndrome

Maksimov N.I., Semenyuta V.V.


Aim. To establish the factors, associated with myocardial damage while performing transcutaneous coronary intervention.

Materials and methods. The retrospective analysis included 255 patients, distributed by the dynamics of creatine phosphokinase-MB in the blood after the surgery.

Results. Myocardial damage while performing transcutaneous coronary intervention is interconnected with the period from the onset of symptoms to the surgery, initial levels of cardiac-specific markers, localization and degree of manifestation of coronary artery stenoses and endovascular interventions implemented.

Conclusions. As a result, the factors associated with myocardial damage while performing transcutaneous coronary intervention were revealed and their concrete boarders were determined.

Perm Medical Journal. 2020;37(1):27-34
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Female population of Perm krai in numbers

Meteleva T.A., Olina A.A., Pirozhnikova N.M.


Aim. The article presents the results of the analysis of data characterizing the female population of the Perm Territory and the city of Perm for the period of 1990–2019.

Results. The gender structure indicates the predominance of the female population. The percentage of women on average over the study period is 52.9 % in Perm Territory and 55.3 % – in Perm. Evaluation of the age structure indicates decrease in the number of women of reproductive age (18–49 years) in the Perm Territory by 13.7 %, decrease in the number of girls (0–14 years) and teenager (15–17 years), and increase in the number women of late reproductive age (35–49 years) – by 2.1 % in the Perm Territory and by 0.5 % in Perm.

Conclusions. The data presented coincide with the general trend of decrease in the total population of the Perm Territory by 3.2 % (122 thousand people), in Perm – by 2.4 % (26 thousand people).


Perm Medical Journal. 2020;37(1):35-40
pages 35-40 views

Features of microbiological parameters in chronic inflammatory diseases of female internal genital organs

Aliyeva U.G.


Aim. The aim of the study was to investigate the microbiocenosis of the urogenital tract in patients with chronic endometritis (CE) and salpingo-oophoritis (CSO).

Materials and methods. To achieve the goal of the study, 100 women aged 18–47 years with diagnosis of CSO and CE were examined.

Results. The dominant flora of the genital tract of patients with PID are polymicrobial associations of opportunistic microorganisms.

Conclusions. The prolonged course of chronic inflammatory diseases is characterized by the activation of opportunistic flora with a predominance of Streptococcus, Staphylococcus, Enterococcus and Escherihia coli, while displacing the normal microbial community that leads to the development of severe dysbiosis.

Perm Medical Journal. 2020;37(1):41-47
pages 41-47 views

Basic clinicolaboratory and genetic characteristic of patients with mucoviscidosis living in Perm krai, other regions of Privolzhsky federal district and Central federal district of Russia

Shadrina V.V., Kondratieva E.I., Furman E.G., Amelina E.L., Starinova M.A., Chernyak A.V., Sheludko V.S., Voronkova A.Y., Krasovsky S.A., Baikova G.V., Borisov A.V., Bulatova I.A., Vasilyeva E.A., Golubtsova O.I., Gubareva T.A., Dyachkova A.A., Erzutova M.V., Kadyrova D.V., Kozyreva L.S., Kondratenko O.V., Kochergina T.A., Lavrova A.E., Osipova E.V., Pavlov P.I., Pyaterkina O.G., Rybalkina M.G., Simanova T.V., Simonova O.I., Skachkova M.A., Starodubtseva O.I., Tryastsyna N.V., Yakovleva V.B., Petrova N.V., Melyanovskaya Y.L., Zodbinova A.E., Adyan T.A.


Aim. The project “National Register of Patients with Mucoviscidosis” (MV), introduced in Russia, opened the widest perspectives for comparative analysis and summarizing of clinico-epidemiological data all over Russia, federal districts, regions and separate territories. The register data permit to generalize the experience of observation and management of MV patients in centers.

Comparative analysis of the clinico-epidemiological characteristics of MV and volume of therapy in patients living in Perm Krai (PK) with the other regions of Privolzhsky Federal District (PFD) and Central Federal District (CFD) of Russia was carried out.

Materials and methods. According to the “Register of MV Patients in the Russian Federation” for 2017, the data of 1576 patients with MV were analyzed: 930 (59.0 %) patients were observed in CFD, 600 (38.1 %) in PFD, 46 (2.9) – in PK.

Results. Among MV patients in PFD and PK, there was noted a great variety of variants of the gene CFTR, associated with both the presence of autochthonic and relatively closed ethnic groups and migration of the population. A high allele frequency of the variant E92K was revealed in patients of Chuvash Republic (55.3 %). A group of patients from PK, registered in 2017, had a low mean age, the lowest age of making a diagnosis.

Conclusions. Clinico-epidemiological studies, according to the data of MV patients register, permitted to detect some peculiar features that can be significant for practical healthcare. Further studies on MV patients register should be continued.


Perm Medical Journal. 2020;37(1):48-62
pages 48-62 views

Clinical studies

Results of surgical treatment of extrahepatic bile duct injuries

Kotelnikova L.P., Burnyshev I.G., Bazhenova O.V., Trushnikov D.V.


Aim. To evaluate the short-and long-term outcomes after surgical repair of iatrogenic lesions of extrahepatic bile ducts depending on the timing of diagnosis in conditions of specialized clinic.

Materials and methods. Our study involved a retrospective analysis of 159 patients who were treated for iatrogenic lesions of extrahepatic bile ducts during 1987-2017. These patients were divided into two groups depending on the timing of surgical treatments: early biliary reconstruction (< 5 days after bile duct transection) and late biliary reconstruction (> 5 days post-transection). These groups were compared on the basis of postoperative morbidity and long-term outcomes.

Results. Following laparoscopic cholecystectomy, 2 patients received endoscopic retrograde stents due to bile leakage from the cystic ducts, and 14 patients underwent hepaticocholedochostomy using Ker drainage. The incidence of bile leakage was observed in 14. 3 % of cases during the early post-operative period, strictures appeared in 28.6 % of cases. Hepaticojejunostomy was performed in 91 cases: in 62 – with stents and in 29 – without stents. Bile leakage was observed in 17.6 % of cases, and strictures – in 19.8 % of cases. Our statistical analyses revealed no significant differences between the two groups (i.e., early and late timing of surgical treatment) in the rates of bile leakage and strictures. The extent of surgeon’s experience in bile surgery significantly correlated with positive outcomes.

Conclusions. Endoscopic retrograde stent proved to be an effective and fast solution in cases of bile leakage from cystic ducts following laparoscopic cholecystectomy. Although it is preferable to perform reconstructive surgeries within the first five days after bile duct injury, our results indicated that in the presence of external bile fistula without peritonitis and severe cholangitis, reconstructive surgery can be performed in specialized surgical departments later than 5 days with satisfactory results.

Perm Medical Journal. 2020;37(1):63-72
pages 63-72 views

Importance of determining macro- and microelemental composition of blood in pregnant women with threat of preterm birth

Abdullaeva N.Y.


Aim. In order to establish the dependence of the threat preterm birth in pregnant women on the concentration of macro- and micronutrients, a comparative analysis of blood was carried out in 92 pregnant women aged 19 to 37 before and after treatment.

Materials and methods. Quantitative elemental analysis of blood serum was performed for 8 elements: Ca, Cu, Fe, K, Mg, Na, Zn, Se using the method of inductively coupled plasma atomic emission spectrometry (ICP MS 7700e, Intertech. Corp., USA).

Results. The conducted macro- and microelements content analysis revealed that during pregnancy, childbirth and perinatal period, a violation of their quantity is of no small importance.

Conclusions. A reliably significant dependence of the threat of abortion, hypoxia, intrauterine growth retardation on the balance of macro- and microelements was noted.

Perm Medical Journal. 2020;37(1):73-78
pages 73-78 views

Methods of diagnosis and technologies

Specificity and sensitivity (expediency) of urgent histological study of surgical material in diagnosis of benign thyroid tumors

Styazhkina S.N., Idiatullin R.M., Akhmadullina A.S.


Aim. To identify the effectiveness of the diagnostic method for urgent histological study of surgical material of benign thyroid tumors.

Materials and methods. The study of diagnostic measures for 91 in-patients of the Surgical Department of the Budgetary Healthcare Institution of the Udmurt Republic “Republican Clinical Oncological Dispensary named after Sergei Grigoryevich Primushko” of the Ministry of Healthcare of the Udmurt Republic”, who suffered from benign thyroid nodular formations during 2016-2018 was conducted.

Results. The findings of an urgent histological study of surgical material coincided with the planned conclusion in 93 % of patients that made it possible to highlight the informative value of this method.

Conclusions. As a result of our study, the main diagnostic method for assessing benign neoplasms was the postoperative histological study but taking into account a high likelihood of their malignization and a number of other factors, complicating their course, it should be recommended to use a comprehensive preoperative examination and active surgical tactics at the early stages of this disease.

Perm Medical Journal. 2020;37(1):79-84
pages 79-84 views

Review of literature

Factors, forming health status of children of first year of life (literature review)

Dymova I.A.


The aim was to study the risk factors, forming the health status of children during the first year of life.

The article presents a review of literature on the identification of various factors, forming health of children during the first year of life. The growing morbidity rate among the child population makes it urgent to find methods for improving children’s health including early diagnosis, so as to eliminate or reduce the impact of risk factors.

In the current conditions, it is possible to affect significantly the health of children, in experts’ opinion, from the standpoint of a systematic analysis of the totality of socio-economic causes and risk factors. The joint efforts of pediatricians and parents will significantly improve the quality of life of a child without significant financial costs, thus, reducing family costs, spent for treatment and rehabilitation activities.

Perm Medical Journal. 2020;37(1):85-92
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Study of urinary monocytic chemotactic factor

Ivanov A.M., Sosnin D.Y., Galkovich K.R.


The review presents the data on clinical diagnostic value of studying one of the components of urinary proteome - macrophage chemotactic protein -1 (MCP-1). Along with the general characteristics of MCP-1, there are given the data on changes in its concentration regarding various diseases of the urinary system. It was shown that for various diseases and research conditions, the concentration of MCP-1 can be an important diagnostic criterion in assessing inflammatory, metabolic, fibrotic and other renal lesions.

Perm Medical Journal. 2020;37(1):93-101
pages 93-101 views

Issues of acute pancreatitis classification – practical surgeon’s point of view

Bogdanov S.N., Mukhin A.S., Voloshin V.N., Otdelnov L.A.


There is presented a review of modern literature regarding acute pancreatitis (AP) and its basic etiological factors. The authors submit a widened classification of AP and its complications but the main attention is paid to severe destructive forms and severe complications, caused by them. This classification of AP, used by practical surgeons, permits to apply the most effective techniques for diagnosis and treatment of different forms of destructive pancreatitis and, finally, to reduce the postoperative lethality and frequency of highly lethal complications.

Perm Medical Journal. 2020;37(1):102-110
pages 102-110 views

Clinical case

Case of cutaneous nodular-plaque amyloidosis development

Elkin V.D., Kobernik M.Y., Borodina E.N.


Cutaneous amyloidosis is a rare disease that represents mesenchymal dysproteinosis and is characterized by amyloid deposition in the dermis. Generally, it has a benign course, but nodular-plaque option with progression can go into systemic form with unfavorable prognosis, therefore, a regular dynamic assessment of somatic status is necessary. A case of nodular-plaque amyloidosis of the skin is described. On the body of a 64-year old woman, on the outer surface of the lower extremities, symmetrically there were found multiple pinkish-cyanotic nodes 1–2 cm in diameter, having a dense consistency, which merged into irregularly-shaped tuberous plaques up to 6 cm in size with excoriated surface, covered with erosions and ulcerations, serohemorrhagic crusts, scaled desquamation. Foci of lichenification, depigmentation and cicatricial-atrophic changes in the skin were also determined. On the basis of clinical data and histological study, cutaneous nodular-plaque amyloidosis was diagnosed. Laboratory and instrumental research and consultations of related specialists (neurologist, therapist) allowed to exclude the systematic process.

Describing this case, we would like to draw attention to a unique dermatosis, the only variant of cutaneous amyloidosis with potentially systemic lesion that requires special monitoring and control.

Perm Medical Journal. 2020;37(1):111-117
pages 111-117 views

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