Vol 35, No 2 (2018)

Aim. To study the peculiar features of roentgenological picture of pulmonary tuberculosis in patients with polymorphous HLA-DRB1 allels in the genotype in associations with pro-and-antiinflammatory cytokines concentration.

Materials and methods. The complex clinicoimmunogenetic examination of 64 patients with pulmonary tuberculosis was carried out. The patients’ age ranged 18 to 52 years. The gene HLA-DRB1 polymorphism was determined using the method of polymerase chain reaction with DNA, previously extracted from blood samples. Cytokine concentration was determined in the peripheral blood before specific treatment, using the assay kits of “Vector-BEST Company” (Russia).

Results. The prevailing clinical form of pulmonary tuberculosis among patients was infiltrative one – 40 (62.5). Bacterioexcretion was stated in 89.5 % of cases. Roentgenological picture of pulmonary tuberculosis in patients with HLA-DRB1 *04, *13, *14, *16 alleles was characterized as disseminated injury of lung tissue with destructive changes, the concentration of IL-1b, TNF-α exceeded the standard values by more than 3 times (r = 0.88; р = 0.040), IL-2, IL-10, g-INF was lower than standard values by more than 4–5 times (r = 0.75; р = 0.003).

Conclusions. When studying HLA-DRB1 gene polymorphism and pro-and-antiinflammatory cytokines concentrations in patients with pulmonary tuberculosis, it was established that patients with HLA-DRB1 *01, *07, *08, *10, *15 alleles more often, compared to the others, had disseminated injury of lung tissue, in most cases with its destruction as well as dysbalanced cytokine balance in the direction of deep immunosuppression.

Aim. To reveal the peculiar features of functional disorders in maxillofacial region among children with cerebral paralysis.

Materials and methods. While carrying out complex neurological, stomatological and logopedic examination of 120 patients (age 3 to15 years) with the above mentioned diagnosis, the following was assessed: the course of speech development (first words, phrases), state of general, fine and speech motor activity, speech sounding, status of speech apparatus.

Results. The data on frequency and structure of functional maxillofacial disorders in children with cerebral paralysis were obtained. Thus, dysfunction of swallowing was detected in 32,5 % of cases. In 53,33 % of cases from the total number of the examined patients, there was revealed the impaired chewing function in the form of slow chewing process, which occurred in 100,0 % of cases among children with double hemiplegia. Impaired speech development in the form of pseudobulbar dysarthria (spasticoparetic, spasticorigid) and anarthria was diagnosed in 82 (68,33 %) persons, speech development corresponded to age in 38 (31,67 %) children.

Conclusions. The obtained data on peculiar features of functional maxillofacial disorders, observed among children with different clinical variants of spastic cerebral paralysis forms, should be used in practical health care for planning treatment-and-prophylactic measures at rehabilitation centres.

Aim. To study the left atrium (LA) remodeling in patients with different body mass, suffering from chronic obstructive lung disease (COLD).

Materials and methods. Seventy two patients with COLD, who were divided into 3 groups, underwent echocardiography: group 1– patients with normal body mass (n = 31), group 2 – patients with excessive weight (n = 21), group 3 – patients with degree I obesity (n = 20).

Results. Among patients with COLD, belonging to group 3, indexed parameters of minimum (15.43 ± 1.62 ml/м2, р = 0.004) and presystolic (20.52 ± 1.88 ml/м², р = 0.03) volumes of LA increased; these patients also demonstrated growth of maximum upper-lower size of LA with elevation of its linear maximum and minimum sizes, when compared with patients of group 1. Patients with different body mass, suffering from COLD, have similar volumes of passive and active depletion and their corresponding fractions. COLD patients with excessive body mass and obesity showed moderate pulmonary hypertension.

Conclusions. Patients with obesity, suffering from COLD, have significantly elevated indexed parameters of presystolic and minimum LA volumes, which can be considered as early markers of impaired function of LA. Increased minimum LA volume can be one of the factors of gas exchange impairment.

Aim. To study the clinical and economic efficiency of treatment in patients with tuberculosis in conditions of day hospital when compared with treatment of patients in conditions of 24-hour hospital.

Materials and methods. The results of treatment of patients with first-ever lung tuberculosis in conditions of day hospital were analyzed.

Results. 76.7 % of patients, by the moment of discharge from the hospital, successfully completed the course of treatment.

Conclusions. Clinical efficiency of treatment in the day hospital did not differ from specialized indices of antituberculous work that confirms its significant economic efficiency.

Aim. To analyze the regulating documents and work out the algorithm of prescribing combined medicinal preparations, containing small quantities of narcotic drugs, psychotropic substances, their precursors and other pharmacological active substances.

Materials and methods. The normative documents, regulating the order of prescribing and selling combined medicinal preparations, containing narcotic drugs, psychotropic substances and their precursors were analyzed.

Results. Some normative documents to regulate the order of prescribing combined medicinal preparations, containing narcotic drugs and psychotropic substances, present problems. To simplify the procedure of prescribing such medicinal preparations, there was suggested an algorithm, explaining: the choice of prescription form; conditions of prescribing combined medicinal preparation by trade name; terms of prescription validity and possibilities of their prolongation; regulated possibilities for exceeding norms of prescribing medicinal preparations and order of their registration.

Conclusions. The suggested algorithm of the order of prescription will promote observation of requirements of the existing normative acts.

Aim. To study the specifics of addressing for medical care among patients under follow-up observation regarding two diseases.

Materials and methods. The data, obtained from ambulatory medical records of 159 patients under follow-up observation for two diseases, were analyzed using the methods of descriptive and inductive statistics.

Results. From among patients, who were under follow-up observation concerning two diseases, there were more women (58.5 %) and pensioners (95.5 %). A mean age was 68,1 ± 11,6 years. The most frequent cause of observation regarding the first disease are the diseases of cardiovascular system (71.7 %), the second – the diseases of endocrine system (52.8 %). A mean duration of the first disease, as the cause of follow-up observation, was 10.8 ± 6.9, the second – 9.9 ± 8.2 years. There is no statistically significant difference between mean duration of disease among pensioners and able-bodied persons (the first disease t = –0.6 p = 0.5; the second disease t = –0.9, p = 0.4). There is no correlation between age and duration of disease: the first disease (χ2 = 0.04, р = 0.8) and the second (χ2 = 0.08, р = 0.6). There is statistically significant difference between mean duration and follow-up observation time of the first disease t = 5.4, р ˂ 0.0001 and the second t = 2.6, р = 0.012. There is statistically significant difference between the number of planned and real visits for the first disease t = 3.5, р = 0.001. Exacerbations were registered in 94.3 %, concomitant diseases – in 90.6 %, emergency calls – in 71.7 %, hospitalization – in 60.4 %, urgent hospitalization – in 36.7 %.

Conclusions. In the group of patients under follow-up observation regarding two diseases, there prevail persons of pension age; the main cause of follow-up observation is the diseases of cardiovascular system; profile specialists were randomly addressed to; the basic way of disease detection is follow-up observation; the disease duration, but not the age influence the severity of status; untimely start of observation and unsatisfactory quality of follow-up was revealed; loyalty to treatment depends on individual motivation of patients; follow-up, conducted by narrow specialists, is not more effective, than that by therapeutists.

The materials, reflecting the course of life and creative work of Ye.A. Vagner, are presented in the paper. His work as a talented surgeon, great scientist, first Academician of the Academy of Medical Sciences of the USSR in the Ural, State prize winner, founder of scientific surgical school, remarkable pedagogue and tutor, experienced head of higher medical school is shown. During 25 years he was the head of Perm State Medical Higher School, named now after him. The contribution of Ye.A. Vagner into development of not only national, but also world surgery, medicine, public health is invaluable.

Aim. Hygienic assessment of foreign students living conditions in the hostel of Perm State Medical University.

Materials and methods. Sanitary and epidemiological assessment of the structure, facilities and maintenance of the Indian students’ hostel was conducted. The hygienic assessment of the site and territory of the dormitory at its location, living rooms and places of common use, facilities and furnishing of the building is given. Sanitary hygienic measurements of the microclimate (90), infrared radiation (20), noise levels (45), electromagnetic radiation (40), natural and artificial illumination (65) were performed in living rooms and auxiliary rooms.

Results. An objective assessment of the socio-biological factors influencing on the adaptation of foreign students to new climatogeographical conditions was obtained.

It was established that the living conditions of foreign students in the dormitory of the Perm State Medical University correspond to sanitary and epidemiological rules and regulations, excepting the noise level.

Conclusions. Overcoming the difficulties associated with the adaptation of medical students from India is facilitated by favorable social and domestic conditions for living in a student dormitory.

Aim to analyze the risk factors for clinically relevant pancreatic fistulas after surgical treatment of infected pancreatic necrosis. Methods and materials. We conducted a retrospective analysis of 44 successive cases of surgical treatment infected pancreatic necrosis. Risk factors for development clinically relevant pancreatic fistulas were investigated by Spearman’s correlation coefficient.

Results. In the follow-up the reoperations were performed due to pancreatic fistulas in 11,36% and to pseudocysts – in 9%. Conversely, a significant moderate correlation was observed between clinically relevant pancreatic fistulas and the following factors: pancreatic necrosis in the neck (r=0,31, p=0,00), its depth 50% and more (r=0,46, p=0,00), volume of drainage fluid output (r=0,55, p=0,00) and drain amylase level (r=0,53, p=0,00). Conclusion. Pancreatic necrosis in the neck, its depth 50% and more, volume of drainage fluid output more than 150 ml (r=0,55, p=0,00) and drain amylase level more 1000 U/L were risk factors for pancreatic fistulas after surgical treatment of infected pancreatic necrosis