Vol 39, No 2 (2022)

Cover Page

Full Issue

Original studies

Complex assessment of cardiovascular risk indicators in young persons ex-amined in Krasnodar Health Center

Tikhomirova N.Y., Eliseeva L.N., Belozerova N.P.

Abstract

Objective. To study the features of the cardiovascular risk profile in young persons.

Materials and methods. The examination involved 153 students of higher school of Krasnodar, including 78 % of women. The mean age was 21,1 ± 1,3 ranging from 19 to 28 years. The cardiovascular risk factors were the following: capillary blood glucose level ≥ 5,6 mmol/l; cholesterol level ≥ 5,0 mmol/l; body mass index (BMI) ≥ 25 kg/m2; AP ≥ 130/85 Hg mm; “Miocard” index > 14 %; abdominal obesity; smoking; cardiovascular diseases (CVD) hereditary load.

Results. The most common risk factors for CVD development are irrational nutrition, hypodynamia and hereditary load. Among men, such risk factors as smoking and hypertension are registered reliably more often.

Conclusions. Young persons with risk factors for the development of cardiovascular diseases were recommended to continue a dynamic observation in such consulting rooms as “Refusal from smoking”, “A healthy diet” and “A rational physical activity” created on the basis of Health Center to prevent a clinically significant realization of risk factors.

Perm Medical Journal. 2022;39(2):5-10
pages 5-10 views

Parasitic contamination of environmental objects (based on materials of Center for Hygiene and Epidemiology in Astrakhan region)

Shemetova S.A., Arakelyan R.S., Nikeshina T.V., Shendo G.L.

Abstract

Objective. To study the sanitary and parasitological state of environmental objects in Astrakhan region.

Materials and methods. A total of 45,475 samples taken from various environmental objects in Astrakhan region were analyzed. The number of unsatisfactory samples was 1.1 % (484 samples).

Results. For the period from 2015 to 2019, there were studied the following samples: soil – 12.5 % (5518 samples), water – 6.9 % (3026 samples) and flushes from solid household surfaces – 80.6 % (35501 samples).

The percentage of washout samples from hard surfaces was 80.6 % (35,501 samples). The number of unsatisfactory samples was 0.003 % (1 sample). In this sample, teniid oncospheres were detected in 2019. The share of water samples was 6.9 % (3026 samples). Positive findings in the form of helminth eggs and larvae, as well as cysts of pathogenic intestinal protozoa were 3.1 % (93 samples). In addition to samples taken from environmental objects, samples of food raw materials and food products were studied – 3.1 % (1430 samples). The number of unsatisfactory samples was 4.6 % (66 samples). In these samples there were found: larvae of Strongyloides stercoralis – 84.8 % (56 samples), eggs and metacercariae of Opisthorchis felineus – 4.5 % (3 samples), cysts of Entamoeba histolytica, larvae of Strongyloides stercoralis + Ascaris lumbricoides – 3.0 % for each (2 samples for each), eggs of Ascaris lumbricoides and Enterobius vermicularis – 1.5 % (1 sample) and larvae of Strongyloides stercoralis + Toxocara Canis – 1.5 % (1 sample).

Conclusions. The presence of mobile strongylid larvae and toxocar eggs in the soil indicates contamination of this object with the feces of invaded animals, and the presence of ascariid eggs, opisthorchis, dwarf tapeworm, teniid oncospheres and dysentery amoeba cysts in the soil indicates contamination with the feces of invaded people. The presence of eggs and larvae of helminths characteristic of animals and humans in samples taken from open reservoirs indicates, first of all, the contamination of these objects with the feces of infected people and/or animals, as well as the presumed version of water contamination with sewage. The presence of Toxocara eggs and strongylid larvae on the samples of fruit and vegetable products indicates soil contamination with the feces of invasive animals. The presence of ascarid eggs on the food indicates contamination of the soil with the feces of infested people.

Perm Medical Journal. 2022;39(2):11-23
pages 11-23 views

Features of changes in hormonal homeostasis among patients with acne

Elkin V.D., Kobernik M.Y., Sedova T.G., Kuznetsov I.D.

Abstract

Objective. To evaluate the nature of changes in hormonal homeostasis among patients with acne, depending on menstrual function disorders. Acne is a common skin disease characterized by the development of an inflammatory process in the sebaceous glands; at the age of 12–24, it is equally observed in boys and girls, and at an older age, it mainly affects women. Acne has a complex pathogenesis, in which hereditary, metabolic, immune and endocrine mechanisms are realized. It is often found in women with a violation of menstrual function. The aim of the study was to evaluate the nature of changes in hormonal homeostasis among patients with acne, depending on menstrual function disorders.

Materials and methods. The study involved 65 patients with acne, who were divided into two groups: group I was formed by 40 patients with acne having menstrual disorders; group II included 35 patients with acne without menstrual function disorders. The groups were comparable by social status and age; all were residents of the Perm Region, all gave voluntary written consent to participate in the study. The study included general clinical techniques, dermatological status and laboratory methods including biochemical blood analysis with indicators of lipid spectrum, glucose, total protein, zinc, liver enzymes, pituitary hormones (FSH, LH, TSH, prolactin) and sex hormones. Methods of parametric and nonparametric statistics were used to analyze the data obtained.

Results. In patients with acne, minor metabolic changes were detected, equally with and without menstrual cycle disorders. In the study of hormonal homeostasis, it was noted that in acne patients with menstrual cycle disorders, hyperprogesteronemia was determined much more often (80.0 ± 6.3 %). The remaining sex hormones and pituitary hormones had insignificant changes in both the groups studied.

Conclusions. Acne, accompanied by a disturbance of menstrual function, is characterized by change in hormonal homeostasis in the form of an increased level of blood progesterone. In acne patients with a normal menstrual cycle, hormonal changes are insignificant. The metabolic disorders observed in acne do not depend on the character of the menstrual cycle. Patients with acne having menstrual dysfunction require joint management and treatment by both dermatovenerologist and gynecologist. In other cases, dermatological tactics is the basic one.

Perm Medical Journal. 2022;39(2):24-28
pages 24-28 views

Relationship of augmentation mammoplasty with peculiarities of self-perception and quality of life level

Khramtsova N.I., Plaksin S.A., Zayakin Y.Y., Glushenkov A.S., Fadeeva M.V., Sotskov A.Y., Ponomarev D.N.

Abstract

Objective. To study the impact of augmentation mammoplasty on some aspects of body image-related quality of life, motivation and self-esteem.

Materials and methods. Seventeen women were surveyed 6-14 months after augmentation mammoplasty using the BIQLI and ASI-R questionnaires.

Results. The aspects of body image-related quality of life associated with physical activity and desire to change one's appearance were higher in younger people with lower body weight. The volume of installed breast implants was inversely proportional to the feeling of confidence and happiness in everyday life (R = –0.6). The larger was the volume of implants, the less was the responsibility for life events (R = –0.8). In the long-term period after mammoplasty, a subjective level of the quality of life increased in 53 %, on average by 0.2 (p>0.05), significantly – only for the motivation scale and the question "feelings of personal dignity and self-respect". Negative dynamics was found for the following aspects: "When I meet new people", "At work (study)" and "Relationships with friends", for all other answers – positive one. The older the patients were, the more attention they paid to their appearance (R = –0.7) and compared themselves with the others (R = –0.6), thought about what the others think about their appearance (R = 0,6), more often thought about how they look like in different situations (R = 0.6).

Conclusions. Preoperative studying of motivation allows more differentially determining the indications for surgery and risk of postoperative dissatisfaction. Augmentation mammoplasty often improves the body image-related quality of life, motivation and self-esteem.

Perm Medical Journal. 2022;39(2):29-36
pages 29-36 views

Contribution of polymorphism of genes of aldosterone synthetase CYP11B2 (C-344T), adrenergic receptors type 1 ADRB1 (Gly389Arg) and type 2 ADRB2 (Arg16Gly) to formation of different obesity phenotypes

Shulkina S.G., Larina O.S., Alikin S.V., Zhelobov V.G., Smirnova E.N., Antipova A.A., Kolomeets N.Y., Kobernik M.Y.

Abstract

Objective. To study the relationship of polymorphism of the genes of aldosterone synthetase CYP11B2 (C-344T), adrenergic receptor type 1 ADRB1 (Gly389Arg) and type 2 ADRB2 (Arg16Gly) with the risk of obesity.

Materials and methods. The study involved 170 patients; the mean age was 45.4 ± 7.3 years. The patients were divided into 2 groups: group 1 – obese patients with metabolic disorders in combination with 1-2 degree hypertension – complicated obesity (n = 90); group 2 – 50 participants with obesity without metabolic disorders (metabolically healthy obesity). The control group consisted of 100 healthy respondents. All the surveyed persons underwent anthropometry and general clinical studies according to the recommendation for examination of patients with obesity and arterial hypertension. Total DNA was isolated from venous whole blood samples by RT-PCR using the DNA-Sorb-B kit.  

Results. It was found that in the group of complicated obesity, the carriage of the TT genotype of the CYP11B2 gene polymorphism (C-344T) and the CG genotype of the Gly389Arg polymorphism of the ADRB1 gene prevailed in comparison with the group of metabolically healthy obesity and healthy respondents. The predominance of carriage of the GG genotype of the ADRB2 gene polymorphism (Arg16Gly) was revealed in the groups of metabolically healthy obesity and complicated obesity in comparison with the healthy group. An association of the polymorphic position of the ADRB1 (Gly389Arg) and ADRB2 (Arg16Gly) genes with the level of low-density lipoprotein cholesterol, triglycerides, the level of systolic blood pressure and diastolic blood pressure, and the level of uric acid was established. The relationship between the polymorphism of the CYP11B2 (C-344T) promoter region and the level of glomerular filtration rate and total cholesterol was determined.

Conclusions. Analysis of ADRB1 (Gly389Arg), ADRB2 (Arg16Gly), and CYP11B2 (C-344T) gene polymorphism variants can be used as an additional marker to assess the risk of developing obesity, arterial hypertension, and metabolic disorders.

Perm Medical Journal. 2022;39(2):37-44
pages 37-44 views

Review of literature

Polycystic ovaries: problematics, etiology, pathogenesis (literary review)

Bakurinskikh A.B., Yakushev A.M., Ten A.R., Kolesova A.A.

Abstract

The polycystic ovary syndrome (POS) is a common hormonal disorder in women all over the world; it is characterized not only by reproductive disturbances but by endocrine and metabolic as well. Women with POS are subjected to an increased risk for the development of type 2 diabetes mellitus, metabolic syndrome and sterility. This article presents information on POS problems, its history. The main etiological factors predisposing to the development of polycystic ovaries syndrome are highlighted. Besides, actual data on pathogenetic theories of POS development are presented.

Perm Medical Journal. 2022;39(2):45-54
pages 45-54 views

Methods of diagnosis and technologies

Analysis of phagocytic activity of peripheral blood and exudate leukocytes in patients with facial phlegmon

Godovalov A.P., Shtraube G.I., Boev I.A.

Abstract

Objective. To assess the phagocytic activity of peripheral blood and exudate leukocytes in patients with facial phlegmon.  Currently, relatively little attention is paid to assessing the functional activity of peripheral blood and exudate leukocytes in facial phlegmon, the incidence of which is characterized by an increase in the number of cases and, especially, among patients with comorbid pathology.

Materials and methods. To study the phagocytic activity of leukocytes using a method based on the assessment of the absorption of formalinized sheep erythrocytes by neutrophils and monocytes, the samples of peripheral blood and exudate were obtained from 18 patients diagnosed facial phlegmon. Blood leukocytes obtained from 29 healthy donors were used as a comparison group.

Results. It was shown that for patients with phlegmon of the face, an increase in the phagocytic activity of peripheral blood leukocytes is characteristic. There was observed a redistribution of leukocytes according to the number of absorbed objects towards an increase in actively phagocytizing cells – 4438 ± 721 per 1 μl (in the comparison group – 297 ± 67 per 1 μl; p < 0.05). However, after migration to the foci of the pathological process, leukocytes lost their phagocytic activity and the number of phagocytic cells decreased to 35.0 ± 8.3 % (for peripheral blood leukocytes of the same patients – 64.3 ± 5.4 %; p < 0.05). Changes in the phagocytic activity of exudate leukocytes affected both neutrophils and monocytes.

Conclusions. Thus, in patients with phlegmon of the face, changes in the phagocytic activity of blood leukocytes are probably associated with the indirect influence of cytokines, and in the focus of inflammation, leukocytes come under pressure from microorganisms. In such a situation, it is necessary to select an effective immunotropic therapy.

Perm Medical Journal. 2022;39(2):55-60
pages 55-60 views

Violation of supporting function of feet in children with hip subluxation of dysplastic genesis

Nikityuk I.E., Bortulev P.I., Vissarionov S.V., Savina M.V.

Abstract

Objective. To study the plantographic characteristics of the feet in children with unilateral dysplastic hip subluxation (DHS) and to analyze the patterns of plantar pressure distribution on the affected and intact sides.

Material and methods. A biomechanical study was conducted in 23 children, aged 13 to 17 years, with unilateral DHS of Crowe group I. The plantographic characteristics of the feet were evaluated and their relationship with the vertical balance of the patient’s body was analyzed. The control group consisted of 18 healthy children of the same age.

Results. In patients with unilateral DHS, there is a significant decrease in all indices of support: anterior – t, medial – m and median – s compared with healthy children, not only on the foot of the affected limb, but also on the intact side. It indicates a deterioration in the spring function of the transverse and longitudinal arches of the feet due to their rigidity. The foot on the affected lower limb has a pathologically increased Clarke's angle α, which indicates an increase in the height of the longitudinal arches of the foot, which leads to a decrease in the total area of its support. In patients, there is a pathological increase in comparison with the norm of functional relationships between the arches of the foot on the affected and intact lower extremities, that is a sign of a formed pathological foot support strategy.

Conclusions. The pathological supporting strategy of the feet on the affected and intact lower extremities in patients with unilateral DHS may be a consequence of a violation of the global sagittal balance of the body, leading to an adaptive reaction of the musculoskeletal system in response to compensatory changes in the links of the kinematic chain "spine-pelvis".

Perm Medical Journal. 2022;39(2):61-72
pages 61-72 views

Reparative and functional state of postoperative wound tissues during hernioplasty with endoprosthesis "titanium silk" in patients with diabetes mellitus

Azimov R.H., Vlasov A.P., Glushkov P.S., Gorsky V.A.

Abstract

Objective. To assess the reparative and functional state of the tissues of the postoperative wound during hernioplasty with the endoprosthesis "titanium silk" in patients with diabetes mellitus.

Materials and methods. Clinical and laboratory examination was carried out in 37 patients with inguinal hernias using the titanium silk endoprosthesis. The patients were divided into two groups. In the comparison group (n = 20), surgical treatment was performed in patients without diabetes mellitus, in the main group (n = 17), patients had type 1 or 2 diabetes mellitus. In the early postoperative period, the dynamics of healing process in the postoperative period was assessed using cytological and instrumental methods.

Results. It was found that inflammation and microcirculation disorders are observed in the tissues of the postoperative period. However, it was noted that when using the endoprosthesis "titanium silk" in patients of both the main and the control groups, no disruption of the reparative processes was detected.

Conclusions. The use of titanium mesh endoprostheses "titanium silk" for hernioplasty of inguinal hernias in patients with diabetes mellitus does not violate the fundamental processes of tissue healing in the region of the ​​operation.

Perm Medical Journal. 2022;39(2):73-79
pages 73-79 views

Method of liver plugging in case of injury

Shapkin Y.G., Chalyk Y.V., Kuzyaev T.R.

Abstract

Objective. To substantiate the methodology of using gauze plugging in surgery of severe liver damages.

Materials and methods. There is presented the experience of treatment of 83 patients with severe closed liver damage of III–IV degree according to E. Moore, who were cured in the clinical bases of the Department of General Surgery of V.I. Razumovsky Saratov State Medical University for the period from 1976 to 2020. 

Results. Various options for using liver tamponade as a method of primary hemostasis are considered. The developed new method of plugging with the use of a hemostatic sponge has been proposed, which makes it possible to achieve hemostasis quickly and minimally traumatic due to adequate compression of the wound surface.

Conclusions. The proposed method of plugging is universal and effective for degrees III–IV liver damages and is available to a wide range of general surgeons. The use of the proposed  methodology of gauze plugging allows to remove tampons with a minimum risk of recurrent bleeding in the early stages without repeated surgery.

Perm Medical Journal. 2022;39(2):80-85
pages 80-85 views

Diagnostics of bronchial obstruction syndrome with portal wheezing detector in children

Kalinina N.M., Furman E.G., Sokolovskiy V.L.

Abstract

Objective. To determine the efficiency of diagnostics of the clinical syndrome of bronchial obstruction with WheezeScan detector in children, to assess the sensitivity and specificity of this method.  Electronic medical devices used for registration and analysis of breath sounds can help to diagnose different syndromes in pediatric pulmonology.

Materials and methods. The study involved 15 children aged 1 to 17 years, who were  hospitalized to Pulmonology Unit of the Regional Children’s Clinical Hospital. The children were divided into two groups depending on the presence or absence of wheezes in auscultation. The detector WheezeScan HWZ-1000T-E (Omron) was used to study the presence of wheezes. The control group included children without any objective signs of bronchial obstruction.

Results. It was detected while examining children that in auscultation 20 % (n=3) of children had   dry wheezes, and in detector diagnostics the result was positive in 100 % of cases. In auscultation, 80 % (n=12) of children did not show clinically marked bronchial obstruction syndrome, the result of WheezeScan detector was 73 % (n=11). Diagnostic sensitivity and specificity was 100 %.

Conclusions. Screening diagnostics of bronchial obstruction syndrome in children by means of electronic detector of wheezing is effective and can be applied for ambulatory patients of different ages in a pediatric hospital unit.

Perm Medical Journal. 2022;39(2):86-92
pages 86-92 views

Preventive and social medicine

Evaluation of effectiveness of algorithm for optimization of preventive and antiepidemic measures in centers of combined HIV infection and tuberculosis pathology

Asmanova M.A., Lukyanenko N.V., Shevchenko V.V.

Abstract

Objective. To evaluate the effectiveness of the algorithm for optimization of preventive and antiepidemic measures in the centers of combined HIV infection and tuberculosis pathology.

Materials and methods. Statistical data on tuberculosis and HIV-infection sickness rate, the results of clinical laboratory studies, maps of epidemiological center examination were investigated.

Results. An algorithm for optimization of preventive and antiepidemic measures in the centers of HIV infection and tuberculosis as a management subsystem of epidemiological control was scientifically grounded and developed.

Conclusions. An algorithm for optimization of preventive and antiepidemic measures in the centers of HIV infection+tuberculosis should be based on the coordination and development of a unique strategy of the services for control of tuberculosis and HIV-infection. Informational and analytical subsystems of epidemiological control provide realization of preventive and antiepidemic measures in the target groups. The developed algorithm supplemented with the data of epidemiological examination permits to elevate the effectiveness of antiepidemic measures.

Perm Medical Journal. 2022;39(2):93-99
pages 93-99 views

Anniversaries and information on events

Popova Natalia Mitrofanovna – social hygienist, health care organizer, professor of Izhevsk State Medical Academy

Saveliev V.N., Shubin L.L., Shabardin A.M.

Abstract

The article presents a life, scientific and professional path of Popova Natalia Mitrofanovna – an organizer of Public Healthcare in Udmurt Republic. Popova N.M. is a representative of a large medical dynasty, who has reached an academic rank of Professor, Doctor of Medicine, Head of the Department of Public Health and Healthcare of Izhevsk Medical Academy. Natalia Mitrofanovna is an active person and a teacher, initiator and organizer of many scientific and creative ideas, a careful keeper of historical basis of Soviet and Russian medicine, its worthy continuer.

Perm Medical Journal. 2022;39(2):100-108
pages 100-108 views

Biology and experimental medicine

Non-infectious epidemiology of antiquity: introduction to a new discipline

Solomennyi A.P.

Abstract

On the basis of the analysis of molecular-biological literature and methods of research used in modern clinical laboratory practice, it is necessary to single out a new direction in biomedical science – non-infectious epidemiology of a human being in historical retrospective view.  

Genetic medicine, considering ecological and social factors of the development of human population, will help to reach personalized approach and realize a potential hidden in our DNA. Unfortunately, there are few specialists-epidemiologists working in this field. Their preparation should be improved.

Perm Medical Journal. 2022;39(2):109-112
pages 109-112 views


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