Vol 39, No 4 (2022)

Cover Page

Full Issue

Original studies

Analysis of acne relapses in women after systemic retinoid therapy

Elkin V.D., Kobernik M.Y., Kuznetsov I.D.


Objective. To analyze the conditions and factors contributing to the development of acne recurrence after therapy with systemic retinoids. Acne is a chronic inflammatory dermatosis characterized by the formation of open and closed comedones, papules, pustules, nodes on skin areas rich in sebaceous glands, significantly disrupting the quality of life of patients. The most effective drugs for its treatment are systemic retinoids. They allow one to achieve complete cleansing of the skin, but even after their use relapses of the disease are possible.

Materials and methods. The study involved 65 women 1 year after the end of acne treatment with systemic retinoids, who were divided into two groups: group I was formed by 30 women with the development of acne relapses; group II included 35 women without acne relapses. The exclusion criteria were the following: severe endocrine pathology, the presence of cardiovascular diseases, liver disease, pregnancy and lactation, alcoholism, smoking. The study consisted of general clinical techniques and standard laboratory methods, including biochemical blood analysis with the determination of lipid and carbohydrate metabolism, the level of pituitary hormones and sex hormones. Methods of parametric and nonparametric statistics were used to account for and analyze the results.

Results. In half of the cases, acne relapses were observed after a new coronavirus infection; much less often, in equal proportions, they developed after stress and menstrual cycle failure, there were patients who could not identify the factors preceding the recurrence of acne. The average age of patients with acne relapses after treatment with systemic retinoids was 24.6 ± 2.4 years, patients without acne relapses after appropriate therapy – 17.3 ± 1.8 years (p = 0.028). Burdened heredity for acne, combination of acne with seborrheic dermatitis and/or menstrual dysfunction by the type of menstrual arrhythmia were significantly more often determined in patients with acne relapses after therapy with systemic retinoids. In the same group, lipid metabolism disorders and hormonal changes in the form of increased levels of progesterone and androgens were observed significantly more often.

Conclusions. Acne, even after the therapy with systemic retinoids, can have a recurrent course. The main external factor, preceding relapse is a new coronavirus infection. Relapses after acne treatment with systemic retinoids are developed against the background of burdened heredity for acne, changes in lipid metabolism, persistent imbalance of sex hormones, as well as when acne is combined with seborrheic dermatitis. For pubertal acne without pronounced metabolic and endocrine changes, relapses after therapy with systemic retinoids are not typical.

Perm Medical Journal. 2022;39(4):5-10
pages 5-10 views

Indicators of connective tissue biopolymers in healthy pregnant women

Teteluytina F.K., Shirobokova L.M., Kondrokhina I.V., Butolin E.G., Korotkova M.N., Malmygin D.A., Petrunin P.M., Valiev R.R.


Objective. To detect the features of connective tissue metabolism in healthy women during pregnancy. 

Materials and methods. The study of the connective tissue components was conducted at the terms of 15–16 weeks, 20–24 weeks as well as before the labor. Under observation there were 52 pregnant women (main group), who underwent the study of the connective tissue components in dynamics of pregnancy and 39 patients (comparison group) – the study of the connective tissue biopolymers before pregnancy.  The main protein of connective tissue – collagen was studied by a quantitative determination of amino acids of the free- and peptide-bound hydroxyproline. Metabolism of glycoproteins was investigated according to the concentrations of free oligo-bound and protein-bound sialic acids, oligo-bound and protein-bound fucose, fucosidose and hyaluronidase activity. Seromucoid, hexasamine and glycosaminoglycan content was analyzed.

Results. There was established a statistically significant increase in the blood serum free and piptide-bound hydroxyproline content, the absence of changes in the blood serum glycoprotein concentration, the growth of glycosaminoglycan concentrations and fucosidase concentrations beginning from the week 20 of pregnancy, the elevation of protein-bound sialic acid concentration from the weeks 20–24 of pregnancy, free and oligo-bound sialic acids – from the week 37 in the blood serum.

Conclusions. The study results indicate that among healthy women, disorganization and structural changes in the connective tissue during pregnancy are based on the changes in the anabolic and catabolic processes conditioned by improvement of the humoral control of metabolism.

Perm Medical Journal. 2022;39(4):11-18
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Assessment of cognitive functions in patients with arterial hypotension

Malkova A.A., Pustovalova А.D., Borisova E.A.


Objective. To conduct a study of cognitive functions in young people (18–44 years old) with arterial hypotension, to determine the prognostic significance of arterial hypotension in the development of cognitive impairment.

Materials and methods. A survey in patients aged 18–44 years with arterial hypotension was conducted in electronic format using the Google Forms service (Google Forms). The survey involved 100 persons with arterial hypotension, the control group consisted of 50 persons. Data processing was carried out using Microsoft Excel as well as statistical methods were used.

Results. Arterial hypotension is the result of a functional disorder of the nervous system and it leads to some unpleasant symptoms: loss of strength, weakness, lethargy, decreased concentration, memory impairment and many other signs that can reduce the quality of life of people. In general, arterial hypotension does not lead to significant impairment of cognitive functions at a young age, but in such patients, attention, concentration, working memory and speech function get worse to some extent.

Conclusions. Arterial hypotension can be a risk factor for the onset and progression of cognitive disorders, therefore, in all patients with this disease, close attention should be paid to the state of higher mental functions while conducting such simple clinical and psychological studies using cognitive function assessment scales to track dynamics.

Perm Medical Journal. 2022;39(4):19-25
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Characteristics of lipid spectrum and functional liver tests in patients with nonalcoholic liver steatosis depending on degree of obesity during menopause

Bulatova I.A., Sobol A.A., Gulyaeva I.L.


Objective. To study the blood lipid spectrum and functional liver tests in women with nonalcoholic liver steatosis (NALS) depending on the degree of obesity during menopause.

Materials and methods. Seventy patients with NALS and obesity (NALS-O-M) in menopause with the mean age of 49,9 ± 1,1 years including 24 with increased body mass index (BMI), 20 – with the degree 1 obesity, 18 – the degree 2 obesity and 8 – the degree 3 obesity were examined. The control group involved 30 practically healthy women in menopause without obesity. Blood serum cytolysis, cholestasis and lipid spectrum indicators were studied in both groups.

Results. According to the results of biochemical investigation, in the group of patients with NALS-O-M syndrome no cytolysis was observed. In case of marked obesity, cholestasis syndrome by the blood alkaline phosphatase level was identified. Lipid spectrum in patients with NALS-O-M statistically significantly differed from the control: hypercholesterinemia, hypertriglyceridemia, increase in the low- and very low-density lipoproteins as well as calculated index of atherogeneity with decrease in the high-density lipoproteins fraction was registered.

Conclusions. A pronounced obesity causes the cholestasis syndrome with an increase in the blood alkaline phosphatase level. Dyslipidemia of different degree of manifestation is registered in all patients with steatosis and obesity during menopause, being more marked in patients with the degree 2–3 obesity.

Perm Medical Journal. 2022;39(4):26-32
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Genetic causes of early miscarriage in patients after assisted reproductive technologies

Rosyuk E.A., Gorodnicheva A.V., Menshikova I.L., Kazantsev Y.A., Shibaeva A.G.


Objective. To analyze the frequency of occurrence of a pathological karyotype during pregnancy that occurred naturally and through the use of ART.  Miscarriage (MC) is a significant problem for the medical community. There is a number of factors affecting the process of gestation. Currently, there is an opinion about the impact of assisted reproductive technologies (ART) methods on the fetal karyotype and an increase in the risk for MC when they are used.

Materials and methods. The study used the data of karyotyping of abortive material from 256 women diagnosed the “non-developing pregnancy” with indication of age and gestational age at the time of termination of pregnancy for the period from 2018 to 2020, provided by JSC "Center for Family Medicine" in Yekaterinburg. In the course of the work, a statistical analysis of the frequency of occurrence of pathological karyotypes in different groups, identified on the basis of the method of pregnancy, was carried out.

Results. To a greater extent, the problem of MC associated with a pathological fetal karyotype, occurs during natural pregnancy. This may be due to the lack of pregravid preparation. In addition, during ART, especially with the use of donor material, the cells without karyotype abnormalities are selected. The problem of MC after the use of ART may be associated with other somatic or functional risk factors.

Conclusions. The available data on the possible genetic causes of early MC draw attention to the need for preimplantation genetic testing to make a timely diagnosis of fetal chromosomal abnormalities. In order to improve the reproductive health of the population, such method as a pregnant woman genetic passport can be proposed.

Perm Medical Journal. 2022;39(4):33-40
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Review of literature

Liver cirrhosis

Shchyokotova A.P.


The liver cirrhosis (LC) is a severe disease, the 11th by the cause of death in the world, 50 % of patients die during 5 years. The most frequent etiological factors are alcoholic disease of the liver and chronic viral hepatitis. The following general pathological mechanisms are involved in LC pathogenesis: hepatocyte damage, endothelial dysfunction, oxidant stress, fibrosis activation, pathological regeneration, neoangiogenesis, architectonic impairment of the organ with the development of portal hypertension. Genetic factors contribute to the progression of the liver pathology. Depending on the LC etiology, there are the features of pathogenesis, clinical picture, morphology, diagnostics, treatment and prognosis for alcoholic liver disease, chronic viral hepatitis, nonalcoholic fat liver disease, autoimmune hepatitis, primary biliary LC, hemochromatosis, Wilson-Konovalov disease, A1-antitripcin deficiency disease. Among rare causes of LC, there are noted Budd-Chiari syndrome, cardiac cirrhosis, Indian childhood cirrhosis.

Perm Medical Journal. 2022;39(4):41-57
pages 41-57 views

Clinical studies

Assessment of impact of a new derivative 2-(diethylamino)-N-(o-toluyl) acetamide, manifesting antiarrhythmic effect in heart rhythm disorders of peripheral origin, on cardiovascular system

Rudakova I.P., Gashkova O.V.


Objective. To study the effect of a new derivative of arylamides of aminocarboxylic acids, which has a high antiarrhythmic activity on the state of the cardiovascular system.

Materials and methods. To study the antiarrhythmic activity of the compound, the experiment was carried out on a model of arrhythmia caused by intravenous administration of aconitine. The effect was evaluated by its ability to prevent the occurrence of arrhythmia or to prolong the survival time of animals. In addition, an analysis of the electrocardiogram of awake rats and rabbits was carried out. The test compound and the comparison drug, lidocaine, were intravenously administered to animals in effective antiarrhythmic doses.

Results. Diethylaminoacetic acid ortho-toluidide nitrate under conditions of aconitine arrhythmia shows a pronounced antiarrhythmic effect; under its influence, there is a statistically significant reduction in the duration of arrhythmia attacks in animals by 2.4 times compared with the control as well as protection from death. The compound does not change the parameters of electrocardiogram of animals, no statistically significant differences from the control results were found.

Conclusions. 1. A new compound, diethylaminoacetic acid ortho-toluidide nitrate, exhibits a pronounced antiarrhythmic effect. Probably, it can be attributed to class IB antiarrhythmic drugs, since it exhibits high activity on calcium chloride and aconitine models of arrhythmia.

2. Given that the studied compound combines high antiarrhythmic activity with no negative effect on ECG parameters, a drug based on it can be used as an effective antiarrhythmic drug.

Perm Medical Journal. 2022;39(4):58-64
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Synthesis and study of psychotropic activity spectrum of 4-aryl-2-benzoylmethylenehydrazono-4-oxobutanoic acids

Pulina N.A., Krasnova A.I., Kuznetsov A.S., Naugolnykh E.A.


Objective. To study psychotropic activity of 4-aryl-2-benzoylmethylenhidrazono-4-oxobutanoic acids, as well as to determine the relationship between the structure of substances and their biological activity.

Materials and methods. The spectrum of psychotropic activity of 4-aryl-2-benzoylmethylenehydrazono-4-oxobutanoic acids was studied on experimental animals using the open field, black-and-white camera, and extrapolation deliverance tests.

Results. Psychopharmacological effects of various severity and direction were revealed. Two compounds showed anxiogenic properties without deterioration in cognitive potential, one substance displayed a trend to anxiolytic activity. The effect of the certain radicals in the structure of the substances on the studied activities was found.

Conclusions. The obtained links between the structure of original compounds and their psychotropic action can be used in further targeted synthesis and search for new domestic pharmaceutical substances with investigated effects in a series of derivatives of 2,4-dioxobutanoic acids.

Perm Medical Journal. 2022;39(4):65-70
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Methods of diagnosis and technologies

Complex wound process in cardiac surgery. Tactics of anterior chest wall reconstruction

Kasatov A.V., Minasyan V.N., Arutyunyan V.B., Vronsky A.S.


Objective. The postoperative wound complications are an integral part of the treatment process in any surgical practice. The aim of this work is to optimize the tactics of management and the choice of a method for reconstructing the anterior chest wall of cardiosurgical patients with postoperative sternomediastinitis.

Materials and methods. The development of sternomediastinitis in patients undergoing open heart surgery is the highest risk factor for life. According to many authors, it occurs in 0.5–11 % of patients, while the fatality of this complication can reach up to 40–50 %. This condition develops in a number of patients in a cardiac surgery hospital who have certain developmental predictors.

Results. Thus, in our work, we consider preoperative, intraoperative and postoperative risk factors for the development of sternomediastinitis. Based on all the data studied in the world literature and our own experience, we algorithmized the approach to choosing the tactics of anterior chest wall reconstruction, determined the time frame and gave specific recommendations based on clinical examples, which confirms the practical effectiveness of the proposed methods.

Conclusions. A differentiated approach to the choice of the method of plastic intervention is given, the tactical priority of using muscle flaps or segmental resection of the sternum is substantiated, and the importance of omentoplasty of a chest defect in severe purulent-septic lesions of a large scale is also updated.

Perm Medical Journal. 2022;39(4):71-84
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Effectiveness of complex treatment associated with ozone therapy on clinical indicators and immunity status in children with atopic dermatitis and concomitant allergic rhinitis

Illek Y.Y., Suetina I.G., Khlebnikova N.V., Suslova E.V., Galanina A.V.


Objective. To evaluate the effectiveness of complex treatment in combination with ozone therapy in children with moderate atopic dermatitis and concomitant moderate persistent allergic rhinitis.

Materials and methods. Under observation were children of preschool and primary school age with moderate atopic dermatitis and concomitant moderate persistent allergic rhinitis. In these children, we studied clinical indicators, the content of populations and subpopulations of lymphocytes in the blood, immunoglobulins and circulating immune complexes in the blood serum, phagocytosis indicators, expression of toll-like receptors on leukocytic cells. Patients were divided into two groups depending on the therapy. The first group received complex conventional therapy, the second group received complex treatment in combination with ozone therapy.

Results. It was found that in the first group of patients during the period of clinical remission, changes in immunological reactivity persisted. In the second group of patients, a more rapid onset of clinical remission was recorded, during which normalization of most immunity parameters was noted. The duration of complete clinical remission in the second group of patients more than twofold exceeded its duration in the first group of patients.

Conclusions. The inclusion of ozone therapy in complex treatment of preschool and primary school children suffering from moderate atopic dermatitis and concomitant moderate persistent allergic rhinitis provides a more rapid onset of clinical remission. During the period of clinical remission, normalization of most immunity parameters, a pronounced increase in the expression of toll-like receptors-2 and toll-like receptors-6 on lymphocytes, monocytes and neutrophils are recorded. This indicates an increase in nonspecific antibacterial resistance. Conducting a repeated course of complex treatment in combination with ozone therapy ensures the preservation of complete clinical remission, the duration of which is twice as long as in the first group. High therapeutic effect of ozone, the availability of ozone therapy, the absence of complications and adverse reactions when using complex treatment in combination with ozone therapy allow us to recommend the widespread use of this method in children of preschool and primary school age suffering from moderate atopic dermatitis and concomitant moderate persistent allergic rhinitis.

Perm Medical Journal. 2022;39(4):85-96
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Autologous fat grafting in patients with volume restoration, soft tissues and skin defects correction

Khramtsova N.I., Plaksin S.A., Sotskov A.Y., Ponomarev D.N.


Objective. To analyze the results of fat grafting in volume restoration, soft tissues and skin defects correction.

Materials and methods. Autologous fat grafting was performed for aesthetic soft tissues correction in 30 women, as well as in 3 patients with long-term non-healing trophic ulcers to obtain a regenerative effect. Subcutaneous fat aspiration was implemented using standard liposuction techniques, water jet, mechanical and syringe.

Results. The volume of fat graft varied depending on the area requiring correction, and averaged 90 (33–195) ml. The areas, most often subjected to fat grafting, were the mammary glands – 10 (33 %), shins – 8 (27 %), buttocks – 5 (17 %), hands – 2 (7 %), lips and nasolabial region – 2 (7 %), the outer surface of the thigh – 1 (3 %). Despite partial decrease of fat graft volume in the postoperative period, all patients were satisfied with the results; no complications of the procedure were noted. The preparation of fat graft for the correction of trophic defects included its washing with saline and filtering with 1.4 and 1.2 mm anaerobic fat transfers; the fat was grafted through a 2 mm cannula into the subcutaneous tissue directly under and around the ulcerative defects. It improved the regeneration of the epithelium around the trophic ulcers and reduced their size.

Conclusions. Thus, the efficiency and safety of using the technique of autologous fat grafting for volumizing and regenerative purposes has been clinically confirmed.

Perm Medical Journal. 2022;39(4):97-107
pages 97-107 views

Preventive and social medicine

Analysis of epidemiological situation for human dirofilariasis in Astrakhan Region

Nikeshina T.V., Kiseleva A.A., Arakelyan R.S., Okunskaya E.I., Sivtsova L.A., Kurbangalieva A.R., Arakelyants O.A., Abylkairov S.K., Raimova A.B., Saulebaeva G.A., Bocharnikova A.A.


Objective. To carry out the retrospective and operative analysis of the epidemiological situation regarding human dirofilariosis in Astrakhan Region for the period from 1951 to 2019.

Materials and methods.  Eighty-one epidemiological maps of persons infected with dirofilaria as well as case histories of ambulatory patients of Helminthological Center were analyzed.

Results. In total, during the analyzed period (from 1951 to 2019), 81 local cases of human dirofilariae infection were registered in Astrakhan Region. The largest number of dirofilariasis cases was observed in the late 90s – early 2000s – 63 % (n = 51). The largest number of dirofilariasis cases was registered in 2000 and 2002 – 13.6 % (n = 11) and 11.1 % (n = 9), respectively. The age of the patients ranged from 11 months to 78 years. Thus, dirofilariasis was registered mainly in the adult population – 84 % (n = 68). Children aged 11 months to 17 years accounted for 16 % (n = 13) of all cases of dirofilariasis. Helminth was localized both in the eye area – 44.4 % (n = 36), and out of – 55.6 % (n = 45). At extra-ocular localization of the parasite, helminth was localized in the lower extremities – 11.1 % (n = 5), in the head – 42.2 % (n = 19), in the chest – 11.1 % (n = 5), in the abdomen and face – 2.2 % for each (n = 1), in the upper extremities – 17.8 % (n = 8). In most cases, incorrect diagnoses were made – 77.8 %. All the described cases were local – patients did not leave Astrakhan Region. The diagnosis of dirofilariasis was made based on the data of the clinical picture, epidemiological history and data from laboratory blood tests.

Conclusions. Thus, the problem of dirofilariasis remains relevant today, as evidenced by new cases of human disease; the main location is the area of the eyelids, orbit and scalp; dirofilariasis was more often observed in women due to the fact that, unlike men, they are more careful about their appearance; characteristic signs of dirofilariosis are hyperemia, edema, pain at the location of helminth as well as the migration of the parasite under the skin; in most cases, incorrect diagnoses are made.

Perm Medical Journal. 2022;39(4):108-116
pages 108-116 views

Сontаminаtion of soil with pаthogens of helminth-protozoаlinvаsions in Аstrаkhаn Region for 2016–2020

Nikeshina T.V., Аrаkelyаn R.S., Shendo G.L., Boldyrevа A.I., Sаlikhov N.Z., Khabirova E.R., Bolurova A.M., Kharkibenov B.N., Davletkazieva A.K., Kulzhanova M.S.


Objective. To study the parasitic contamination of the soil in Astrakhan Region based on the materials of the Center for Hygiene and Epidemiology in Astrakhan Region for 2016–2020.

Materials and methods. The research work was carried out on the basis of the Department of Infectious Diseases and Epidemiology of Astrakhan State Medical University of the Ministry of Healthcare of the Russian Federation, the Sanitary Department of the Center for Hygiene and Epidemiology in Astrakhan Region as well as the Department of Rospotrebnadzor in Astrakhan Region.

Results. In total, during the analyzed period, 4243 soil samples were selected and examined from various places in the territory of Astrakhan Region, 8486 studies were performed. The number of samples, which do not meet sanitary and parasitological standards, was 5.6 % (237 samples). The samples of soil were taken in places, regulated by normative documents, according to instructions of the Department of Rospotrebnadzor in Astrakhan Region including places of crop production (collective farms, state farms, agricultural lands) – 1.7 % (71 samples), the zone of industrial enterprises, transport highways, places of application of pesticides and mineral fertilizers – 4.7 % (198 samples), the territories of livestock complexes and farms – 3.7 % (157 samples), the residential zone (the territory intended for residential, public (public-business) and recreational zones as well as separate parts of engineering and transport infrastructure, other objects, the placement and activity of which does not have an impact requiring special sanitary protection zones) – 86.8 % (3682 samples), including the territory of children's institutions and playgrounds (kindergartens, orphanages) – 83.5 % (3076 samples) of the number of all the examined selected and investigated samples from the residential zone, places of locations of water sources – 0.8 % (36 samples) as well as the territories of other objects of supervision (medical and preventive institutions, beaches, places for development etc.) – 2.3 % (99 samples).

Conclusions. Contamination of the soil with eggs and larvae of geohelminths (toxocara eggs and strongylid larvae) indicates contamination of these objects with feces of invaded animals (the role of stray animals (dogs) in soil contamination is not excluded). The contamination of the soil with eggs of ascaris, opisthorchis, oncospheres of teniids and cysts of amoebas suggests that these objects are contaminated with sewage water resulting from accidents.

Perm Medical Journal. 2022;39(4):117-124
pages 117-124 views

Epizootic and epidemiological risks associated with development of Platov airport infrastructure (Rostov-on-Don)

Panasyuk N.V., Pichurina N.L., Lyukshina E.Y., Batashev V.V., Balakhnova V.V., Alieva A.A., Sidelnikov V.V., Noskov A.K., Dobrovolsky O.P., Orekhov I.V., Zabashta A.V., Zabashta M.V., Logvin F.V., Polovinka N.V., Sidelnikov V.V., Polonsky A.V., Goncharov A.Y., Kovalev E.V., Karpushchenko G.V., Tyutyunkova N.G., Stakheev V.V.


Objective. To identify the potential epizootic and epidemiological risks arising from the development of the infrastructure of Platov Airport in the territory adjacent to the airport for the development, if necessary, of a set of anti-epidemic and preventive measures.

Materials and methods. Epizootological monitoring was carried out in the vicinity of Platov airport, as well as on the territory of the complex itself for three seasons (2019–2021). The capture of small mammals was carried out according to the standard method of trap-lines with Hero crushers; 1200 trap-days were accumulated. Route records of bats with the determination of their species were carried out. The species belonging of blood-sucking arthropods was determined using determinants. Regulatory support for the above monitoring was formed in accordance with the current normative and methodological documents: SanPiN 3.3686-21 "Sanitary and Epidemiological Requirements for the Prevention of Infectious Diseases"; MP 3.1.0211-20 "Trapping, Accounting and Forecasting the Number of Small Mammals and Birds in Natural Foci of Infectious Diseases"; MU 3.1.3012-12 "Collection, Accounting and Preparation for Laboratory Examination of Blood-sucking Arthropods in Natural Foci of Dangerous Infectious Diseases".

Laboratory studies of samples of extracted biomaterial for the search of markers of pathogens of natural focal infections were carried out taking into account the requirements of current regulatory documents. Samples for laboratory testing were formed in compliance with the principle of "one point of collection of material, one time of collection of material, one type of material".

Results. The results of epizootological monitoring of the territory of the Platov airport (Rostov-on-Don) are presented, according to which a real possibility of the development of epizootics of dangerous infectious diseases among small mammals living in the adjacent territory to the Platov airport has been established. In order to eliminate potential risks that can lead to complications of the epidemiological situation, it is necessary to carry out planned deratization and acaricide treatments on the territory of Platov airport. The continuation of regular epizootological monitoring of the airport territories and adjacent territories remains very relevant.

Conclusions. The results of epizootological monitoring of the territory of the Platov International Airport (Rostov-on-Don) revealed the presence of mouse-like rodents penetrating from the surrounding fields, including those belonging to groups I and II of infectious sensitivity to tularemia, which form potential epizootological risks. A comprehensive laboratory study of biological material obtained from mouse-like rodents captured during epizootological monitoring did not reveal markers of pathogens of natural focal infections. At the same time, systematic regular epizootological monitoring of the airport territory is necessary due to the presence in the territories surrounding the airport complex of natural foci of particularly dangerous infections common to humans and animals, where mouse-like rodents live and reproduce, including house mice and rats, capable of migrating and inhabiting residential and warehouse premises and in case of activation of epizootic process to introduce infection into the territory of the airport complex, especially in autumn and winter.

Perm Medical Journal. 2022;39(4):125-135
pages 125-135 views

Provision of practical direction of educational process on the discipline «Epidemiology»

Menshikova M.G., Bikmieva A.V., Sergevnin V.I., Devyatkov M.Y., Subbotina K.A., Golodnova S.O., Gorelikova E.V., Zhdanova T.M.


Objective. The article presents various forms of interaction between Academician E.A Vagner Perm State Medical University and authorities and institutions of healthcare as well as Rospotrebnadzor to ensure practical orientation of the educational process at the undergra-duate and postgraduate levels of training the discipline "Epidemiology".

Materials and methods. The most significant directions of educational process are described, which allow students to acquire the necessary skills and abilities for future professional activities.

Results. Practical training permits to form a number of universal and general professional competences among students.

Conclusions. Involvement of highly qualified specialists of practical healthcare and Rospotrebnadzor in educational process allows making the learning process not only fascinating and informative, but also improves the quality of training students.

Perm Medical Journal. 2022;39(4):136-143
pages 136-143 views

Gender features of malignant neoplasms associated with human papillo-mavirus in St. Petersburg

Lyalina L.V., Kholopov D.V., Khizha V.V., Kasatkin E.V., Topuzov Е.Е.


Objective.To study the peculiarities of morbidity and mortality from malignant neoplasms associated with the human papillomavirus among male and female population in a megalopolis. The International Agency for Research on Cancer relates cancer of the oral cavity, tonsils and oropharynx, larynx, anal canal and skin of the perianal region, vulva, vagina, cervix and penis to malignant neoplasms associated with the human papillomavirus.

Material and methods. The analysis of morbidity and mortality was carried out according to the Population Cancer Registry of St. Petersburg for the period 2011–2020. The structure of the localization of the tumor process, trends and levels of morbidity and mortality from neoplasia associated with papillomavirus infection were studied. The study included information on 13,117 cases of the disease and 7,257 deaths.

Research methods: epidemiological, clinical, statistical methods.

Results. Among all the malignant neoplasms, the proportion of HPV-associated neoplasias was 5.1 % in men and 5.8 % in women (p < 0.05). In the structure of morbidity and mortality from HPV-associated tumors, cancer of the oral cavity and larynx occupies the largest share among men, and cervical cancer among women. The incidence of oropharyngeal cancer among the male population is higher compared to the female, the incidence of anal cancer among women is 2.9 times higher and there is an upward trend with higher growth rates (p < 0.05).

Conclusions. The established gender differences of HPV-associated malignant neoplasms should be taken into account when justifying the directions for improving dispensary monitoring of patients and vaccination of papillomavirus infection.

Perm Medical Journal. 2022;39(4):144-154
pages 144-154 views

Clinical case

Clinical case of severe pseudomembranous colitis caused by pathogenic infection Clostridium Difficile

Styazhkina S.N., Kapustin B.B., Malchikov A.Y., Valinurov A.A., Gabdrakhmanov D.I., Borisova E.A., Grichik A.S.


Objective. Literature review of pseudomembranous colitis caused by pathogenic Clostridium difficile infection and description of a clinical case of pseudomembranous colitis.

Materials and methods. A clinical case of a patient with pseudomembranous colitis is presented.

Results. In a patient with multiple injuries and grade II shock, whose condition required numerous surgical interventions and intensive antibiotic therapy, after the completion of antibiotic therapy there appeared signs of pseudomembranous colitis – loose stools (up to 5 times a day), fever up to 39 ° C, signs of endogenous intoxication, A C. difficile toxin was found in faeces. Antibiotic-associated colitis was diagnosed; metronidazole 500 mg 3 times a day, activated charcoal, infusion therapy were prescribed – on the 12th day, the therapy led to recovery. During the subsequent reconstructive operation, lincomycin 600 mg was administered by infusion for prophylactic purposes, after which, 6 hours later, the patient developed a clinical picture of severe pseudomembranous colitis. A laboratory study of faeces again revealed toxin A C. difficile. The recurrence of the disease required a long-term treatment in the gastroenterology department.

Conclusions. Pseudomembranous colitis is certainly a complex pathology that is a serious hospital-acquired infection. Accurate diagnosis requires correct assessment of the patient’s condition through clinical and laboratory diagnostic methods, correct prescription of conservative treatment and choice of surgical intervention tactics.

Perm Medical Journal. 2022;39(4):155-160
pages 155-160 views

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