Vol 35, No 4 (2018)

Cover Page
Articles
Experience of using domestic phytocomplex in treatment of patients with benign hyperplastic processes of reproductive system
Sandakova E.A., Rakitina Y.V., Kapustina E.Y., Kotovskaya E.Y., Simonova O.S.
Abstract

Aim. To estimate the clinical efficiency of phytocomplex “Flavopersin”.

Materials and methods. Phytotherapy is one of advanced directions in modern medicine. Fifty women with clinicoechographic signs of benign hyperplastic diseases of reproductive system were examined and treated. The methods of study included: registration of complaints and anamnesis data, standard general clinical examination and gynecological study; instrumental methods of investigation included: pelvic and mammary ultrasound using Siemens Sonoline Elegra with vaginal sensor of 6,5 MHz. The methods of study also contained assessment of pelvic pain and mastalgia by Visual Analogue Scale (VAS).

Results. After completing the therapy during six menstrual cycles, a positive effect in treatment of dysmenorrhea, significant reduction of mastalgia manifestation as well as reliable decrease in anterior-posterior uterine size and optimization of endometrial structure by pelvic US data was reached. Besides, phytocomplex permitted to reduce anxiety, tension, to raise activity, mood, psychological stress tolerance and social adaptation that improved the quality of life among patients.

Conclusions. The therapy, including phytocomplex “Flavopersin” is a method, which promotes intensification of the effect of drug therapy, increases the interval between hormonal therapy courses and, thus, reduces the manifestation of its side effects and improves patients’ health status at the expense of optimization of psycho-emotional status.

Perm Medical Journal. 2018;35(4):5-13
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Nutritive status changes, studied in hiv-positive patients with pneumonias, caused by Streptococcus pneumoniae
Nikolenko V.V., Nikolenko A.V., Minikeeva M.R.
Abstract

Aim. To study the changes in nutritive status of HIV-positive patients, hospitalized with community-acquired pneumonias, caused by Streptococcus pneumoniae.

Materials and methods. During 2014–2017, clinicolaboratory examination of 676 HIV-positive patients was carried out on the basis of Perm Regional Clinical Infectious Hospital. There were formed the groups of “observation”, including patients with pneumonias, caused by Streptococcus pneumoniae with lethal outcomes, and groups of “comparison”, including patients, discharged from hospital in satisfactory status.

Results. Negative dynamics of nutritive status, caused by progression of the main disease and addition of bacterial agent was revealed. The moderately severe and severe changes were registered in patients with lethal outcomes already at the moment of hospitalization.

Conclusions. Direct correlation between the protein-energy insufficiency and the number of life-threatening complications was determined.

Perm Medical Journal. 2018;35(4):14-19
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Symptomatology of gastrointestinal tract foreign bodies
Davidov M.I., Subbotin V.M., Nikonova O.E.
Abstract

Aim. To study the clinical problems and develop the symptomatology of the foreign bodies (FB) of the gastrointestinal tract (GIT).

Materials and methods. Ninety patients with GIT foreign bodies were observed over the period from 1997 to 2017. To diagnose, a complex of endoscopic and radial methods was used. Localization, size and type of the detected foreign bodies were compared with the symptoms revealed.

Results. Fifty patients intentionally swallowed foreign bodies, 40 – accidentally. Altogether, 90 patients swallowed 193 items (nails, needles, pieces of wire etc.). On the basis of the study, three forms of clinical course regarding the swallowed GIT FB were singled out: latent, manifest and complicated. The pathognomonic symptoms of GIT FB are “migrant” abdominal pains associated with migration of FB along the GIT lumen, intensification of pains while moving, exercise stress and palpation, feeling of “heaviness” in epigastric region. Multiple gastric FB cause the auscultative symptom of “ringing”. Pains, available with GIT FB, are not connected with taking food and are not ceased after taking antacids.

Conclusions. Introduction of the developed GIT FB symptomatology into healthcare practice and training of physicians will contribute to earlier and more accurate diagnosis.

Perm Medical Journal. 2018;35(4):20-25
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Damages of locomotor apparatus in children as a result of road accidents
Belokrylov N.M., Ladeischikov V.M., Schekolova N.B., Belyakov S.A., Belokrylov A.N., Yagovkin M.A.
Abstract

Aim. To study the specific features of locomotor apparatus injuries and to improve the surgical tactics of treatment using low invasive osteosynthesis techniques in case of road accidents among children.

Materials and methods. The results of surgical treatment of 35 children (age range 2 to14 years) after road accidents were studied at the pediatric traumatology and orthopedics unit. Associated multisystem injuries of the locomotor system constituted 77,1 %. Clinicoroentgenological data, MRT and CT indices were studied. Vegetative dysfunction was assessed. All the patients underwent low invasive surgical intervention with minimized surgical approach, including elastic intramedullary nails, closed transcutaneous pin osteosynthesis under electro-optic transducer control, transosseous osteosynthesis.

Results. All the patients were operated, 80 % of them were operated during the first day after the admission to the hospital. It resulted in early arrest of pain syndrome, fast normalization of vegetative function, prevented the development of traumatic disease or stopped its manifestations. All the results of surgical treatment were estimated as positive. Insignificant contractures were observed in 2 patients after the distal comminuted fracture of the shoulder with decrease in movement amplitude at the level of elbow joint within 15%; no disability was noted; no slowed consolidation and false joints were registered.

Conclusions. Low invasive techniques provide optimal conditions for osseous consolidation and positive functional outcome after road accidents. It is recommended to take into account the status of vegetative functions in patients with associated multisystem injuries.

Perm Medical Journal. 2018;35(4):26-38
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Peculiar features of immunoinflammatory syndrome in patients with ulcerous colitis, depending on severity of disease attack
Tretyakova Y.I.
Abstract

Aim. To study the blood serum interleukin-6 (IL) and circulating immune complexes (CIC) levels in patients with ulcerous colitis (UC), depending on the severity of disease attack, colonic inflammation dissemination, and presence of abenteric manifestations.

Materials and methods. One hundred patients with UC in the phase of active inflammation were examined. Blood serum IL-6 and CIC concentrations were studied with IFA method.

Results. 88,5 % of UC patients in the phase of active inflammation showed an elevated mean IL-6 index, 80 % had increased CIC concentration as compared with normal values. The highest IL-6 and CIC levels were obtained in case of severe forms of disease (11,50 (7,30–23,65) pg/ml and 115,50 (105,00–118,00), respectively); CIC and IL-6 levels were significantly higher in patients with abenteric manifestations and frequently relapsing course in comparison with patients, having rare UC relapses (p < 0,005). Strong direct correlations of IL-6 and CIC with each other (r = 0,65; p = 0,001) as well as with the severity of pathological changes in the colon were established.

Conclusions. Among patients with UC, significantly elevated blood serum IL-6 and CIC concentrations were determined. Patients with severe attack of disease as well as those with abenteric manifestations and frequent relapses demonstrated reliably higher levels of these indices. It is recommended to use determination of blood serum IL-6 and CIC levels as an available and informative method, permitting to estimate the degree of severity of inflammatory process in the colonic wall among patients with ulcerous colitis.

Perm Medical Journal. 2018;35(4):39-45
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Differential approach to diagnosis and treatment of tendinites, enthesites and degenerative arthropathies
Samartsev V.A., Kadyntsev I.V.
Abstract

Aim. To improve the results of treatment of periarticular tissue diseases and degenerative arthropathies at the expense of differential use of modern technologies.

Materials and methods. During the period of 2010–2017, examination and treatment of 10608 patients, suffering from the locomotor diseases, was carried out. There were 5792 (54,6 %) patients with degenerative arthropathies and 4816 (45,4 %) patients with tendinites and enthesites of different localization.

Results. The long-term results of treatment with chondroprotector Alflutop, used in complex therapy of 1969 (33,9 %) patients with arthropathies were studied for the period from 1 to 3 years. Pain syndrome was arrested after 4–5 injections. After 8–9 injections of this preparation, no pain syndrome was revealed, movement amplitude in the joint increased, patients returned to their previous work, Lequesne index declined and varied within the range of 3–6 scores. When using hyaluronic acid, pain syndrome was arrested in most cases after 2 injections. After the third injection of preparation, no pain factor was registered, movement amplitude in the joint increased, patients returned to their previous work, Lequesne index declined and varied within 3–6 scores. The long-term results from 1 to 5 years were studied in 1179 (20,3 %) patients.

Conclusions. One-year remission with combined application of chondroprotector and hyaluronic acid was 76,5 %. Two-year and longer remission was 47,6 %. Diagnostic algorithm for locomotor diseases was developed and approach to conservative therapy was differentiated.

Perm Medical Journal. 2018;35(4):46-49
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Problem of insufficient involvement of population into pharmacovigilance system
Krasheninnikov A.E., Romanov B.K., Safiullin R.S.
Abstract

Aim. To ground the necessity of taking into account the double-component nature of the phenomenon of poor activity of the population in the system of pharmacovigilance so as to work out the measures, aimed at development of UR reporting. The process of formation of a modern system of pharmacovigilance in Russia with appropriate level of reporting on the cases of unfavorable response (UR) to application of drugs is difficult because of the absence of involvement of the population into the system of spontaneous messages.

Materials and methods. The methods of content-analysis of messages and surveys were used; the measures, promoting development of the level of reporting on unfavorable responses to drugs were worked out. The object of the analysis included randomized sampling of 100 tests of messages for the period of 2009–2017, the selection criterion of which was the category “side effects of drugs”. The survey was conducted in direct form among the inhabitants of Kazan in 2018.

Results. Pharmacovigilance of the population in Russia is insufficiently developed and concentrated mainly in metropolitan region (Moscow, Moscow region) and neighboring regions (Republic of Tatarstan, St. Petersburg). Pharmacovigilant culture of the population in Russia has an insufficient level of development and is expressed by lack of correct notions of pharmacovigilance system in this country (responsible state institutions, reporting channels) among the citizens that, probably, makes their participation in active reporting difficult.

Conclusions. When influencing both factors, we can form the basis for working out the measures of efficient development of the proper level of UR reporting among the population of the Russian Federation.

Perm Medical Journal. 2018;35(4):50-55
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Peculiar features of life quality in patients with type 2 diabetes mellitus and postmenopausal osteoporosis
Nurullina G.M.
Abstract

Aim. To study the peculiarities of the quality of life in patients with type 2 diabetes mellitus (DM2) and postmenopausal osteoporosis (PO).

Materials and methods. 104 postmenopausal women aged 49–67 were examined. They were divided into 3 groups: group 1 (38 persons) – patients with DM2 and PO, group 2 (24 persons) – patients with PO, group 3 (42 persons) – postmenopausal patients with DM2 without any osteoporosis signs. Their quality of life was assessed using SF-36 survey, sensations of pain – with four-component visual analogue scale.

Results. Physical component of health (PH) was statistically significantly lower in DM2 and PO group. Most patients of this group had decreased psychical component of health. In DM2 and PO group as compared with PO group statistically significantly lower values according to physical status-conditioned role functioning scales (RP) (p = 0,018), emotional status-conditioned role functioning (p = 0,028), PH (p = 0,038) were detected. When compared with DM2 group, physical functioning (p = 0,04), RP (p = 0,014), pain intensity (p = 0,049), PH (p = 0,014) appeared to be statistically significantly lower. The factors, negatively influencing the quality of life in patients of DM2 and PO group were the following: remoteness of diabetes, comorbidity, level of pain sensations, presence of diabetic polyneuropathy, insulin therapy in treatment, unsatisfactory glycemic control.

Conclusions. Osteoporosis in patients with type 2 diabetes mellitus worsens their quality of life, in particular at the expense of elevated intensity of pain sensations.

Perm Medical Journal. 2018;35(4):56-62
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Comparative analysis of blood hematological and biochemical indices in children with different vitamin provision
Yambulatov A.M.
Abstract

Aim. To study the peculiar features of hemogram indices and biochemical indices of blood in children with different vitamin provision.

Materials and methods. Vitamin A, C, D, E, B6 and B12 content in blood was determined in 188 children (aged 5–6 years) of pre-school educational institutions (PEI), who attended PEI for not less than 3 years and had a standard C-vitaminised diet.

Results. The study of a season provision with vitamins A, C, D, E, B6 and B12 showed that 75–85 % of children have a whole-year deficit of vitamins, characterized as polyhypovitaminosis in 40 %. Comparative analysis of blood hematological and biochemical indices in children with different vitamin provision was carried out.

Conclusions. Among children with insufficient vitamin provision there was noted more stressed state of hemopoietic erythrocytic blast and decreased proliferative activity of lymphomonocytic blast against the background of higher activity of allergic-type cell responses; lower level of protein, carbohydrate, mineral and energetic metabolism is observed in children with insufficient vitamin provision.

Perm Medical Journal. 2018;35(4):63-71
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Analysis of follow-up observation efficiency criteria
Sandakov Y.P.
Abstract

Aim. To carry out the comparative analysis of follow-up observation efficiency criteria among patients under medical check-up and persons, who had been followed up from the number of those, dead at home.

Material and methods. The age, duration of disease, duration of follow-up observation, real visits to a doctor, rate of exacerbations, emergency calls, hospitalizations were compared in two groups of patients under medical check-up. Group 1 – “dead” – included 100 persons from the number of those, dead at home; group 2 – “alive” – 400 patients, who at the moment of being studied were under follow-up observation. Medical records of ambulatory patients were used as the source of information. The obtained data were analyzed with the method of descriptive and inductive statistics.

Results. In the studied groups, the difference in patients’ mean age was significant t = 3,7 p = 0,0001, the share of persons of the same gender was similar p < 0,01, the difference in men’s mean age was not significant t = –0,21 p = 0,83. The average number of planned (t = 14,2 p = 0,0001) and real (t = 7,4 p = 0,0001) visits to a doctor, exacerbations (t = 9,6 p = 0,0001), emergency calls (t = 7,6 p = 0,0001), hospitalizations (t = 5,2 p = 0,0001), urgent hospitalizations (t = 6,6 p = 0,0001) was significantly higher in the group of “dead”.

Conclusions. The able-bodied men form the risk group regarding unfavorable outcome of noninfectious chronic diseases; follow-up observation does not promote development of loyalty to treatment.

Perm Medical Journal. 2018;35(4):72-76
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Cognitive functions and vegetative regulation in practically healthy young persons with different health status
Vetsler M.V., Cherkasova V.G., Muraviyov S.V., Kulesh A.M., Chainikov P.N.
Abstract

Aim. To study the level of cognitive functions and peculiarities of vegetative regulation in practically healthy young persons.

Materials and methods. The study included 116 practically healthy persons of young age (23,06 ± 2,3), 81 women and 35 men. They were divided into five groups of health according to G.L. Apanasenko; in all the groups of comparison, the following was assessed: vegetative regulation using cardiointervalography, cognitive functions – with Montreal Cognitive Assessment Scale.

Results. Variety of reliable differences among the obtained data permits to consider the principles of vegetative regulation formation and cognitive disorder manifestations in different groups. The scheme, reflecting the depen-dence of manifestation of the studied indices in the comparison groups, was offered as a visual confirmation.

Conclusions. The optimal level of providing cognitive functions in practically healthy young persons was shown to be reached by the balance of sympathetic and parasympathetic effects, more typical for subjects, corresponding to moderate health status.

Perm Medical Journal. 2018;35(4):77-82
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Rare combination of liver alveococcus with right lung and cerebral echinococcus
Barykov V.N.
Abstract

The paper presents the observation regarding successful combined (surgical and medicamentous) treatment of patients with multiple parasitic damage: liver alveococcosis and pulmonary and cerebral echinococcosis. Surgical treatment, combined with albendasole, permits to reach clinical improvement even in case of multiorgan parasitic damage.

Perm Medical Journal. 2018;35(4):83-87
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Difficulties of life-time diagnosis of rabies. Clinical observation
Mamunts A.K., Batrakova G.V., Trefilov I.N., Ogorodova N.I., Mamunts M.A.
Abstract

The paper presents a case of rabies with lethal outcome in a fourteen-year-old adolescent. The child did not undergo postexposure prevention of rabies after a cat’s attack in connection with late addressing for medical care, just after occurrence of clinical symptoms of this disease. The child was not diagnosed “rabies” when was alive. Diagnosis was verified by detection of rabies virus RNA in autopsy material using polymerase chain reaction.

Perm Medical Journal. 2018;35(4):88-93
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Symptomatology of foreign bodies of the gastrointestinal tract
Davidov M., Subbotin V., Nikonova O.
Abstract

Goal. To study the questions of the clinic and develop the symptomatology of foreign bodies of the gastrointestinal tract (GIT).

Materials and methods. From 1997 to 2017 years. 90 patients with foreign bodies of the gastrointestinal tract were observed. A set of endoscopic and radial methods was used for diagnostics. The localization, magnitude and nature of the detected foreign bodies (IT) was compared with the detected symptoms.

Results. Deliberately swallowed IT 50 patients, accidentally - 40. only 90 patients were swallowed 193 subjects (nails, needles, wire pieces, etc.). Based on the study, three forms of clinical course were identified with ingested IT intestinal tract: latent, manifest and complicated. Pathognomonic symptoms of the intestinal tract are "migrating" abdominal pain associated with migration of IT through the lumen of the gastrointestinal tract, increased pain during movement, physical stress and palpation, a feeling of "heaviness" in the epigastric region. With multiple gastric IT, the auscultative "pinging" symptom is identified. Pain in the IT GI tract is not associated with food intake and does not stop after taking antacid drugs.

Conclusions. The introduction of the developed symptomatology of the GIT intestinal tract into the practice of health care and training of physicians will contribute to their earlier and more accurate diagnosis.

Perm Medical Journal. 2018;35(4):
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COMPARATIVE ANALYSIS OF HEMATOLOGICAL AND BIOCHEMICAL INDICATORS OF BLOOD IN CHILDREN WITH VITAMINS VARIOUS SECURITY
Yambulatov A.M.
Abstract

Goal. Study of the features of hemogram and biochemical indicators of blood in children with different supply of vitamins.
Materials and methods. The laboratory determination of the content of vitamins A, C, D, E, B6 and B12 in the blood of children attending pre-school educational organizations (hereinafter - OED), where the standard C-vitaminization of the diet was carried out.
The observation group consisted of 146 children with hypovitaminosis in two or more vitamins, the comparison group included 42 children with a physiological level of vitamin supply for all the vitamins studied. An integral evaluation of hematological and biochemical blood indices in children of the compared groups was carried out.
Results. It is shown that 75-85% of the children surveyed have a year-round deficit of vitamins, which has the character of polyhypovitaminosis in 40%. It has been established that in the autumn and winter period, the supply of children with vitamins A and C is characterized as "subnormal", while in spring 70% of children experience a deficiency of vitamin C and 15% of vitamin A. In autumn, every third child has a vitamin B6 deficiency, and each 10 is vitamin D; by spring, the number of children with insufficient availability of these vitamins increases in 1.8-6.3 times. Half of the children attending pre-school educational organizations experience a year-round vitamin B12 deficiency. From September to May, the level of provision of children with vitamin A is reduced by more than 60%, vitamin E - by 55%, vitamin C - by 25%, vitamin D - by 15.
Conclusions. In children with inadequate supply of vitamins, a more intense state of the erytriocyte germ of the hematopoiesis and a decrease in the proliferative activity of the lymphocytic monocystic sprout are observed against a background of a higher activity of allergic cell reactions; there is a lower level of activity of protein, carbohydrate, mineral and energy metabolism in children with insufficient vitamin supply.

Perm Medical Journal. 2018;35(4):
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Challenges of intravital rabies diagnosis. Clinical case.
Mamunts A., Batrakova G., Trefilov I., Ogorodova N., Mamunts M.
Abstract

A case of rabies with a fatal outcome in a teenager of 14 years is presented. Due to seeking medical help only after the appearance of clinical symptoms of the disease, the child was not subjected to post-exposure prophylaxis of rabies after a cat attack. During the life of the child, the diagnosis of "rabies" was not established. The diagnosis was verified after rabies virus RNA was detected in the sectional material using polymerase chain reaction.

Perm Medical Journal. 2018;35(4):
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Original studies
Cognitive function and autonomic regulation in healthy young adults of different health groups
Muravyev M.V.
Abstract

Comorbidity of the flow of autonomic and cognitive dysfunction in young adults is a poorly studied problem and requires the development, taking into account different level of health patients. Purpose. To study the level of cognitive functions and peculiarities of vegetative regulation in healthy young people. Materials and methods. 116 practically healthy young people (23,06±2,31), 81 women and 35 men were examined. The subjects were divided into five groups of health on G.L. Apanasenko, in all groups comparison was assessed by an autonomic regulation method of cardiointervalography, cognitive functions were studied using the Montreal scale assessment of cognitive functions. It is shown that the optimal level of providing cognitive functions in healthy young people is achieved by a balance of sympathetic and parasympathetic influences, more characteristic of persons corresponding to the average level of health.

Perm Medical Journal. 2018;35(4):
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