Vol 35, No 5 (2018)

Cover Page
Influence of non-motor manifestations of Parkinson’s disease on quality of life
Khegai O.V., Selyanina N.V., Karakulova Y.V.

Aim. To estimate the degree of influence of non-motor manifestations on the quality of life among patients with Parkinson’s disease.

Materials and methods. In the study, the “case-control” design was used, processing of the data was conducted with nonparametric methods. Complex examination of 58 patients with Parkinson’s disease was performed. The control group included 15 healthy persons.

Results. Manifestation of cognitive, anxiety-depressive, vegetative symptoms in the main group was significantly higher than in the control. There was revealed a negative correlation dependence between the general manifestation of vegetative disorders and the social functioning indices (R = – 0.5; p = 0.001), pain intensity (R = – 0.5; p = 0.001) and psychical health (R = – 0.5; p = 0.005) that proves aggravation of the data on health components as the severity of symptoms was growing. The analyzed vegetative disorders of separate subsystems demonstrated the analogous tendencies. Severity of depressive symptoms influences the pain indices (R = – 0.4; p = 0.01) and the social functions (R = – 0.3; p = 0.03). According to unified scale, non-motor symptoms negatively influence the general health status (R = – 0.3; p = 0.001), social functioning (R= – 0.23; p = 0.004), pain assessment (R = – 0.5; p = 0.001).

Conclusions. Non-motor symptoms aggravate the quality of life, influencing both physical and psychological component of health. The absence of correlation between the duration of therapy and the severity of non-motor symptoms confirms the independence of this block of symptoms.

Perm Medical Journal. 2018;35(5):6-11
Characteristic features of correcting testosterone deficiency syndrome in young men with obesity
Shevchuk V.V., Kashkina N.V., Vladimirskaya N.L.

Aim. To assess the approaches to treatment of testosterone deficiency syndrome (TDS) in fertile (young) men with obesity.

Materials and methods. Comparative analysis of peculiarities of TDS correction in 120 men aged 21–35, suffering from class III abdominovisceral obesity, was performed taking into account the personified approach. Testosterone deficiency syndrome was detected in all the examined men. The examined patients were divided into two completely comparable groups: in group I, androgen replacement therapy was administered to patients, in group II – individual balanced diet, combined with individual physical loads and course of inhibitor of gastrointestinal lipases.

Results. In both groups, identical efficiency of TDS therapy in young men with obesity was established: when applying androgen replacement therapy and body mass decreasing therapy. However, the most favorable conditions for restoration of fertility are created when using complex multifactor therapy without testosterone preparations, since along with correction of erectile dysfunction, there is observed optimization of spermogram indices.

Conclusions. Differentiated approach to correction of testosterone deficiency syndrome among patients with obesity permits to optimize financial expenditure for treatment and preserve reproductive function. The body mass decrease leads to liquidation of testosterone deficiency syndrome, normalization of erectile function and lipid spectrum.

Perm Medical Journal. 2018;35(5):12-18
New opportunities to correct equvinus foot deformity in orthopedic-traumatological practice
Schekolova N.B., Zinovyev A.M., Kozyukov V.G., Tokarev A.E., Nenakhova Y.V.

Aim. To prove the efficiency of using a new variant of leg tutor for correction of locomotor system pathology in treatment of equvinus foot deformity.

Materials and methods. A mean age of 23 patients with hemiparesis and equvinus foot deformity was 42.5 years. Tonus and strength of legs was assessed. Angulometric and stabilometric studies were realized.

Results. The developed model of leg tutor was used. To eliminate equvinus foot deformity, hyperextension of the knee joint was gradually eliminated using individual choice of the heel form and height, thus strengthening a quadriceps muscle of the thigh. The knee joint stability increased, the intensity of pain syndrome reduced. Arthropathies and deformities of the knee joint were prevented. Innovation of the developed model is the following: a soft glue-based responsive side of textile band “Contact” “Velcro” was stably fixed to the outside surface of posterior third of the plantar part of tutor sleeve. To the responsive side of a textile band, there were fixed removable heel pads (heels from microporous rubber of different height (from 5 to 25 mm) with a responsive hard (with hooks) part of textile band “Contact” “Velcro”). Tutor provided the ability to move and guaranteed stable holding of the extremity segments in the posterior position. There was observed a positive dynamics of changes in the muscular tonus of paralyzed leg.

Conclusions. The developed tutor model can be used in orthopedic-traumatological practice to correct equvinus foot deformity; the model efficiency is confirmed by clinical and stabilometric parameters.

Perm Medical Journal. 2018;35(5):19-23
Infrared laser light in dental practice
Mozgovaya L.A., Gavrilenko M.S., Mozgovaya S.V., Fokina N.B., Rochev V.P., Sivak E.Y., Soboleva O.S.

Aim. To optimize the conditions, necessary for elimination of inflammatory phenomena in parodontium tissues

Materials and methods. Fifty practically healthy and socially adapted patients (age range 16 to 40 years) with uncomplicated mandibular fractures participated in the study.

Results. The studies showed that among patients with two-jaw dental splints, who experienced traditional complex treatment, the main clinical indices did not change throughout the period of observations. Infrared laser light applied reduced the severity of inflammation in the tissues of marginal parodontium.

Conclusions. The obtained results permit to recommend complex medical effect on the parodontium tissues for patients with intraoral fixing constructions. This effect is aimed at correction of the oral cavity hygiene and multifactor pathogenetic action of infrared laser light, making it possible to stabilize significantly the state of parodontium tissues in unfavorable conditions of intermaxillary fixation in patients with mandibular fractures.

Perm Medical Journal. 2018;35(5):24-31
Characteristic features of type B Haemophilus Influenzae-caused purulent meningitis in children
Grishkina L.Y., Lvova I.I., Trefilov I.N., Banko N.V., Odintsova O.V.

Aim. To study the clinical peculiar features of type b Haemophilus influenza-caused purulent meningites among children in Perm.

Materials and methods. Twenty children with purulent meningitis were examined. Clinical and bacteriological studies, latex-agglutination reaction, polymerase chain reaction (PCR) were used.

Results. Most patients with Hib-meningitis (70 %) were hospitalized in grave condition during the first three days of disease with fever, meningeal symptoms. Spastic syndrome was diagnosed in 5 patients, disseminated intravascular clotting syndrome – in 6 patients.

Conclusions. Hib-meningitis in 80 % of cases is developing in children aged under two, has an acute onset and severe course with general cerebral and meningeal symptoms, changes in blood and liquor, typical for bacterial infection, high neutrophilic pleocytosis and hyperproteinorrhea; it is frequently accompanied by complications. In etiological diagnosis of Hib-meningitis PCR is the most informative method.

Perm Medical Journal. 2018;35(5):32-35
Express diagnosis of connective tissue dysplasia in conditions of ambulatory-polyclinic service
Denisov A.S., Zagorak D.P.

Aim. To detect the most informative signs of connective tissue dysplasia (CTD) and develop the method for CTD express diagnosis in conditions of ambulatory and stationary traumatologo-orthopedic service.

Materials and methods. Sixty practically healthy persons were examined. To diagnose the connective tissue pathology, there were used the criteria developed by S.K. Evtushenko (2002), T.Yu. Smolnova (2003) and T.I. Kartunova (2006). Eighteen the most informative criteria were chosen.

Results. The paper is devoted to a widespread and yet not fully studied problem – the connective tissue dysplasia. The basic signs of this disease were analyzed. The most informative criteria of connective tissue dysplasia were singled out. Express test for primary diagnosis of this pathology in conditions of traumatologo-orthopedic service was offered.

Conclusions. Express test of the state of connective tissue structure is simple to perform. It can be used to improve surgical aids in connective tissue dysplasia, when additional stabilization of loco motor system is required.

Perm Medical Journal. 2018;35(5):36-41
Results of studying disinfectant-resistance of bacteria, excreted from patients in microbiological provision of epidemiological surveillance of hcai at multitype medical institution
Nesterova D.D., Neshataev A.N., Lukyanenko N.V., Petrova A.A., Prokopyev V.V., Sergeev T.S.

Aim. To improve microbiological monitoring of disinfectant-resistance of microorganisms, excreted from clinical material in epidemiological surveillance of HCAI.

Materials and methods. Over the period from 2012 to 2016, while conducting resistance monitoring, 3320 investigations of clinical material were performed. The number of studied microorganisms was 1557. The number of excreted disinfectant-resistant microorganism strains was 337. The studies of microorganisms from clinical material for resistance were realized to 48 disinfectants of 15 groups with different reactants.

Results. During the present study it was established that microbiological monitoring, oriented for continuous monitoring of microorganisms circulation will permit to increase the number of studies in 2016 by 2.6 times, to reduce the total number of disinfectant-resistant flora in 2016 by 62 %. The greatest weight of excreted cultures was in the units of surgical profile – 48.8 %, resuscitation profile – 30 %, therapeutic one – 21.2 %. Clinical material, from which positive results were obtained, was determined by scourage (from 43.5 % in the surgical unit to 74.8 % in therapeutic), blood sterility (from 2.7 % in therapeutic units to 31.4 % in resuscitation units). Microflora, excreted from clinical material is presented predominantly by P. aeruginosa – 24.0 %, Kl. pneumoniae – 30.0 %, E. coli – from 12.9 to 22.1 %, St. aureus – from 3.0 to 7.6 %. The studies regarding disinfectant-resistance to 48 items from 15 groups of chemical compounds are the evidence of growing resistance to QAC, including QAC + amines – 24.7 %, QAC + aldehyde-containing – 6.8 %, chlorine-containing – 21.9 %. The highest resistance to disinfectants used was in Acinetobacter spp., Kl. pneumoniae, P. aeruginosa, E. coli.

Conclusions. The developed algorithm of microbiological study, based on software, permitted to form the database, to monitor epidemiologically significant microorganisms and correct choice of disinfectants and disinfection tactics.

Perm Medical Journal. 2018;35(5):42-50
Personified approaches to organization of risk-oriented medical observation in conditions of opportunistic-pathogenic microbial air contamination of working zone
Masyagutova L.M., Gizatullina L.G., Vlasova N.V., Khairullin R.U., Sadrtdinova G.R., Bakirov A.B.

Aim. To ground the personified approaches when organizing risk-oriented medical observation of animal breeding workers.

Materials and methods. The total capillary blood analysis with calculation of percentage of peripheral blood cellular composition was carried out, allergization index (AI) and immunoreactivity index (IRI) was assessed, the total number of microorganisms per 1 m3 of the air in the working zone was determined, the total microbial count (TMC) was calculated.

Results. The standard periodic medical examination of workers is sufficient with TMC value less than 500 CFU/m3, absence of chronic infectious inflammatory diseases (CIID), AI value less than 1.08 standard units, IRI value less than 13 standard units. When having a mean level of microbiological risk, CIID detection ranging from 1 to 3, AI value less than 1.08 and IRI value less than13 standard units, it is recommended to add a survey to the previous stage, using special questionnaire (attitude to work, working conditions, fatigability degree, susceptibility to allergy etc.). When having TMC value more than 2500 CFU/m3, CIID detection from 4 to 5, AI value 1.08–1.3 standard units, IRI value 13.1–15.7 standard units, an additional study of the upper airways microflora as well as immune status using tests of the first level should be realized; further recommendations on treatment-and-preventive measures in outpatient conditions should be given; with TMC value more than 5000 CFU/m3, presence of CIID – 6 and more, AI value 1.4–1.5 standard units, IRI value 15.8–18.3 standard units, it is recommended to perform immunological studies using tests of the second level with determination of susceptibility to antimicrobial preparations in hospital conditions of Occupational Pathology Center.

Conclusions. The method of personified risk-oriented medical observation of persons, working in animal breeding is offered.

Perm Medical Journal. 2018;35(5):51-56
Comparative analysis of maternal mortality indices in Perm Krai over the past 20 years
Padrul M.M., Cherkasova E.V., Skryabina V.V., Berseneva S.N.

Aim. To compare the maternal mortality (MM) indices in Perm Krai with MM indices in the Russian Federation (RF) and Privolzhskiy Federal District over the past 20 years.

Materials and methods. On the basis of official statistical data, intensive indices and image indices, mean multiyear MM indices, 95 % confidence intervals, median, 25 and 75 percentile indices were calculated. The mean multiyear indices are presented as M (mean value) ± SD (standard deviation).

Results. According to official statistical data, the mean multiyear (1997–2016) indices of MM coefficient in Perm Krai tend to decline, but they do not reliably differ from the analogous indices in RF. During the last 20 years, there was noted a steady and obvious decrease in MM index on the territory of Perm Krai, especially marked for the last 2 years (2015–2016) that resulted in appearance of statistically significant differences regarding this index in Perm Krai compared to these indices in RF as a whole.

Conclusions. Perm Krai is a rather favorable region as far as rendering of medical aid to pregnant, parturient women and puerperas is concerned.

Perm Medical Journal. 2018;35(5):57-62
Catheter-associated urinary tract infections in patients of TSBHI “Altai territory hospital for war veterans” urological unit
Sursyakova K.I., Safyanova T.V.

Aim. To assess manifestations and risk factors of epidemiological process of catheter-associated urinary tract infections (UTI) in patients of the urological unit of “Altai Territory Hospital for War Veterans” (ATHWV).

Materials and methods. One hundred medical records of UTI patients, treated in this urological unit were analyzed to determine the association between the UTI sickness rate and the insertion of catheters among patients, treated in the urological unit of “Altai Territory Hospital for War Veterans” during 2017.

Results. Assessment of epidemiological process in catheter-associated UTI patients of “ATHWV” urological unit resulted in the following: UTI sickness rate in “ATHWV” is associated with urinary bladder catheterization and can be interpreted as health care-associated infections since all the observed patients underwent urinary tract catheterization procedure in conditions of “ATHWV” urological unit.

Conclusions. Microbiological urine analysis with determination of antibiotic-resistance and disinfectant-resistance of the excreted pathogens should be conducted in all the patients, who undergo urinary bladder catheterization procedure since there is a high percentage of microbiologically-evidenced symptomatic UTI (35.9 %).

Perm Medical Journal. 2018;35(5):63-69
Availability of social networks as marketing instrument in esthetic surgery
Khramtsova N.I., Plaksin S.A., Lebedeva T.M., Ens M.A., Belyakova O.S.

Aim. To determine the availability of social networks for involvement of clients in the sphere of esthetic surgery.

Materials and methods. The data of a social group from The Clinic of Esthetic Surgery “EstMed” in the social network vkontakte were analyzed.

Results. The number of subscribers was 533, the main contingent – women aged 25 to 44 years; 48 % of users look through the group posts by means of mobile devices. The participants of this group were not satisfied with the form and dimension of their breast, pendulous abdomen, wrinkles on the face, “ears” on the femurs and form of buttocks; 95 % voted for plastic surgery as an appropriate way to fight with aging. Most subscribers were ready for surgery; 50 % of interrogated persons consider psychologist’s consultation to be necessary. The greatest number of persons consider buttocks, breast and legs to be the most sexual part of the body. One third of the questioned persons have breast size number one, but the majority of interrogated persons consider that men prefer breast size number three. Posts, containing jokes, arouse the greatest interest, information not concerned with the subject matter of the group – the least.

Conclusions. When used professionally, social networks can be a strong instrument to involve clients.

Perm Medical Journal. 2018;35(5):70-74
Optimized use of eight-arm maze when studying effect of preparation “Cycloferon®” on cognitive potential of experimental animals
Kuznetsov S.V., Kuznetsov V.F., Makunina E.V., Kasimova R.M., Tyutyunschikova V.D., Obernebesova T.P.

Aim. To develop the testing algorithm in conditions of radial eight-arm maze and to study the effect of preparation “Cycloferon®” on cognitive processes in experimental animals in conditions of repeated training.

Materials and methods. The study was conducted on experimental animals – white outbred male rats (n = 21) aged 8–9 months using the original method. “Radial eight-arm maze” was used as experimental laboratory device. During the experiment, to activate searching behavior, daily nutrition regime was reduced by 15–20 %. To fortify, milk product “Thickened milk” was used. At the first experimental stage, the animals received a typical vivarium ration. During the second part of this study, the rats underwent repeated training after taking “Cycloferon®”, calculated for each rat by the mass – 0.77 mg per 100 g of the animal body mass; after that the rats’ spatial memory was assessed.

Results. Taking into account the results of the second part of experiment, statistically significant tendency to increase was revealed among animals with positive result of testing with one-sided Fisher criterion (p = 0.037). No correlation between taking “Cycloferon®” and the number of repeated entering of the arms and the total number of entering of the arms was detected (p > 0.05) that proves the formation of purposive movement.

Conclusions. A reliable tendency to increase in the number of animals, trained during the repeated testing against the background of using “Cycloferon®”, which possesses immunomodulating effect as well as antioxidant action, confirms the actuality of applying the offered method while studying cognitive effect of substances, requiring long-term introduction.

Perm Medical Journal. 2018;35(5):75-81
Cortical superficial siderosis is a new MRT-phenomenon in neurological practice: clinical observations and review of literature
Kulesh A.A., Gorst N.K., Drobakha V.E., Kaileva N.A., Shestakov V.V.

Cerebral amyloid angiopathy (CAA) is a specific variant of cerebral small vessel disease, associated with high risk of spontaneous intracerebral bleedings, cognitive disorders and hemorrhagic complications of antithrombotic and thrombolytic therapy. One of key markers of CAA is a relatively rare neurovisual phenomenon – cortical superficial siderosis (CSS). Two clinical cases of CAA with CSS are described in the present paper. In the first case, typical CAA complication were observed: intracerebral bleeding and cognitive disorders. In the second case, CAA was symptom-free. Analysis of clinical cases and literature data shows phenotypic heterogeneity of CAA and confirms advisability of routine use of paramagnetic conditions of MRT to examine patients with cerebrovascular disease.

Perm Medical Journal. 2018;35(5):82-92
Factors of formation and diagnostic problems of malignant lung diseases
Kirillova E.V., Lipatov O.N., Mufazalov F.F., Masyagutova L.M., Akhmetov V.M., Maksimov G.G., Aznabaeva Y.G.

In the paper there is presented a review of foreign and literature data, documented in electronic search system PubMed regarding epidemiology, early and prenosological diagnosis, carcinogenic factors for development of malignant respiratory neoplasms, lung cancer.

Perm Medical Journal. 2018;35(5):93-97
Clinicodiagnostic problems of hepatic fibrosis/cirrhosis
Schekotova A.P., Bulatova I.A., Paducheva S.V.

The problems of hepatic fibrosis/cirrhosis diagnosis are discussed in the paper. At the modern stage, diagnosis of chronic hepatic diseases is based on laboratory, instrumental, morphological methods of study and calculated indices. Puncture biopsy of the liver is referred to the most reliable diagnostic methods. However, there are some complexities while implementing this procedure, which do not permit to use morphological studies for dynamic observation. The method of ultrasound elastometry is offered as an alternative to puncture biopsy of the liver. However, it also has some technical limits that resulted in development of noninvasive, in particular, laboratory methods of hepatic fibrosis/cirrhosis diagnosis.

Perm Medical Journal. 2018;35(5):98-107
Inflammatory bowel diseases: course peculiarities and drug therapy in pregnant women. Lactation. Personal matters (by the materials of the second european consensus on reproduction and pregnancy in patients with inflammatory bowel diseases, 2015)
Khlynova O.V., Sandakova E.A., Zitta D.V., Stepina E.A., Koposova K.A., Okisheva L.G.

The paper presents a continuation of discussion regarding personal matters on the course of inflammatory bowel diseases (IBD) such as ulcerative colitis (UC) and Crohn’s disease (KD) in pregnant women, including the problems of basic drug therapy of the main disease both during pregnancy and lactation period. Separately, there are data on safety of conducted therapy, indications for surgical treatment and use of biological genetically engeneered drugs. The paper is based on the materials of “The Second European Consensus on Reproduction and Pregnancy in Patients with Inflammatory Bowel Diseases, 2015”. The main positions are presented according to the criteria of evidence-based medicine.

Perm Medical Journal. 2018;35(5):108-115

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