Vol 36, No 4 (2019)

Cover Page
Клинические исследования
Renovasal relationship in patients with uncomplicated hypertensive disease
Chernyavina A.I., Koziolova N.A., Mironova S.V.

Aim. To assess the influence of arterial stiffness on the renal filtration function in patients with uncomplicated hypertensive disease.

Materials and methods. The study included 88 patients of able-bodied age, suffering from stage I–II hypertensive disease. The mean age was 50.38 ± 5.19 years. All the patients underwent  sphigmopletismography with assessment of cardio-malleolar-vascular index (CAVI1),  evaluation of renal filtration function by creatinine and cystatin C levels as well as by calculated glomerular filtration rate (GFR) by creatinine and cystatin C. All the patients were divided into 3 groups according to CAVI1 level: group 1 – patients without arterial lesion and CAVI1 < 8; group 2 – patients with borderline changes in arteries and CAVI1 8.0–8.9; group 3 – patients with arterial lesion and CAVI1<9.

Results. No statistically significant differences by clinicoanamnestic characteristics were found out in patients of all groups. In patients of group 1, cystatin level appeared to be statistically significantly lower than in patients of group 2 and 3 (pmg = 0.013). Patients of all groups statistically significantly differed according to GFR by cystatin C (pmg = 0.015). No difference according to creatinine level and GFR by creatinine were registered in the groups.

Conclusions. As arterial stiffness by CAVI1 level is increased, there occurs statistically significant aggravation of renal filtration function, assessed by cystatin C level and GFR using the formula CKD-EPI by cystatin C. Changes in the renal filtration function indices were observed within the normal values that shows early preclinical changes.

Perm Medical Journal. 2019;36(4):5-12
Programming of oblique laparotomy optimal parameters when implementing splenectomy
Amarantov D.G., Zarivchatsky M.F., Alkhamaidkh A.A., Gudkov O.S., Zhuravlev O.S.

Aim. To develop the method of prediction of the optimal parameters of oblique laparotomy when implementing splenectomy.

Materials and methods. The newly developed method was used in treatment of 108 patients, who needed splenectomy.

Results. It was detected that the optimal length of laparotomy is 98 % of the revealed with computed tomography distance from the center of splenic portal to the center of laparotomy. The offered method for determining laparotomy sizes was used in 25 open splenectomies.

Conclusions. Introduction of the offered method for determining laparotomy sizes into clinical practice permitted to reduce the sizes of laparotomy by 23 % without any losses in the quality of splenectomy implementation.

Perm Medical Journal. 2019;36(4):13-20
Characteristic features of perinatal period in newborns with intrauterine growth retardation of different gestation age
Yuditskiy A.D., Kovalenko T.V., Petrova I.N.

Aim. To study the perinatal features and sickness rate of newborns of different gestation age with intrauterine growth retardation (IUGR).

Materials and methods. Group 1 (n = 82) included newborns with gestation age boarders 32–36 weeks, group 2 (n = 120) – full-term newborns with gestation age 37–40 weeks. Characteristic features of anamnesis, gestation period and labor were evaluated; clinical and laboratory-instrumental investigations were performed.

Results. Early hypoglycemia during the first hours of life was registered in 46.3% of premature newborns with IUGR and in 26.7 % of full-term newborns (p < 0.01), transitory hypocalcaemia – in 13.4 and 20.0 %, respectively. In patients of group 1 – chronic intrauterine fetal hypoxia (25.7 %) (p < 0.05), intranatal asphyxia (40.2 %) (p < 0.05), respiratory distress-syndrome at early neonatal period (34.1 %) (p < 0.01) were registered more often. During the neonatal period, no differences in frequency and character of perinatal nervous system lesions were detected in the examined groups.

Conclusions. Thus, there were obtained the proofs of significant influence of gestation age on the course of perinatal period, character and severity of pathological states in newborns with IUGR.

Perm Medical Journal. 2019;36(4):21-26
Ozonotherapy influence on hormonal status of pregnant women of older reproductive age
Safarova R.B.

Aim. To study the hormonal status in pregnant women of older reproductive age and estimate the influence of administration of medical ozone on the course of pregnancy.

Materials and methods. Ninety pregnant women aged 35–44 years were examined over the period from 2013 to 2015. They were randomized by their age, social factors, associated gynecological and extragenital diseases. The main group (group I) joined 30 patients, the group of comparison (group II) – 30 patients and the control (group III) – 30 patients. All the patients underwent clinical and laboratory investigations according to the existing standards of obstetric examination. In the main group, complex treatment included therapy with medical ozone. In the comparison group, a standard medico-preventive therapy by the protocol №05 (20.02.2014 MH of AR) was implemented. In the control group, estrogen indices were studied in dynamics.

Results. Pregnant women aged 35 years and older have an unfavorable background of extragenital and gynecological pathology that is confirmed by hormonal background.

Conclusions. Planning of pregnancy, timely prevention and correction of clinicolaboratory indices permit to reduce the frequency and severity of pregnancy and delivery complications and improve the perinatal indices among patients of this age group.

Perm Medical Journal. 2019;36(4):27-32
Методы диагностики и технологии
Influence of polymorphism of the gene GCLC on antioxidant defense status in healthy children of Omsk region
Pavlinova E.B., Kirshina I.A., Kurmasheva E.I., Vlasenko N.Y., Mingairova A.G., Savchenko O.A., Indutnyi A.V., Novikov D.G.

Aim. To study the status of antioxidant defense in healthy children, living in Omsk Region, depending on polymorphism of the gene GCLC.

Materials and methods. There were examined 50 healthy children aged 3 to 17 years, including 54 % of boys. Polymorphism of the gene GCLC 129С/C, 129C/Т, 129T/T and reduced (GSH) and oxidized (GSSG) glutathione concentrations were determined. Statistical analysis was implemented using the programs «Statistica 6.0 and DoctorStat1.9.

Results. Polymorphism of the gene GCLC was represented by the genotypes 129C/C (43 children, 86 %) and 129C/T (7 children, 14 %); GSH concentration was within 6.0 [4.4; 7.0] mcmol/l, GSSG concentration – 3.0 [2.3; 3.5] mcmol/l, GSH:GSSG ratio was 2:1. Weak direct correlation between the child age and GSH (r = 0.31; р = 0.028) and GSSG (r = 0.31; р = 0.031) content was established; no gender differences were revealed. Among the subjects with the genotype 129C/T, the blood plasma GSH (р = 0.017) and GSSG (р = 0.016) concentrations decreased by 30 %.

Conclusions. Glutathione concentration in children depends on polymorphism of the gene GCLC.

Perm Medical Journal. 2019;36(4):33-38
Particular neurophysiological aspects of etiopathogenesis of juvenile idiopathic scoliosis
Muravyov S.V., Cherkasova V.G., Chainikov P.N., Mekhonoshina O.O., Kovalev M.A., Guschin M.O.

Aim. To study the data of mathematical model of mismatch between the vertebral length and the spinal cord calculated length in adolescents with juvenile idiopathic scoliosis.

Materials and methods. The paper presents the data on the calculated value of spinal cord and vertebral growth mismatch coefficient according to computed optic tomography and transcranial magnetic stimulation data in 46 adolescents, suffering from multiplane vertebral deformity of different degree of severity.

Results. The obtained data confirm the theory of mismatch between the spinal cord and vertebral growth. It was shown that spinal cord growth is the process, which does not depend on patient’s age and length of vertebral column.

Conclusions. There was constructed a mathematical 3D-model of link between the multiplane deformity severity, age and spinal cord and vertebral growth mismatch coefficient value, which can serve as a perceptive prognostic instrument in diagnosis of idiopathic scoliosis.

Perm Medical Journal. 2019;36(4):39-45
Influence of congenital heart disease-caused hypoxia on intrathymic development of t-lymphocytes in children of first year of life
Loginova N.P., Chetvertnykh V.A., Khromtsova G.A., Shekhmametyev R.M., Chetvertnykh L.A.

Aim. To study the influence of hypoxia, caused by congenital heart disease, on the intrathymic development of T-lymphocytes and provision of the organism with T-cellular resource in children with cardiac pathology of different degree of severity.

Materials and methods. The paper presents the results of complex immunomorphological study of the thymus in children of the first year of life (n = 129) with congenital heart diseases. Hystochemical and immunological methods were used to assess the influence of congenital heart disease-caused hypoxia on the functional status of thymus regarding provision of a child with T-lymphocytes.

Results. It was established that the degree of severity of congenital heart disease correlated with the degree of suppression of T-lymphocyte pool formation. During the first year of life, proliferative activity of thymocytes (assessed by Ki-67 expression) in the thymus falls, being the reason of decrease in the number of CD3+ thymocytes. In conditions of marked hypoxia (blue type of defect) the process of T-lymphocyte differentiation is inhibited that causes preservation of less mature forms of thymocytes. As a result, hypoxia is the reason of proliferation suppression and thymocyte differentiation, influencing subpopulation composition of the cells. Thus, insufficient quantity of thymic migrants enters the peripheral blood that confirms low functional activity of thymus regarding provision of the organism with T-cellular resource.

Conclusions. No doubt, it can be the cause of immunodeficient state and reduced formation of adaptive immunity in this category of children.

Perm Medical Journal. 2019;36(4):46-54
Профилактическая и социальная медицина
Evaluation of sociopsychological factors of HIV vulnerability in youth of Russian South (according to the data of behavioral research)
Kondratenko T.A., Vorontsov D.V., Saukhat S.R., Tyutyunkova N.G., Maksimova E.A., Chernigovets L.F., Dorofeeva I.K., Logvin F.V., Shemshura A.B.

Aim. To evaluate the links between the individual gender ideology, sexual statements, relationship system characteristics and the vulnerability of heterosexual HIV infection.

Materials and methods. Behavioral questioning, based on sampling of 239 students (mean age 20 years).

Results. Among both young men and women, there was detected a correlation between loyalty to conservative gender ideology and justification of sexual abuse against women as well as characteristics of interpersonal relations, reducing motivation to use of condoms. Conservative gender ideology significantly raises vulnerability of young women against HIV-infection through their justification of sexual abuse and domination of men. Egalitarian gender ideology is essentially connected with the statements, aimed at less risky, as for HIV infection, sexual practice. Conservative gender ideology supports orientation of youth to behavioral models, elevating vulnerability against HIV infection in heterosexual contacts: refusal from use of condoms, resistance to recommendations for decrease of risk.

Conclusions. Conservative gender ideology significantly increases vulnerability of young women against HIV infection through their justification of sexual abuse and domination of men. It is useful to include determination of a number of sociopsychological characteristics into the procedure of behavioral studies in the framework of epidemiological supervision of HIV infection, which can indirectly increase vulnerability of youth against HIV infection. There were offered content changes in programs, directed to decrease of risk among youth.

Perm Medical Journal. 2019;36(4):55-62
Epidemiological and economic efficiency of mass vaccinal prevention against pneumococcal infection in children compared with selective immunization at the example of community-acquired pneumonia
Semerikov V.V., Zubova E.S., Sofronova L.V.

Aim. To study the epidemiological pattern of community-acquired pneumonias in children and the influence of mass vaccinal prevention on morbidity and mortality.

Materials and methods. Vaccination of children against pneumococcal infection on the territory of a large industrial center of Western Urals was analyzed, influence of mass vaccination against pneumococcal infection on pneumonia morbidity and mortality in children was determined.

Results. Mass vaccinal prevention of children of the first year of life against pneumococcal infection (vaccination volume 102 353.6 per 100 thousand children under 6) significantly influenced morbidity level regarding community-acquired pneumonias in the group of vaccinated children under 2 (1619.9 ± 0.78 versus 15233.7 ± 2.5 per 100 thousand in the group of unvaccinated, odds ratio and its confidence interval was 9.40 [95 % CI 8.46–10.44]), on community-acquired streptococcal morbidity of children under 6 (r = 0.97; regression coefficient = 36.30, р < 0.001; R2 = 91.0 %, significance F = 0.01 and possibility 95.0 %) and 5-fold decreased the mortality level (from 35.2 before vaccination started to 6.8 per 100 thousand) till its full absence in the third year of realization of this strategy. No analogous influence on the main manifestations of epidemiological process of community-acquired pneumonia was noted in case of selective immunization against pneumococcal infection among 2–5 year olds, belonging to high risk groups (vaccination volume 10 417.08 per 100 thousand children under 6).

Conclusions. The strategy of mass vaccination of children of the first year of life was characterized by the greatest epidemiological and economic benefits. Economic efficiency taking into account vaccination costs in terms of 1000 of vaccinated children was 17.1 times higher and was equal to 8.3656 mln rub per 1000 inhabitants versus 0.4890 mln rub in case of selective immunization of high risk group children.

Perm Medical Journal. 2019;36(4):63-73
Modern epidemiological characteristic of gonococcal infection incidence manifestations
Rumyantseva M.A., Isaeva N.V.

Aim. To carry out the epidemiological analysis and assessment of manifestations of gonococcal infection incidence on the model of the city of Perm.

Materials and methods. Retrospective analysis of gonococcal infection morbidity indices was implemented on the basis of the data of official statistics of Federal Budgetary Healthcare Institution “Center of Hygiene and Epidemiology of Perm Krai” for the years 1990–2016 (form 2, form 12), Territorial Board of Federal Service of State Statistics of Perm Krai (Permstat) and State Budgetary Institution of Healthcare of Perm Krai “Regional Clinical Dermatovenerological Dispensary” for the years 2012–2016. Epidemiological method includes evaluative-descriptive epidemiological methods: analysis and assessment of multiyear dynamics of gonorrhea incidence for the years 1990 to 2016, gender, age, urban structure of gonorrhea patients.

Results. Analysis and assessment of gonococcal infection (GI) incidence manifestations in Perm and Perm Krai for the years 1990 to 2016 according to the data of official statistics permitted to detect the epidemiological characteristic features of this infection at the present stage. Among them are the following: in a multiyear dynamics – a marked tendency to decrease, absence of regular cyclic fluctuations; in an annual dynamics – a year-round observed epidemic level of morbidity irrespective of the periods of high and low levels, rises and falls, involvement into epidemic process as risk groups: adults aged 21–30 and adolescents aged 15–17, mainly males.

Conclusions. The absence of regularly repeated fluctuations in a multiyear dynamics of morbidity shows no influence of periodically available causative agents and impossibility of epidemiologic control of GI process on gonorrhea incidence at the modern stage.

Perm Medical Journal. 2019;36(4):74-81
Случай из практики
Clinical case of granulomatosis with polyangiitis (Wegener’s) with isolated pulmonary lesion
Obukhova O.V., Khlynova O.V.

Pulmonary vasculites include geterogenic group of diseases, characterized by destruction of pulmonary vessels with inflammation and tissue necrosis. From the clinical point of view, pulmonary vasculites are still difficult to diagnose and treat.

Pulmonary lesion is one of typical features of granulomatosis with polyangiitis (GPA) along with upper respiratory tract and renal pathologies, composing classical triad of this disease.

In case of GPA, pulmonary lesion is diagnosed in 60–85 % of patients. As a rule, it is combined with involvement of other organs, but in 9 % of patients, it can be the main manifestation of disease. The paper presents a case of GPA with isolated pulmonary lesion.

Perm Medical Journal. 2019;36(4):82-87
Asthmatic status in pediatric practice. Clinical case
Ilyenkova N.A., Stepanova L.V., Konopleva O.S., Alekseeva O.V., Pastukhova S.Y.

Bronchial asthma (BA) is a global issue of public health care that is connected with a stable tendency to sickness rate growth. In Russia, mortality rate from BA exacerbation is one of the highest in the world. The most severe attack of BA is considered as asthmatic status (AS) and needs resuscitation measures. Despite the fact that death from BA occurs as a result of acute severe attack (often – asthmatic status), it is almost always the consequence of previous incorrect treatment or the absence of proper medical care and observation. The paper presents a clinical case of asthmatic status in a twelve-year old child, which was complicated by spontaneous pneumothorax. The cause of the development of threatening status in a child with bronchial asthma was the absence of basic anti-inflammatory therapy and proper medical observation. The absence of rational therapy and regular observation, rendered to BA patient by a physician of primary care link with training of self-control and self-observation habits, can cause the development of the most severe exacerbation – asthmatic status. A timely hospitalization of AS patients to resuscitation and intensive care unit according to indications will promote faster transfer to pediatric department.

Perm Medical Journal. 2019;36(4):88-96
Exacerbation of ulcer as a cause of Mellory-Weiss syndrome. Case reports
Timerbulatov S.V., Valeev M.V.

Aim. To analyze the results of treatment of patients with Mellory-Weiss syndrome (MWS) and describe a number of MWS cases, caused by exacerbation of the ulcer. To detect the characteristic features of the course of disease and possible variants of unfavorable outcome.

Materials and methods. There were analyzed the results of treatment of 176 patients with MWS, who received hospital treatment from 2008 to 2018.  Fifteen MWS cases, caused by ulcer exacerbation, were described. Statistical analysis was conducted; features of disease course were revealed. A clinical case of unfavorable variant of the disease course is presented.

Results. The study included 176 patients. Mellory-Weiss syndrome, caused by  ulcer, was registered in 15 of them (main group). The patients of the main group had pain syndrome, lower systolic arterial pressure, lower hemoglobin and erythrocyte amount at admission to hospital. The paper presents the variant of extremely unfavorable course of disease, when relapse of bleeding occurred not from laceration of the mucous membrane, but from the ulcer.

Conclusions. According to our observations, ulcer is a relatively frequent cause of MWS development and takes the second place after alcohol etiology. Such patients have peculiar features of disease course, which require different approach to diagnosis and management.

Perm Medical Journal. 2019;36(4):97-103

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