Vol 38, No 6 (2021)

Objective. To study the effect of preoperative atrial fibrillation (AF) on the risk of stroke and long-term mortality after Off Pump Coronary Artery Bypass (OPCAB).

Materials and methods. A retrospective analysis of the results of OPCAB in 212 patients with coronary artery disease (CAD), who were operated on from May 2009 to November 2013, was carried out. After propensity score matching, patients were divided into 2 groups: Group I – 82 patients with sinus rhythm (SR) before surgery, Group II (control) – 102 patients with AF before surgery. The average age of the included patients was 61 ± 6.7 years, with 95 % CI: 60–62. Fifty-four (29.3 %) patients were over 65 years of age. There were 162 men (88 %) and 22 women (12 %). The median follow-up was 93.5 (66.7–102.0) months.

Results. The time spent in the clinic was statistically significantly shorter in the SR group than in the AF group (10 (9–11) and 14 (11–16) hours, respectively, p < 0.001). There was no statistically significant difference in the number of perioperative myocardial infarctions (in the group with SR it occurred in 1 (1.2 %) patient, in the group with AF – 2 (2 %), p = 0.7), strokes (in the group with SR – 1 (1.2 %), in the group with AF – 3 (2.9 %), p = 0.6), as well as a 30-day mortality (in the group with SR it was 0 %, in the group with AF – 3 (2.9 %), p = 0.2). In the long-term postoperative period, there were statistically significantly fewer strokes in the group with SR than in the group with AF (in the group with SR, the 10-year stroke freedom was 88.8 %, and in the group with AF – 71.8 %, p = 0.018), and also better long-term survival in the group with sinus rhythm (in the group with SR, the 10-year survival rate was 79 %, in the group with AF – 63.9 %, p = 0.016).

Conclusions. In the group with preoperative AF, the frequency of distant strokes and deaths is higher than in patients with sinus rhythm.

Objective. To determine the effect of ozonotherapy on the clinical indicators and immunological reactivity state in children with a moderate course of persisting allergic rhinitis.

Materials and methods. Children aged 5–10 years with a moderate persisting allergic rhinitis were under observation. They were divided into two groups depending on the therapy applied. Group I of allergic rhinitis patients received a complex generally accepted therapy, group II of allergic rhinitis patients – a complex therapy associated with ozonotherapy. Clinical indices and immunological reactivity parameters were studied during exacerbation and clinical remission in allergic rhinitis children.

Results. Ozonotherapy, included into a complex treatment of group II patients, was established to promote a faster occurrence of full clinical remission and normalization of most parameters of immunological reactivity. Duration of a full clinical remission in the group of allergic rhinitis patients, who received a complex therapy associated with ozonotherapy, more than twofold exceeded its duration in the group of allergic rhinitis patients receiving a complex generally accepted therapy.

Conclusions. The data obtained indicate high clinical, immunomodulating and antirelapsing effect of ozonotherapy that allows recommending its wide use in complex of medical measures among children with persisting allergic rhinitis.

Objective. To study the features of the karyotype in patients with miscarriage. This article is devoted to the role of maternal chromosome polymorphisms and their role in the genesis of miscarriage.

Materials and methods. A comparative assessment of the karyotypes in women, whose pregnancy proceeded without complications and ended in the birth of a healthy child (75 persons, group I), and a group of patients with NB (135 persons, group II) was carried out. Group IIa consisted of 68 women with the first pregnancy that ended in spontaneous abortion in the first trimester, group IIb - 67 women with the first and subsequent pregnancy, interrupted in the first trimester. Statistical processing of the obtained material was carried out using the Exel program, and StatTech v.2.1.0.

Results. A significantly greater number of patients with normal karyotype was in group I – 72 persons (98.1 %). Data on the structure of chromosome polymorphisms showed that in patients of group II, changes in one chromosome are found in 8.8 % (3 people), two chromosomes – in 23.5 % (8 persons). Analysis of the data of group II showed significant differences in the subgroups in the frequency of chromosome polymorphisms, in patients of group IIa changes were noted only in one chromosome, and in IIc, every fifth patient had polymorphism of two chromosomes.

Conclusion. Despite the fact that genetic breakdowns are uncontrollable factors and it is not possible to directly influence them, the search for possible mechanisms leading to them is promising.

Objective. To determine whether inorganic menstrual dysfunction (MD) is associated with magnesium, iron and vitamin D deficiency in women of reproductive age.

Materials and methods. The study group I consisted of 50 women with MD: dysmenorrhea (16 women), oligomenorrhea (12 women), functional hypothalamic amenorrhea (3 patients) and acyclic abnormal uterine bleeding (19 women), the comparison group II was composed of 30 patients with normal menstrual function. The methods of study included history taking using a questionnaire to detect the signs of magnesium deficiency, physical examination, echography of pelvic organs, full blood count, blood tests to determine the concentration of magnesium, vitamin D and ferritin as well as consulting a therapeutist.

Results. Magnesium deficiency was registered significantly more often in patients with MD (93.0 ± 3.6 %, 73.0 ± 8.1 %, respectively; p < 0.05). The most typical signs of magnesium deficiency were the central symptoms: headache (58.0 ± 7.1 %, 22.0 ± 7.6 %; p < 0.001), irritability (53.0 ± 7.1 %, 26.0 ± 8.0 %; p < 0.01), dyssomnia (45.0 ± 7.0 %, 17.0 ± 6.9 %; p < 0.01), dizziness (42.5 ± 7.0 %, 22.0 ± 7.6 %; p < 0.05), a decrease in libido (34.0 ± 6.7 %, 13.0 ± 6.1 %; p < 0.05), as well as trophic disturbances including hair loss (38.0 ± 6.9 %, 13.0 ± 6.9 %; p < 0.01). Similar findings were obtained when we studied the iron supply: the frequency of latent iron deficiency (according to ferritin concentration) was 77.0 ± 5.9 and 35.7 ± 8.4 % respectively; p < 0.001. Deficiency or insufficient supply of 25(ОH)D was registered significantly more often in women with MD in comparison with healthy women (45.0 ± 7.0 %, 20.0 ± 7.3 %; p < 0.05).

Conclusions. In summary, determination of the level of micronutrients and adequate compensation of their deficiency can be important factors in physiological correction of endocrine imbalance leading to functional disorders in the reproductive system and a decrease in fertility.

Objective. To study a wound-healing activity of the earlier synthesized ‘compound-leader” sodium 2- (adamantan-1-yl)-2-hydrazino-5-phenyl-4-oxobutenoate (1), as well as to establish the possibility of its practical application in the ointment dosage form.

Materials and methods. The “substance-leader” 1 was synthesized by the chemical methods described earlier. The experimental 5 % ointment composition based on an aqueous solution of sodium alginate was developed in compliance with the rules for preparing homogeneous ointments. Its effect on the healing of linear aseptic skin wounds in white rats was studied by the method of wound-tensiometry.

Results. The experimental 5 % ointment composition with compound 1 was found to significantly increase the scar tensile strength compared to control without treatment. The developed model ointment showed wound-healing activity comparable to that of the reference drug (Levomekol ointment).

Conclusions. The selected “substance-leader” 1 in the composition of a model 5 % hydrophilic ointment based on sodium alginate exhibits pronounced biological activity and is a candidate for further research as a potential pharmaceutical substance with complex wound-healing and anti-inflammatory property.

Objective. To conduct a comparative study of the prevalence of specific symptoms in patients with kidney damage using the automated program "Electronic Polyclinic" to optimize the algorithm for early diagnosis of chronic kidney disease.

Materials and methods. 18 patients of the therapeutic unit with kidney lesions, confirmed by laboratory and instrumental studies, as well as 7 healthy persons were examined. The main problems of patients were identified by the method of interactive questioning with the help of the program "Electronic Polyclinic". Further, a statistical analysis of the data and a comparative study with the control group of healthy persons were carried out using STATISTICA 12.0 program.

Results. The main symptoms of kidney damage were reliably determined and a low sensitivity of individual symptoms in the diagnosis, in contrast to the syndromic approach, was revealed. It showed that in 100 % of cases the automated program "Electronic Polyclinic" detected the syndromes, that indicates its high efficiency. An algorithm for early diagnosis of chronic kidney disease was proposed, which consists in an initial interactive survey followed by examination formulated by the computer program.

Conclusions. The method of interactive survey using the automated program "Electronic Polyclinic" allows you to effectively identify the syndromes of kidney damage, makes a preliminary diagnosis and draws up a plan of examination for further confirmation of the diagnosis. Symptomatic diagnosis has a number of disadvantages including low sensitivity and specificity, so it yields to syndromic diagnosis.

The article is devoted to the analysis of journals included in the list of peer-reviewed publications recommended by the Higher Attestation Commission for the publication of materials of works on the specialty 14.02.04 “Occupational Medicine” (edition 12.07.2021). The data on the characteristics and publication activity of these journals are presented from the point of view of choosing a printed publication for publishing the materials of the dissertation research and when choosing a journal for publishing the results of scientific research in accordance with the requirements for the indicators of publication activity of scientific and pedagogical workers.

Objective. To assess the effectiveness of the low-dose air ozonation for disinfection of the air in the working room.

Materials and methods. We investigated 90 air samples (3 samples were taken weekly before and after the production meeting using the automatic sampling device of biological aerosols of air PU-1B). The total bacterial contamination, the content of staphylococci and mold spores were determined. Ozonation of the room (83.3 m3) was carried out for 20 minutes by means of domestic ozonator. The accumulated dose of ozone was 133.3 mg (1.6 mg/m3). Statistical data processing was carried out using the MedStat licensed program. The median, median error (Me ± me), left and right 95 % confidence intervals (95 % CI) were calculated. Paired comparisons were made using Wilcoxon's T-test.

Results. After the meeting, the total bacterial contamination of the air was 56.0 ± 9.3 (47.0–78.0) CFU. The content of staphylococci and mold spores in the air was 85.5 ± 12.5 (76.0–100.0) and 44.5 ± 6.5 (32.0–54.0) CFU, respectively. After ozonation, the total bacterial contamination of the air was 14.5 ± 3.6 (10.0–21.0) CFU. The content of staphylococci and mold spores in the air after ozonation was 35.5 ± 6.7 (25.0–52.0) and 26.0 ± 5.0 (18.0–32.0) CFU, respectively. Ozonation of the room provided a significant decrease (p < 0.001) in all three of the above indicators. The room ozonation carried out promoted a reliable decrease (p < 0.001) in all the above mentioned parameters.

Conclusions. The above data and analysis of the literature show the possibility of using low doses of ozone for the prevention of bacterial, fungal and viral infections including SARS-CoV-2. Further study and development of reasonable modes of ozone disinfection, including low doses of ozone, is needed, as well as determination of the efficiency degree of air disinfection with non-toxic gas concentrations.

This article presents an observation of a clinical case in a patient with the postoperative sternomediastinitis. In cardio-thoracic surgery this complication ranges from 1 to 10 % [2, 3, 14, 16, 19] depending on who the work is done by and the ratio of deaths can reach up to 40 % [13]. Due to untimely diagnosis of the pyoinflammatory process in the tracheostomy orifice, the patient developed progressive instability of the sternum followed by sternomediastinitis.

A two-staged tactics of treatment of the postoperative sternomediastinitis using the technique of negative pressure followed by two-flap omentoplasty according to K. Yoshida in this case is the technique of choice for surgical treatment, which allows to restore the integrity of the chest wall frame in the shortest possible time and ensure tightness for the mediastinum. This technique is the most effective in the treatment of destructive forms of purulent complications of the sternum after a median sternotomy. The relevance and expediency of the use of omentoplasty is also justified from a financial and medico-social position, since the procedure reduces mortality among patients of this category, as well as the risk of severe disability at the able-bodied age.

The article is devoted to the 85-th anniversary of the birth of Professor Viktor Vasilyevich Trusov (1936-2012), one of the prominent representatives of the therapeutic scientific school of Izhevsk State Medical Academy. In the range of diverse scientific interests and developments of Viktor Vasilyevich, the issues of practical assistance to patients with endocrinological pathology, including patients with diabetes mellitus, occupied a significant part. Professor Trusov V. V. was a member of the Board of Endocrinologists of Russia, a member of the European Association of Diabetologists, a member of the American Association of Diabetologists. He worked on the problems of optimizing care for patients with diabetes.