Perm Medical Journal

Objective. To analyze the correlation between dental symptoms and clinical and functional manifestations of Crohn's disease (CD) and ulcerative colitis (UC).

Materials and methods. A prospective, observational, longitudinal clinical study of 70 patients with verified inflammatory bowel diseases, i.e. Crohn's disease and ulcerative colitis, has been performed. For an in-depth assessment of the oral mucosa (OM) and red lip border (RLB) condition in patients with these systemic diseases, a complete dental examination has been carried out. The validated questionnaire "7´7" was used to objectify the symptoms of functional gastric dyspepsia.

Results. In patients with the main clinical manifestations of the gastrointestinal tract impairments in CD and UC, extraintestinal dental manifestations in the form of meteorological cheilitis (16 and 9, respectively;
p = 0.081), glossitis (15 and 11, respectively; p = 0.323), onset of recurrent aphthous stomatitis (17 and 11;
p = 0.144), chronic mechanical trauma of oral mucosa (14 and 11; p = 0.455), and the presence of scalloped tongue (28 and 21, p = 0.068) were diagnosed. At the same time, the incidence of associated pathologies of OM and RLB was significantly higher in patients with CD (p<0.05) than in patients with UC. Clinical examination of patients revealed predominance of flatulence symptoms in patients with CD and UC in 74.3 and 77.1 % of cases, respectively (р = 0.771). Patients with CD prevailed in the number of dyspeptic disorders and their variability but statistically significant differences were determined only for the symptom 'abdominal pain decreasing after bowel emptying'. The correlation between the frequency of dyspeptic disorders in patients and characteristic changes in the clinical state of RLB and OM was revealed. For the CD and UC groups Chuprov conjugacy coefficients were statistically significant (ChC=0.36, ChC=0.28 respectively). In patients with CD clinically apparent changes in the RLB and OM associated with various dyspeptic disorders were manifested more often than in patients with UC.

Conclusion. The conducted study has shown that in patients with CD and UC there is a correlation between the frequency and severity of the main functional and clinical symptoms/syndromes (in the form of edema, hyperemia, pitting edema of the ОМ (in fact) and the RLB) and dyspeptic disorders, this correlation being stronger in Crohn's disease (p = 0.031 vs p = 0.046).

Objective. To study the relationship of the upper gastrointestinal tract acidity index and collagen metabolites and proteoglycans in children with GERD.

Materials and methods. 62 children with GERD were observed. The control group included 32 children. All children underwent esophagogastroduodenoscopy with parietal endoscopic pH-metry. The content of free hydroxyproline (FHOP), peptide-bonded hydroxyproline (PSHOP), glycosaminoglycans (GAG), as well as
a-mannosidase activity in gastric juice were studied.

Results. The hyperacidity of the pH in the esophagus, the gastric “lake” and the body of the stomach in children with GERD was revealed. A relationship between hyperacidity and the breakdown of collagen in the mucous membrane of the gastroesophageal area demonstrated by high levels of GAG, FHOP, and PSНOP
a-mannosidase in the gastric juice has been shown.

Conclusions. In children with GERD, the dynamic balance of aggressive-protective factors in the gastroduodenal area is disturbed. As a result of it, degradation of collagen in the mucous and submucous layer of the esophagus and stomach is observed.

Objective. To identify the relationship of eating behavior and clinical and metabolic status of 6–11-year-old children in order to develop effective methods for prevention and treatment of obesity and its complications.

Materials and methods. 94 children aged 6 to 11 participated in the research. They formed 2 groups:
group I (n = 64) – obese children (standard deviation score (SDS) of body mass index (BMI) ≥ +2.0),
group II (n = 30) – children with normal body weight (SDS BMI –1.0 … +1.0). Clinical and laboratory
parameters were studied and eating behavior was assessed using the Child Eating Behavior Questionnaire.

Results. As a result of the study, it was determined that average values of triglycerides (TG), uric acid (UA), thyroid-stimulating hormone (TSH), fasting glycemia (FG), p = 0.001, p = 0.002, p < 0.001, p < 0.001 were higher in obese children. The following features of the eating behavior in obese children have been revealed: a more active reaction to food and emotional overeating, p = 0.016, p = 0.004 Statistically significant direct moderate correlations between SDS BMI and the level of TG, UA, TSH and FG under the influence of eating behavior according to the “eating approach” type were established.

Conclusions. An association between the pattern of eating behavior in obese children aged 6–11 and their clinical and metabolic status, which determines the risk of atherosclerosis and cardiovascular diseases in the future was revealed. The results obtained are a justification for identifying the nature of children`s eating
behavior in order to prevent the development of obesity and associated complications, as well as to increase the effectiveness of therapy.

Objective. To assess the influence of the autonomic nervous system tone on the activity of the inflammatory process in facial phlegmon.

Materials and methods. A group of patients with facial phlegmon (n = 74) was divided into two parts according to the predominant type of ANS. To identify the dominant type of ANS the method of A.M. Vayne was used. The content of leukocytes and their types was assessed in peripheral blood samples. The concentration of glucose, total protein, C-reactive protein was determined in the patients` blood serum. Statistical data processing was carried out using Student's t-test.

Results. Significant differences in laboratory parameters of patients with facial phlegmons with different types of the autonomic nervous system are demonstrated. In patients with prevailing sympathetic division, leukocytosis with a shift of the formula to the left was more pronounced. When the parasympathetic division dominated, a higher concentration of C-reactive protein was observed.

Conclusion. Assessment of the autonomic nervous system tone in case of facial phlegmons indicates its significant impact on the activity of the inflammatory process, which affects the duration of inpatient treatment.

The search and analysis of data on treatment options of advanced stages of Parkinson's disease from various scientific sources on biomedical research PubMed in the Medline, Russian scientific electronic library CyberLeninka databases are summarized in the article. A comparison of data was performed to highlight the main directions of modern approaches to the treatment of advanced stages of Parkinson's disease. To treat the disease at a late stage with pronounced motor fluctuations in the form of “off” symptoms and painful dyskinesias during the “on” period, invasive and non-invasive high-tech methods of treatment are used. The most relevant method of treatment for Parkinson's disease in patients with a long history of the disease and side symptoms of traditional medicinal methods of correction are the use of Duodopa - levodopa/carbidopa intestinal gel (LCIG). It is important to note that the increased "on" period can allow people with advanced Parkinson's disease to raise motor activity, thereby improving their independence in daily activities from other people.

Objective. To develop a way of prediction of fetal growth restriction in the first trimester of pregnancy in obese women.

Materials and methods. 85 obese pregnant women at 6–9 weeks of gestation took part in the study. Obesity was determined by body mass index, as squared height (m)-to-weight (kg) ratio, with a BMI > 30 kg/m2. In the blood serum of all patients the level of total copper (Cuvol.) was determined by the colorimetric method, and ceruloplasmin (CP) by of V.S. Kamyshnikov`s method and the percentage of free copper (Cufree) was calculated. The free copper index was calculated using the formula: Cufree = (Cuvol. – (ceruloplasmin · 3)) / Cuvol. · 100, where
Cufree is the percentage of free copper in the blood serum, %; Cuob. – content of total copper in blood serum, µmol/l; CP – content of ceruloplasmin in blood serum, mg/l; 3 – conversion factor. All pregnant women were divided into two groups depending on the percentage of free copper: group A – pregnant women with obesity and free copper content > 25 % (n = 26); group B – obese pregnant women with a percentage of free copper < 25 %, (n = 59). The control group consisted of 20 pregnant women with normal body weight.

Results. Among the studied groups, in pregnant women with obesity statistically significant differences in the content of total copper (p = 0.013), and the percentage of free copper (p = 0.041) were revealed. In the group of pregnant women with a free copper content > 25 % chronic placental insufficiency occurred 1.5 times more frequently and fetal growth restriction syndrome was 6.4 times more frequent than in the group of patients with a free copper content of < 25 %.

Conclusion. The free copper level, determined in the first trimester of pregnancy equal to 25% or more, can be considered as a predictor of fetal growth restriction in obese pregnant women.

Objective. To conduct a comparative analysis of the informative content of cone beam computed tomography (CBCT), multispiral computed tomography (MSCT) and paranasal sinuses half-axial X-ray images in the upper jaw pathology diagnosis.

Materials and methods. 96 CBCT and MSCT scans of the upper jaw and the similar number of X-ray images of the same patients were analyzed.

Results. The analysis of a three-dimensional image and native slice reading in the Planmeca programme makes it possible to determine metric parameters, localization, prevalence of the pathological process and involvement of the upper jaw structures validly. Software features of the Radiant and OneDemand3D had error interval of р ≥ 0,2 mm while analyzing the same criteria. Half-axial X-ray examination demonstrated the lowest informative content.

Conclusion. The most informative method of visualization of the upper jaw connective tissue structures, pathological processes, their borders and mutual involvement is CBCT. This is predetermined by the interface functionalities.

Objective. To evaluate the effectiveness of implementation of lean production methods into the practical activity of primary health care on the example of the State Institution of Health Care «Saratov City Polycli nic № 2».

Materials and methods. The study was divided into three stages: data collection through anonymous sociological surveys using phones or tablets, timing and improvement of the process, and a follow-up questioning of participants to assess their satisfaction. 296 residents of Saratov receiving primary health care at the polyclinic took part in the survey. The survey was conducted using a specially developed electronic questionnaire via Google Form. For mathematical processing, the results of the study were initially transferred into an electronic database; the results of the study were analyzed using the descriptive statistics method.

Results. According to the survey, the majority of respondents are satisfied with the quality of outpatient medical care. This shows that organization of the medical care is focused on the patients` needs and desire to meet their demands. The organization of the front office and the premises of the polyclinic in accordance with the requirements for the new model of the organization providing primary medical care made it possible to achieve a high evaluation of the information stands and the waiting area. The study showed that ineffective organization of the registry office contributed significantly to the patients` low assessment. In our opinion, in order to solve the problem, it is necessary to optimize the work of the registry office by introducing modern technologies and equal distribution of duties among the employees.

Conclusions. In order to improve the quality and accessibility of medical services, it is necessary to make certain changes in the organization of medical care. The level of patient satisfaction with the work of medical institutions may depend on various factors, such as waiting time for a doctor, the timing of medical services provision after the appointment, the availability of necessary diagnostic tests and specialists.

One of the common causes of urinary retention and pain symptom in urological practice is ureteric stricture. Surgery remains the only effective method of treatment. Currently, the modern minimally invasive operations are the most relevant. Minimally invasive high-tech surgery: percutaneous endoureterotomy followed by the installation of tandem stents demonstrates effectiveness in treatment of recurrent strictures of the upper urinary tract.

Favorable outcomes of surgical treatment of two patients with blunt liver damage of IV degree according to E. Moore as part of polytrauma are presented. In conditions of unstable hemodynamics and extremely severe state of the patient, the authors used a method of liver damage tamponing with a single tampon material (cotton surgical sheet) as an initial hemostasis. The applied method of liver damage tamponing helps to achieve a stable initial hemostasis, it does not require a highly-qualified surgical team and can be used in second- and third-level trauma centers.

Family papillary microcarcinoma of the thyroid gland is observed in 3–10 % of patients with cancer from follicular epithelial cells. Diagnosis and treatment are controversial. Three patients from the same family of the first degree of kinship were operated for family papillary microcarcinoma of the thyroid gland in Voronezh Regional Clinical Hospital No. 1. Only the first patient complained of the neck deformity, her son and granddaughter had an asymptomatic course of the disease. Metastases to the lymph nodes of the neck and bilateral localization of the tumor were not revealed. In the third generation, multifocal tumor growth was diagnosed at the age of 19. All patients underwent thyroidectomy. In the first patient, the period of relapse–free follow-up after surgery was 18 years, in the second and third – 5 years.

In the family form of papillary thyroid carcinoma, we consider active screening of relatives justified since the disease in the new generation may develop at a younger age and with the risk of multifocal thyroid damage even in microcarcinomas.

Objective. To assess changes in the generation of hydroxyl radicals by leukocytes under the influence of cadaverine at concentrations of 1, 5 and 25 mmol/L.

Materials and methods. Peripheral venous blood samples were obtained from 40 apparently healthy donors. To assess the production of hydroxyl radicals, a luminol-dependent chemiluminescence reaction with blood leukocytes, which were pre-incubated with cadaverine at concentrations of 1, 5 and 25 mmol/L was carried out. The study was conducted on a Luminoskan Ascent® Thermo Labsystems (USA) luminometer for 180 minutes. For statistical analysis, the integral chemiluminescence indicator for the entire measurement period (RLU) was used. The time to reach the maximum of light flashes in minutes, the intensity of the utmost glow, and the area under the luminescence extinction curve were calculated.

Results. It was determined that pre-incubation of cells with cadaverine significantly reduces their time to reach the maximum generation of hydroxyl radicals. In addition, cadaverine enhances the intensity of the reaction of luminol-dependent chemiluminescence of leukocytes of healthy donors, and the greatest stimulating effect was recorded at a polyamine concentration of 5 mmol/L (p =0,009 to samples with a spontaneous reaction, p =0,007 and 0,010 to samples with cadaverine 1 mmol/L and 5 mmol/L respectively). Cadaverine increases the area under the reaction curve, it being the most significant at a concentration of 5 mmol/L – 20.89±3.00 c.u. versus 0.86±0.07 c.u. with a spontaneous reaction (p=0,001).

Conclusions. The results of the study indicate a possible effect of cadaverine on the mechanisms of hydroxyl radical formation, as well as the activity of the diamine oxidase enzyme in leukocytes. It can be supposed that the combination of these effects contributes to the development of the environment favorable for microorganisms at the focus of inflammation. Thus, microorganisms that produce cadaverine, which modulates the generation of hydroxyl radicals by leukocytes, adapt to their environment, creating a special type of microenvironment, which probably results in an asymptomatic course of the inflammatory process.