Vol 4, No 1 (2019)

Obstetrics and Gynecology
Endometriosis in perimenopausal transition period and in postmenopause: clinical, diagnostic and therapeutic aspects
Kalinkina O.B., Tezikov Y.V., Lipatov I.S., Aravina O.R., Martynova N.V.
Abstract

Objectives – efficiency assessment of the dienogest (Visannе) in treatment of perimeopausal patients with adenomyosis and postmenopausal women, in whom the adenomyosis was newly diagnosed.

Material and methods. Included in the study, there were 64 patients (aged 45–52 years) who had undergone the surgical treatment of adenomyosis followed by the dienogest treatment at a dose of 2 mg, and 47 women in the age of 54–57 years with newly diagnosed adenomyosis in the course of menopausal hormone therapy (MHT). All patients received 2 mg of dienogest (Visannе, Bayer) during the period of 3–6 months. Medical checkup was performed in 3 and 6 months after initiation of treatment.

Results and Discussion. The remarkable reduction in clinical manifestations and improvement of uterine walls structure was registered in both groups of patients in 3 months of treatment. However, in 25% of patients the echographic changes remained significant. In 6 months all the patients had a sustained remission and amenorrhea.

Conclusion. In the course of investigation the dienogest (Visannе) at a dose of 2 mg revealed high efficacy in treatment of endometriosis in late perimeopausal and postmeopausal patients with a diagnosed abnormal uterine bleeding associated with adenomyosis.

Science and Innovations in Medicine. 2019;4(1):4-7
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Combined approach to clinical classification of chronic placental insufficiency in perinatal period: setting standard in diagnostic and obstetric management
Tezikov Y.V., Lipatov I.S., Gogel L.Y., Azamatov A.R., Ermetov V.K.
Abstract

Objectives – to implement both a new clinical classification of chronic placental insufficiency (CPI) and a new complex rating scale based on calculation of an integral indicator of compensatory-adaptive placental reactions in order to improve perinatal outcomes.

Material and methods. We examined 154 pregnant women with high risk of severe placental insufficiency (PI) in whom the markers of apoptosis, endothelial dysfunction, cell transformation and energy exchange were detected in gestation weeks 18–24 and 28–38 via blood analysis. It served the basis for development of the CPI severity rating scale. Diagnostic correlations in 359 pregnant women with various clinical and morphological manifestation of chronic PI allowed us to develop an original method of diagnosing the severity of this complication.

Results and Discussion. The sequential changes in placenta in CPI ("placenta dysfunction" → "decompensated PI" → "progressive decompensated PI" → "acute PI") formed the basis of a new CPI clinical classification. The final indicator was calculated according to the complex point scale. The indicator's value from 1 to 3 points corresponds to placental dysfunction; the decompensated PI is diagnosed at 4 to 9 points; at 10 to 13 points – progressive decompensated PI; starting from 14 points – acute PI. The absence of PI is reported if the value of the final indicator scores zero.

Conclusion. Setting a standard in the CPI diagnostic makes it 39% more accurate in severe PI, improves the perinatal outcomes by 60%, helps to avoid the disabling conditions in the neonates. High informativity and reliability of the developed PI severity rating diagnostic method was confirmed within the evidence-based medicine approach.

Science and Innovations in Medicine. 2019;4(1):8-15
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Infectious diseases
New prognostic method for estimation of lipid distress syndrome development in patients with chronic hepatitis C
Konstantinov D.Y., Nedugov G.V., Popova L.L., Konstantinova E.A.
Abstract

Objectives – to work out a prognostic method, based on clinical and laboratory data, which can predict the development of lipid distress syndrome in patients with chronic viral hepatitis C.

Material and methods. We studied the outcomes of chronic viral hepatitis C with respect to development of lipid distress syndrome in 267 patients who did not receive antiviral therapy during the observation period lasting for 1 to 7 years.

Results. Discriminant function analysis of the data acquired after examination of 167 patients helped us to work out a discriminative model of predicting the development of lipid distress syndrome in patients with chronic viral hepatitis C in the absence of antiviral therapy. Cross-checking of prediction accuracy was carried out on the data of examination of other 100 patients.

Conclusion. The designed technique for predicting the development of lipid distress syndrome in patients with chronic hepatitis C is characterized by point estimates of sensitivity and prognostic value of the negative result equal to 100%.

Science and Innovations in Medicine. 2019;4(1):16-19
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Cardiology
Risk factors in patients with familial hypercholesterolemia: risk stratification and treatment tactics
Simerzin V.V., Krasovskaya M.A., Gagloev A.V.
Abstract

This review focuses on traditional and occasional risk factors in patients with familial hypercholesterolemia (FH) that influence their medical condition along with the level of the extreme hypercholesterolemia and their age (time of exposure to hypercholesterolemia).

The risk factors in question can define the patients' stratification in groups of high and extreme risk, assist in treatment tactics and strategy.

Science and Innovations in Medicine. 2019;4(1):20-25
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Pharmacoeconomics of treatment patients with high level hypercholesterolemia
Fatenkov O.V., Panisheva Y.A., Galkina M.A., Sytdykov I.K.
Abstract

This review highlights the principles of early diagnosis and treatment of patients with heterozygous familial hypercholesterolemia. Innovative and highly efficient technologies exist for prevention of the atherosclerotic process in the arterial part of the vascular system, its inhibition and elimination. They help to stabilize the patient's condition and to reduce the target organs damage. The treatment strategy, described in this review, is effective in terms of cure and pharmacoeconomics. It decreases the risk of atherosclerotic cardiovascular disease (ASCVD) and its complications in patients. The positive outcomes are the decrease of exposure to extreme level of LDL-C, reduction of the cumulative burden of disease and mortality rate, the extension of patients' life expectancy.

Science and Innovations in Medicine. 2019;4(1):26-31
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Occupational medicine
Male reproductive function in concurrent vibration disease and arterial hypertension
Babanov S.A., Baraeva R.A.
Abstract

Objectives – to study the severity of androgen deficiency and erectile dysfunction in patients with vibration disease and in its combination with arterial hypertension.

Material and methods. 145 male patients with various forms of vibration disease were thoroughly examined. The following groups were defined – I stage and II stage vibration disease induced by local vibration; II stage, induced by local vibration with concurrent arterial hypertension; I and II stage vibration disease induced by whole body vibration; II stage vibration disease induced by whole body vibration with concurrent arterial hypertension. The control group included 30 patients. Evaluation of erectile function in men with vibration disease and its combination with arterial hypertension was carried out using the scale of severity of erectile dysfunction (International Index of Erectile Function, IIEF-5). The questionnaire for detection of androgen deficiency (Dedov II, Kalinchenko SYu, 2006) and the AMS (aging males' symptoms) questionnaire assisted in revealing the symptoms of aging in men.

Results. According to the IIEF-5 questionnaire results the erectile dysfunction was defined in patients with vibration disease, most pronounced in II stage of vibration disease induced by whole body vibration and in vibration disease of any etiology with concurrent arterial hypertension. AMS-questionnaire presented the most expressed signs of androgen deficiency in patients with II stage of vibration disease induced by whole body vibration and in vibration disease of any etiology with concurrent arterial hypertension (p <0.001). The questionnaire for the detection of androgen deficiency in patients with vibration disease revealed the androgen deficiency in II stage of vibration disease induced by local vibration, in I and II stage of vibration disease induced by whole body vibration, and in vibration disease of any etiology with concurrent arterial hypertension (p <0.001).

Conclusion. Thus, the influence of whole-body and local vibration and its combination with arterial hypertension on the androgen deficiency and erectile dysfunction in male patients was defined. It damages male reproductive function and there is a set of features that must be considered in prophylaxis and treatment.

Science and Innovations in Medicine. 2019;4(1):32-36
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Public health and health service
Advanced approach to diagnostics of chronic alcohol abuse
Tsarev S.A., Shcherban A.V., Suslin S.A., Katin A.A., Sirotko I.I.
Abstract

Objectives – to identify the criteria of selecting the applicants for professional drivers who require the carbohydrate-deficient transferrin (CDT) assay, which can be applied by an addiction psychiatrist.

Material and methods. The extensive analysis of testing results of 232 patients admitted to Samara Regional Narcological Dispensary from its local subsidiaries in Samara and the Samara Region was carried out.

Results. The fact of driving in drunk condition in the past was defined as the criterion having the diagnostic value.

Conclusion. The patients with the known fact of drunk driving had the majority of positive test results of the chronic alcohol abuse, compared to other groups of patients in this study.

These findings make it possible to declare the deprivation of driving license due to the drunk driving to be a valuable criterion to submit the applicant for the CDT assay during his qualifying as a driver.

Science and Innovations in Medicine. 2019;4(1):37-41
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Establishing and development of hematology service in Russia
Sheshunova R.A.
Abstract

Objectives – in this review of the hematology service in Russia we focus on its characteristic features in formation, structure, development and prospect.

Results. The review presents the characteristics of the Russian hematology service in whole period of existence – starting from its origin and leading to its modern condition. The problems and prospects for development of the hematology service are thoroughly considered.

Science and Innovations in Medicine. 2019;4(1):42-47
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Paediatrics
New clinically relevant biochemical and functional markers in neonatology
Zakharova L.I., Pechkurov D.V., Poretskova G.Y., Koltsova N.S.
Abstract

Objectives – to identify the markers of liver functional maturation, the dynamics of the cyclic nucleotide in blood plasma, the indicators of cerebral hemodynamics in premature infants during the early and late neonatal periods.

Material and methods. The study included 330 premature infants of 26th – 37th weeks of gestation, examined in early and late neonatal periods. There were 3 groups profiled according to the type of leading pathology – respiratory distress syndrome (RDS) (group I, included 80 children), newborn jaundice and edema syndrome (group II, included 80 children), intraventricular hemorrhage Grade1 (IVH Grade1) (group III, consisted of 46 children). The groups in the study were matched by 3 comparison groups of 124 healthy preterm infants.

Results. The clinical significance of the first assayed quantitative indicators of AFP, serum albumin system, cyclic nucleotides, plasma fibronectin in conditionally healthy children of different gestation periods is discussed. The scientific credence was given to pathogenetic role of deviations of these indicators in the development of RDS (the decrease in cAMP, the increase in cGMP, the decrease in ratio cAMP/cGMP); in jaundice and edema syndromes (the increased AFP, the reduction in effective serum albumin concentration (EAC) and overall serum albumin concentration (OAC)), IVH grade 1 (the reduction of plasma fibronectin, and the blood flow speed in vein of Galen according to neurosonography with with Doppler measurements (NSDG) in the first days of life).

Science and Innovations in Medicine. 2019;4(1):48-52
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New approach to assessment and correction of intestinal microbiome imbalance in children with atopic dermatitis
Pechkurov D.V., Zaynullina O.N., Tyazheva A.A., Lyamin A.V.
Abstract

Objectives – to study intestinal microbiota species for differentiated approach to treatment of atopic dermatitis (AD) in children.

Material and methods. The study included 60 children, 34 girls and 26 boys aged from 3 to 12 years, with AD and concurrent intestinal dysbiosis. The experimental group consisted of 30 children assigned to differentiated correction of intestinal microbiome imbalance in addition to the standard therapy. Correction mode depended on the results of microbiological fecal examination of microbiota species using the mass spectrometry. The control group of 30 children received the standard treatment of atopic dermatitis.

Results. Gut microbiome imbalance of different severity was revealed in all children with AD. The study ascertained the increase of the enterobacteria of various types, including true pathogenic ones, in atopic dermatitis. The direct correlation was revealed between the AD severity and the degree of dysbiosis with the coefficient value 0.69. As a result of complex treatment in the experimental group, the ratio of children with severe dysbiosis reduced from 60.0% to 20.0%, the proportion of children with moderate dysbiosis also decreased from 26.6% to 20.0%.

The reduced treatment time was one of the study outcomes: 14 days in the experimental group and 21 days in the standard therapy group. Clinical remission was observed in 26.7% of children.

Conclusion. The study supported the rationale for the differentiated approach to the treatment of AD in children. The preliminary microbiological study of feces for microbiota species by MALDI-ToF mass spectrometry is necessary. Selection of probiotics depends on the deficit or overbalance of the specific types of microorganisms in a patient. Thus the treatment effectiveness is improved and the remission period is extended.

Science and Innovations in Medicine. 2019;4(1):53-57
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Schoolchildren and adolescents health problems in Samara: current trends
Poretskova G.Y., Tyazheva A.A., Rapoport I.K., Voronina E.N.
Abstract

Objectives – to reveal the health dynamics in schoolchildren in Samara, to identify the types of pathological conditions.

Material and methods. We used data from school medical records of pupils in grades 1–4 (2070 children), clinical examination of adolescents aged 14 years (788 people), and data of dynamic monitoring of schoolchildren aged 15–17 years (1002 people). Statistical processing was carried out according to the standard procedure using a package of Windows applications (Excel, Word), Statistica.

Results. We revealed the decrease in the number of healthy children from 1st to 4th grade from 27.2% to 8.8%, and an increased quantity of pupils with functional and chronic health conditions. The morbidity analysis of the 1st grade schoolchildren demonstrated the high ranks of nervous system diseases, mental and behavioral disorders (289.3‰ and 241.6‰), the third place was taken by musculoskeletal system pathologies (200.0‰), in the fourth – diseases of the respiratory system (148.8‰), in the fifth – diseases of the eye (144.1‰). In the 4th grade the leader was the diseases of the musculoskeletal system (548.5‰), diseases of the eye (374.4‰), diseases of the digestive system (167.4‰). In adolescents the pathology of musculoskeletal system was most often registered (376.0‰), vision impairment was the following (346.6‰).

Conclusion. In respect to the nosology and dynamics of health problems in schoolchildren it is necessary to identify the risk factors and to implement targeted prevention programs.

Science and Innovations in Medicine. 2019;4(1):58-62
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Adaptive capacity characteristics in children with tonsillitis in course of acute infectious diseases
Santalova G.V., Plakhotnikova S.V., Gasilina E.S.
Abstract

Objectives – to improve a method of assessment for adaptive capacity of children with tonsillitis in course of acute infectious diseases, based on the parameters of the autonomic nervous system.

Material and methods. The prospective study included clinical, anamnestic and laboratory examination of children with acute infectious diseases with concurrent tonsillitis syndrome. The factors under study underwent a systematic multivariate analysis.

Results. Heart rate variability was assessed with the following comparative statistical analysis of the acquired data. By mathematical modeling we estimated the influence of the studied factors on the adaptation process. Based on the developed models, a diagnostic algorithm was proposed.

Conclusion. Mathematical modeling of the basic ANS function parameters in children with tonsillitis and acute infectious diseases of different etiology has allowed to improve the assessment of the adaptive capacity and to identify the crucial factors which influence the choice of examination tactics.

Science and Innovations in Medicine. 2019;4(1):63-66
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Dentistry
Analysis of hemodynamics and state of the head and neck vessels in patients with gnatic form of malocclusion class III before and after the orthognatic surgery (clinical case)
Postnikov M.A., Andrianov D.A., Osadchaya E.I., Malkina V.D.
Abstract

Objectives – to evaluate and compare the hemodynamics and the condition of the head and neck vessels in patients with gnathic form of malocclusion class III before and after the orthognathic surgery on the lower jaw; to find the relationship between the disturbance in blood flow and the occlusal pathology.

Material and methods. We examined an 18-year-old female patient with gnathic form of malocclusion class III who previously had received the orthodontic treatment. An operation on the lower jaw was performed. We used X-ray (orthopantomography (OPT), teleradiography), cone-beam computed tomography (CBCT) and functional diagnostic methods (Doppler ultrasonography of the head and neck vessels) before and after surgery on the lower jaw.

Results. After the surgery on the lower jaw there were changes in angular and linear parameters in the patient with malocclusion class III according to the teleradiography data. We also detected local hemodynamically significant effects using Doppler ultrasonography.

Conclusion. We can recommend this new method that improves the quality of diagnosis of maxillofacial anomalies and the state of hemodynamics of the head and neck vessels to dentists of various specialties.

Science and Innovations in Medicine. 2019;4(1):67-72
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