Vol 4, No 4 (2019)

ENT Disorders

Estimation of auditory threshold in an extended frequency range in elderly people

Aizenshtadt L.V., Vladimirova T.Y., Kurenkov A.V., Kashapova A.M.


Objectives – to study hearing thresholds at high frequencies in elderly and senile patients, taking into account the age norm and the presence of comorbid diseases.

Material and methods. 111 patients aged from 50 to 97 years (mean age 70.5 ± 2.1) were examined, their age, auditory function, and concomitant diseases were also registered.

Results. The measured average auditory thresholds at high frequencies, if compared to the age-related standards for auditory sensitivity, have revealed an underestimated hearing loss in 12.6% of patients. The presence of concomitant diseases has a significant impact on the development of chronic sensorineural hearing loss in each age group.

Conclusion. Audiometry in an extended frequency range in elderly patients with concurrent diseases can improve the hearing examination algorithm.

Science and Innovations in Medicine. 2019;4(4):4-7
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Virtual reality in rehabilitation of sensorineural hearing loss in adults

Vladimirova T.Y., Aizenshtadt L.V., Kurenkov A.V., Martynova A.B.


Objectives – to study the influence of the individual characteristics of a patient with chronic sensorineural hearing loss on the perception of VR technique.

Material and methods. The perception of VR was studied in 77 people in relation to their gender, age, auditory function, psychological and cognitive status.

Results. All the patients positively evaluated the use of the virtual reality method. The level of perception of VR in adults is determined by the degree of auditory impairment. A negative correlation was revealed between the indicators of cognitive and psychological status of the examined persons and the level of perception of VR.

Conclusion. The VR technique can improve the existing aural rehabilitation methods, especially in the group of people with socially significant hearing impairments.

Science and Innovations in Medicine. 2019;4(4):8-11
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Somatic tinnitus: clinical and neurophysiological features

Gilaeva A.R., Mosikhin S.B., Safiullina G.I.


Objectives – to identify variations in the intensity of tinnitus during the certain motor maneuvers, to evaluate the clinical and neurophysiological features of modulation in patients with tinnitus.

Material and methods. Vertebro-neurological, otorhino-laryngological examinations, audiological and neurophysiological (trigeminal evoked potentials) examinations were carried out in 100 patients with complaints of tinnitus.

Results. In 55% of patients the change in the intensity of tinnitus during various motor maneuvers was registered. The examination of these patients revealed a tendency towards the expression of myofascial disorders, a high burden with ear noise, the low values of compliance according to tympanometry, and the lengthening of the latent periods of peak trigeminal evoked potentials.

Conclusion. The results obtained may indicate the participation of the somatosensory system in the pathogenesis of tinnitus.

Science and Innovations in Medicine. 2019;4(4):12-15
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Formation of larynx topographic-anatomic relations with neck organs and structures in the intermediate fetal period of ontogenesis

Lutsay E.D., Anikin M.I., Murtazina N.I.


Objectives – to present topographic and anatomic characteristics of the larynx relationship with neck organs and structures in the intermediate fetal period of human ontogenesis.

Material and methods. The study included 85 organocomplexes of the fetuses neck of both sexes, from the 14th to the 27th week of development. The study material was divided into 2 age periods: the first group – fetuses aged 14–20 weeks; the second group – 21–27 weeks. The classical morphological techniques were used: (macromicroscopic preparation, modified method of saw cuts according to N.I. Pirogov, histotopographic method).

Results. Larynx syntopy with thyroid gland, cervical esophagus, thymus, submandibular glands was described in detail. Larynx skeletotopy with incisurae jugularis sterni, cervical vertebrae, hyoid bone, mandible was described quantitatively.

Conclusion. The data, obtained as a result of the study, supplement the data on the topographic anatomy of larynx and some neck organs and structures in the prenatal period of human ontogenesis. The revealed formation features of larynx and other neck organs and structures topography can be used in the study of intravital anatomy.

Science and Innovations in Medicine. 2019;4(4):16-20
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Features of microcirculation and effectiveness of conservative therapy in exacerbation of chronic tonsillitis

Ovchinnikov A.Y., Burenkov E.S.


Objectives – to study the characteristics of microcirculation in patients with chronic tonsillitis, caused by Streptococcus pyogenes, with confirmed sensitivity to the group of inhibitor-protected penicillins.

Material and methods. The study of micro vascular blood flow in the tonsils was performed with laser Doppler flowmetry, using the multifunctional diagnostic complex "LAKK-M" (Russia, 2010).

Results. The analysis of the microcirculation parameters of patients in group I showed significant changes in the functioning of their micro vascular blood flow, if compared to patients in the control group. The intensity of blood flow in the tonsils was significantly less in the individuals with low sensitivity to antibacterial therapy.

Conclusion. 1. In case of the clinical inefficacy of the antibacterial therapy in patients with microflora, sensitive in vitro to the same antibiotics, it is necessary to study the microcirculation in their tonsils. 2. Perfusion indicators can be used as an additional express-criterion for predicting the effectiveness of the conservative therapy. 3. If there is a significant change in the micro vascular blood flow, it is necessary to consider the possibility of surgical treatment of patients with chronic tonsillitis.

Science and Innovations in Medicine. 2019;4(4):21-24
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Diseases of the nervous system

Evaluation of heart rhythm variability in diagnosis of vegetative dysfunction in chronic cerebral ischemia

Poverennova I.E., Zakharov A.V., Vasemazova E.N., Khivintseva E.V., Novikova N.P.


Objectives – the assessment of the possibilities of using heart rhythm variability in the diagnosis of vegetative dysfunction in chronic brain ischemia (CBI).

Material and methods. Сardiointervalography was performed for 157 patients with varying intensity of CBI at rest and while performing functional tests. The resulting statistical and spectral parameters were estimated on the basis of multiple regression analysis depending on the severity of the CBI. The parameters, obtained as a result of spectral analysis of cardiointervalography, were used as the predictor data: low, high frequency end and their integrative indicators.

Results. With an increase in the severity of CBI, there is a clear tendency towards an increase in heart rate variability with a predominance of autonomous regulation, against the background of its expressed decentralization during physical exercise. The obtained model describes the changes in cardiointervalography that occur with the progression of CBI. These changes can act as independent factors aggravating the course of concomitant cardiovascular pathology, or can serve as its trigger factors.

Conclusion. The obtained data may indicate a decrease in the adaptive effects of suprasegmental structures of the autonomic nervous system on the cardiac cycle. Various methods of analysis of cardiointervalography make it possible to conduct a multilevel analysis of the heart rhythm, to identify not only the obvious pathology of the regulation of cardiac activity, but also the violation of its adaptive mechanisms.

Science and Innovations in Medicine. 2019;4(4):25-28
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Public health and health service

Analysis of syphilis incidence in the Republic of Mordovia

Blinova E.V., Balykova O.P., Laseev D.I., Chernova N.N., Kitaeva L.I.


Objectives – to study the syphilis morbidity rate in the population of the Republic of Mordovia in years 2015–2017, to determine the age, sex and social patterns of morbidity.

Material and methods. The subject of the analysis was the data of the official annual report on sexually transmitted infectious diseases, and contagious skin diseases in the Republic of Mordovia in 2015–2017.

Results. In 2017 the syphilis morbidity comprised 21.1 per 100k (total of 171 cases), this result is 2.8% lower than in 2016 (21.7 per 100k). In general, the morbidity rate remains 1.5 times higher than overage in Russia. Despite the positive dynamics, the preconditions for the further prevalence of syphilis among the population remain.

Conclusion. Additional measures are required, aimed at raising the general cultural level and health education of the population, regarding to the safe sexual behavior, especially among people of fertile age.

Science and Innovations in Medicine. 2019;4(4):29-32
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The main aspects of improvement of emergency medical care for patients with acute coronary syndrome

Breusov A.V., Kharchenko V.V., Breusov D.A.


Objectives – to develop the main strategies of emergency medical care improvement for patients with acute coronary syndrome, in order to reduce the morbidity and mortality in the population of a large industrial region.

Material and methods. The study was conducted on the basis of the Moscow regional ambulance station. We used the content analysis, logical, system analysis, the method of mathematical statistics.

Results. In the period 2017–2018, in the region's population, there is a tendency for decrease in the number of calls for ambulance teams caused by acute coronary syndrome. During the analyzed period, we noticed the reduction of the number of cases of pre-hospital thrombolytic therapy (by 17.5%). The response time to the patient's call not more than 20minutes was observed in 92.9% of cases, the number of lethal outcomes in presence of the ambulance team decreased by 4.6%. The results can be explained by the dynamic development of the infrastructure of cities and districts of the Moscow Region, by the improvement of road networks, by the complete renewal of the service's motor vehicle fleet, and by the opening of a number of new specialized medical institutions. A set of medical and organizational measures has been developed and put into practice in the ambulance service of the region, aimed at further improvement of the system of ambulance care for patients with acute coronary syndrome at the prehospital stage.

Conclusion. The mortality reduction, preservation and improvement of public health can be achieved only through the comprehensive sustainable development of the region’s infrastructure, improvement of the organizational structure of the emergency medical service, mandatory use of algorithms and standards for the provision of medical care to patients at all stages.

Science and Innovations in Medicine. 2019;4(4):33-37
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International practices of quality management in healthcare (a review)

Ginnyatulina R.I.


An analysis of international publications revealed a growing interest in all aspects of quality in medical care, especially in the definition of the concept of quality in healthcare. In the world community, the following approaches to quality management are widely used: the Total Quality Control (TQC); Total Quality Management (TQM), which includes Quality Assurance and Quality Improvement; Continuous Quality Improvement (CQI); Lean management, including Hoshin Kanri's policy and PDCA's Deming – Shuhart Cycle (Plan–Do–Check–Act).

Practical implementation of the principles of General Quality Management (TQM) and Continuous Quality Improvement (CQI) is based on the models of business improvement in quality management: the EFQM (European Foundation for Quality Management) model, the MBQA (Malcolm Baldrige Quality Award) model and the Chronic Care Model.

In management of medical organizations, the International standards for services perfection are more often used, which use the experience of quality assurance, as well as the international systems and standards: JCI, ISO 9001, IWA1, ISO 15189, ISO 14000, OHSAS 18001.

The ISO interstate standards represent the international consensus of world practice in quality management. Nowadays, medical organizations use the following standards: SRPS ISO 9001: 2015, SRPS EN 15224: 2017, SRPS EN ISO 15189: 2014, SRPS EN ISO 13485: 2017, IWA 1: 2005. In the period of globalization of the world economy and healthcare, the best international practices should form the basis for improving domestic health care in medical care quality management.

Science and Innovations in Medicine. 2019;4(4):38-43
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Risk factors of narcological disorders among rural population

Tsarev S.A., Shcherban A.V., Suslin S.A., Katin A.A., Sirotko I.I.


Objectives – to analyze the correlation between the risk factors of alcohol and drugs consumption, revealed during the preventive medical examination of the adult rural population, and the main epidemiological indicators of narcological diseases, registered in the rural areas of the Samara Region in 2015–2018.

Material and methods. The indicators of the general and primary incidence of narcological disorders were calculated. The risk factors for alcoholization and drug addiction were studied according to the clinical examination of the adult rural population of the Samara region. The rank correlation coefficient was used to establish the relationships between the risk factors and epidemiological data.

Results. There is a tendency for decline in the narcological general and primary morbidity of the rural population. The risk factors of alcohol consumption were identified in 1% of the population, the risk factors of drug use – in 0.08% of the population.

Conclusion. A moderate correlation between the number of persons with alcohol consumption risk factors and some epidemiological data supposes the former investigation of the risk factors for identifying the narcological disorders.

Science and Innovations in Medicine. 2019;4(4):44-49
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A method of endoprosthesis implantation in patients with breast cancer

Kozlov S.V., Borisov A.P., Moryatov A.A., Tkachev M.V.


Objectives – to improve the immediate results of treatment in patients with breast cancer, using a new method of reconstruction.

Material and methods. The prospective study included 215 patients diagnosed with breast cancer. The patients received medical treatment in the Samara Regional Clinical Oncology Center from 2013 to 2016. The patients in the control group (n = 111) underwent a subcutaneous mastectomy with a standard endoprosthesis plastic, with complete muscular shelter of the endoprosthesis. The patients of the study group (n = 104) underwent a subcutaneous mastectomy with a new method of single-stage reconstruction.

Results. The mean time of operation in the control group was 115 ± 15 minutes, in the study group – 90 ± 10 minutes, the difference was statistically significant (p = 0.000). Intraoperative blood loss in the patients of the control group reached 115 ± 15 ml, in the study group – 70 ± 10 ml (p = 0.000). The duration of postoperative lymphorrhea in the control group was 14.6 ± 3.5 days, in the study group – 10 ± 3.4 days (p = 0.000). Postoperative bed-day in the control group was 17.1 ± 3.7, and in the study group – 14.2 ± 2.4 days (p = 0.001).

Conclusion. The use of the new method of reconstruction statistically significantly improves the immediate results of treatment in patients with breast cancer in comparison with the group of patients who underwent a mastectomy with plastic surgery with the endoprosthesis in the standard way.

Science and Innovations in Medicine. 2019;4(4):50-52
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Severe damage of respiratory muscles in polymyositis

Scryabina E.N., Magdeeva N.A., Melehina I.F., Alexandrova O.L.


Objectives – to present a clinical case of polymyositis in a 55-year-old man. The patient was admitted with a diagnosis "transient ischemic attack", quickly followed by an acute respiratory failure, which required the continuous use of mechanical ventilation. Other clinical symptoms included: a high diaphragm position up to the 4-th ribs, the concurrent purulent endobronchitis, bilateral pneumonia, pleurisy, multiple atelectasis, myocardial dysfunction with a decrease in ejection fraction to 46%, local hypokinesia according to EchoCG data. Despite the severe condition of the patient, there was not registered any distinct impairment of the proximal limb muscles and an increase in creatinphosphokinase blood level. The antinuclear myositis-specific antibodies, the signs of primary muscular damage according to the limb muscles ENMG data were also absent. The paraneoplastic process was excluded. The results of clinical examination made the diagnosis of polymyositis uncertain. To clarify the cause of the respiratory muscles damage, an intercostal muscle biopsy was performed.It revealed expressed changes in the muscle, with massive necrosis areas, and perivascular lymphohistiocytic infiltration.

Conclusion. The described case of polymyositis is extremely rare, has a severe course and is complicated for diagnosis and treatment. In this case, the most informative examination method can be a biopsy of the intercostal muscles, which allows to identify the inflammatory origine of the disease and to determine the pathogenetic therapy.

Science and Innovations in Medicine. 2019;4(4):53-57
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Forensic medicine

Statistical diagnostics of postmortem artifacts for determination of ethanol concentration

Nedugov G.V., Ardashkin A.P., Nedugov V.G.


Objectives – statistical estimation of the physiological limits of the quantitative distribution of ethanol in cadaveric blood and bladder urine and development of an automated method for diagnosing postmortem artifacts of forensic medical examination of acute alcohol intoxication on the corpse.

Material and methods. We performed a retrospective statistical analysis of the results of toxicological determination of ethanol concentration in a blood and in the urine in 2376 deaths from acute alcohol intoxication.

Results. Regression equations have been developed that allow us to determine the physiological limits of the quantitative distribution of ethanol in blood and urine with any confidence probability for any degree of alcohol intoxication and phase of acute alcohol intoxication. The set of computational procedures is implemented in the format of the computer program "Alcohol calculator Z 3.0".

Conclusion. If the concentrations of ethanol in the blood or in the urine are beyond their physiological limits, the results of toxicological analysis should be considered as a postmortem artifact.

Science and Innovations in Medicine. 2019;4(4):58-62
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Features of local pulmonary hemostasis in patients who received surgical treatment for benign peripheral lung tumors

Bogorodskiy A.Y., Kuligin A.V., Fisun A.M.


Objectives – to develop a method for prevention of thromboembolic events in small branches of pulmonary artery in post-operative period, based on features of local pulmonary hemostasis in patients who underwent lung surgery for benign tumors.

Material and methods. 30 male patients aged 62 ± 2.4 years old were included in the study. All patients underwent lung surgery (mainly lobectomy). Blood was drawn intra-operationally from a. pulmonale (arriving venous blood), v. pulmonale (outflowing blood) and cubital vein. The following parameters of coagulative and thrombocytic-vascular hemostasis were examined: free endogenous heparin was evaluated by protamine titration, platelet count and platelet aggregative properties were registered, using hematology analyzer, activated partial thromboplastin time (aPTT), quantitative analysis of fibrinogen and protein C was performed using CoaLAB 1000 analyzer.

Results. Study of hemostasis features in patients, who underwent lung surgery, has revealed an imbalance of coagulation and anticoagulation systems, which manifested itself as dysfunctions in thrombocytic-vascular hemostasis (increase in platelets aggregative properties, most notable in peripheral venous blood), plasma hemostasis (decrease in aPTT, most notable in arterial blood, and increased fibrinogen level) and anticoagulation (modestly decreased protein C and heparin levels in peripheral blood), which is characteristic of hypercoagulation, being the possible basis for development of thromboembolic complications in post-operative period. These changes are most typical for blood taken from cubital vein, which is indicative of increased possibility of clot formation specifically in systemic circulation. The least risk of clot formation was established in pulmonary vein blood (outflowing blood). Moderate correlation between free heparin level in arterial blood and venous blood was established.

Conclusion. The derived results have allowed us to develop an individual management plan for patients with increased risk of thromboembolic events, which includes early administration of anticoagulant agents in prophylactic doses.

Science and Innovations in Medicine. 2019;4(4):63-67
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New approaches to the study of cell vital activity cultivated in different growing conditions with analysis of oxygen in the medium

Volova L.T., Pugachev E.I., Riazanova T.K., Nefedova I.F., Boltovskaya V.V., Maksimenko N.A.


Objectives – to develop new approaches to the study of morphofunctional state of chondroblasts, cultured at 37°C on a 3D carrier in different environments: in a CO2 incubator with 5% of CO2 and in a thermostat in an air-proof tube.

Material and methods. The study cell culture – chondroblasts, isolated from the cartilage of the articular surfaces of the extra-fingers' phalanges. 3D carrier for cells – the demineralized lyophilized human spongiosa Lioplast®. The resulting tissue-engineered structures were grown in a complete cell culture medium at 37°С under different conditions: in a closed system in thermostat and in an open system in CO2 incubator (5% CO2). To assess the morphofunctional state of the cells on the surface of the 3D carrier, the picrosirius red staining, a LIVE/DEAD® fluorescent dye kit, and scanning electron microscopy were used. The oxygen concentration in the culture medium was evaluated by the modified Winkler titration method.

Results. The complex of morphological methods revealed the presence of living cells on the surface of human spongiosa within the 7-day period of cultivation. The cells either are fusiform or have a polygonal form and have a capacity to grow in 2 or more layers. The titrimetric analysis has demonstrated a decline in the concentration of dissolved oxygen in the medium with cellular tissue material in 7 days of cultivation. The concentration declined by 72.4% in a thermostat and by 63.5% in a CO2 incubator. In the tests tubes which contained only the medium and no cells, there was a similar decline in oxygen concentration by 47.3% in a thermostat and by 66.1% in a COincubator.

Conclusion. 1. A method of measuring the amount of dissolved oxygen in a culture medium, during the adhesive cell cultivation on a 3D carrier, was developed, based on the Winkler titration method. 2. A comparative analysis of the amount of dissolved oxygen in the medium in the process of chondroblast cultivation on a 3D human spongiosa carrier, both in a CO2 incubator and in a closed test tube, revealed an overall tendency to a decrease in the concentration of oxygen within 7 days of cultivation. 3. A decrease in oxygen concentration in the test tubes with human spongiosa samples (without cells), within the 7 days of cultivation, was registered. 4. An efficient and cost-saving method of graft manufacturing for the purposes of chondroplasty is the transfer of juvenile joint cartilage chondroblasts to 3D human spongiosa carriers and their further cultivation in air-proof test tubes copletely filled with medium within a period of 7 days.

Science and Innovations in Medicine. 2019;4(4):68-72
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