Vol 6, No 2 (2021)

Human Anatomy

Growth rate of thyroid gland in human fetus

Murtazina N.I., Lutsai E.D., Ershova S.V.


Objectives – to determine the thyroid gland growth rate in the intermediate fetal period of human ontogenesis.

Material and methods. The thyroid glands of 60 male and female fetuses aged from 14 to 27 weeks were the subject of this research. The material was divided according to fetus age in three groups: Group I – from 14 to 18 weeks, Group II – from 19 to 22 weeks and Group III – from 23 to 27 weeks.

Results. The study revealed the increase in all dimensions of thyroid gland related to the increase of fetus age. During the intermediate fetal period of ontogenesis, the growth varied from 19% (for the anteroposterior isthmus size) to 59% (for the right lobe height). The thyroid gland growth rate for different sex groups varied between 24% and 60% in female fetuses, in male fetuses – from 20% to 57%. Besides, the thyroid lobes and isthmus of female fetuses grew at a higher rate than those of the male fetuses. The uneven growth of the anatomical structure was also registered when comparing different age groups within the intermediate fetal period. The highest rate of thyroid gland growth was observed starting from the 22nd week of fetal life; until the 19th week the growth rate ranged between 7% (isthmus) and 25% (right lobe). The study of the thyroid gland growth rate in female and male fetuses in different age groups revealed identical tendencies involving the active growth of thyroid gland dimensions starting from the 22nd week.

Science and Innovations in Medicine. 2021;6(2):4-7
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ENT Disorders

Remote examination and testing of elderly persons in detecting hearing impairments

Vladimirova T.Y., Martynova A.B., Kurenkov A.V., Popov M.N.


Objectives – to assess the efficiency of using a comprehensive hearing test, including a questionnaire survey and determination of hearing thresholds using the "Automated system of primary hearing assessment" web application, in comparison with tone threshold audiometry in elderly people.

Material and methods. We examined 138 patients of the Samara Regional Clinical Hospital for War Veterans who were over 60 years old. The group included 67 women and 71 men with the average age of 71.6 ± 6.4 years. The patients underwent ENT endoscopy, an online survey on hearing self-assessment, hearing thresholds study using the Automated Primary Hearing Assessment web application, and tone threshold audiometry.

Results. The prevalence of hearing impairment in the group was 76.1% according to the online questionnaire on hearing self-assessment. When comparing the general results of the on-line test questionnaire and the study of hearing thresholds, the on-line test data were confirmed when conducting tonal threshold audiometry in 75.0% of people with normal test indicators, in 25.0% of people an in-depth study showed some hearing loss. According to an online survey of patients with hearing complaints, 89.1% had a certain degree of hearing loss. Hearing parameters according to the web application were comparable in terms of both hearing threshold values and the degree of hearing loss with the data of tonal threshold audiometry. The maximum difference was 3.9 and 3.5 dB at 1 and 2 kHz for the right ear and 7.2 dB at 4 kHz for the left ear. Low agreement of mean hearing thresholds was observed in patients at frequencies of 1 and 4 kHz on the right (κ = 0.24 and κ = 0.3, respectively) and at a frequency of 4 kHz - on the left (κ = 0.14), which may be due to high-frequency hearing loss in this group of patients and more significant fluctuations of indicators. The discrepancies in the data of the web application and in the values of the hearing thresholds when taking into account the comorbid status were minimal in persons with diabetes mellitus and amounted to 2 dB at a frequency of 8 kHz, the maximum deviations were observed in patients with occupational risk factors of 7.2 dB at a frequency of 4 kHz.

Conclusion. The comprehensive study that includes an online survey on hearing self-assessment and the hearing function evaluation in the Automated System for Primary Hearing Assessment web application is a convenient and simple tool for screening hearing impairment in outpatients and clinical examination, as well as at the stage of monitoring, treatment, and rehabilitation of patients with various degrees and types of hearing loss, especially in the elderly people.

Science and Innovations in Medicine. 2021;6(2):8-12
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Sequential bilateral cochlear implantation in children: selection criteria for second ear surgery

Daikhes N.A., Balakina A.V., Machalov A.S., Kuznetsov A.O., Zueva E.N., Nayandina E.I.


Objectives – to develop a safe and effective way of qualifying children for a second device cochlear implantation.

Material and methods. There were 50 children from two to twelve years old after unilateral cochlear implantation under our observation. During qualification, the following criteria were taken into account: audiometry results, use of the hearing aid in the non-implanted ear and benefit of the device, speech and hearing development after the first cochlear implantation.

Results. According to our findings the second cochlear implantation was recommended for 12 (24%) patients; in 16 (32%) cases the second cochlear implantation was refused; in 22 (44%) cases it was recommended to postpone implantation of the second device.

Conclusion. Our results demonstrate that the safe and effective way of qualifying for a second cochlear implant can restore binaural hearing that is crucial for the child's speech and hearing development and enhance integration into a world of peers.

Science and Innovations in Medicine. 2021;6(2):13-19
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Observation of COVID-19-associated coagulopathy in a patient of ENT hospital

Zavalko T.A., Vladimirova T.Y., Baryshevskaya L.A., Fileva L.V., Medvedeva E.D.


The article presents a clinical case of a patient of the otorhinolaryngology department of the Samara Clinical Hospital No. 8 who had a new coronavirus infection. Complications were manifested by primary thrombosis of the orbital veins, facial veins, followed by the spread of the process into the pterygoid plexus, veins of the nasal cavity and paranasal sinuses.

The study analyzes the dynamics of the clinical picture and compares it with the results of the postmortem examination.

Vascular thrombosis of the nasal cavity and paranasal sinuses during X-ray examination can manifest itself as a decrease in pneumatization of the sinuses with possible minor exudation due to ischemic changes in the mucous membrane. Thrombosis developing with underlying COVID-19-associated coagulopathy can have different initial localizations and are a formidable complication with a high mortality rate.

Patients who have undergone COVID-19 need to control the coagulogram not only during the illness, but also during the period of convalescence and early periods after recovery.

Science and Innovations in Medicine. 2021;6(2):20-24
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Risk factors for the formation of effusion in tympanic cavity and its clinical features in adults

Kalesnikava S.M., Merkulava E.P., Yadchanka K.S.


Objectives – to analyse the risk factors for developing effusion in the tympanic cavity in adults.

Material and methods. We examined patients who were treated for otitis media with effusion (n=51) aged 18-70 years in the ENT department of the 11 Minsk City Clinical Hospital and the Gomel Regional Clinical Hospital during the 2018-2020 years.

Results. The acute otitis media with effusion was significantly prevailing in patients of the age group 31-40 years, the chronic form predominated in people of 51-60 years old, and in all analyzed groups women dominated. In 81% of chronic inflammation of the paranasal sinuses the chronic form of otitis media with effusion prevails.

Conclusion. The most frequent risk factors for the formation of the tympanic exudate were inflammatory diseases of the paranasal sinuses, pathology of the nasal cavity, predominantly female sex of working age. According to the research, it was reliably proved that smoking and rural or urban residence were not a risk factor for the formation of tympanic effusion.

Science and Innovations in Medicine. 2021;6(2):25-29
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A local rehabilitation service for children with hearing loss

Tufatulin G.S., Koroleva I.V.


Objectives – to discuss the issues of inter-disciplinary cooperation for improvement the pediatric audiological care using modern technologies for hearing restoration.

Material and methods. An epidemiological study of hearing impairments in 3098 children registered in the Center of Pediatric Audiology (St. Petersburg) and analysis of the city pediatric audiological services were carried out.

Results. The introduction of the universal newborn hearing screening helped to diagnose hearing loss in children under 1 year of age in 47% of cases. Before the screening implementation, it was diagnosed in 22% of cases. The hearing screening results testify that 26% of children meet modern requirements of early diagnosis (under 3 months) of congenital hearing loss. 54% of children registered in the Audiology Center are using hearing aids or cochlear implants. The mean age of initial amplification is 3 years 8 months. 5.4% of children got amplification under 6 months of age, 20% of children - under 1 year and 58% - under 3 years. The mean interval between diagnosis and amplification was 15.7 months, only 24% of children got amplification within 3 months after being diagnosed.

A system of family-centered medical, psychological and pedagogical rehabilitation of children with hearing impairments was developed at the Center of Pediatric Audiology.

Science and Innovations in Medicine. 2021;6(2):30-36
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Central nervous system and respiratory system functioning in pupils of higher secondary school preconditioned by intensive educational process

Setko A.G., Bulycheva E.V., Zhdanova О.М.


Objectives – to identify the specific features of central nervous and respiratory systems functioning in pupils of last grades in secondary school in conditions of high intensity of educational work.

Material and methods. The study assessed the intensity of the educational process in a multidisciplinary lyceum for more able learners and a secondary school for general education in accordance with the Federal Recommendations "Hygienic assessment of the intensity of students' educational activities". In both educational institutions, the observation groups were formed from pupils of grades 9th and 10th. The first group consisted of 200 children from the lyceum specializing in education of gifted learners. The second group included 200 children from a traditional secondary education school. The functional state of central nervous system was evaluated by the method of variational chronoreflexometry. The state of respiratory system was assessed using the spirography method.

Results. In conditions of pronounced tension of the educational process (class 3.1), in the pupils of a multidisciplinary lyceum the level of nervous reaction was stabilized, the ability of the central nervous system to form an intra - and intersystem adaptation was increased in comparison with the corresponding data of general secondary school pupils who were studying with the optimal educational workload(class 1). These results can testify the sufficient training status of nervous processes as a result of intense cognitive activity underlined by the harmonious development of systems that ensure functioning of the central nervous system in an operational mode.

Conclusion. The study results can be useful for educational institutions specializing in teaching students with increased educational abilities. We suppose that the introduction of techniques for the development of operational indicators of central nervous system into the educational process might ensure high intellectual achievements.

Science and Innovations in Medicine. 2021;6(2):37-42
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Laboratory and instrumental indicators associated with decreased left ventricle ejection fraction in patients with chronic heart failure

Aidumova O.Y., Rubanenko A.O., Kompanets N.V., Shchukin Y.V.


Objectives – to evaluate laboratory and instrumental indicators, associated with decreased left ventricle ejection fraction in patients with heart failure of ischemic etiology.

Material and methods. The observational study included 71 patient with coronary heart disease and chronic heart failure (CHF). All patients underwent the testing on the following parameters: uric acid concentration, C-reactive protein (hs-CRP), NT-proBNP, ST2 and cystatin C tests, glomerular filtration rate. Instrumental examination included transthoracic echocardiography and 6-minute walk test.

Results. The study revealed several indicators, associated with decreased left ventricle ejection fraction less than 50% in patients with CHF: NT-proBNP level >822.2 pg/ml, ST2 >38.61 ng/l, uric acid > 419.9 mmol/l, hs-CRP > 2.54 mg/l, end diastolic volume index > 73.68 ml/m2, left ventricular mass index > 127 g/m2, left ventricular contractility index > 1.75, pulmonary artery pressure > 29 mm Hg. and vena cava inferior diameter > 20 mm.

Science and Innovations in Medicine. 2021;6(2):43-47
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Extrasystolic arrhythmia – an unaccounted risk factor of atherosclerosis development in main arteries?

Germanova O.A., Galati G., Germanov V.A., Shchukin Y.V., Germanov A.V.


Objectives – to determine the hemodynamic changes within arterial vessels in different variants of extrasystole, to analyze whether extrasystole is an additional risk factor for the development of atherosclerosis.

Material and methods. The study included 286 patients (175 men and 111 women) with extrasystole of more than 3000 per day and 88 patients with extrasystole of less than 3000 per day as a control group. When selecting eligible patients for the study, we tried to minimize the impact of traditional risk factors of atherosclerosis. The presence of cardiocerebral complications in medical history was also considered. The examination methods used in the study are electrocardiography, phonocardiography, 24-hour electrocardiography monitoring, Doppler ultrasound of the brachiocephalic vessels, lower extremities arteries, renal arteries, transthoracic or transesophageal echocardiography. Stress echocardiography was performed if indicated; as well as renal artery angiography, coronary angiography, computed tomography of the brain with angioprogram. When performing a biochemical blood test, the lipid spectrum and hemostasiogram were necessarily determined. All patients underwent left ventricular apexcardiography, as well as sphygmography, recorded on arteries of elastic type (a. Carotis communis) and muscular-elastic type (a. Tibialis posterior). The clinical examinations were confirmed and modeled using the original "Device for modeling of intra-arterial circulation", developed by us (RF patent No. 202780 dated 05.03.2021).

Results. We determined an increase in the main parameters of the heart biomechanics and the kinetics of the main arteries in the 1st post-extrasystolic wave in patients with various types of extrasystole with the following pattern: the earlier extrasystole had appeared in the cardiocycle, the greater was the increase in the parameters under observation. A universal concept of hydraulic shock and possible cases of its formation were described.

Conclusion. Extrasystole is an additional risk factor for the onset and progression of atherosclerosis. Hydraulic shock during the passage of the 1st post-extrasystolic wave is a powerful traumatic factor for the walls of the arteries, which can lead to the formation of an atherosclerotic process.

Science and Innovations in Medicine. 2021;6(2):48-53
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Scientific evidence for efficiency of medicinal plants in otorhinolaryngology

Kurkin V.A., Avdeeva E.V., Pravdivtseva O.E., Kurkinа A.V., Varina N.R., Stenyaeva V.V., Tsybina A.S., Pervushkin S.V.


Objectives – to provide scientific evidence for rational use of herbal medicines in otorhinolaryngological practice.

Material and methods. The study included the following plants: Eucalyptus viminalis leaves, Monarda fistulosa herbs, Melissa officinalis herbs, Echinacea purpurea herbs, Calendula officinalis flowers, rhizomes of Rhodiola rosea, rhizomes of Eleutherococcus senticosus, Glycyrrhiza glabra roots, Macleaya microcarpa herbs, Macleaya cordata herbs, Plantago major leaves, Origanum vulgare herbs, Thymus serpyllum herbs. Phenylpropanoids, flavonoids, euglobals, monoterpene phenols, phenylpropanoids, terpenoids of essential oils, saponins and alkaloids were isolated from the medicinal plants and studied with thin-layer chromatography, spectrophotometry, NMR spectroscopy, mass spectrometry, and various chemical transformations.

Results. It was scientifically proved that medicinal plants containing such biologically active compounds as phenylpropanoids, flavonoids, euglobals, terpenoid and phenolic components of essential oils, saponins, carotenoids, alkaloids and polysaccharides are useful for otorhinolaryngology. The active substances of the mentioned chemical groups in combination can provide antimicrobial, antifungal, antiviral, anti-inflammatory, regenerating, antihistamine, adaptogenic and immunomodulatory effects.

Conclusion. The expediency of using medicinal herbal preparations containing euglobals, monoterpene phenols, flavonoids, phenylpropanoids, terpenoids of essential oils, saponins, alkaloids and polysaccharides in otorhinolaryngological practice was scientifically justified.

Science and Innovations in Medicine. 2021;6(2):54-59
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Identification of tuberculosis in patients of pulmonology department, including patients with HIV infection

Dubrovskaya I.I., Zenkova L.A., Bagisheva N.V., Mordyk A.V., Lobastov A.Y., Nebesnaya E.Y., Bakhshieva L.I., Mordyk D.I.


Objectives – to define the possibilities of diagnosing tuberculosis in patients of pulmonology hospital, including patients with HIV infection.

Material and methods. During this retrospective one-step study, we analyzed 103 medical records of patients in pulmonology departments who had received a full range of laboratory and instrumental examinations, including the Mantoux test and the test with a recombinant tuberculosis allergen (Diaskintest). The patients were divided into two groups depending on their HIV status: Group 1 included 78 HIV-negative patients, Group 2 consisted of 25 HIV-positive patients.

Results. A microscopy of sputum and bronchial lavage did not reveal acid-resistant mycobacteria in all patients. PCR test for M. tb DNA was positive in three patients in Group 1 (33.3 ± 13.9% of the total number of examined patients) and in one patient in Group 2 (25.0 ± 13.9%) (χ2 = 0.01; p = 0.931). According to the results of immunodiagnostics, a positive normergic reaction to the Mantoux test was observed in 24 patients in Group 1 and in 7 patients in Group 2 (30.8 ± 5.2% and 28.9 ± 9.0% respectively), χ2 = 0.04; p = 0.846. The reaction for recombinant tuberculosis allergen (Diaskintest) was positive in 9 patients in Group 1 (11.5 ± 3.6%) and in 5 patients in Group 2 (20.0 ± 8.0%), χ2 = 0.85; p = 0.358. Based on clinical, laboratory, instrumental and immunological examinations by a TB doctor, in total 12 patients (11.7%) were diagnosed with tuberculosis. These patients were distributed among the study groups as follows: 9 people (11.5 ± 3.6%) in Group 1 and 3 people (12.0 ± 6.5%) in Group 2 (χ2 = 0.0; p = 0.956).

Conclusion. The inclusion of the Mantoux test and the reaction for recombinant tuberculosis allergen (Diaskintest) in the set of diagnostic tests for patients of the pulmonology department of the general hospital simplified the differential diagnosis of tuberculosis and pneumonia, both for a pulmonologist and a TB specialist.

Science and Innovations in Medicine. 2021;6(2):60-65
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Five-year experience in surgical treatment of temporal bone paragangliomas

Diab K.M., Daikhes N.A., Umarov P.U., Pashchinina O.A., Zagorskaya D.A.


Objectives – to discuss a five-year experience in surgical treatment of temporal bone paragangliomas from the point of view of U. Fisch and D. Mattox classification modified by М. Sanna in 2013.

Material and methods. In the period from February 2015 till December 2020, we performed 130 operations to remove temporal bone paraganglioma. The examined and operated patients included 34 men and 96 women aged from 2 to 82 years. The paraganglioma types A, B and C were distributed as follows: type A in 22 patients (A1 – 12 cases, A2 – 10 cases); type B in 73 patients (B1 – 25 cases, B2 – 16 cases, B3 – 32 cases); type C in 35 patients (С1 – 10 cases, С2 – 12 cases, С3 – 7 cases, С4 – 5 cases)

Results. The evaluated results included the quality of tumor removal, the auditory function and the function of the facial nerve in relation to the size of the neoplasm, registered during the early and late postoperative periods. Based on the study data, we developed an algorithm of tactics of surgical treatment of patients with this type of temporal bone pathology aimed to avoid damage to the vital structures of the lateral skull base.

Science and Innovations in Medicine. 2021;6(2):66-72
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