Vol 6, No 3 (2021)

Human Anatomy

Modern concepts of constitutional and X-ray anatomy of the chest in adolescents and adults

Lutsay E.D., Shekhtman A.G., Volodin A.V., Alekseeva T.A.


The review presents the analysis of domestic and foreign literature, selecting the available scientific data on the features of constitutional and X-ray anatomy of the chest in adolescents and adults. The size and shape of the chest depends on age, sex and anthropometric parameters: height, body mass index, and also the presence of concomitant pathology. These patterns are characteristic of individual anatomical structures of the chest: sternum, ribs, spine and diaphragm. The study of constitutional anatomy is necessary for the development of morphological foundations for the interpretation of the results of intravital imaging of the chest and organs, justification of various methods of surgical access to the organ and structures of the chest and chest cavity.

Science and Innovations in Medicine. 2021;6(3):4-7
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ENT Disorders

Comparison of sound perception using CIS and ACE sound coding strategies in cochlear implants

Kolokolov O.V., Kuznetsov A.O., Machalov A.S., Grigoreva A.A.


Objectives – to study the effect of ACE and CIS sound coding strategies on sound perception in patients with the cochlear implants system produced by Cochlear Limited.

Material and methods. The study included 50 patients taking the rehabilitation course in the Astrakhan branch of the National Medical Research Center for Otorhinolaryngology of the Federal Medico-Biological Agency over the past 5 years (from 2014 to 2019). The group of subjects included children over 7 years old and adults, whose success in rehabilitation made it possible to perform a full range of tests. The patients underwent tonal threshold audiometry and speech audiometry in a free sound field; the results obtained were registered in special MS Excel tables and further analysed using statistical methods.

Results. There were no statistically significant differences in hearing thresholds on tonal audiometry when using the coding strategies ACE and CIS, however, differences in speech perception were observed on average by 4.2%. The patients experienced in using hearing aids reported improved speech recognition, with scores varying within 5%.

Conclusion. Using a higher-resolution coding strategy can significantly improve speech recognition, while lower-resolution coding is beneficial for patients with digital hearing aid experience.

Science and Innovations in Medicine. 2021;6(3):8-12
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Features of the inflammatory process of the nasal mucous membrane and paranasal sinuses in patients with chronic rhinosinusitis with nasal polyps

Pestova R.M., Saveleva E.E., Aznabaeva L.F.


Objectives– to assess the features of the inflammatory process of the nasal mucous membrane and sinuses in patients with сhronic rhinosinusitis with nasal polyps (CRSwNP).

Material and methods. We analyzed the results of examination of 44 patients with CRSwNP. The objects of investigation were smears-reprints from the mucous membrane of the middle turbinate (rhinocytograms) and the intensity of the extracellular peroxidase activity of the lavage fluids of the maxillary sinuses. The data obtained were processed using the Statistica 8.0 software.

Results. When analyzing rhinocytograms of the mucous membrane of the middle turbinates, the epithelial type of rhinocytogram was most often detected – in 65.9% of cases (epithelial cells more than 50%); the eosinophilic type – in 22.7% (eosinophils more than 1%) and smears with mast cells – in 4.6% of cases; the neutrophilic type was less frequent (neutrophils more than 50%) – 6.8% of cases. In 34.1% of patients, the cells of the columnar epithelium had pronounced changes in the cytoplasm (vacuolization and enzymatic activity); and in 38.6% of cases the gross pathology was recorded directly in the nucleus of the cells (nucleoli, granules, destruction of the nucleus). The revealed pathology of the cell nucleus suggests the viral etiology of the development of productive inflammation in the nasal cavity and sinuses In the lavage fluids of the maxillary sinuses, a high intensity of extracellular peroxidase activity was recorded (1777.9±132.4 a.u. compared to 1225.0±190.9 a.u. in patients with chronic purulent rhinosinusitis and 1245.0±362.3 a.u. in patients with purulent-polypous rhinosinusitis).

Conclusion. Chronic rhinosinusitis with nasal polyps is accompanied by a pronounced inflammatory process of the nasal mucous membrane and paranasal sinuses in the form of structural and functional changes in the cells of the columnar epithelium and a high intensity of extracellular peroxidase activity. The epithelial nucleus damage (the presence of nucleoli, granules, destruction of the nucleus) suggests a viral nature with the development of productive inflammation in the nasal cavity and sinuses.

Science and Innovations in Medicine. 2021;6(3):13-16
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Hyperdentia in adult patient in the ENT practice

Fileva L.V., Baryshevskaya L.A., Chernyshenko I.O., Zavalko T.A., Rodionova S.V., Zeleva O.V., Kotova Y.D.


According to the literature, such dentition anomaly as supernumerary teeth is more common in the practice of a dentist than of an otorhinolaryngologist. Clinical manifestations of this pathology in adults are less frequent than in children. Periodically, there appear descriptions of individual cases of hyperdentia, in which the tooth is located in the nasal cavity, paranasal sinuses, orbit. It is not always possible to find such a tooth on examination, therefore, additional research methods help to determine the location and pathological process in more detail. We present our clinical observation of tooth retention and ectopia in the nasal cavity and upper jaw. The diagnosis was confirmed by the data of endoscopic examination and computed tomography of the paranasal sinuses. The ectopic tooth was found before the development of pronounced local inflammation. The tooth was removed from the nasal cavity using endoscopic techniques, no communication between the nasal cavity and the oral cavity was found. The postoperative period was uneventful. On examination two weeks after the operation, no pathological changes in the nasal cavity, paranasal sinuses were found, as well as defects in the mucous membrane and bone part of the nasal cavity floor.

Science and Innovations in Medicine. 2021;6(3):17-20
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Method of selection and assessment of hearing aids efficiency based on comparative speech audiometry

Tsygankova E.R., Gaufman V.E., Grebenyuk I.E., Saveleva E.E., Savelev E.S.


Objectives – to improve the quality of hearing aids (HA) selection for patients with sensorineural hearing loss using a comparative free sound field speech audiometry according to our modified method "Delta Test".

Material and methods. The study involved 56 patients aged from 18 to 62 years with bilateral chronic sensorineural hearing loss of 2-4 degrees. The study group included 32 patients, a test for speech recognition in a free sound field (speech audiometry) was conducted using the method proposed by us. The control group consisted of 24 patients who were aided without the use of comparative speech audiometry.

The "Delta Test" included the use of audio files sets containing a speech material in pure form and mixed with speech noise with different signal-to-noise ratios, supplied through a speaker system connected to a personal computer. The percentage of correctly repeated words was measured without HA and with several HA having different settings. The effectiveness of using HA was defined as the difference in the percentage of speech recognition when using HA in relation to the "ear without HA".

Results. According to "The International Outcome Inventory for Hearing Aids" the average score was 4.13± 0.10 in the group where the HA were selected using the "Delta Test", which is statistically significantly higher than in the control group, where the average score was 3.72±0.15(p < 0.05). "Delta Test" allows optimally select the HA parameters. This method is easy to perform and does not require expensive equipment.

Science and Innovations in Medicine. 2021;6(3):21-24
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Gerontology and geriatrics

Impairment of stability and gait in elderly patients of a social inpatient institution of the Kyrgyz Republic

Arstanbekova M.A.


Objectives – to study the frequency of impairments of the ability to move in elderly patients – care recipients of a social inpatient institution of the Kyrgyz Republic.

Material and methods. We examined 88 inmates of a social inpatient institution, among them there were 47 (53,4%) men and 41 (46,6%) women aged 65 to 74 years. The average age was 71,9±6,4 years.

Results. Disorders of general motor activity were observed in 62 (70,5±5,31%) patients. The violations of stability and walking parameters were more pronounced, they were found in 70 (79,5±5,04%) and 71 (80,7±6,31%) patients respectively. When assessing the parameters of stability, the disturbances were observed in all positions; mostly they manifested themselves during the tests for standing with closed eyes (46,6±4,27; р<0,05) and when leaning back (44,3±3,83; р<0,05).

Conclusion. A comprehensive geriatric assessment to identify the main geriatric syndromes in elderly patients of residential social institution should become an integral part of the organization of medical care aimed at solving these problems and the subsequent mandatory correction of these disorders.

Science and Innovations in Medicine. 2021;6(3):25-28
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Accelerated aging and psychological age of an individual as risk factors for COVID-19 complications

Berezina T.N., Yakovats E.A., Faskhutdinova Y.F., Rybtsov S.A.


Objectives – to study the effect of psychological age on the risk of severe forms of Covid-19 in adults.

Material and methods. Research method: natural experiment. The 1st measurement: indicators of biopsychological age - mid-2020, the 2nd measurement: assessment of Covid-19 disease - the end of 2020. Subjects: 239 people aged 35-70 (155 women). Methods for assessing psychological age, expected retirement age, biological age, and analysis of variance were used.

Results. Indicators of the relative psychological age of an individual affect the development of the disease and its severity, while the combination of low indicators of psychological age with high biological indicators is most dangerous and increases the likelihood of developing severe forms of the disease.

Science and Innovations in Medicine. 2021;6(3):29-32
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Parameters of functional activity in elderly and senile women with polymorbidity and risk of sarcopenia

Kurmaev D.P., Bulgakova S.V., Zakharova N.O.


Objectives – to identify the correlations between the Charlson comorbidity index and the results of functional activity tests as predictors of sarcopenia among elderly and senile women with polymorbidity.

Material and methods. The study included 269 elderly and senile women aged from 65 to 84 years, having polypathology.

Results. Sarcopenia was detected in 14.63% of the elderly, and in 27.40% of senile women. The Charlson comorbidity index was associated with the risk of progression of frailty, a decrease in basic functional activity, increased muscle weakness and impaired function of skeletal muscles.

Conclusion. Dynamometry and functional activity tests can be used in clinical practice to diagnose sarcopenia syndrome in elderly and senile women.

Science and Innovations in Medicine. 2021;6(3):33-37
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The risk of burnout syndrome in medical professionals under the impact of working conditions and psychological climate in the team

Yeliseeev Y.Y., Ratushnaya N.S., Eliseeva Y.V.


Objective – to assess the risk of developing the burnout syndrome in medical workers under the influence of working conditions and psychological environment in the team.

Material and methods. To evaluate the level of emotional burnout, 134 medical workers of medical institutions of the Saratov region were tested according to Viktor Boiko methodology, based on the study of the working environment and the labor process, as well as according to Fiedler’s methodology of assessing the psychological climate in the team.

Results. The study results testified the direct influence of the factors of the labor process that determine the class of working conditions on the risks of developing emotional burnout in medical workers. The 2.0 class of working conditions implies the risk of occupational burnout in 30.7% of doctors after five years of work. The 3.2 class of working conditions leads to burnout in 46.7% of doctors after five years of work.

Discussion. The high degree of emotional burnout registered in medical workers in the course of this study was naturally determined by both the level of the class of working conditions and the level of the psychological tension in the team. The prognosis of burnout syndrome development in the teams with positive psychological climate is 20.0%, while in the teams with unfavourable psychological situation the risk of occupational burnout reaches 46.6%.

Conclusion. The results obtained in the course of this study were used as the basis for the development of a method for predicting the risk of developing burnout syndrome in medical professionals.

Science and Innovations in Medicine. 2021;6(3):38-41
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Diseases of the nervous system

Development of multifocal ischemic stroke after cessation of anticoagulant therapy in a patient with antiphospholipid syndrome

Minina Y.D., Kalinin V.A.


The clinical case presents a young patient with antiphospholipid syndrome, which was the cause of recurrent acute ischemic cerebrovascular accidents and pathology of pregnancy.

During the clinical and laboratory examination, the patient was diagnosed with systemic lupus erythematosus. To determine the etiology of ischemic strokes and recurrent pregnancy loss, the patient underwent an immunological blood test which led to diagnosing the antiphospholipid syndrome. The patient failed to comply with the doctor's recommendations for taking an anticoagulant in the early postpartum period that resulted in the development of multifocal ischemic stroke.

After treatment, the patient's condition improved, focal neurological symptoms partially regressed, and laboratory parameters returned to normal. As a secondary prevention of thrombosis, the patient was prescribed anticoagulant therapy.

Science and Innovations in Medicine. 2021;6(3):42-45
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Public health, organization and sociology of health

Main areas of development of public-private partnership in providing cancer care

Breusov A.V., Rios E.A., Breusov D.A.


Objectives – to substantiate and define the main directions of the development of public-private cooperation in the provision of specialized oncological care to patients.

Material and methods.The research was based on the data of official statistics, scientific and methodological literature presented in the eLibrary, Publons, Scopus, the Cochrane Library databases. Research methods included bibliographic, descriptive and analytical, content analysis method, mathematical and statistical (calculation of relative indicators, mean values, methods of aligning the interval time series).

Results. Reducing morbidity and mortality from oncopathology is a state-scale problem that can only be solved comprehensively by attracting private investors when implementing innovative public-private partnership projects in healthcare. One of the modern models of interaction between state and business is the construction of public-private partnerships for new medical infrastructure.

Conclusion. The Center for Nuclear Medicine for the treatment of cancer is an innovative project, the implementation of which will help to reduce mortality from malignant neoplasms, increase the availability of specialized care and the quality of life of patients.

Science and Innovations in Medicine. 2021;6(3):46-50
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The effect of patient's gender on the results of managing cardiovascular risk factors using specialized software

Galimzyanov A.F., Anisimov A.Y., Garipov R.Z., Sleiter M.


Objectives – to assess the effect of the gender of patients on the severity of risk factors for the development of cardiovascular diseases using specialized software.

Material and methods. In order to identify and correct the severity of risk factors for the development of cardiovascular diseases in the population, in 2018-2019, the data of residents of the Republic of Tatarstan were registered in specialized software. The severity of risk factors was assessed before the start of the study and after one year. The research included two groups of persons: men and women.

Results. In 2018, the program "Cardiovascular Risk Management" had registered the data of 32,746 residents of the Republic of Tatarstan aged from 18 to 80 years. The risk factors for the development of cardiovascular diseases were identified in 22,999 individuals, where there were 7,188 men and 15,712 women. The patient's data included gender, age, history of coronary artery disease, smoking, physical activity, blood pressure, the levels of cholesterol, glucose and blood creatinine. The data on the severity of the risk factors in both groups were statistically processed. Based on the data obtained, the supervised persons received recommendations for correcting their lifestyle. In 2019, an assessment of the severity of risk factors was carried out in persons included in the system in 2018.

Conclusion. We found a statistically significant difference in the results of managing risk factors in men and women. The software "Management of cardiovascular risks" is recognized as an effective tool for managing risk factors for the development of cardiovascular diseases and reducing mortality from diseases of the circulatory system.

Science and Innovations in Medicine. 2021;6(3):51-55
pages 51-55 views

Traumatology and Orthopedics

Structural changes of the tendon in experimental tendinopathy and administration of autologous platelet-rich plasma

Malanin D.А., Rogova L.N., Grigorieva N.V., Ekova M.R., Povetkina V.N., Laskov I.G., Demeschenko M.V., Suchilin I.A., Voronina A.V.


Objectives – assessment of structural changes in the calcaneal tendon tissue in experimental tendinopathy under autologous platelet-rich plasma.

Material and methods. Twenty mature Wistar rats, selected for the study, were divided into 5 groups. Rats of all groups received intra- and peritendinous injections of 0.5 ml of 10% sterile talc suspension to provide the experimental modeling of tendinopathy of the calcaneal tendon. Then the tendinopathy area was treated by injections of autologous platelet-rich plasma (PRP), a hyaluronic acid preparation "Rusvisk" (Rusvisk, Russia) and their sequential combination. The results were evaluated after 10 weeks in the autopsy preparations using a light microscopy method and morphometry.

Results. The histological signs characteristic of tendinopathy were revealed, such as the disorganization of collagen structures, mucoid and lipoid degeneration, neovascularization, lymphoid and histiocytic infiltration. The injection of PRP, hyaluronic acid, or their sequential combination in the area of simulated tendinopathy led to changes in the histological presentation of the tissue. As a result, the collagen matrix had less signs of disorganization and less pronounced degenerative changes, as well as manifestations of the inflammatory process in the peritenon and the soft tissues surrounding the tendon, in comparison with the histological profile, which was observed in micropreparations in animals with tendinopathy who had no treatment.

Conclusion. The introduction of PRP into the area of the calcaneal tendon has reduced the manifestations of the inflammatory process, disorganization of the collagen matrix, promoted the enhancement of collagen synthesis by cells and, ultimately, the processes of tissue remodeling.

Science and Innovations in Medicine. 2021;6(3):56-62
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Platelet-rich plasma in the treatment of chronic inflammatory diseases of lower extremities

Gilevich I.V., Shubrov E.N., Chuchvarev R.V., Kolomiytceva E.A., Triandafilov K.V., Sotnichenko A.S., Melkonyan K.I.


Objectives – to evaluate the effectivenes of platelet-rich plasma preparations in the treatment of chronic inflammatory diseases of lower extremities.

Material and methods. The study involved patients hospitalized in the Research Institute – S. V. Ochapovsky Regional Clinic Hospital No.1, Krasnodar, with trophic ulcers and chronic osteomyelitis. The patients received injections of platelet-rich plasma as platelet lysate and/or platelet gel.

Results. The study involved 19 patients with trophic ulcers of the lower extremities with a duration of more than 2 months. Previously, the patients had underwent therapy without effect. In all cases, the patients received a complex of therapeutic measures, including debridement, dressing, conservative treatment, physiotherapy, antibiotic therapy. In the presence of large ulcers, 8 patients underwent autodermoplasty with complete engraftment. It has been noted that during platelet-rich plasma use the average healing time was 6-7 weeks.

Four patients were observed with chronic osteomyelitis. During operation, the bone cavity was filled with platelet gel. The postoperative period was uneventful in all cases. The maximum observation period was 1.5 years. No recurrence of osteomyelitis was detected.

Conclusion. The results of the study demonstrate the positive effects of platelet-rich plasma products use.

Science and Innovations in Medicine. 2021;6(3):63-68
pages 63-68 views

Immunological and hemostasiological aspects of pathogenesis of obliterating atherosclerosis of arteries of the lower extremities

Korymasov E.A., Krivoshchekov E.P., Kazantsev A.V., Pribytkov D.L.


Objectives – to study the changes in the immunological status and hemostatic system in patients with obliterating atherosclerosis of the lower limb arteries with the damage to the femoral-popliteal-tibial segment.

Material and methods. A comprehensive study of the cytokine status and hemostatic system in patients with obliterating atherosclerosis of lower limb arteries with lesions of the femoral-popliteal tibia segment was carried out.

Results. The progressive course of obliterating atherosclerosis is often associated with an increased content of cytokines (IL-1â, IL-6, IL-8, TNFá), as well as with the phenomena of hypercoagulation (increased platelet aggregation activity, shortened APTT, CT, TT, increased fibrinogen content), SFMCs, D-dimer).

Conclusion. The study of the immunological status and hemostatic system should be performed in all patients with obliterating atherosclerosis of the lower limb arteries in order to adequately medically correct and prevent postoperative complications.

Science and Innovations in Medicine. 2021;6(3):69-72
pages 69-72 views

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