Vol 7, No 1 (2022)

Human Anatomy

Anatomical features of the human fetus mandible

Neprokina A.V., Lutsay E.D., Vinidictova M.A.

Abstract

Aim – to obtain new data on the anatomy of the mandible of a human fetus aged 19–23 weeks.

Material and methods. The object of the study was 40 mandibles of human fetuses of both sexes aged from 19 to 23 weeks. The morphological method (macromicroscopic preparation; the method of saw cuts according to N.I. Pirogov; production of serial histotopograms) and the method of ultrasound scanning by the device VOLUSONS 10, RAB 6 – RS sensor in 2D mode and in the "Skeleton" program (3D mode) were used.

Results. In fetuses aged 19–23 weeks the mandible represents a paired bone connected in the center by a symphysis. According to the shape of the body, it is possible to select wide and short, long and narrow mandibles in a ratio of 2 to 1, respectively 67% and 33%. The length of the alveolar arch is 52.4 ± 5.6 mm (with a range of 45.3–60.2 mm), the angular width is 23.4 ± 1.7 mm (with a range of 19.0–27.8 mm). The height of the branch at the cutting level was equal to 6.2 ± 1.4 mm (with a range of 3.6–9.0 mm). On the anterior surface of the body, one chin opening is determined on both sides, at an average distance of 16.4 mm from the angle of the mandible and at a height of 2.2 mm. On the inner surface of the branch, the opening of the mandible is determined, located at a distance of 3.6 ± 1.1 mm from the angle, 3.2 ± 0.9 mm from the anterior edge of the branch, 4.1 ± 1.2 mm from the posterior edge of the branch. In the second trimester of pregnancy, dental alveoli are determined in the mandibular dental arch of the fetus. Significant sex differences were found for the angle of the mandible (p ≥ 0.05). In girls, the angle was 141.1° ± 10.1, in boys – 129.5° ± 9.4.

Conclusion. The mandible of the fetus at the age of 19–23 weeks is formed and has fetal characteristics. During this period, no significant bilateral differences were revealed, sexual differences start to form.

Science and Innovations in Medicine. 2022;7(1):4-8
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Phase contents of bone mineral of the hipbone in streptozotocin-induced diabetic pre-senile rats after surgical perforation of the tibia

Torba A.V.

Abstract

Aim – to investigate changes in phase contents of bone mineral of the hipbone in pre-senile streptozotocin-induced diabetic rats after surgical perforation of the tibia.

Material and methods. Diabetes was induced in 35 animals with an initial weight of 290-310 g at the age of 17-18 months by a single intraperitoneal injection of streptozotocin in dosage of 55 mg per kg of body weight. Surgical perforation of the tibia was modeled as 2.0 mm opening in the proximal metadiaphysis (35 animals). Another group comprised 35 animals with both perforation and diabetes. 35 intact animals comprised the control group. The content of whitlockite, calcite and hydroxylapatite in bone mineral of the hipbone was determined.

Results. Surgical perforation of the tibia resulted in instability of phase contents of bone mineral of the hipbone by the 15th day of observation; peak of deviations was registered on the 90th day of observation, when the proportions of whitlockite and calcite increased by 7.20% and 8.91%, while the proportions of hydroxyapatite decreased by 3.53% in comparison with the controls. In diabetic animals, the destabilization of the phase composition of bone mineral was observed by the 7th day of the experiment. By the 90th day, the proportion of whitlockite and calcite exceeded those of the controls by 9.00% and 9.01% while the proportion of hydroxylapatite decreased by 4.00%. Surgical perforation of the tibia in diabetic pre-senile animals resulted in more marked increase of hipbone mineral amorphousness from the 7th day of observation; by the 90th day the proportion of whitlockite exceeded this in rats with perforation by 7.95%, while the proportion of hydroxylapatite decreased by 2.35%.

Conclusion. Surgical perforation of the tibia in diabetic pre-senile rats results in increasing of the amorphousness of bone mineral of the hipbone, which grows starting from the 7th day after operation.

Science and Innovations in Medicine. 2022;7(1):9-12
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ENT Disorders

Evaluation of tinnitus severity in military personnel after exposure to high intensity noise

Dvoryanchikov V.V., Kuznetsov M.S., Golovanov A.E., Syroezhkin F.A., Mironova Т.A., Yurikov K.E.

Abstract

Aim – to evaluate the severity of tinnitus before and after medical treatment in military personnel exposed to high-intensity noise.

Material and methods. The study involved 14 soldiers with complaints of tinnitus who suffered hearing damage caused by gunshot noise (AK74 gun) during military training without hearing protectors. The tinnitus severity and its dynamics during the treatment by glucocorticosteroids was assessed using the Tinnitus Functional Index (TFI). The Tinnitus Handicap Inventory (THI) was used before the treatment, on the 3rd and 7th days after the treatment.

Results. It was found that the greatest discomfort was caused by the intrusiveness of noise and inability to control it during the day, and the least discomfort was associated with sleep. The changes in the severity of noise on the THI and TFI scales on the third and seventh days after treatment were significantly different, if compared with the pre-treatment results, and had a positive trend. The therapy provided the significant decrease of noise intrusiveness and established the sense of noise control during the day, as well as minimized its effect on relaxation, hearing and quality of life, if compared to the data before treatment.

Conclusion. The TFI and THI scales are recommended for assessing the severity of tinnitus and monitoring the treatment of patients exposed to high-intensity noise. Particular attention should be paid to the use of personal hearing protection equipment when working in conditions of increased level of noise.

Science and Innovations in Medicine. 2022;7(1):13-17
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A modified way to improve the quality of life of patients in the early postoperative period after septoplasty

Elizarev V.V., Saveleva E.E., Pestova R.M.

Abstract

Aim – to improve the quality of life of patients in the early postoperative period after septoplasty.

Material and methods. The study involved patients who underwent septoplasty (n=51). The patients were divided into two groups: in group A (n=26) classic intranasal splints were installed at the end of the operation; in group B (n=25) we used the modified intranasal splints with an integrated rigid duct, with a pressure distributor placed mainly in the anterior nasal septum and the latches along the periphery (patent No. 191163). To assess the patients comfort before and on the first day after surgery, a quality of life assessment questionnaire (Sino-Nasal Outcome Test – SNOT-20) was used. The headache intensity was evaluated in the early postoperative period using a visual analog pain scale. Statistical data processing was carried out using the STATISTICA 12 software.

Results. According to the results of SNOT-20, we obtained a statistically significant (p < 0.05) improvement in the quality of life of patients when using our modified splits against the traditional splits. Comparing the data of the SNOT-20 questionnaire and VAS, we found a statistically significant (p < 0.05) reduction in pain in the early postoperative period when using our intranasal splints with an integrated air duct and pressure distributor.

Conclusion. The use of our modified intranasal splints improves the quality of life of patients in the early postoperative period.

Science and Innovations in Medicine. 2022;7(1):18-21
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Gerontology and geriatrics

Bioimpedance analysis of body composition in elderly and old men with polymorbid pathology

Kurmaev D.P.

Abstract

Aim – to compare the parameters of bioimpedance analysis of body composition in elderly and old men with polymorbid pathology.

Material and methods. The study involved 123 men aged from 65 to 84 years (mean age 73.7 ± 5.9 years) with polymorbid pathology. The Group 1 included 65 elderly men; the Group 2 consisted of 58 old men.

Results. The study revealed the decrease in strength, mass and muscle function parameters related to aging. The bioimpedance phase angle was lower in the group of old men than in the group of elderly men. The correlations of the phase angle with anthropometric and functional parameters, as well as with body composition were revealed.

Conclusion. The decrease in muscle mass parameters and low phase angle may be associated with degenerative processes in skeletal muscles due to aging and polymorbidity. The bioimpedance analysis of body composition can be used in geriatric practice for the diagnosis of sarcopenia syndrome in elderly and old men.

Science and Innovations in Medicine. 2022;7(1):22-25
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Prevalence of osteopenia and osteoporosis in elderly and senile individuals of Kyrgyzstan

Tagaev T.J.

Abstract

Aim – to study the age-related prevalence of osteopenic syndrome and osteoporosis using ultrasound bone densitometry in elderly and senile individuals of the Kyrgyz Republic.

Material and methods. The study included 1,700 elderly and senile individuals, of which 820 were male and 880 were female. The patients were divided into two age groups: elderly (60–74 years old) and senile individuals (75–90 years old). For screening examination, a portable ultrasonic bone densitometer SONOST-3000 was used.

Results. The prevalence of osteoporosis, osteopenia and normal bone mineral density in the elderly age group was 31.3%, 43.5% and 25.2%; in the senile group – 45.5%, 36.5% and 18.1%, respectively. The incidence of osteoporosis increased with age (p < 0.003) and was more common in women (p < 0.001).

Conclusion. Osteopenia and osteoporosis, determined by densitometric thresholds, are widespread among the elderly population of Kyrgyzstan, with a higher incidence among women.

Science and Innovations in Medicine. 2022;7(1):26-29
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Hygiene

Drinking water as an element of a healthy lifestyle of medical students

Novokreshenova I.G., Novokreschenov I.V., Berezin I.I., Semikina N.A., Chunakova V.V., Smotrova J.N.

Abstract

Aim – to study medical university students’ attitude to water intake as an element of a healthy lifestyle.

Material and methods. 824 students of medical university took part in a survey on their attitude to drinking water. The data obtained were processed using the methods of descriptive, parametric and nonparametric statistics.

Results. The students’ attitude to water consumption corresponds to the current WHO recommendations. Almost all respondents (93.2%) agree that water and its rational consumption have positive impact on human health. 87.3% of the students consume water as a drink, with an average of 1.53±0.02 liters per day. 81.8% of respondents use drinking water to satisfy their thirst. 55.3% of respondents prefer still spring water. 32.9% of respondents pointed to the leading role of the family and traditions in forming a certain attitude to drinking water consumption. The respondents also noted the influence of media reports and advertising (20.0%) and of the immediate environment such as friends, classmates, etc. (19.8%). 51.8% of respondents are ready to replace the drinks they use with drinking water.

Conclusion. The main factors determining the behavior of the majority of students in relation to the rational use of drinking water are age and family (including the presence of medical workers among relatives).

Science and Innovations in Medicine. 2022;7(1):30-34
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Infectious diseases

Prediction of chronic kidney disease in patients with hemorrhagic fever with renal syndrome

Stulova M.V., Konstantinov D.Y., Popova L.L., Lyubushkina A.V., Nedugov G.V.

Abstract

Aim – to develop, using mathematical and statistical analysis of clinical, laboratory and instrumental data, a method for predicting the development of chronic kidney disease (CKD) in patients with hemorrhagic fever with renal syndrome (HFRS).

Material and methods. 244 patients at the age from 18 to 50 years with a confirmed diagnosis of HFRS were examined. Patients were observed in the following periods: oliguric, polyuric, early (30th day of illness) and late (90th and 180th day of illness) convalescence. Clinical, laboratory and instrumental data, including computer photoplethysmography, were evaluated.

Results. Prediction of CKD in patients with HFRS (polyuria period) based on a linear discriminant model is possible with an accuracy index of 92.2%. In subsequent periods, the accuracy index increases: in early convalescence – 98.4%, in late convalescence up to 100%. The following markers were the most informative: RI before ischemia, leukocytes and platelets in the general blood test, total protein and creatinine in the biochemical blood test, GFR calculated using the CKD-EPI and MDRD formulas, daily microalbuminuria, BMI and weight.

Conclusion. A complex of discriminant models for predicting the development of CKD in patients with HFRS at various stages of the disease, including convalescence, with an accuracy index from 92 to 100% has been developed. These models are implemented in the software "Calculator for predicting CKD after HFRS".

Science and Innovations in Medicine. 2022;7(1):35-38
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Cardiology

Early signs of disorders of cardiovascular biomechanics

Garanin A.A.

Abstract

Aim – a comprehensive study of disorders of the biomechanics of blood circulation for early diagnostics of atherosclerosis.

Material and methods. The study included 120 people having one of the following risk factors for cardiovascular diseases: smoking, hypertension, Type 1 or Type 2 diabetes. All subjects underwent computer-assisted rheopulmonography, rheovasography, apexcardiography, and direct sphygmography of the major arteries. The functioning of the heart, the arterial wall, the vascular bed of the pulmonary and systemic circulation was evaluated.

Results. Smoking patients mainly had violations of the pulmonary circulation hemodynamics and the biomechanics of the arterial wall of the peripheral arteries due, obviously, to direct damage by nicotine. In patients with arterial hypertension, there was an increase in the work of the myocardium, obviously as a result of the formation of a hyperkinetic type of blood circulation in this disease. Patients with type 1 and type 2 diabetes mellitus were characterized primarily by the development of systolic-diastolic vascular dysfunction, which may be a predictor of the development of angiopathies in the future. In addition, the study of the kinetics of the major arteries revealed violations of the biomechanics of the wall of all vessels under study with risk factors for atherosclerosis. At the same time, it should be noted that more pronounced changes were found in the distal arteries of the muscular type than in the arteries of the muscular-elastic type, which is obviously associated with hemodynamic overloads experienced by peripheral vessels, both as a result of the hydraulic shock that occurs with hyperkinetic type of blood circulation, and the effect of hydrodynamic forces on the vessel wall under the influence of gravity.

Conclusion. Each factor contributes to the development of disorders of cardiovascular biomechanics and hemodynamics. It is necessary to consider changes in the biomechanics of the heart and vascular bed as early manifestations of the circulatory system malfunction with present risk factors for cardiovascular diseases.

Science and Innovations in Medicine. 2022;7(1):39-44
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Atrial fibrillation in COVID-19 convalescent patient

Slatova L.N., Borzenkova G.A., Fedorina T.A.

Abstract

We present a clinical case of spontaneous recovery of sinus rhythm in a patient with persistent atrial fibrillation who underwent COVID-19 infection. Global and Russian data on the effect of COVID-19 infection on the development and course of atrial fibrillation are discussed. 

Science and Innovations in Medicine. 2022;7(1):45-49
pages 45-49 views

Oncology

Assessing the risk of ovarian cancer relapse with special software: a clinical case

Gataullin I.G., Savinova A.R.

Abstract

The article presents a clinical observation of a patient with ovarian cancer, stage IIIA according to FIGO (International Federation of Obstetrics and Gynecology), after completing the first-line combination therapy for whom we determined the risk of recurrence using a special software.

The early prediction of the ovarian cancer relapse was based on calculated ARRNO index (Assessment of Risk of Relapse of Neoplasm of Ovary). As initial data the following characteristics were inserted into the program: disease stage according to FIGO, tumor differentiation stage (Grade), hystotype, state of residual tissue on ultrasound examination after the treatment, levels of СА-125 before the treatment, levels of НЕ-4 after the treatment. The ARRNO software calculated the individual risk of relapse in 3 limits: low (0 - 0,39), moderate (0,40 - 0,85) and high (0,86 - 1,0).

Conclusion. The special software for assessing the risk of relapse of ovarian neoplasm proved to be simple to operate and allowed to predict the relapse with high probability.

Science and Innovations in Medicine. 2022;7(1):50-53
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Combination of biomarker testing and radiation diagnostics of kidney tumors in clinical practice

Ilivanov S.Y., Khaertinov K.S., Usmanova G.A., Khasanov R.S.

Abstract

Aim – determination of the most informative combination of biomarker tests and modern methods of radiological diagnosis of kidney tumors in clinical practice.

Material and methods. The study included clinical and morphological data of 133 patients with kidney tumors. In order to identify the informative markers of kidney tumors, such indicators as gender, age; CT and ultrasound imaging results; vascularization, density, tumor contrast, histological examination, levels of tumor pyruvate kinase and vascular endothelial growth factor were analyzed. The results were statistically processed using Statistica 10 and SAS JMP 11 software.

Results. Determination of biomarkers showed a significant increase in the level of tumor pyruvate kinase and vascular endothelial growth factor in the group of patients with kidney cancer. The TuPKM2 level in these patients reached 46.3 ± 27.2 u/l, and in the group with benign tumors – 27.8 ± 16.4 u/l, the VEGF indices were 330.0 ± 42.91 pg/ml and 266.3 ± 26.39 pg/ml, respectively (p < 0.05). The analysis of CT results showed that in the group of patients with kidney cancer, hypervascular mass was diagnosed much more often than in the group with benign tumors (69.5% and 26.7%, respectively) (p < 0.05). Vascularization is associated with the histology of neoplasms. The nature of contrast and density, determined using CT, are interrelated. The ROC analysis revealed that the most important variables for the diagnosis of kidney cancer are vascularization (relative risk = 1.24) and an increase in TuPKM2 levels above 15 u/l (relative risk = 1.24).

Conclusion. The study results revealed TuPKM2 and the nature of tumor vascularization to be the key markers for the diagnosis of kidney cancer. The groups of patients with different neoplasms had statistically significant difference in terms of TuPKM2 and VEGF. In clinical practice, a comprehensive study for kidney tumor diagnosis is rational, including the determination of tumor pyruvate kinase in combination with ultrasound examination of the kidneys and computed tomography.

Science and Innovations in Medicine. 2022;7(1):54-59
pages 54-59 views

Traumatology and Orthopedics

A new method for adapting the acetabulum for installation of customized implants

Varfolomeev D.I.

Abstract

Aim – to assess the accuracy and duration of acetabulum adaptation when using the developed method of installing the acetabular components of the hip joint endoprosthesis.

Material and methods. A method and a special device for its implementation have been developed for adapting of the acetabulum with defects. An experimental study was conducted on 3D printed plastic models of pelvic bones of patients with acetabulum defects of type 2A-3B according to the Paprosky classification. In the main group, pelvic bones were treated using the developed method. The control group used Zimmer (USA) hip endoprosthesis kit cutters as well as standard surgical instruments. The accuracy of the pelvic bone treatment was evaluated by the volume of liquid silicone that was poured into the space between the endoprosthesis component and the pelvic bone. The duration of preparation of the acetabulum for cup implantation was assessed using a stopwatch.

Results. The mean duration of pelvic bone preparation for cup implantation did not differ significantly between the groups (p = 0.7). The average volume of solidified silicone in the space between the cup and the pelvic bone model in the main group was significantly less than in the control group (p = 0.02). This indicates a high accuracy of the acetabulum adaptation. Acetabulum wall damage in control group occurred in 5 cases.

Conclusion. The proposed method and the device for its implementation allow you to prepare the pelvic bone for implantation of a customized cup with high accuracy. Its application can simplify the complex revision operations and reduce their invasiveness.

Science and Innovations in Medicine. 2022;7(1):60-64
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Surgery

Technical aspects of performing a transumbilical midline laparotomy

Vanzha Y.E., Vertyankin S.V.

Abstract

Aim – to present a new midline approach technique with dissection of the navel and umbilical ring, that allows to reduce the number of postoperative ventral hernias after median laparotomy.

Material and methods. The study involved 230 patients operated using the median approach with the transumbilical technique and with the traditional technique of midline laparotomy with a bypass of the umbilical ring on the left. The observation period lasted from 2016 to 2021.

Results. The observation helped to assess the course of the postoperative period and the long-term outcome in the area of the surgical intervention on the abdominal wall. The advantages of the proposed technique were determined.

Conclusion. When performing an access with a dissection of the umbilical ring, a strict compliance with the sequence of actions of suturing the laparotomic wound is of great importance. For the prevention of postoperative ventral hernias, it is important to combine the methods of access and suturing of the median laparotomic wound.

Science and Innovations in Medicine. 2022;7(1):65-70
pages 65-70 views


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