Vol 7, No 4 (2022)

Gerontology and geriatrics

Association of drug therapy with falls in elderly and senile patients: Subanalysis of the epidemiological study EVKALIPT

Khovasova N.O., Vorobyeva N.M., Naumov A.V., Tkacheva O.N.


Aim – to evaluate the structure of drug therapy in patients with falls and to identify the associations of falls with drug administration.

Material and methods. This work is a subanalysis of the epidemiological study EVKALIPT. 4301 patients who had information about presence or absence of falls in the previous year were selected. The patients were divided into 2 groups: 1 group (n = 1307) – having falls, 2 group (n = 2994) – without falls. We studied the complaints and medical history, conducted general examination and analyzed medical documentation to get the information on drug treatment. A regular intake of 5 or more drugs was considered polypharmacy.

Results. All patients had chronic diseases. In patients with falls, most diseases were more common, the Charlson Comorbidity Index was higher (5.53±2.4 versus 4.73±2.03, p<0.001), as well as the proportion of high comorbidity (62.2% versus 47.7%, p<0.001). All study participants took medications, on average 5.4 ± 2.6 drugs. The patients with falls received higher number of drugs (5.73±2.6 versus 5.3±2.5, p<0.001). The frequency of polypharmacy was 64.6% and 56.7% (p<0.001) in groups 1 and 2, respectively. The patients with falls were more likely to take sartans, beta-blockers, diuretics, centrally acting antihypertensives, anticoagulants, nitrates, amiodarone, insulin, NSAIDs, proton pump inhibitors, calcium, vitamin D, anti-osteoporrotic therapy. Administration of a number of drugs was associated with falls (OR 1.18-2.15). For some drugs, a trend in favor of falls was revealed. Only statin therapy was associated with a 24% reduction in the odds of falling. The presence of polypharmacy increased the risk of falls by 1.3 times (OR 1.27, 95% CI 1.10-1.46, p=0.001).

Conclusion. Polypharmacy and drug evaluation are important in assessing the risk of falls. In clinical practice, it is necessary to regularly conduct an audit of medications in elderly patients.

Science and Innovations in Medicine. 2022;7(4):220-225
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Clinical and anamnestic analysis of in-patients with COVID-19 infection hospitalized during one month

Gubareva E.Y., Fatenkov O.V., Konstantinov D.Y., Gubareva I.V.


Aim – to analyze the clinical and anamnestic data of the patients with a confirmed diagnosis of COVID-19 who were hospitalized in the emergency department of the designated COVID-19 hospital of the Clinics of Samara State Medical University during one month and to compare the results with published registries’ data.

Material and methods. A retrospective anonymous data sample included patients hospitalized in the emergency department of the designated hospital of the Clinics of Samara State Medical University during a calendar month (01.03.2021–31.03.2021) with a confirmed diagnosis of COVID-19. A total of 126 patients (57.9% women) were included in the study, the average age was 65.9±12.8 years.

Results. Statistically significant differences (p<0.05) in age and body mass index, as well as in the proportion of obese patients were obtained depending on the gender of the patients. Almost every hospitalized person had at least one comorbidity, among which the diseases of the cardiovascular system and gastrointestinal tract prevailed. In general, the obtained data are comparable with the international registries. The differences can be explained by the fact that there were no universal criteria for inclusion, except for the confirmed diagnosis of COVID-19, in the analyzed data samples.

Conclusion. The high frequency of some diseases makes it possible to significantly expand the possibilities of analysis and increase the reliability in identifying the causes affecting the prognosis in a particular region. The clinical and anamnestic features of a patient may allow individualizing the prognostic assumptions.

Science and Innovations in Medicine. 2022;7(4):226-231
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Production of growth factors by fibroblasts in the conditions of the wound process and under the exposure of a bacterial biofilm matrix

Yarets Y.I.


Aim – to analyze the production of growth factors by fibroblasts in the wound process and under the influence of the bacterial biofilm matrix.

Material and methods. We assessed the levels of such growth factors as: VEGF, TGF-1β, GM-CSF, FGF produced by granulation tissue fibroblasts of acute wound (AW) (group 1, n=9) and chronic wound (CW) (group 2, n=17). Skin fibroblasts (n=5) were used for reference. The primary cultures were obtained by the method of explants. The experimental biofilm matrix included S. aureus, E. faecalis, A. baumannii, P. aeruginosa, K. pneumoniae, P. mirabilis (5 of each species).

Results. The elevated levels of TGF-1β and VEGF, secreted by the primary cultures of fibroblasts, against of the absence of changes in the values of FGF and GM-CSF, are the criteria for the imbalance of growth factors characteristic of CW. The impact of the biofilm matrix P. aeruginosa, K. pneumoniae, A. baumannii, P. mirabilis on skin fibroblasts was accompanied by an increase in the production of VEGF and GM-CSF and a decrease in the synthesis of TGF-1β and FGF. In the experiments with S. aureus and E. faecalis, a similar direction of changes was recorded, but the degree of its severity was lower than for experiments with the gram-negative bacteria.

Conclusion. The obtained results have demonstrated various effects of the biofilm matrix on the production of growth factors by fibroblasts and updated the information on the pathogenesis of CW formation. The revealed imbalance in the synthesis of growth factors by fibroblasts in the granulation tissue of wounds with “borderline” lifetimes (22–28 days) determines the need for tactical approaches in the treatment of CW.

Science and Innovations in Medicine. 2022;7(4):232-238
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Modeling the outcomes of thrombolytic therapy in ischemic stroke

Minina Y.D., Kalinin V.A., Tkachenko A.S.


Aim – to predict the effectiveness of systemic thrombolysis based on a comprehensive assessment of risk factors at the stage of decision making for thrombolytic therapy.

Material and methods. The study included 110 ischemic stroke patients hospitalized between 2016 and 2021 who received the rt-PA systemic thrombolytic therapy. Depending on the outcome of the disease, all patients were ranked into two groups. Group I (favorable outcome) included 79 patients who had regression of focal neurological deficit, assessed using the NIHSS, mRS, Rivermead scales. Group II (unfavorable outcome) included 31 patient, among whom 4 patients had a worsening condition, expressed as an increase in focal neurological deficit, assessed using the NIHSS scale, as well as 27 patients who developed a lethal outcome.

Results. The following factors were revealed having the greatest impact on the outcome of the thrombolytic therapy: the age of patients, the time passed from the development of stroke symptoms to systemic thrombolysis, the severity of neurological deficit, the ASPECTS score at admission, the blood glucose level at admission. In order to group the array of processed clinical, laboratory and neuroimaging data, we used a two-stage cluster analysis. Four clusters were formed in the process of cluster analysis. A mathematical model was developed in order to improve the efficiency of systemic thrombolysis and to predict the outcome of the disease in patients with ischemic stroke, which was tested on the basis of the neurological department of the Regional Clinical Hospital named after V.D. Seredavin.

Conclusion. The application of this mathematical model based on medical information systems will make it possible to stratify the risk of disease outcome in patients with ischemic stroke timely and effectively at the stage of the emergency department in the vascular centers and primary vascular departments of the city of Samara.

Science and Innovations in Medicine. 2022;7(4):239-244
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Public health, organization and sociology of health

Criteria for evaluating the effectiveness of preventive care in a fitness center

Valiev A.S., Galikeeva A.S., Khukhrin M.S., Idrisova G.B.


Aim – to formulate the criteria for evaluating the effectiveness of prevention of non-communicable socially significant diseases on the basis of fitness centers.

Material and methods. The longitudinal retrospective study included 370 visitors of fitness centers who attended wellness programs. The adaptation potential (AP) formula according to R.M. Baevsky served the basic method for research. According to the results of screening, the visitors were divided in three groups. Hemodynamics and trophological status were measured in each group.

Results. The hemodynamics and trophological status differed depending on the adaptation potential. In the group with the AP score less than 2.6, the SBP at rest was 113±11.1 mmHg, DBP 68.1±7.4 mmHg. In the second group, the SBP was 126±11.2 mmHg, DBP = 77.5±10 mmHg, heart rate = 75±10 bpm, BMI = 26.7±3 kg/m2 and waist/hip ratio= 0.84±0.17. In the third group: SBP = 142.8±11.2 mmHg, DBP = 85.7±10 mmHg, heart rate = 79±10 bpm. BMI = 29.8±4.8 kg/m2, waist/hip ratio =0.90±0.16. The level of SBP in all three groups after the functional test was 119.5 [95% CI 115–123], 125.0 [95% CI 116–155] and 144.5 [95% CI 133–172] mmHg (H = 52.1227, p = 0.00199), respectively.

During the study period, in the first group, the AP score remained at the same level in all age groups. In the second group, there was a decrease of AP score from 2.81±0.13 to 2.66±0.21 points. In the third group, we observed the decrease from 3.3 ± 0.14 to 3.13 ±0.28 points with a sufficient number of visits (101 or more per year) in all age groups.

Conclusion. The use of such criterion as adaptation potential makes it possible to assess the effectiveness of mass preventive measures due to more precise differentiation of visitors and the use of homogeneous impact methods.

Science and Innovations in Medicine. 2022;7(4):245-249
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Donor-specific production of cytokines by blood cells under the influence of immunomodulators: New aspects of a personalized approach in medicine

Volova L.T., Osina N.K., Kuznetsov S.I., Gusyakova O.A., Alekseev D.G., Pugachev E.I., Goncharenko S.A.


Aim – to study the immunomodulator-induced individual cytokine production by peripheral blood mononuclear cells (PBMCs) and to evaluate the potential of using this approach as a universal cellular test system in personalized medicine.

Material and methods. The peripheral blood mononuclear cells given by donors were cultured in vitro in the presence of immunomodulators Imunofan and Polyoxidonium. After incubation, the enzyme-linked immunosorbent assay (ELISA) of the culture medium for the presence of pro-inflammatory cytokines IL-6, IL-8/CXCL8, MCP-1/CCL2, and IFN-α cytokines was performed.

Results. The results of the experiment have demonstrated the absence of spontaneous or immunomodulator-induced production of IFN-α by PBMCs. These data correspond to the information presented earlier in the scientific literature. We also observed a pronounced inhibitory effect of both immunomodulators on the production of cytokines MCP-1/CCL2, IL-6, IL-8/CXCL8 by PBMCs, along with the individual variability of their production and the cumulative effect of production over time.

Conclusion. The features of the production of pro-inflammatory cytokines by PBMCs into the medium in the presence of immunomodulators, revealed by the in vitro screening, can be used to develop universal in vitro cellular test systems for personalized diagnosis of a number of socially significant inflammatory and autoimmune diseases.

Science and Innovations in Medicine. 2022;7(4):250-257
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Analysis of morbidity and mortality from cervical cancer in the Samara region for 10 years

Okuneva I.V., Zolotareva T.G., Orlov A.E.


Aim – to study the dynamics of morbidity and mortality from cervical cancer, the age characteristics of the patients for the period 2010-2019 in the Samara region.

Material and methods. We used the statistical data on morbidity and mortality in women with cervical cancer in the period from 2010 to 2019, registered in the statistical reporting forms of the Samara region.

Results. In 2010, 12,329 patients were diagnosed with malignant neoplasms (MN) for the first time, of which 281 patient (2.3%) was diagnosed with cervical cancer. In 2019, 14,456 patients were diagnosed with MN for the first time, of which 422 patients (3%) had cervical cancer. At the same time, the peak incidence of cervical cancer was registered in 2017 – 627 patients (4.5%). Between 2010 and 2019 there was an increase in patients with a confirmed diagnosis of cancer by 30.2%, and with a diagnosis of cervical cancer – by 18.3%.

Conclusion. The analysis indicates a trend towards an increase in the incidence of cervical cancer. This result may demonstrate both a real increase in the frequency of this pathology, where an unfavorable environmental situation in the Samara region may be a risk factor, and an improvement in the quality of diagnosis and statistical records.

Science and Innovations in Medicine. 2022;7(4):258-263
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The opinion of medical and biological students on the prevention of sexually transmitted diseases in the context of the COVID-19 pandemic: A social monitoring

Timoshilov V.I., Breusov A.V., Kuznetsova A.A.


Aim – to analyze the dynamics of the opinions of medical and biological students on the problem of preventing sexually transmitted infections before and during the pandemic of the new coronavirus infection.

Material and methods. A sociological survey was conducted in 2017 (372 respondents) and 2021 (574 respondents) among the students of institutions of higher and secondary vocational education in medical and biological specialties. We used the authors' questionnaire, consisting of 54 questions grouped into 5 blocks. In both samples, the principle of equal representation of age, gender, social and professional groups was observed. The average age of the respondents was 19.1±0.74 years. The distribution of the respondents by sex was as follows: in 2017, female – 51.9% (n=193), male – 48.1% (n=179); in 2021, female – 50.7% (n=291) and male – 49.3% (n=283). Both samples had sufficient size to obtain results with the accuracy level of α=0.05. The analytical, statistical, sociological methods were used for research. In the processing and presentation of the data, the extensive indicators were used, compared with the assessment of the significance of differences according to Student's t-test.

Results. The proportion of people who had an objective idea of the risk of contracting sexually transmitted infections increased from 72.8% (2017) to 87.8% (2021), while the association of the threat only with the frequent change of partners was noted significantly less often (5.9% in 2021 and 16.7% in 2017). The proportion of students linking the risk with social status has decreased from 8.1% to 4.7%, which may indicate a tendency for more objective ideas about the risks of sexually transmitted infections.

Conclusion. During the period of the COVID-19 pandemic, the prevalence of an objective self-assessment of the epidemiological situation and the associated risks of contracting sexually transmitted infections increased statistically among students. Also, increased their readiness to undergo screening examinations and seek qualified medical care.

Science and Innovations in Medicine. 2022;7(4):264-268
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Oncology and radiotherapy

Newly formated (tertiary) lymphoid structures in tumor growth

Rustamkhanov R.A., Kzyrgalin S.R., Arybzhanov D.T., Gantsev K.S., Tursumetov D.S., Gantsev S.K.


Aim – to reproduce tertiary lymphoid structures and study their features in a malignant neoplasm in the experiment.

Material and methods. Male white rats of the Wistar stress-resistant line were inoculated with the tumor strain sarcoma M1. Using the methods of microsurgical preparation, color lymphography and ultrasonic sonolipodestruction we isolated the lymph nodes without metastatic lesions (described as secondary in normal anatomy), the lymph nodes with metastases of M1 sarcoma, and the newly formed nodes (extrauterine or tertiary). Lymph nodes were examined macroscopically, micromorphometric studies were performed, histological and immunohistochemical signs of tertiary lymph nodes were determined. The obtained data were subjected to statistical analysis.

Results. In 60% of rats, in the right axillary region, in addition to the secondary lymph nodes described in normal anatomy, the tertiary lymph nodes were found on the side of the tumor. They were located near the histologically verified metastatic lymph node. The studied parameters of the main structural and functional zones of the tertiary lymph nodes had the following features: the enlarged marginal sinuses; a fewer number of lymphoid follicles; the average total area of blood vessels increased by 92% in relation to the metastatic lymph nodes and by 78% in relation to the secondary lymph nodes. The significant differences were registered with CD3, CD4, CD20, CD30 markers.

Conclusion. The study proved the possibility of reproducing tertiary lymphoid nodes in the experiment with malignant growth and revealed a number of their features.

Science and Innovations in Medicine. 2022;7(4):269-274
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Traumatology and Orthopedics

A new method of distal blocking of intramedullary implants

Varfolomeev D.I.


Aim – to assess the capabilities of the developed method and device for distal blocking of intramedullary implants.

Material and methods. An experimental study on the tibia models was performed in the settings of the Department of Traumatology and orthopedics of the Voronezh State Medical University. The main group included 10 models on which the blocking was done using the developed method. In the control group (10 models) the "free hand" method was used. The study evaluated the following parameters: the duration of blocking, the time of X-ray exposure, the number of blocking attempts.

Results. In the main group, the duration of distal blocking procedure was significantly shorter than in the control group (T-criterion = -36.0; p < 0.05). The time of X-ray exposure in the main group was also less than in the control group (T-test = -30.2, p < 0.05). The number of blocking attempts in the control group was higher than in the main group (U-criterion = 20, p = 0.02). In the main group, all screws were inserted at the first attempt. In the control group, drilling holes past the pin holes was noted.

Conclusion. The developed method and the device for its implementation are universal. They can be used with most intramedullary pins and revision femoral components of a hip endoprosthesis, both cannulated and non-cannulated.

Science and Innovations in Medicine. 2022;7(4):275-280
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Current trends in the development of long tubular bones osteosynthesis

Pankratov A.S., Rubtsov A.A., Ogurtsov D.A., Kim Y.D., Shitikov D.S., Shmelkov A.V.


We reviewed scientific literature on the problem of osteosynthesis of long tubular human bones, published during the last 10 years. The Scopus, Web of Scince, Pubmed, RSCI databases were searched for the articles reporting the results of clinical studies and biomechanical experiments using plate osteosynthesis. The advantages and disadvantages of minimally invasive plate osteosynthesis for different segments have been revealed. The articles reported a lower probability of displacement development in minimally invasive plate osteosynthesis in comparison with intramedullary osteosynthesis, good biological conditions for fracture healing, decreased rate of complications of postoperative wounds due to reduced incisions.

In the concept of biological osteosynthesis, the advantage of axial dynamization and fracture micro-mobility over absolute rigidity was noted. The study also revealed the influence of the parameters of a plate and osteosynthesis technique on the rigidity of the plate-bone system, such as: the working length of the plate, the number of screws on the plate, types of screws (cortical or locking), the plate material and its profile.

The bone osteosynthesis seemed to have new directions of evolution. These include far cortical locking screws allowing micromobility under the plate, providing a "controlled dynamization". An experimental technology of Active Locking Plates has been reported, where the screws with angular stability are locked in holes on elastic sliding elements providing micromobility of the screw relative to the plate.

In general, all the visible results differed in various studies and, sometimes, contradicted each other.

Science and Innovations in Medicine. 2022;7(4):281-288
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