Vol 22, No 2 (2018)

CARDIOLOGY
MANIFESTATIONS OF FRAILTY IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROME
Soseliya N.N., Bagmanova N.K., Villevalde S.V., Kobalava Z.D.
Abstract

Background. Frailty is a high-priority issue in cardiovascular medicine because of the aging of patients. It reflects the complex functional disorders and is associated with high morbidity and adverse outcomes. The aim of the study was to examination prevalence of frailty, its associations with mortality and hemorrhagic risk in elderly patients with ACS. Materials and methods. In 130 patients ≥ 75 years (82,7 ± 4,7 years, arterial hypertension (AH) 91,5%, previous myocardial infarction (MI) 32,3%, atrial fibrillation 32,3%, diabetes 26,9%, admitted with MI 75,4% or unstable angina 24,6%, frailty (national validated questionnaire), nutritional status (Mini Nutrition Assessment), cognitive function (Mini Mental State Examination) were assessed. Results. Mean score on a national validated questionnaire was 2,9 ± 1,4 points. Only 8.5% of patients responded negatively to all questionnaire questions. None of the patients had 7 points. 6,2, 19,2, 32,3, 23,8, 6,9 and 3,1% patients had 1, 2, 3, 4, 5 and 6 points. 8,5% of the patients were non-frail, 25,4% pre-frail and 66,1% frail. Patients with frailty were more likely women, had higher incidence of AH, MI in this hospitalization, GFR < 60 ml/min/1,73 m2. Conclusion. Frailty occured in 66,1% of elderly patients with ACS, was associated with increased prevalence of cardiovascular diseases.

RUDN Journal of Medicine. 2018;22(2):141-147
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TYPE 2 MYOCARDIAL INFARCTION: CLINICAL AND DEMOGRAPHIC FEATURES, LABORATORY AND INSTRUMENTAL ASSOCIATIONS
Hoang H.T., Kitbalyan A.A., Lazarev P.V., Maiskov V.V., Shkolinikova E.E., Meray I.A.
Abstract

Background: Type 2 (T2) myocardial infarction (MI) is diagnosed in patients with acute coronary syndrome with increasing frequency. However, the information on etiology, pathogenetic mechanisms, instrumental and laboratory features is inconsistent. Purpose: to examine the clinical and demographic parameters, and results of routinely performed laboratory and instrumental test in patients with T2 MI and compare them with population characteristics of type 1 (T1) MI. Methods: We retrospectively included 450 consecutive patients admitted with acute MI diagnosed in accordance with the Third Universal Definition (2012) that underwent coronary angiography. T1 MI was diagnosed in the presence of intraluminal thrombus in the epicardial vessel, or absence of atherosclerotic plaque integrity with decreased myocardial blood flow (TIMI < 3). All other patients were classified as having T2 MI. We analyzed electronic medical records to obtain their data. Student’s t-test and chi-square methods were used to compare single variables in patients with T1 and T2 MI. Multiple logistic regression was then performed to establish independent association of studied parameters with the type of MI. Results: Type 2 MI was diagnosed in 175 (39%) patients and was associated with increasing age (p = 0.007) and female gender (p = 0.01). T2 MI patients more frequently present without ST segment elevation (p = 0.001) and have lower troponin values (p = 0.001). They also had more often had a previous MI (p < 0.001) and had undergone myocardial revascularisation (p = 0.002). The absence of obstructive coronary atherosclerosis was diagnosed in a small fraction of patients with T2 MI [12 (6.9%)]. Independent predictors of having T2 MI were the presence of anemia (p < 0.001), left bundle branch block (p = 0.019), the absence of ST-segment elevation (p = 0.001), age ≥ 70 years (p = 0.014) and the absence of local wall motion abnormalilties on echocardiography (p = 0.002). Conclusion: Type 2 myocardial infarction is diagnosed in a substantial proportion of MI patients and is independently associated with concomitant anemia, left bundle branch block, absence of ST-segment elevation, older age, and the echocardiographic absence of local hypo- and akinesia of the left ventricle.

RUDN Journal of Medicine. 2018;22(2):148-158
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TRAUMATOLOGY
CHOICE OF THE OPTIMAL METHOD OF SURGICAL TREATMENT OF COMPLEX FRACTURES AND FRACTURE-DISLOCATIONS OF THE PROXIMAL HUMERUS
Zagorodniy N.V., Fedorov S.E., Abakirov M.D., Smirnov A.V., Al Bawareed O.A.
Abstract

Purpose and objectives of the study:evaluate and compare the results of surgical treatment of complex fractures and fractures of the proximal humerus. Materials and methods: an analysis of the results of surgical treatment of 202 patients with 3 and 4 fragmentary fractures and fractures of the proximal humerus was performed. During the period of 2015-2017 in the City Clinical Hospital named after V.P. Demikhov. Results: Based on the analysis of surgical treatment of 202 patients with fractures and complex fractures of proximal metaepiphysis of the humerus within 7 days from the time of injury, we came to the conclusion that the most effective method is endoprosthesis of the shoulder joint by a reversible system. This method allows you to reach the maximum amplitude of movements in the shoulder joint in the early stages of rehabilitation treatment. In the main group, where reversive endoprosthetics were used, excellent and good results on the Constant-Murley and ASES scales were obtained in 46 patients (85.2%). Unsatisfactory outcomes were not encountered. More modest results were obtained in the groups where the osteosynthesis of the fractures with pins and plates was performed, and hemiarthroplasty for the surgical treatment of "fresh" fractures and complex fractures of the proximal metaepiphysis of the humerus was found to be untenable.

RUDN Journal of Medicine. 2018;22(2):159-164
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INCIDENCE OF PRIMARY ENDOPROSTHESTIC REVISION IN PATIENTS WITH BILATERAL HUMERAL HEAD FRACRTURE
Fedorov S.E., Zagorodny N.V., Abakirov M.D., Smirnov A.V., Al Bawareed O.A.
Abstract

The purpose and objective of the study is to evaluate the results of the surgical treatment method of primary reversible endoprosthesis in bilateral humerus head fractures and osteosynthesis in bilateral humeral head fracture-dislocation. The study will also compare the method of primary reversible endoprosthesis with osteosynthesis. Materials and methods: we performed analysis of the clinical case in a patient with bilateral humeral head fractures using a single-stage bilateral reversible Endoprosthesis of the shoulder joints with Zimmer endoprosthetics with cement fixation of the stem. Results: We evaluated the result of the treatment 2 months after the operation on the Constant-Murley scales (81 points - good) and ASES (83 points - good), on the basis of the analysis of these surgical treatment methods, we came to the conclusion that the method of choice for bilateral fracture of the humeral head is a one-stage total reversive endoprosthesis. After rehabilitation, the patient performs his domestics routines and performs light work at home.

RUDN Journal of Medicine. 2018;22(2):165-170
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EXPERIMENTAL PHYSIOLOGY
ACTIVE DYNAMICS OF THE ENZYMES OF THE ANTIRADICAL PROTECTION AND THE GENERAL ANTIOXIDATIVE ACTIVITY BY THE DEVELOPMENT OF THE EXPERIMENTAL ISCHEMIC REPERFUSION OF LIVER
Popov K.A., Bykov I.M., Ermakova G.A., Tsymbalyuk I.Y.
Abstract

The purpose of the study: to research the active changes in several enzymes of the antioxidative protection within the dynamical development of the liver reperfusion in rats. Materials and methods: the study has been performed on 95 white non-lineal male rats with the mass of 240-280 g divided into groups, the biological material of which has been sampled within 5-20 minutes of the ischemic period and 5-20 minutes of the reperfusion period with the interval of 5 minutes. To evaluate the changes of the antioxidative system the activity of the superoxide dismutase, the erythrocyte catalase and the liver homogenate as well as the general antioxidative activity have been determined. Results: the performed study has demonstrated the imbalance development for the relation between the activity of catalase and superoxide dismutase by the development of the ischemic reperfusion syndrome with the change of this relation to the prevalence of the catalase activity on the systemic level and the superoxide dismutase activity on the organic level after the circulatory restoration. Besides the increase in activity of the studied enzymes from the erythrocyte, meal by 2 times in comparison with the control group has been determined especially at the ischemic period as well as the tendencies to the progressive activity decrease of the same enzymes in the liver tissue. The general antioxidative activity in the period of ischemic reperfusion has been decreasing to the fifth minute of ischemia by 2 times and has lasted on the same level (0.04-0.05 mg/l of vitamin C in terms of 1 gram of homogenate protein) during the entire experiment. Conclusion: the received results have demonstrated the possibility for the evaluation of the functional state for the system of oxidative restorative homeostasis in an animal by ischemic reperfusion of the liver against the background of the lowered general antioxidative activity. It was marked also the necessity of the metabolic support of this link within the system of non-specific resistance for the correction of the developing disorders.

RUDN Journal of Medicine. 2018;22(2):171-182
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ALLERGOLOGY. DERMATOLOGY
ASSOCIATION OF CC16 POLYMORPHISM WITH RISK FACTORS OF FORMATION OF BRONCHO-OBSTRUCTIVE SYNDROME IN CHILDREN
Seliverstova E.N., Bashkina O.A., Stroikova T.R., Sergienko D.F., Averina I.A.
Abstract

Syndrome of bronchial obstruction is a symptomatic complex arising on the background of constriction or occlusion of bronchial tubes of different caliber due to bronchospasm, edema and inflammation of the bronchial mucosa, hypersecretion of mucus or compression by surrounding structures. Bronchoobstructive syndrome (BOS) is one of the most common pathological conditions in pediatric practice. The outcome of BOS can be different: from the complete disappearance of clinical manifestations to the process, disability or even death. Accordingly, the study of this problem and the search for methods for early diagnosis and prediction of the outcome of BOS is a very urgent problem. In order to identify risk factors for BOS and to clarify the association with polymorphism of the CC16 gene, 126 children belonging to the main group and 58 from the comparison group were examined. In the course of the study, the triggers influence on the formation of the BOS of concomitant ENT pathology, burdened personal and family allergic anamnesis, and also the recurrent nature of respiratory infections in the first year of life was proved. The association of polymorphism of AA gene of CC16 with the presence of weighed allergic anamnesis and frequent episodes of ARVI, as well as the influence of this genotype on the early debut of respiratory diseases in children, has been revealed. The relationship of the GG genotype with the concomitant ENT pathology among patients with recurrent BOS has been proved.

RUDN Journal of Medicine. 2018;22(2):183-190
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ОBJECTIVE METHOD SELECTION OF CHILDREN WITH INFANTILE HEMANGIOMAS FOR TREATMENT BY LASER RADIATION AND EVALUATION OF EFFECTIVENESS
Trapeznikova T.V., Pisklakova T.P., Gubina V.O.
Abstract

Infantile hemangiomas, the most common neonatal tumors, are characterized by rapid proliferation which induces various complications. The goal of the study is to develop an algorithm for selection of patients for the treatment of with laser radiation the basis of study characteristics of the infantile hemangiomas with the help non-invasive methods and evaluation of effectiveness carried out by the therapy. Materials and methods. A prospective study of 122 children with infantile hemangiomas aged 1 to 24 months was performed, including assessment of hemangiomas clinical picture, distribution of hemangiomas according to their localization and size, erythemometry and ultrasound scanning. Superficial hemangiomas were detected by Doppler ultrasound in 84 patients (63.6%), combined ones - in 38 patients (28.8%). Findings of hemangioma erythemometry before the course of treatment ranged from 180 to 450 standard units. Results. In 122 children 132 vascular tumors were detected. An algorithm for selection of patients for infantile hemangioma treatment was developed taking into account objective non-invasive methods of ultrasound and skin erythemometry. 2 patients clinical follow-up is recommended, 10 patient is sent for further surgical treatment. The course of treatment is short (1-5 sessions) for 81 patients with superficial hemangiomas. The course of treatment is long (6-10 sessions) for 81 patients with combined hemangiomas Nd:YAP/KTP Q-Sw laser with 3 mm nozzle, radiation wavelength 1079/540 nm was used. Ultrasound examination of all superficially located hemangiomas after the course of laser therapy didn’t show vascular formation and blood flow, the structure of the dermis and hypoderm did not have structural changes in the study. Erythemometry values after treatment to fit the values of the control skin area and 110 - 85 standard units are decreased. Conclusion. An algorithm for selecting patients for Nd: YAP / KTPQ-Sw 1079/540 nm laser treatment was developed including erythemometry, involvement area, depth of involvement, feeding vessel diameter and exclusion of dangerous anatomical localizations.

RUDN Journal of Medicine. 2018;22(2):191-208
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IMMUNOLOGY. INFECTIOUS PATHOLOGY
STUDY OF EXPRESSION OF HBD-1 AND HBD-2 GENES IN EPITHELIAL CELLS OF MUCOUS UPPER AIRWAY IN NEWBORNS WITH PNEUMONIA DEPENDING ON THE CAUSATIVE AGENT
Rasskazova N.D., Alieva A.I., Gankovskaya L.V., Zhigalkina P.V., Svitich O.A.
Abstract

Β-defensins play an important role in protecting the fetus from infection, so the expression of these antimicrobial peptides in the respiratory tract in newborns is really important. In this regard, we set a task of studying the expression of the HBD-1 and HBD-2 genes in the epithelial cells of the mucous of the upper airway in newborns with pneumonia and in healthy newborns, depending on the causative agent. Also, the polymorphic marker G(-20) A in the DEFB1 gene was associated with infectious pathology of newborns (in particular pneumonia). Methods: The microflora and the factors of congenital immunity on the mucous membranes of the upper airway have been studied in two groups: newborns with ventilator-associated and congenital pneumonia. The biological material was scrapings of epithelial cells of the mucous membrane of the upper airway of newborns and puerperas and blood. Results: It was found that the expression of the HBD-2 gene increases 2.3-fold in children who have an infectious agent, but there are no clinical manifestations of pneumonia. A significant decrease in HBD-2 (3.2 times) in patients with pneumonia caused by K. pneumonia was shown. The frequencies of alleles of the DEFB1 gene in the fetal infection group and in the comparison group: allele G - 0.66, 0.79, allele A - 0.34, 0.21, respectively. The frequencies of the genotypes of the test marker in mothers in the ventilator-associated, congenital pneumonia and the comparison group were as follows: GG - 0.78, 0.58, 0.58; AA is 0, 0.25, 0; AG - 0.22, 0.17, 0.42, respectively. In newborns allele G dominated among alleles (frequency was higher than 0.73 in all groups) and genotype GG (frequency exceeded 0.52). Conclusion: In the course of the study, it was confirmed that β-defensins protect the mucous from infectious agents. The results indicate that the genetic marker G (-20) A of the DEFB1 gene is associated with the risk of developing the child's UTI.

RUDN Journal of Medicine. 2018;22(2):209-217
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IMMUNOGENETIC CRITERIA FOR THE DEVELOPMENT OF INFECTIOUS-ASSOCIATED FORMS OF CERVIX CANCER
Levkova E.A., Pushkar V.A., Grebenya O.A., Savin S.Z.
Abstract

The aim of the work is to carry out immunogenetic studies of women at risk of developing infectious-associated forms of cervical cancer and to develop immunogenetic criteria for the risk of cervical cancer. Materials and methods of the prospective study - 120 women participated in the study with the obligatory presence of voluntary medical consent in the age range from 19 to 42 years. Processing of biological material (biopsy, scrapings) was carried out using sets of “DNA technology” for human papillomavirus 16.18 types. The program included the study of cytolytic cells in cervical biopsies with phenotype CD3-CD16+CD56+. Normative values for a given pool of cells was defined as comparable in the peripheral blood in the range of 5-9%. Generirovanie pre sekvenirovanie material was performed at clinical Centre absolute. The basic pathologic-and-genetic mechanisms for its implementation and the Association with certain genotypes. As a result of studies, the risk criteria for the development of neoplastic process in women with different degrees of dysplasia infected with human papilloma virus 16/18 type were determined. It was revealed that the number of natural killers associated with genetic markers is a criterion of infection-induced process, including neoplastic. It is shown that the decrease in the activity of cytolytic cells associated with the genotype of human leukocyte antigen HLAV35, with the human papillomavirus 16\18 positive women, compared with groups II and III (human papillomavirus 16\18+), leads to the aggravation of the pathological process and the development of cervical cancer. The number of natural keellers associated with genetic markers is a criterion of infection-induced.

RUDN Journal of Medicine. 2018;22(2):218-225
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MONO- AND MIXED-HERPESVIRUS INFECTIONS: ASSOCIATION WITH CLINICAL SYNDROMES OF IMMUNODEFICIENCY
Nesterova I.V., Khalturina E.O.
Abstract

In recent years, the number of hard diagnosed, polysymptomatic and polysyndrome conditions and diseases caused by mono- and mixed-herpes infections has sharply increased in the practice of physicians of all specialties. The clinical aspects of the close attention of physicians, virologists and epidemiologists to this viral family are due not only to the onset of atypical forms of these infections, but also to the emergence of the relative new concept of “active chronic atypical infection” caused by herpesviruses and in particular the Epstein-Barr virus. We observed 198 people of both sexes aged between 23 and 60 years, suffering from mono- and mixed herpetic infections (EBV, CMV, HSV 1/2, and HSV type 6). 36% of these, suffered from mono-herpesvirus infections, mixed-herpesvirus infections were diagnosed in 63.7% of cases. A study of functioning characteristics of antiviral protection system as well as defects and disorders in the system of interferons was carried out in patients suffering from various mono-, mixed herpes virus infections and bacterial co-infections. The main clinical syndromes associated with these herpetic infections, as well as prevailing nosological forms of concomitant diseases were revealed. The revealed clinical syndromes and functioning characteristics of an antiviral protection will allow developing of a conceptual, individualized, etio- and immunopathogenetic therapy.

RUDN Journal of Medicine. 2018;22(2):226-234
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