Vol 23, No 1 (2019)

Physiology
FUNCTIONAL FEATURES OF THE MYOCARDIUM AMONG FIRST-YEAR STUDENTS OF DIFFERENT ETHNIC GROUPS WITH REGARD TO THE TYPE OF AUTONOMIC REGULATION OF THE CARDIAC RHYTHM
Al-Shammari M.J., Pogrebnyak T.A., Chernyavskikh S.D., Gorbunova I.I.
Abstract

The analysis of the dynamics of heart rate and blood pressure components in students of five ethnic groups - Arabic, Indian, African, Latin American and Russian, taking into account the most characteristic types of autonomous regulation of heart rate (HR) with the third moderate predominance of autonomous regulation (MPAR) and the fourth - a pronounced predominance of autonomous regulation (PPAR) HR. A mediocre level of fitness of the cardiovascular system among students: Russian and Arab with MPAR HR at both stages; Indian and Latin American with MPAR and PPAR HR types of regulation of heart rhythm at the 1st stage; African with MPAR HR on the 2nd stage. The rest of the students - a good level of fitness. High vs. normal values of systolic pressure indicate a maladaptive state of groups of Arab and African students at both stages, Indian with the MPAR HR at the second stage. Increased pulse pressure (PP) in Russian students at the second stage with the PPAR HR, among Arabic, Latin American, African students at both stages, notes a decrease in their myocardial functionality against the background of diastolic fatigue and disadaptation to conditions of relative physiological rest. Under conditions of relative physiological rest, the high anti-normal values of systolic blood pressure (SBP) indicated the maladaptive state of groups of Arab and African students at both stages, Indian with MPAR at the 2nd stage. High PD in all subgroups of Arab, African and Latin American students at the 2nd stage with PPAR and at the rest of the groups with MPAR and PPAR HR are objective indicators of myocardial diastolic fatigue, reduction of its functional capabilities and manifestation of maladaptation in conditions of relative physiological rest.

RUDN Journal of Medicine. 2019;23(1):9-18
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DEFENSINS-a AT AN EARLY AGE IN RATS WITH ACUTE SOMATIC PAIN
Bykov I.M., Alekseev V.V.
Abstract

This article presents the results of studies on the reaction of α-defensins to acute somatic pain in newborn rats and in the early puberty period. Studies were carried out on white mongrel rats for three hours after pain exposure. The level of α-defensins was determined by enzyme immunoassay. During the experiments, a short-term increase in the level of α-defensins in newborns and rats in the early puberty period was revealed. At the same time, in animals of one month of age a two-phase, labile reaction of an increase in the level of α-defensins in peripheral blood occurs.

RUDN Journal of Medicine. 2019;23(1):19-24
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CARDIOLOGY
INFORMATION ABOUT SCIENTIFIC STUDDING LEVEL ON PROBLEM OF HYPERTENSION-MEDIATED ORGAN DAMAGE IN MONGOLIA
Maksikova T.M., Barsuren T., Kalyagin A.N., Babanskaya E.B.
Abstract

Despite of arterial hypertension high prevalence and its complications in Mongolia, the epidemiology and structure of hypertension-mediated organ damage remains insufficiently studied. Aim. To assess elaboration level of the problem of AH-associated hypertension-mediated organ damage in Mongolia. Materials and methods. Leading international guidelines and recommendations, reviews, meta-analyzes, randomized controlled, population-based research and Mongolian scientific papers with different evidential value, related to hypertension-mediated organ damage were analyzed. Results and discussion. In developed countries, hypertension-mediated organ damage structure and their contribution to total cardiovascular risk stratification in patients with hypertension is well studied. In 2018 ESC/ESH Guidelines for the management of arterial hypertension hypertension-mediated organ damage criteria were only slightly extended. Data on arterial hypertension epidemiology, including hypertension-mediated organ damage structure, in Mongolian population, mainly obtained from ethnic Mongols living in the territory of Inner Mongolia and other provinces of China, or in international studies with Mongolia participation. Directly in Mongolia, hypertension-mediated organ damage were studied in small samples; a systemic epidemiological analysis of hypertension-mediated organ damage was not carried out. Conclusions. Given arterial hypertension significance in Mongolia and insufficient scientific elaboration of problem, population studies are needed to clarify hypertension-mediated organ damage prevalence and structure in order for improving arterial hypertension management.

RUDN Journal of Medicine. 2019;23(1):25-39
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SURGERY
EFFECT OF CONNECTIVE INSUFFICIENCY AND SIZES OF MEDIAN HERNIAS ON BEFORE AND POSTOPERATIVE FUNCTION OF THE ABDOMINAL MUSCLE
Railianu R.I., Podoliniy G.I., Marshaluk A.V.
Abstract

The article analyzes the results of electromyography of the abdominal muscles in 189 patients with median postoperative hernia of the anterior abdominal wall of different sizes before and after the combined methods of hernioplasty, including considering the level of connective tissue failure. In the preoperative period, electromyography was performed in 69 (36,6%), after combined hernioplasty, 120 (63,4%) patients. The patients were divided into a group of 161 (85,1%) patients with clinically significant or histologically confirmed connective tissue insufficiency and into a group of 28 (14,9%) patients without it. The distribution of patients in the examination groups was carried out using an original method of assessing the degree of deviation of collagen fibers from the projection of the Langer lines in microscopic specimens of the skin areas excised during the operation and based on the results of a retrospective analysis of case histories with determination of the intraoperative adhesions of the adhesions in the abdominal cavity or hernial sac. In the formed groups, we studied the amplitude, frequency, front and area of electromyograms obtained from the direct and lateral muscles of the anterior abdominal wall. It was found that in patients with median postoperative hernias, mesenchymal dysplasia was the main reason for the decrease in functional activity and the imbalance of forces between the direct and lateral abdominal muscles. Optimal restoration of electroactivity of the abdominal muscles after combined hernioplasty occurred among patients without clinically significant connective tissue insufficiency. When reaching a giant postoperative hernia of gigantic size in patients with a clinically significant level of connective tissue dysplasia, the functioning of the abdominal muscles decreased by 26%, and in patients without it only by 15%. The pathology of collagen in skin grafts excised during surgery was detected in 91,5% of patients with mid-incisional hernias.

RUDN Journal of Medicine. 2019;23(1):40-53
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OPHTHALMOLOGY
PSEUDOEXPHOLIATIVE SYNDROME
Bekmirova B.B., Frolov M.A.
Abstract

Today, the clouding of the lens is one of the common pathology of the organ of vision. The clouding of the lens-cataract is one of the most common causes of blindness and low vision in children and adults. According to most authors, the main method of cataract treatment is surgical. In modern cataract surgery, the leading place is occupied by the most common cataract extraction method, phacoemulsification. The modern level of phacoemulsification technology made it possible to perform operations less traumatic, gave a full restoration of visual functions. It makes no sense to talk about the indications of IOL implantation, since Currently, there is a wide range of IOL models that can be implanted for all types of complicated cataracts. It is advisable to talk about contraindications, in this case, the surgeon makes a decision based on the material capabilities, experience, and perfection of the surgical technique. There are various associated syndromes in the development of cataracts. One of the syndromes that occurs in cataracts is the pseudo-excoliation syndrome. This review addresses the unresolved issues of pseudoexfoliation syndrome. The results of studies of some scientists, data analysis, clinical cases and ways to solve this problem are considered. In particular, a number of questions remain about the tactics of patient administration before and after surgical interventions. This syndrome, as far as we know, affects the development and outcome of the disease. It is sometimes difficult to diagnose pseudo-excoliation syndrome at an early stage, sometimes contradictory statements about the initial appearance of the syndrome are encountered. The issues of prevention of postoperative complications, less traumatic surgical approaches at various stages of PES remain open.

RUDN Journal of Medicine. 2019;23(1):54-61
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IMMUNOLOGY. ALLERGOLOGY
ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS
D’Mello R., Kilaikode S., Bahna S.L.
Abstract

Aspergillus is a saprophytic mold and its natural habitat is the soil. It is found worldwide indoors and outdoors in potted soil, compost, freshly cut grasses, decaying vegetation and in sewers. Aspergillus produces a bountiful number of spores and releases 2-3 micron sized spores into the air daily. It grows best at 37-40 °C, which is similar to the temperature in the lungs. These spores will remain airborne for a long period of time. It is estimated that humans inhale hundreds of spores daily. Several fungi other than aspergillus have been known to be implicated. Hence, the term allergic bronchopulmonary mycoses would be more appropriate unless the specific fungus is identified - which could be candida, helminthosporium, curvularia, bipolaris, cladosporium, or others. The review article is focused on the prototype allergic bronchopulmonary aspergillosis, its epidemiology, pathogenesis, diagnosis and treatment. Bronchopulmonary aspergillosis should be considered in patients with poorly controlled asthma despite appropriate routine therapy and environmental control. The need for frequent courses of corticosteroids with temporary improvement should raise the index of suspicion and appropriate evaluation be done. Early recognition and prompt initiation of appropriate corticosteroid treatment regimen would reduce the risk of development or progression of bronchiectasis and lung tissue damage. Regular follow up and monitoring serum total IgE level can predict exacerbations and should prompt corticosteroid treatment. Long term follow-up is important as relapses can occur years of remission.

RUDN Journal of Medicine. 2019;23(1):62-69
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THE MAIN CLINICAL SYNDROMES ASSOCIATED WITH ACTIVE CRONIC ATIPICAL EPSTEINE-BARR VIRUS INFECTION: CREATED ALGORITHM OF CLINICAL AND LABORATORY DIAGNOSTIC
Nesterova I.V., Khalturina E.O.
Abstract

The annual steady increase of the herpesviral infections number in the human population is one of the most important interdisciplinary problems of modern medicine. Clinicians and laboratory diagnostics physicians face difficulties in clinical symptoms assessing, inadequate laboratory diagnostics and difficulties in interpretation of the obtained results. This is connected with a low awareness of atypical chronic active infection symptoms caused in particular by the Epstein-Barr virus (EBV), of the ability to fully diagnose, and of serious consequencescaused by prolonged activity of herpesviruses in the human body. Studies were carried out to determinethe functioning features of the antiviral defense system, as well as defects and disorders in the interferon system in patients suffering from various mono-, mixed herpesvirus infections and bacterial co-infections. The main clinical syndromes associated with these herpetic infections, as well as prevailing nosological forms of concomitant diseases, have been identified. Among the group of patients suffering from mono-herpesvirus infections, the leading position takes the allergic syndrome (55%), while the syndrome of chronic fatigue syndrome (85%) and the infectious syndrome (68%) prevail in the incidence of patients with mixed herpesvirus infections. Extended testing of the antiviral protection main mechanisms state made it possible to identify the most frequent defects in the functioning of antiviral immunity: disturbances in induced production of IFNα and IFNγ, deficiency of cytotoxic T lymphocytes, deficiency of natural killer cells, including EKT, and / or inadequate absence of their activation, neutropenia. The revealed clinical syndromes and functioning features of the antiviral defense system will allow us to further develop the concept of complex, individualized, etio- and immunopathogenetic therapy.

RUDN Journal of Medicine. 2019;23(1):70-78
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MATHEMATICAL MODELING AND CONTROL OF HIV INFECTION DYNAMICS TAKING INTO ACCOUNT HORMONAL REGULATION
Savinkova A.A., Savinkov R.S., Bakhmetyev B.A., Bocharov G.A.
Abstract

Aims: The problem of effective treatment of HIV-infected patients is an important task of clinical virology and immunology due to the high cost of drugs, the presence of side effects and the need for strict adherence to the schedule of drug intake for patients. Therefore, the urgent task is to develop new approaches to optimize the use of antiretroviral therapy to reduce the cost of treatment and to improve the quality of life for patients. The tasks are addressed to test the hypothesis that the system of therapeutic interruptions in the treatment of HIV infection can give better results (both the duration and comfort of the patient’s life, and the need for fewer drugs) compared with regular medication in standard doses. Methods: In this work, an extended version of the mathematical model of the immune response in HIV infection (proposed in Hadjiandreou et al., 2009) was constructed to take into account the hormonal regulation of the immune response and the impact of antiretroviral drugs on the course of the disease, the calibration of the parameters of the resulting model to match the actual trends of the disease and the search for an optimal treatment strategy. The model is formulated as a system of ordinary differential equations. The therapy optimization is modeled following the structured treatment interruptionapproach using the methods of simulated annealing and the simplex method. The mathematical model and optimization methods are implemented in C ++. Results: It has been shown that in treating HIV-infected patients, it is possible to significantly (up to 3 times) reduce the total amount of required medications simultaneously with an increase in the duration of the period with a high quality of life (due to reducing the intensity of side effects) during antiretroviral therapy. Conclusion: The use of mathematical models and optimization methods opens up the possibility for the implementation of personalized approaches to the treatment of HIV infection, taking into account the side effects, the hormonal status of patients and the cost of drugs.

RUDN Journal of Medicine. 2019;23(1):79-103
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SOCIAL HEALTH AND HEALTH PROTECTION
PATIENT-CENTERED MEDICINE: BACKGROUND TO THE TRANSFORMATION AND COMPONENTS
Khalfin R.A., Madyanova V.V., Kachkova O.E., Demina I.D., Krishtaleva T.I., Dombrovskaya E.N., Milchakov K.S., Rozalieva Y.Y.
Abstract

Purpose of the study. To analyze the concept of creating patient-oriented medicine, the prerequisites for its emergence, the difficulties of introducing it into existing health systems based on foreign experience. Materials and methods. The main materials of the study were used sources of foreign literature, which presents the concept of patient-oriented medicine, analyzed the prerequisites for changing models of health care in the European Union, USA and Asia in accordance with the principles of patient-oriented medicine, as well as data on the components and levels of patient-oriented medicine in foreign countries Results. The analyzed literature quite fully describes the difficulties of introducing patient-oriented medicine into existing health care systems. Particular attention should be paid to a multidisciplinary approach, continuity at different levels of medical care and effective communication between the physician and the patient towards the integration of this model into clinical practice. The analysis of the availability of medical care in developed countries and its dependence on social status, ethnicity and disease of the patient. Conclusion. Patient-oriented medicine is a new model for planning, implementing and evaluating medical services, which is based on mutually beneficial partnerships between medical workers, patients and their families. Taking into account the current problems of domestic health care, the introduction of the patient-oriented model will significantly improve the quality of medical care provided to the population of our country. Globally, the implementation of the principles of this model is far from complete. In the Russian Federation, targeted work in this direction requires additional scientific research, systematization of available data, and development of new legal documents

RUDN Journal of Medicine. 2019;23(1):104-114
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THE PRIORITY ORIENTATION OF THE PERSON OF A YOUNG DOCTOR IN PROFESSIONAL LIFE AND PROFESSIONAL TASKS
Milekhin S.M., Derbenev D.P., Orlov D.A.
Abstract

Purpose. The purpose of the study was to study the priority orientation of the personality of the young doctor in the professional sphere of life and the solution of professional problems. Materials and methods. The priority orientation of the individual to the professional sphere of life and the solution of professional tasks as a component of the professional socialization of young doctors was determined by us using the psychodiagnostic methodology “Motivation in professional activities” developed by B. Bass. This technique allows you to build a personal profile of the subject, based on three scales characterizing the level of orientation of the individual: the “case”, “self” and “communication”. The number of young doctors with a priority orientation of the individual to the professional sphere of life and the solution of professional tasks were attributed to the surveyed, in the personal profile of which the level of orientation “towards the case” was the highest and at the same time exceeded the level of the greatest of the two remaining directions of not less than 10% . The percentage of people with a priority orientation of the individual on the “case” was 35.0%, those with a priority focus on “themselves” 41.0%, on “communication” 24.0%. The object of the study was 600 young doctors of the Tver region at the age of 35 years with work experience in the specialty from 1 year. In total, the impact of 141 factors was analyzed by comparing the distribution of their gradations in the main and control groups. The significance of differences between distributions was estimated by calculating and verifying χ2. The presence of reliable χ2 (p < 0.05) allowed us to consider the influence of the corresponding factor as statistically significant. To assess the strength of the influence of factors, the coefficient of mutual conjugacy of Chuprov (K) was used. Results. Formation of the orientation of the individual to the professional sphere of life and the solution of professional tasks on the gradations of representative factors of conditions and lifestyle contributes to: a high level of health and an active desire for a healthy lifestyle, a relatively low level of alcohol consumption, a relatively high level of remuneration; availability of official documents of moral incentives (letters of appreciation and thanks); the fact of work in the period of study in a medical university; relatively prosperous family relationships (level assessed as excellent, good); relatively high level of relationships with colleagues (rated as excellent, good). This priority orientation of an individual is also the result of a relatively high importance for them as factors motivating the following to work: flexible working hours; the amount of sufficient information about what is happening in the medical institution; difficult and difficult work. The priority orientation of the individual to the professional sphere of life and the solution of the professional tasks of young doctors in a medical organization is determined by the dominance of such terminal value as “physical and mental health”. Conclusion. It is concluded that factors of the conditions and lifestyle of young doctors are of greater importance for its formation.

RUDN Journal of Medicine. 2019;23(1):115-127
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