Vol 23, No 2 (2019)

Obstetrics and Gynecology
INTEGRATED ASSESSMENT OF THE FUNCTIONAL STATE OF HEALTHY STUDENTS IN DEPENDENCE ON THE PHASE AND THE DURATION OF THE MENSTRUAL CYCLE
Penzhoyan G.A., Kashina Y.V., Abyshkevich V.G., Pokrovsky V.M.
Abstract

Relevance: one of the causes of menstrual disorders are functional disorders associated with a violation of the central regulatory level.The aim: integratively assess the functional state of healthy girls, depending on the phase and duration of the menstrual cycle. Materials and methods: observations were performed on 65 practically healthy girls 18-19 years old with regular menstrual cycles. They conducted questionnaires, gynecological examinations, tests on functional diagnostics tests, ultrasound scanning of pelvic organs. To determine the phases of the menstrual cycle used the method of Ogin-Knaus, the onset of ovulation used a test for luteinizing hormone (strip tests of the brand Eviplan). The concentration in the blood of estradiol and progesterone was selectively determined. All subjects underwent a cardio-respiratory synchronism test. The parameters of the serous-respiratory synchronism determined the index of the regulatory-adaptive status, and according to it the regulatory-adaptive capabilities (functional state) were evaluated. Statistical analysis of the results of the study was carried out using the following programs: «STATISTICA 10» of «Stat Soft, Inc.». After establishing the normal distribution of the variant, significant differences were used in comparing the mean values in paired comparisons, taking the t-test of Student for p < 0.05. Results: in 35 people the duration of the menstrual cycle was 21-27 days. In the follicular phase, the regulatory-adaptive status index was 183.0 ± 0.4, which indicated a high regulatory adaptive capacity. In the luteal phase, respectively, 60.1 ± 0.3, - good regulatory adaptive capacity. In 30 watchers, the cycle was 28 to 32 days. In the follicular phase, the regulatory-adaptive status index was 156.5 ± 0.6. Regulatory adaptive capabilities were good. In the luteal phase, respectively, 52.4 ± 0.5 are good regulatory adaptive capacities. The conclusion: Regulatory adaptive opportunities for female students are greater in the follicular phase of the menstrual cycle than in the luteal cycle. Regulatory adaptive capacity is greater for a cycle of 21 to 27 days than for a cycle of 28 to 32 days.

RUDN Journal of Medicine. 2019;23(2):141-146
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ENDOMETRITIS ULTRASOUND DIAGNOSIS: FEATURES OF BLOOD SUPPLY OF DIFFERENT MORPHOLOGICAL TYPES
Ozerskaya I.A., Kazaryan G.G.
Abstract

Aim. Despite significant advances in modern gynecology, endometritis is often unrecognized, being the main reason leading to persistent infertility or repeated pregnancy loss. There are 3 morphological types of chronic endometritis: hyperplastic, hypoplastic and mixed. The aim of the study was to develop ultrasound signs and hemodynamic features of various morphological types of chronic endometritis. Matherials and Methods. A retrospective analysis of 162 patients of reproductive age (22-50 years old) diagnosed with endometritis was carried out. The comparison group consisted of 96 women 17-42 years old without gynecological pathology (P > 0.05). The study was conducted in the proliferative phase of the cycle up to 10 days. The hemodynamics of the uterus and endometrium was evaluated on the basis of Doppler blood flow parameters in the uterine arteries, the calculation of arterial perfusion index (API), vascularization index (VI) and flow index (FI) of the uterus and endometrium obtained by 3D Doppler. Results. Depending on the morphotype of endometritis, hemodynamic features were evaluated. It was revealed that in the hypoplastic type, to which patients are related with the ratio of the endometrial volume to the volume of the uterus less than 2.5%, there is a significant (P < 0.05) decrease API, as well as hypovascularization of the uterus. Hypervascularization of the uterus and endometrium was observed both with a mixed morphotype, when the ratio of the endometrial volume to the volume of the uterus was from 2.5 to 9.0%, and in the case of a hyperplastic morphotype, when the volume of the endometrium to the volume of the uterus exceeded 9.0%. AIP was no different from healthy women. Conclusions. Diagnosis of impaired blood supply to the uterus will allow reasonable treatment and restore the reproductive function of women.

RUDN Journal of Medicine. 2019;23(2):147-155
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SURGERY
HOW ACTIVE SHOULD BE SURGICAL TACTIC IN TREATMENT OF ACUTE CHOLECYSTITIS?
Natroshvili I.G., Prudkov M.I.
Abstract

Acute cholecystitis (AC) is one of the most common surgical diagnoses in emergency setting. Despite its high incidence there remains a range of treatment approaches. There is growing evidence in support of performing early cholecystectomy for acute cholecystitis but the definition of early operation varies from 0 through 10 days from onset or admission. The optimum time to perform cholecystectomy is still controversial. Aim. To determine the best practice for the patients presenting with AC focused on patients characteristics, timing of surgery, disease severity and intra- and postoperative complications. Materials and Methods. A multicentric retrospective study was conducted and included 754 patients operated for acute cholecystitis at 8 hospitals in 4 cities of Russian Federation (Moscow, Yekaterinburg, Volgograd, Kislovodsk) during 1 year period (from Jan 1, 2011 to Dec 31, 2011). Median time from symptoms onset to hospitalization varied from 15 to 72 hours, and median time spent at hospitals before operation was 9-71 hours. Results. We found that optimal time for cholecystectomy is 60 hours from the onset of symptoms in Grade I AC (TG18) and 36 hours for patients with Grade II of the disease. Delay of the operation beyond this time leads to more difficult cholecystectomies and higher complication rates. We compared results of the surgical treatment of AC in 2 groups of patients, operated in median 9 [4; 13] and 50 [29; 88] hours from admission using propensity score matching technique. Rate of Grade I AC in the 1st group was higher (59,8% vs 17,0%, p < 0,001) and incidences of gangrenous cholecystitis (15,3% vs 34,1%, p < 0,001) and difficult cholecystectomies (28,4% vs 41,5%, p=0,003) were lower. The Integral Complications Severity Index (based on Accordion classification and takes into account all intra- and postoperative complications and summarizes their respective severity) was also lower in the 1st group. Conclusions. The optimal time for cholecystectomy for mild (Grade I) acute cholecystitis is 60 hours of presentation of disease and for Grade II - 36 hours from symptoms onset. Cholecystectomy performed after short trial conservative treatment in 6-8 hours from admission yielded the best outcomes.

RUDN Journal of Medicine. 2019;23(2):156-167
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FEATURES OF MANAGING PATIENTS AFTER THE FEMOROPOPLITEAL BYPASS
Kasianov B.V.
Abstract

The approach to managing patients after femoropopliteal bypass surgery among vascular surgeons, even of one country, is sometimes not the same. The main difficulty is the problem of the late postoperative period patency of femoropopliteal bypasses (FPB). Aim. Analysis of the risk factors for occlusion of the FPB and the effects of postoperative diagnostic ultrasound on the primary, primary-assisted patency and secondary patency of such bypasses. Materials and methods. The Pubmed database was analyzed and the studies were selected from 2007 till 2017. The effect of preoperative risk factors on the FPB’s primary patency was evaluated in patients of the department of vascular surgery at the Orel regional hospital in comparison with the of foreign researchers’ data. The second stage was the evaluation of the effect of ultrasound diagnostic on the primary, primary-assisted and secondary patency of such bypasses. Results. The greatest impact on the primary patency of FPB was exerted by the presence of CLI, arterial hypertension and the male gender, and a slightly fewer by smoking and angina pectoris (χ2 cf. = -0.983-0.985*). The effect of diabetes was 2 times weaker (χ2 = -0.547*). Ultrasound control, in turn, had the greatest impact on the frequency of primary-assisted patency compared with the group without ultrasound control (81.3% vs. 76.1%). The frequencies of primary patency (67.4% vs. 64.9%) and secondary patency (83.2% vs. 82.8%) turned out to be almost comparable between the two groups of patients. Conclusions. Thus, the male sex, arterial hypertension and CLI are the most significant pre-operative risk factors affecting the primary patency of FPB. Regular diagnostic ultrasound in the postoperative period, especially in the period of 4-6 weeks, 3 months, 6 months and 1 year, allows to improve long-term results of such bypasses’ patency.

RUDN Journal of Medicine. 2019;23(2):168-173
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OPHTHALMOLOGY
HYPERFAKIA WITH COMPLICATED CATARACT
Frolov M.A., Bekmirova B.B.
Abstract

The article presents a clinical case of a patient who was implanted with a phakic lens 27 years ago. At the moment, the patient was diagnosed with a complicated cataract on the background of hyperphakia. This article describes the effectiveness of the step-by-step operational approach in a patient with hyperphakia, which allowed achieving high visual functions.

RUDN Journal of Medicine. 2019;23(2):174-177
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CRITICAL FREQUENCY OF FLICKER MERGING AND VISUAL POTENTIALS UNDER COMPUTER LOAD
Akhmadeev R.R., Timerbulatov I.F., Koshelev D.I., Evtushenko E.M., Timerbulatova M.F.
Abstract

The urgency of the development and improvement of methods for studying the functional state of users of computer technology is growing in parallel with the growth of their negative impact on the main targets - visual and neuropsychic functions. Therefore, the aim of the study was to study the processes of perception of rhythmic light incentives and induced electrical activity of the visual cortex during a computer load. The study was conducted with the participation of clinically healthy students ( n = 182), who determined the critical fusion frequency of flashes and recorded rhythmic cortical evoked visual potentials during a computer-assisted visual load. To assess the nature and duration of use of computer students, as well as determining the presence and severity of computer dependency, a survey was conducted. Various types of perception of light flashes and changes in the rhythm assimilation reaction under the influence of a computer load are revealed. The data are discussed taking into account the rhythmic processes of the brain. A conclusion is drawn about the weakened, stable and strengthened types of response of oscillatory neural mechanisms to computer visual loads.

RUDN Journal of Medicine. 2019;23(2):178-186
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ONCOLOGY
NEW INFORMATION TECHNOLOGIES FOR ANALYSIS SKELETON PLANAR SCINTIGRAMMS OF PATIENTS WITH BREAST CANCER
Kang X., Kosykh N.E., Levkova E.A., Razuvaev V.A., Savin S.Z.
Abstract

In work is described practical approach to the expert system building for the analysis skeleton planar scintigramms. The aim is to analyze the numerical characteristics of bone metastases by scintigraphy. Objective. Progress in the development of bioinformatics and mathematical methods in biomedicine, as well as the development of computer and telecommunications systems and networks determines the look of the present and future of oncology technology and of medicine in general. At last years of one of the directions of high-tech-medicine development is a processing the digital image: improvement of quality of image, recovering image, its recognition of separate elements. Recognition of pathological processes is one of the most important problems of processing the medical image. Methods and results. Method of computer-aided analysis of planar osteostsintigrammy studied the skeleton of patients with breast cancer are in complete remission and in the phase progression of the disease with metastases to the skeleton. As analyzed parameter was used brightness of images. The study of the physiological accumulation of radiopharmaceuticals in patients without metastasis to the skeleton indicates a wide variation in the brightness values of the scintigram in some areas of the skeleton. At the same anatomical areas of the skeleton there are significant differences in the values of the index of average brightness. In almost all areas of the skeleton averages of the brightness lesions hyperfixation RFP for scintigram significantly prevail over those of «physiological» lesions hyperfixation. Thus, there is a direct relationship between the levels of accumulation of the radiopharmaceutical in areas of the skeleton without metastatic lesion and bone metastases occurring in these zones. Consider methodological approaches to studies of quality of qualifier at the expert system building for the analysis skeleton planar scintigramms, as well as results of conducting calculations.

RUDN Journal of Medicine. 2019;23(2):187-196
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PROBLEMS OF NUTRITION
AGE AND GENDER PECULIARITIES OF CONSUMPTION OF MACROONUTRIENTS BY THE POPULATION OF THE RUSSIAN FEDERATION
Radzhabkadiev R.M., Evstratova V.C., Vybornaya K.V., Khanferyan R.A.
Abstract

The article contains the results of a survey of 11,850 persons of both sexes in eight Federal Districts of the Russian Federation. The survey was conducted on the following age groups of men and women: 12-17, 18-30, 31-45 and 46-60 years. In each group of subjects, the number of questionnaires was at least 150 persons of each sex. When comparing the consumption of macronutrients in different federal districts, it is established that there are insignificant age and gender differences in the level of their consumption. Studies have shown that the intake of proteins and carbohydrates is within the recommended consumption rates, and the fat component has been increased in the population of all federal districts of Russia.

RUDN Journal of Medicine. 2019;23(2):197-202
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THE EFFECTIVENES OF COMPLEX DRUG “BIFIDUM BAG” FOR STATUS CORRECTION OF LARGE INTESTINE MICROBOICENOSIS AND ANTIOXIDANT PROPERTIES OF COLONOCYTES IN EXPERIMENTAL DYSBIOSIS
Medvedeva O.A., Korolev V.A., Verevkina N.A., Riadnova V.A.
Abstract

The effectiveness of complex drug “Bifidum BAG” for status correction of large intestine microbiocenosis and antioxidant properties of colonocytes in experimental dysbiosis has been studied. Acomplex drug was administered to experimental animals, which includes Bifidobacterium and Dihydroquercetin. Quantitative and qualitative study of large intestine was done in mices by bacteriological method. The state of lipid peroxidation system was evaluatedaccoding to the content of acylhydroperoxide and malonic dialdehyde. The state of antioxidant protective system was reached by means of catalase and superoxide dismutase activity. Experimental dysbiosis was shown as significant changes in mucosal microflora, changes colonocytes antioxidant properties. The use of the complex preparation “Bifidum BAG”, led to the normalization of the colon microbiota (11 of 16 microorganisms were recovered). After correction gentamicin-associated dysbiosis with a complex probiotic, a positive effect of the drug on the colonocytes antioxidant defense was noted. So the activity of catalase increased 1.1 times, compared with the determined index in the group “dysbiosis”. The activity of superoxide dismutase increased 2 times in comparison with the group “dysbiosis”, exceeding the value of the control group. The concentration of LPO products in colonocytes of experimental animals decreased significantly. The content of malonicdialdehyde and acylhydroperoxide decreased 1.6 times and 5.6 times in comparison with the determined index of the group “dysbiosis”, respectively.

RUDN Journal of Medicine. 2019;23(2):203-210
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SOCIAL HEALTH AND HEALTH PROTECTION
THE DISCREPANCY OF STATISTICS ON THE NUMBER OF ROAD TRAFFIC DEATHS AND INJURED ACCORDING TO OFFICIAL DOCUMENTS OF VARIOUS DEPARTMENTS
Melnikova I.S., Shkatova E.Y.
Abstract

Every year on the Earth, as a result of road accidents (road traffic accidents), 1.25 million people are die and 50 million are injured of varying degrees of severity, of which more than 30% of the dead are people of working age. This dictates the adoption of decisive measures in the field of prevention and elimination of the consequences of accidents, which requires detailed and reliable statistical data. Aim: to compare statistical data on the dead and injured in road accidents in the Udmurt Republic for 2011-2016. Materials and methods. Statistical data was obtained from the official databases of the Budgetary Healthcare Institution of the Udmurt Republic “Republican Medical Information and Analytical Center of the Ministry of Health of the Udmurt Republic” (“RMIAC of the UR”, MH of the UR) and the official website of Traffic police “Main Traffic Safety Directorate of the Ministry of the Interior of the Russian Federation” (“MTSD of the RF”, TP). The calculation of the indicators was carried out using the calculation of the arithmetic mean of simple, errors of representativeness, the reliability of differences of indicators by the Student’s t -test was determined. Results. It has been established that the data of the “MTSD of the RF” and “RMIAC of the UR” for the dead and injured in road accidents differ significantly. According to TP for 2011-2016 years 1471 people died on the roads of the Udmurt Republic, according to the MH of the UR - 1165 people, which, when converted to 100 thousand people, this figure differs 1.3 times ( p < 0.05). On average, over the five-year period, according to official data of the traffic police, non-fatal injuries of 120.0 ± 22.6 per 100 thousand people annually get on the roads of the Udmurt Republic, according to the Ministry of Health of the Udmurt Republic - 2 times more often ( p < 0.05) (230.4 ± 38,1 per 100 thousand population). Conclusion: A comparative analysis of road traffic injuries “MTSD of the RF” and “RMIAC of the UR” showed a discrepancy in statistical data on the dead and injured, which requires a revision of the system of accounting for accidents and changes in the scheme of information transfer.

RUDN Journal of Medicine. 2019;23(2):211-218
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