Vol 24, No 3 (2020)

IMMUNOLOGY
Physiological and clinical aspects in COVID-19
Satyanath R.K., Sorout J., Jayachandra S., Gandhi A., Kacker S.
Abstract
There is a new public health crises threatening globally with the emergence and spread of 2019 novel corona virus (COVID-19) or the severe acute respiratory syndrome corona virus 2 (SARS-CoV-2). In very recent decade we have seen endemic outbreaks in the form of Middle East respiratory syndrome coronavirus (MERS CoV) and severe acute respiratory syndrome related coronavirus (SARS-CoV). Now we again see the emergence of another serious outbreak due to a new strain called the SARS-CoV-2 virus. This SARS-CoV-2 initially presented as pneumonia of unknown etiology with group of symptoms including fever, dry cough and shortness of breath in a cluster of patients in December 2019 Wuhan, China. COVID-19 now has quickly became a health emergency now across worldwide. SARS-CoV-2 is a newly emerging human infectious corona virus that causes COVID-19, now this has been recognized as a pandemic by the World Health Organization (WHO) on 11th March, 2020. Because of the pathogenesis and proliferation pathways of COVID-19 are still unknown the development of vaccine was not developed yet and definitive treatment was not implemented. Therefore, in this article, new potential COVID-19 therapies are briefly reviewed. The world is in emergent need for searching of possible medications for COVID-19.
RUDN Journal of Medicine. 2020;24(3):201-206
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Immunopathogenetic features and prognostic criteria for severe hemorrhagic fever with renal syndrome
Ivanov M.F., Balmasova I.P., Zhestkov A.V.
Abstract

Aim. Assessment of the features of cellular immunological mechanisms at the early stage of HFRS of varying severity and development of prognostic criteria for the risk of a severe course of the infectious process. Materials and methods. An immunological blood test (flow cytofluorimetry method) was performed in 12 patients with severe HFRS and 53 patients with moderate course in the dynamics of the disease. Statistical data processing was performed based on the SPSS software package. Results. At the initial stages of HFRS, immunological features of the severe course of the disease were established in the form of a higher content of T-helper and regulatory T-cells in the blood and a reduced number of CTL, including their activated pool. Based on these changes, an immunological prognostic coefficient of HFRS was developed, which allows determining the risk of severe course in the early days (febrile period) of the disease with high prognostic accuracy. Conclusion. The results obtained allowed us to identify previously unknown features of the immune process at the initial stages of HFRS development, which allowed us to propose a new approach to predicting the severe course of the disease.

RUDN Journal of Medicine. 2020;24(3):207-217
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Systemic and local effective function of neutrophilic granulocytes associated with transformation of the phenotype of their functionally significant subset in children with small purulent infection
Chudilova G.A., Nesterova I.V., Rusinova T.V., Kovaleva S.V., Pavlenko V.N., Tarakanov V.A., Barova N.K.
Abstract

Defects in the functioning of neutrophilic granulocytes (NG) are accompanied by various purulent-inflammatory diseases that have a persistent-relapsing course. The bactericidal activity of NG, the processes of intracellular and extracellular killing of bacteria, is directly dependent on their phenotypic features: the expression level of functionally significant membrane receptors CD64, CD16, CD32, CD11b triggering effector processes. It was shown that there are subsets of NG with different phenotypic characteristics and the course and outcome of infectious and inflammatory diseases directly depends on their usefulness. Despite the large amount of accumulated information, the question of the transformation of NG subpopulations phenotype during NG response formation in children with local purulent processes of soft tissues - a small purulent infection (SPI) remains poorly understood. Purpose: to evaluate the local and systemic effector function of neutrophilic granulocytes (phagocytosis, NET formation) with clarification of the phenotype of functionally significant CD64-CD16+CD32+CD11b+, CD64+CD16+CD32+CD11b+ and CD64-CD16+CD32-CD11b+ NG subpopulations in peripheral blood (PB) in children with SPI. Materials and methods. We evaluated the phagocytic function of NG in 60 PB samples of children 5-9 years old, on the 2-3rd day of acute purulent process, before surgery, in smears - prints taken from the local focus of purulent inflammation and 17 PB samples of conditionally healthy children. Also the ability to form NET was additionally determined in smears-prints in children with SPI. In parallel, in PB we evaluated:% NG simultaneously carrying CD64, CD16, CD32, CD11b receptors and their expression density (MFI) by flow cytometry (CYTOMICS FC500, Beckman Coulter, USA). Statistical data processing was performed in the Microsoft Exel 2016 and Stat Plus 2010 software packages. Nonparametric criteria were used: median (Me) and interquartile range (Q1; Q3), Mann-Whitney U-test and Wilcoxon test. Results . We found a significant increase in the content of the NG subpopulation with a negatively transformed phenotype CD64-CD16+CD32-CD11b+ with defects in the expression of CD64 and CD32 receptors, which is the cause of inadequate inclusion of NG in inflammatory processes, disruption of phagocytic activity at the systemic and local levels and the occurrence of SPI in children. The formation of NET in the first stage is necessary to supplement the effector function of NG in order to compensate for disorders of phagocytosis.

RUDN Journal of Medicine. 2020;24(3):218-226
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TRAUMATOLOGY AND ORTHOPEDICS
Clinical evaluation for the transforaminal endoscopic hernia of the intervertebral disc of the lumbosacral spine with puncture nucleoplasty
Abakirov M.D., Al-Bawareed O.A., Mamyrbaev S.T., Panin M.A., Nurmukhametov R.M., Abdrakhmanov R.R., Alawaida W., Ramulgon K., Alenizi A.A.
Abstract

Transforaminal endoscopic hernia removal is currently one of the most effective and relatively safe methods of treating an intervertebral hernia of the lumbosacral spine. In the current study we aim to evaluate the effectiveness of transforaminal endoscopic discectomy in combination with puncture nucleoplasty as a surgical protocol to treat hernias of the lumbosacral spine. 87 patients (43 men and 44 women) aged 19 to 62 years were enrolled in our study and underwent proper evaluation. The duration of follow-up in the postoperative period averaged 18.7 ± 6 months (from 7.2 to 28 months). To assess the clinical effectiveness of the performed surgical interventions, the dynamics of the pain syndrome was analyzed using a visual analogue scale (VAS). Patient status, pain and disability were assessed using Oswestry Disability Index (ODI). Postoperative complications were also analyzed to evaluate the results of the operation. Moreover, objective criteria were used to assess the level of pain and the degree of disability. All patients showed a decrease in pain intensity and an improvement in the vital signs. Long follow up for ODI within six months after the operation showed a significant decrease by two to three times. Due to the lack of similar studies (endoscopy plus nucleoplasty), the results of our work were compared with the results of endoscopic hernia removal without nucleoplasty. However, in the evaluated patients, some intra- and postoperative complications were observed. In conclusion, the use of puncture nucleoplasty as the second stage of minimally invasive hernia removal of muscle tension dysphonia (MTD) is an effective treatment method, significantly reducing the recurrence rate of the disease.

RUDN Journal of Medicine. 2020;24(3):227-236
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Comparative analysis of surgical interventions in the treatment of patients with metastatic lesions of the femur in combination with pathological fractures
Wang J., Kharchenko N.V.
Abstract

One of the most severe complications of metastatic lesion of the skeleton is the development of a pathological fracture, which not only affects the quality of life, makes it difficult to carry out adequate systemic treatment, but also has a negative effect on survival. In case of a pathological fracture, the main method of treatment is a surgical method. The main goal of the correction is to achieve stability and reduce metastatic pain in the area of damage or fracture. Today, the most popular organ-preserving operations for metastatic lesions of the femur in combination with pathological fractures are endoprosthesis and intramedullary osteosynthesis. In this paper, a comparative analysis of the results of their use is carried out, the advantages and disadvantages of each of the methods are described.

RUDN Journal of Medicine. 2020;24(3):237-244
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Physiology
Function test of the activity and interrelations of lower extremity muscles of football players with the use of surface electromyography method
Shevelev O.A., Khodorovich N.A., Privalova I.L., Sheveleva E.O., Bobrovskii E.A., Pushkina V.V., Taglanov A.A.
Abstract

“Efficient performance” of physical activity is becoming a vital trend in modern football, which requires maximum objectification of the functional state of muscles. Aim: studying the electrical activity and functional relationships of sartorius and crurae muscles involved in phase movements of walking (running) by the method of multichannel registration of surface electromyogram (SEMG). Materials and methods: the study engaged the students of KSMU attending the football section and participating in football matches (n = 12). The electrical activity (EA) of the muscles involved in the implementation of walking (running): biceps femoris, musculus semimembranosus of the thigh and tibilais anterior muscle was registered. EA research was conducted with maximum volitional muscle tension. The recording was conducted using an 8-channel electroneuromyograph Neuro-MVP-8 prior to the football training and 30-60 minutes after. The data obtained were checked using Shapiro - Wilk tests. Ansari-Bradley test was used for small groups. Lastly, Kendall correlation coefficient was calculated to evaluate the functional relationships between the parameters of muscle EA. Results : The most significant changes in EA parameters after training consisted in their correlation. The presence of medium negative correlations between musculus semimembranosus of the thigh on right and left (r = -0.349) and the absence of correlation between the latter in the amplitude of EA were registered. Concurrently, positive correlations were noted between the EA parameters of the biceps femoris and semimembranosus (values ram.= 0,204, rfreq.= 0,226), as well as biceps femoris and tibilais (values ram.= 0,486, rfreq.= 0,452) of the left feet of football players. Conclusion: SEMG allows you to quantify the changes in electrical activity and functional connection of the muscles of the thigh and crurae involved in stepping and running. A realignment of the functional muscle complexes appears, which contributes to motor actions and implementation of dribbling after a training.

RUDN Journal of Medicine. 2020;24(3):245-252
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Physiological cost as a factor determining the effectiveness of human activity in the visual images reproduction
Merkulova M.A., Lapkin M.M.
Abstract

Physiological value is one of the factors affecting the effectiveness of human activities. Currently, there is no single approach to assess the physiological value of human behavior. The article presents data on the role of the physiological cost of human activity, estimated by the indicators of mathematical analysis of heart rate, in the reproduction of matrix visual images. The article puts forward the position that the physiological cost of activity is an important factor in the formation of unequal performance. At the same time, the physiological cost is reflected not only in shifts in a number of physiological indicators when the subjects perform a particular activity, but in the nature and levels of expression of correlation relationships between indicators of this activity and indicators that reflect physiological changes in the body at the same time.

RUDN Journal of Medicine. 2020;24(3):253-261
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PSYCHIATRY
Main methods of psychotherapy for negative schizophrenia symptoms
Munin A.O., Akulova A.A., Belokrylov I.V.
Abstract

The review covers publications on the main methods of psychotherapy that can reduce negative symptoms of schizophrenia. Negative symptoms are difficult to treat, and generally persist despite standard antipsychotic treatment. Combined methods including medical and non-medical treatments can be more effective and fully meet the therapeutic needs of a patient. We examined the effects of cognitive-behavioral therapy, social skills training, and family interventions on negative symptoms. The negative symptoms of schizophrenia underlie poor functioning, impaired professional performance and patient disability, thereby being a key factor in the enormous financial cost to the healthcare. Effective treatment of negative symptoms will lead to clinical and functional recovery in patients with schizophrenic spectrum disorders.

RUDN Journal of Medicine. 2020;24(3):262-268
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MICROBIOLOGY
Advisable including glucosaminylmuramyldipeptide in Helicobacter pylori therapy: experience of ten-year investigation
Konorev M.R., Guryanova S.V., Tyshevich E.N., Pavlyukov R.A., Borisova O.Y.
Abstract

Helicobacter pylori infection is a common bacterial infection in humans and is associated with peptic ulcer disease and chronic gastritis. The presence of natural resistance to some antibiotics in bacteria, as well as the appearance of primary and secondary resistance to antibacterial agents, complicates treatment and determines the search for new methods of therapy. The aim of this study was to evaluate the efficacy and safety of 10-year complex treatment of patients with duodenal ulcer associated with H.pylori , 136 patients (96 men, 40 women; mean age 45.8 ± 14.8 years; 18-65 years). H.pylori was determined morphologically and by rapid urease test one day before the start of therapy, after 1, 6, 12 months, 2 years, 5 and 10 years. Patients of the first group received basic therapy: omeprazole 0.02 g 2 times a day, clarithromycin 0.5 g 2 times a day, amoxicillin 1 g 2 times a day, for 10 days (OCA group 1; n = 98). Patients of the second group, in addition to the basic therapy, took 1 mg per day drug Liсopid (group 2 OСAL; n = 38). At the 1st stage of the clinical study, 130 patients completed eradication therapy. Tracking completeness was 96 %. The frequency of H.pylori eradication after per protocol treatment: OCA - 83 % (95 % CI: 75 %-91 %), OCAL - 97 % (95 % confidence interval (CI): 92 %-100 %). The incidence of adverse reactions after treatment (per protocol): OCA - 26 % (95 % CI: 17-35 %; nausea; n = 24), discontinued treatment - 5 % (95 % CI: 0.8 %-10 %; diarrhea; n = 5); OCAL - 3 % (95 % CI: 0.01 %-8 %; nausea; n = 1), all were treated. Taking the drug Liсopid 1 mg (glucosaminyl muramyl dipeptide, JSC Peptek, Russia) as part of complex therapy contributed to the elimination of H.pylori and the absence of relapses for 2 years. Observation of patients in the next 5 and 10 years also showed the advantage of including the immunomodulator in therapy: a significant 15 % decrease in H.pylori reinfection (P <0.05), a 23 % decrease in the frequency of gastrointestinal adverse reactions (P<0.01), compared with a 10-day standard triple regimen without immunomodulatory therapy with glucosaminylmuramyl dipeptide. When using several antibiotics in H.pylori eradication therapy, not only pathogenic, but also commensal microorganisms are destroyed, the waste products of which are vital and maintain immune homeostasis, including through the NOD2 receptors of innate immunity. The effectiveness of the complex therapy of H.pylori infection can be explained by the fact that the drug Liсopid compensates for the signal for innate immunity receptors that is missing due to the absence of commensals, providing an adequate immune response and preventing chronicity and recurrence of infection.

RUDN Journal of Medicine. 2020;24(3):269-282
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