Vol 25, No 4 (2021): CARDIOLOGY


Long-term results of proximal and distal reconstructions in patients with lower limb arteries diffuse lesions and diabetes mellitus

Bockeria L.A., Arakelyan V.S., Papitashvili V.G., Tsurtsumiya S.S.


Relevance . Treatment of diffuse lesions of the arteries of the lower extremities is often reduced to primary amputation at the hip level, since the healing of trophic ulcers is not guaranteed during arterial reconstruction. Profundoplasty without distal bypass surgery can be considered an alternative method. The aim of this study is to compare the long-term results of distal shunting and isolated profundoplasty in patients with diffuse lesions of the lower limb arteries and trophic ischemic ulcers. Materials and Methods . The study included 86 patients with diffuse lesions of the lower limb arteries. There were 52 (60.4%) men and 34 (39.6%) women. The average age was 67.3 ± 16.8 years. All patients had diffuse lesions of the arteries below the pupar ligament, the state of the lower leg arteries was 5-8.5 points on the Rutherford scale, in all cases there were trophic ulcers. Group 1 included 48 patients who underwent reconstruction of the leg arteries. Group 2 consisted of 38 individuals who had limited intervention with endarcteriotomy from common femoral and deep femoral arteries. Results and Discussion . Amputations at the hip level were performed within a year in 11 (23.4%) patients of group 1 and in 3 (6.3%) patients within 30 days after surgery. Thus, 14 (29.7%) patients lost their limbs. A comparative analysis revealed that the group of patients with amputations had a more severe form of diabetes (p = 0.003), an outflow score on the Rutherford scale (p <0.001), and lower transcutaneous oxygen tension values before and after surgery. Within 12 months after the bypass surgery, the primary patency of the shunts was 65.9% (thrombosis occurred in 16 patients). Conclusion . The preservation of the limb in patients in our study by the end of 1 year after reconstruction is similar regardless of the reconstruction method. Given the minimal invasion during profundoplasty, this operation may be the method of choice for diffuse lesions of the arteries of the lower extremities.

RUDN Journal of Medicine. 2021;25(4):271-281
pages 271-281 views

Blood pressure time load formation in patients with arterial hypertension without metabolic syndrome

Zotova T.Y., Lukanina A.A., Blagonravov M.L.


Relevance . The study of the daily dynamics of blood pressure in arterial hypertension both on the basis of the daily index and on the basis of the time load is a relevant task, since, these indicators are associated in the literature with stable changes in the neurohumoral regulation of the cardiovascular system in arterial hypertension . The aim of the study was to compare data of the time load in patients with arterial hypertension , depending on the nocturnal blood pressure profile, with integrative indicators of the activity of the cardiovascular system in the form of a Circadian index, a structural point of blood pressure, double product. Materials and Methods. The study included 72 patients who were treated at the City Clinical Hospital No 13 in Moscow and signed a voluntary consent to participate in the research and the processing of personal data. Inclusion criteria: arterial hypertension. Exclusion criteria: metabolic syndrome, secondary forms of arterial hypertension and concomitant pathology. Depending on the daily index (DI≥10% and DI≤10%) patients were divided into 2 groups: 1 group (N= 32): patients with arterial hypertension without nocturnal decrease in blood pressure (non-dippers and night-pickers100%); Group 2 (N = 40): patients with arterial hypertension who had a nocturnal decrease in blood pressure (dippers and over dippers 100%). All patients and members of the control group (N=15) underwent daily monitoring of blood pressure (24-hour Arterial Blood Pressure Monitoring). The data were statistically processed to determine the 5% level of significance of differences (p≤0.05) (Student’s test). In the comparative analysis of integrative indicators at day and at night, a variance analysis was applied. Results and Discussion . As a result of the study, it was found that the values of Circadian Index for blood pressure vary depending on the type of night decrease in blood pressure and the blood pressure time load, while daily index and structural point of blood pressure remain on the same level as a reflection of the hemodynamic allostasis existing in both groups. Conclusion. Reflection of the allostatic load on hemodynamics is change of values of double product and of the structural point of blood pressure compared with the control group. These changes are not associated with the peculiarities of the nocturnal blood pressure profile in patients with hypertension without metabolic syndrome.

RUDN Journal of Medicine. 2021;25(4):282-289
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Integrated 2D Doppler indices of uteroplacental and fetal blood flow in diagnosis of intrauterine hypoxia

Matskevich N.V., Famina M.P.


Relevance . Intrauterine hypoxia associated with placental disorders is a significant factor of ante-, intra- and postnatal fetal and newborn death. Despite clinical examination of pregnant women using ultrasound and cardiotocography, cases of intrauterine hypoxia often remain undetected prenatally. Clinical manifestation of placental disorders and intrauterine hypoxia are associated with pathological changes of blood flow resistance in the uterine, placental and fetal vessels. A combined Doppler assessment of blood flow in the uterine, placental and fetal vessels could improve detection of intrauterine hypoxia. The aim of the study was to assess the prognostic significance of integrated 2D Doppler indices of uteroplacental and fetal blood flow for the detection of fetal hypoxia in the 3rd trimester and to predict unfavorable perinatal outcomes. Materials and Methods. The outcomes of pregnancy of 48 women with fetal hypoxia delivered at 29 - 40 gestational weeks (study group), and 21 women who gave birth to healthy full-term infants (control group) were retrospectively analyzed. On the eve of delivery all women had 2D Doppler assessment of the uterine arteries, umbilical arteries, and fetal middle cerebral artery with an assessment of the cerebro-placental ratio, umbilical-cerebral ratio and cerebro-placental-uterine ratio. Results and Discussion . Analysis of the obtained values of cerebro-placental-uterine ratio, cerebro-placental ratio and umbilical-cerebral ratio showed the benefit from use of integrated 2D Doppler indices in the diagnosis of fetal hypoxia at 29 - 40 gestations’ weeks and in predicting complications in newborns. The high sensitivity of the cerebro-placental-uterine ratio (90.5%) makes it possible to effectively use this index for the diagnosis of intrauterine hypoxia. Conclusion. Pathological cerebro-placental-uterine ratio < 2.44 is a clinically significant 2D Doppler criterion that predicts a high risk of asphyxia, respiratory distress syndrome, hypotrophy, and perinatal hypoxic-ischemic encephalopathy. Lower values of the cerebro-placental ratio and umbilical-cerebral ratio sensitivity (77.1% and 81.3%, respectively) limit their use for the diagnosis of fetal hypoxia as compared with cerebro-placental-uterine ratio.

RUDN Journal of Medicine. 2021;25(4):290-297
pages 290-297 views

Pulmonary embolism in Bujumbura

Ndirahisha E., Sibomana T., Nyandwi J., Nyandwi R., Manirakiza S., Barasukana P., Nahayo H., Baransaka E.


Relevance . Pulmonary embolism constitutes a diagnostic and therapeutic emergency. In Africa, data are still difficult to obtain. Thus, the objectives of this work is to describe epidemiological, clinical, therapeutic aspects and short-term outcomes of pulmonary embolism confirmed by thoracic angioscan at Kira hospital in Bujumbura, the biggest city of Burundi with population about 375 000. Patients and Methods . This was a descriptive study of 18 patients who had a pulmonary embolism confirmed by thoracic angioscan in Bujumbura from January 1st, 2015 to December 31st, 2018. We included in our study any patient with pulmonary embolism consenting to participate and processing personal data after some clarified explanations in accordance with the World Medical Association’s Declaration of Helsinki. For each registered patient, we collected socio-demographic, past history of cardiac disease and factors risk, clinical, echocardiographic and scannographic findings with Wells’ score. Variables were presented as means and percentages. Results and Discussion. The average age was 53.5 ± 12.3 years with a sex ratio of 1.25 in favor of women. The modal class was the 50 to 59 age group (33.3%). The clinical probability pre-test by simplified Wells score was high in 66.6% and medium in 33.3% of cases. A history of venous thromboembolic disease was the most common risk factor. Dyspnea was the most reason of consultation with 94.4% of cases. One patient died (5.6%) during hospitalization. Six months after discharge from the hospital, we recorded 3 cases (16.7%) of death, 6 cases (33.3%) of pulmonary heart, 3 cases (16.7%) of recurrent pulmonary embolism and one case of vitamin K antagonist overdose with minor bleeding. Conclusion. Pulmonary embolism is common in relatively young population with a predominance of females and chronic no communicable diseases as risk factors. Examination of a patient with an angioscanner is a sensitive and specific clinical study of pulmonary embolism. The outcome is favorable under appropriate treatment in short term.

RUDN Journal of Medicine. 2021;25(4):298-305
pages 298-305 views

Heart rate variability in persons of Tajik nationality during adaptation

Raufov S.S., Shilov S.N.


Relevance . Maintaining the health of migrants while adapting to the new climatic and geographical conditions of residence is an urgent task. The impact of non-specific factors on the body of migrants in new climatogeographic conditions leads to the strain of regulatory and adaptive mechanisms, and in extreme cases to their failure. Objective - to determine the features of heart rate variability in young Tajiks, depending on the type of temperament living in Krasnoyarsk for more than a year. Materials and Methods: A study of heart rate variability in 63 Tajiks aged 18-40 years with different types of temperament, living in Krasnoyarsk for more than a year, was conducted. The types of temperament were determined by indices in accordance with the method of identifying VP-types of temperament according to E.Yu. Petrosyan, Yu. I. Savchenkov. The following indicators of heart rate variability (HRV) were evaluated: heart rate, the power of the high-frequency, low-frequency and very low-frequency spectrum (BV, MV-2, MV-1) of the HRV component, the voltage index of regulatory systems (IN), the centralization index (CI) and the activity index of regulatory systems. To assess the statistical significance of the differences between the samples, the Student’s criteria were used. Results and Discussion. It was revealed that migrants with an «intense» type of temperament after moving to a new place of residence increased the indicators of heart rate, BV and IN. At the same time, in the studied groups with a «calm» and «adequate» type of temperament, the power of BV was significantly reduced, with an increase in heart rate and CI. The conclusion is made about the influence of typological features of temperament on HRV indicators, when adapting to new climatogeographic living conditions. Individuals with an «adequate» type of temperament demonstrate the normal functioning of the adaptive capabilities of the body. In individuals with the «calm» type, an increase in the tension of the regulatory mechanisms was revealed. Conclusion . Significant changes in HRV are demonstrated by migrants with an «intense» type of temperament, in particular, they are characterized by a high voltage of regulatory mechanisms.

RUDN Journal of Medicine. 2021;25(4):306-312
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Respiratory health evaluation of construction workers using questionnaire

Ojha U.C., Spalgais S., Ranjan A., Choudhari O.K.


Relevance . With growing economy and flourishing construction industries the comorbidities among construction workers are also raised. They are exposed to various dust, fumes, noxious gases and vapours making them susceptible to chronic airway diseases like Chronic Obstructive Lung Disease. The aim of the study was to evaluate the respiratory health status of construction workers in an unorganised sector. Materials and Methods . The data collected from National Capital of Delhi region in an unorganised sector of construction workers by using a Saint George Respiratory Questionnaire by the Institute of Occupational Health and Environmental research, Basaidarapur, Delhi, India. All the participant response was noted and the answers were evaluated to see respiratory health status of workers. Total 200 workers were evaluated. Total 182 males and 18 female participated in the study. Results and Discussion . 25% of workers reported poor health at the time of the survey, while only 4% of workers considered their health to be very good. Among the main complaints were indicated: cough, sputum production, shortness of breath, chest infections, attacks of wheezing. The overall mean of Saint George Respiratory Questionnaire core was 33.55. It increases with the working period in the construction field with 21.6% for <10years and 49.1 for >30years experienced workers, while workers with 11 to 20 years of experience, the score was 28.4. The Saint George Respiratory Questionnaire score was 35.1 in 21-30 years of experienced construction workers. Conclusion . As a result of the study, construction workers are found to be at high risk of various respiratory diseases and related disabilities. Participants in this study did not receive any treatment for respiratory problems at any clinic. This means the importance of occupational health education and the use of personal protective equipment and safe working conditions for construction workers.

RUDN Journal of Medicine. 2021;25(4):313-320
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Development and functional significance of the pulmonary surfactant system

Shakhbanov R.K., Asadulaeva M.N., Alieva S.N., Alimkhanova A.A.


Relevance. Prevention of the development of postoperative acute respiratory distress syndrome during operations on the descending thoracic aorta increases the effectiveness of therapy. The study of damage to the surfactant complex during ischemia and reperfusion of the lungs is relevant, since it involves the prophylactic use of the surfactant preparation during operations on the descending part of the thoracic aorta, which are characterized by a high risk of postoperative acute respiratory distress syndrome. Objective: to increase the effectiveness of pharmacological and respiratory therapy of acute respiratory distress syndrome, as well as to identify the role of the surfactant system of the lungs in the onset of inflammation against the background of tuberculosis and the development of regeneration mechanisms that affect the course and outcome of the disease. Materials and Methods. The study involved 24 people, including 14 volunteer patients with a diagnosed respiratory disease in an acute course (while the whole group received the drug from the study as an additional therapy). The sample of 14 people was formed solely due to the compliance of these patients with the criteria that were established before the start of the study of the drug, which had postoperative acute respiratory distress syndrome of various origins in their diagnosis. Results and Discussion. For a comprehensive laboratory determination, an algorithm was used that corresponded to the state standard to identify postoperative acute respiratory distress syndrome. For each participant in the experiments, it was proposed to develop a plan of treatment procedures, taking into account individualization and standardization. Conclusion. Some of the resulting data are collected with respect to the surfactant pulmonary system, which is presented in a compactor model format. A number of basic components are reflected here, which are classified according to cellular and non-cellular factors. At the same time, the surfactant substance helps to reduce the pronounced swelling, which can significantly reduce the process of «sticking» of the alveolar structures during inhalation. All this added up to the normal system of gas metabolism in the lung structures, including the control of the mucociliary system, which acts as a natural stimulator of the function of alveolar macrophages.

RUDN Journal of Medicine. 2021;25(4):321-331
pages 321-331 views


Microbiological landscape of the periodontal pocket in inflammatory diseases in the periodontal tissues

Miklyaev S.V., Leonova O.M., Sushchenko A.V., Kozlov A.D., Agarizaev I.F., Novikov A.V.


Relevance. The study of the microbiological composition of periodontal pockets in inflammatory diseases of periodontal tissues is of great importance directly for the effective treatment and understanding of the pathogenetic stages of these diseases. Objective: to study the microbiological landscape of periodontal pockets with inflammatory diseases of periodontal tissues. Materials and Methods. 62 patients aged 20 to 45 years were selected and divided into groups depending on the form of periodontitis: with localized aggressive periodontitis - group №1, group №2 - with chronic generalized periodontitis, group № 3 - with exacerbation of chronic generalized periodontitis. The material for the study was taken from the periodontal pockets and examined by cultural and microbiological methods. Results and Discussion. It was found that the proportion and number of microbial associations in the periodontal pockets of different depths differs. In localized aggressive periodontitis, mainly facultative Gr+ (A. actinomycetemcomitans) and Gr- (St. aureus, Str. mitis) anaerobes were found in the periodontal pockets no more than 4 mm. In generalized chronic periodontitis of moderate degree, the same microorganisms were present in the periodontal pockets as in the localized form, but Str. mitis was more common among facultative aerobes. With the exacerbation of generalized chronic periodontitis from facultative anaerobes, St. aureus was more common and the proportion and number of A. actinomycetemcomitans significantly increased. Conclusion. According to the results of the study, the microorganisms that inhabit the periodontal pockets in inflammatory diseases of periodontal tissues mainly belong to facultative Gr+ and Gr - anaerobes, obligate Gr+ and Gr-anaerobes and yeast fungi.

RUDN Journal of Medicine. 2021;25(4):332-338
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The state of the microflora of prostate secretions in healthy individuals and in acute bacterial prostatitis

Masljakov V.V., Pavlova O.N., Cymbal A.A., Pronina E.A., Sultonov F.P.


Relevance. Acute bacterial prostatitis is one of the urgent problems in urology. According to the data presented in the literature, the number of men who have been diagnosed with this disease ranges from 10 to 40 %. At the same time, the main etiological factor in the development of this pathology is most often assigned to the bacterial microflora. However, most of the works are devoted to the study of the microflora in chronic prostatitis, and the state of the microflora in acute bacterial prostatitis remains insufficient. The aim of the study is to evaluate the state of prostate secretion microflora in a comparative aspect in healthy individuals and in patients with acute bacterial prostatitis. Materials and Methods. The study included a comparative analysis of microbiological cultures in prostate secretion of 30 people. All examined were divided into two groups: the first included 15 people without established urological pathology, the second - 15 people with an established diagnosis of acute bacterial prostatitis. Results and Discussion. As a result of the study, it was found that when sowing prostate secretion in persons without established pathology, the absence of microorganism growth was not observed in 60 % of observations, while in 40 % of cases, microorganism’s growth was obtained. In the group of examined without established urological pathology, the growth of microorganisms of the following was noted: Escherichia coli - in 58 % of observations; Staphylococcus epidermidis - in 10 % of observations; Staphylococcus warnerii - in 6 % cases and Enterobacter spp. - in 26 %. At the same time, the number of detected microorganisms did not exceed 104 CFU/ml. At the same time, the presence of microbial associations was not recorded. In patients with acute bacterial prostatitis, the sterile prostate secret was 13,3 %, and in 86,7 % of people, microflora growth was obtained. Most often, in the group examined with acute bacterial prostatitis, Escherichia coli was obtained - in 45 % of the observations; Klebsiella spp. - in 23 % cases and Proteus spp. - in 19 %. Less often Staphylococcus epidermidis - in 8 % of observations; Enterobacter spp. - 3,2 %. Serratia spp. - 1,1 % and Staphylococcus warnerii - in 0,7 % cases were the least obtained. At the same time, 86 % of observations in this group revealed microbial associations. Conclusion . Comparison of the state of microflora of prostate secretions in healthy individuals and patients with acute bacterial prostatitis revealed that in patients with acute bacterial prostatitis, the absence of inoculated microflora in prostate secretions was 3 times less than in healthy individuals (13.3 % and 40 %, respectively.), and Escherichia coli was the most common microorganism in the group of patients with acute bacterial prostatitis.

RUDN Journal of Medicine. 2021;25(4):339-345
pages 339-345 views

Analysis of the infectious morbidity of humans, domestic animals and poultry in Russia for 2016-2019

Bessonova L.P.


Relevance . The article provides an analysis of the infectious mor-bidity in the Russian Federation of humans, domestic animals and birds for 2016-2019. The aim of the study is to compare the epizootological and epidemiological situation and to establish a correlation between individual types of zoonoses, anthro-ponoses and zoonoses with anthroponoses. Materials and Methods . The study was carried out by processing statistical data obtained from open sources of Rosstat and the Federal State University of the Russian Academy of Sciences of the IAC of the Department of Veterinary Supervision of Vladimir. Collected data were processed using Excel and STATISTICA-10 programs. Results and Discussion . A sample of infectious diseases (IB) was formed, which, during the specified period, infected peo-ple, pets, incl. cattle and small ruminants, pigs, horses and poultry. The average per-centage of patients with a specific type of infectious diseases was calculated, taking into account the differentiation by zoonoses, anthroponoses and the average percent-age of sick animals for all identified types of IB, which made it possible to establish IB, which are most common in each of the groups, and in general in all animals and birds. The assessment of the distribution of information security in differentiated groups has been carried out, distribution graphs have been constructed and formulas have been established by which it is possible to predict the dynamics of their further development. The STATISTICA-10 software was used to calculate the correlation coefficients ( r ) between zoonoses (XX), anthroponoses (YY), as well as zoonoses and anthroponoses (XY). Conclusion . Stably significant positive correlations were determined for zoonoses and anthroponoses. The data obtained prove the existence of a close connection of a person with the environment and his responsibility for the health of animals and birds, in order to prevent the risk of infectious diseases.

RUDN Journal of Medicine. 2021;25(4):346-356
pages 346-356 views

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