Vol 27, No 3 (2023): PHYSIOLOGY


Neurophysiological cognitive assessment and its association with neutrophil to lymphocyte ratio

Rajprabha -., Sharma A., Sorout J., Kacker S., Jangid N.


Relevance. Cognition is an important physiological and higher mental functions in human being. There are various studies showing that inflammatory condition could negatively affect fronto temporal cognitive abilities such as memory, attention and executive functions. A non-invasive test P300 a component of Auditory events related potentials and Mini mental state examination (MMSE), a questionnaire based test reflect cognitive function, and haematological parameter neutrophil/lymphocyte ratio (NLR) is a convenient parameter of systemic inflammation. Aim of present study was to assess the cognitive function assessment by P-300, MMSE and academic performance and find an association with neutrophil to lymphocyte ratio in first year medical students. Materials and Methods. This was an observational study conducted on 79 first year medical students of age group 18-25 years in the department of physiology RUHS College of medical sciences Jaipur. For cognitive assessment non-invasive test P300, MMSE and academic performance was recorded. A haematological parameter NLR was calculated by dividing the absolute neutrophil count with the absolute lymphocyte count. To find an association statistical analysis was done by MEDCALC 16.4 version software. Results and Discussion. The association between P-300 amplitude and latency and MMSE with NLR was found non-significant. Marks have a significant positive correlation with NLR (0.015). Conclusion. In the present study neurocognitive function test P-300 and MMSE found non-significant association with inflammatory marker NLR although academic performance (marks) have a significant positive correlation with NLR.

RUDN Journal of Medicine. 2023;27(3):285-292
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Osobennosti tserebral'nogo krovoobrashcheniya studentov-pervokursnikov severnogo regiona

Govorukhina A.A., Maltsev V.P., Malkov O.A., Nagovitsina U.V.


Relevance. Intense psycho-emotional and intellectual loads during the period of higher education, combined with climatic and environmental pressure, living in the northern regions, cause enormous stress for the emerging organism and can lead to violations of the functional state of the organism as a whole and cerebral hemodynamics in particular. In this regard, early identification of students with risk factors of circulatory system dysfunction for timely assistance and correction of their lifestyle is relevant. The purpose of the study was to analyze the features of cerebral circulation of first-year students of the northern region. Materials and Methods. Within the framework of the pilot study, first-year students (n = 30; 13 girls and 17 boys, average age 18 ± 0.6 years) of Surgut State Pedagogical University living in the territory equated to the conditions of the Far North took part. Indicators of cerebral circulation of the examined patients were diagnosed using the rheographic complex «Reo-Spectrum» (LLC «Neurosoft», Ivanovo) in four standard leads: front-mastoid (FM) on the left and right, and occipito-mastoid (OM) on the left and right. The diagnosis was carried out in accordance with bioethical norms with the voluntary written consent to conduct the study. Results and Discussion. In the course of the study, it was found that rheoencephalography indicators in the majority of the examined young men reveal insufficient blood filling in all the diagnosed arterial basins of the brain. At the same time, the tone of the arteries of different calibers correspondes to the normative indicators. Cerebral blood flow in them is provided mainly by increasing the tone of arterioles. An adequate blood outflow was diagnosed against the background of normal tone of venous vessels In young men. The tone of small vessels of girls was increased in all brain leads, in the carotid artery basin there was an increase in volumetric blood filling of brain vessels against the background of increased tone of large vessels, which can be considered as a regulatory mechanism for normalizing reduced blood filling of the corresponding vascular region. The outflow of blood from arterioles and vein tone was increased only on the left. Conclusion. To identify the peculiarities of cerebral circulation of first-year students of the northern region, it is necessary further to study the hemodynamic mechanisms of regulation of vascular tone, as well as the relationship with central circulation.

RUDN Journal of Medicine. 2023;27(3):293-304
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Cardiorhythm in postural changes depending on the autonomic centers reactivity

Skorlupkin D.A., Golubeva E.K., Yarchenkova L.L.


Postural changes are accompanied by the formation of an adaptive response of the cardiovascular system. This is manifested by a change in heart rate variability. The features of the reaction largely depend on the excitability (reactivity) of the vegetative centers. The aim of the study was to identify individual features of heart rate regulation in postural changes depending on the reactivity of sympathetic and parasympathetic autonomic centers in students. Material and Methods. In 50 men, temporal, frequency, geometric and calculated indicators of heart rate variability were determined in a horizontal position, with active orthostasis, passive orthostasis and passive antiorthostasis. The reactivity of the sympathetic system was assessed by the change of heart rate in active orthostasis. The reactivity of the parasympathetic system was determined by K30:15. Results and Discussion. With normal and high sympathetic reactivity, active orthostasis causes an increase in the low-frequency power of the spectrum, stress index, heart rate, a decrease in the high-frequency component and the duration of cardiac intervals. The changes are more pronounced with high sympathetic reactivity. In passive orthostasis, high sympathetic reactivity is manifested by a large increase in heart rate, shortening of cardiac intervals and a decrease in the proportion of the spectrogram high-frequency component. Passive antiorthostasis with normal sympathetic reactivity causes a decrease in the adequacy of the regulation processes and an expansion of the scatterogram. In subjects with high parasympathetic reactivity with active orthostasis, the increase in the stress index is less than with normal and low reactivity. With low parasympathetic reactivity, the indicator of the adequacy of the regulation processes is greater than with normal and high reactivity, and the increase in heart rate and shortening of the minimum cardiac interval is greater than with normal. In passive orthostasis, the proportion of the high-frequency component decreases, the proportion of the ultra-low-frequency component increases, the modal cardiointerval shortens, which is more pronounced with low parasympathetic reactivity than with normal. In passive antiorthostasis, the ultra-low frequency component decreases in individuals with normal reactivity. With high reactivity, the maximum value of the high-frequency component increases and the adequacy of the regulation processes decreases. Conclusion. Active and passive orthostasis is accompanied by activation of sympathetic centers. It is more pronounced with high reactivity of the sympathetic department and low reactivity of the parasympathetic. Passive antiorthostasis stimulates the activity of parasympathetic cardiac centers in subjects with normal, high parasympathetic reactivity and normal sympathetic reactivity.

RUDN Journal of Medicine. 2023;27(3):305-317
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Techniques for assessing hearing loss in infants

Soni R., Kacker S., Saboo N.


The ability to hear is one of the five major senses that allows us to communicate effectively with others. Unfortunately, individuals frequently take their sense of hearing for granted, and they do not know how important it is until it is lost or compromised. Hearing loss was not a top concern for the Indian government until recently. Prevention, early diagnosis, and care can prevent half of all occurrences of deafness and hearing impairment. The auditory sense is critical for a child’s brain development. This will also reduce the strain of hearing loss, preventing the loss of many potentially productive years. The most cost-effective strategy to lessen the burden of hearing loss is to screen new-borns and babies. Hearing loss is the most frequent sensory deficiency in people all over the world. The severity of hearing loss can range from mild to severe. Kapoor Set al. suggested that by screening, the condition is detected earlier than it would otherwise be diagnosed. Because of the urgent need to prevent infectious causes of mortality, neonates and new-borns are not regularly checked for any specific disease in India. The Department of Prevention of Communication Disorders of All India Institute of Speech and Hearing (AIISH) located in the Southern India, conducts infant screening for hearing disorder on regular basis in different hospitals attached to it using Behavioural Observational Audiometry, Otoacoustic Emissions (OAE) screening, and administering High Risk Register (HRR). In the year 2009-2010, a total of 12416 new-borns in 10 hospitals associated with AIISH were screened for hearing disorder. The following paragraphs deals with various issues related to the hearing screening of infants in India. Methodology of study was as we searched PubMed Central and Google Scholar for relevant articles with key words «hearing, screening, hearing loss and infants». Full-text articles were downloaded dated July 2022 to September 19, 2022. Relevance was judged according to articles describing theories of hearing screening of infants India. Conclusion. Hearing screening for new-borns is critical for detecting congenital hearing loss and providing early management. Every person has the right to live a healthy lifestyle. Hearing impairment, like communication disorders, begins early in life. Infants with hearing loss will only be able to reach their full potential as fully active, contributing, and integrated members of society if systematic early screening programmes are implemented. Hearing screening for new-borns is critical for detecting congenital hearing loss. The AABR is considered necessary for HRNHS in high-risk new-borns (prematurity, anoxia, hyperbilirubinemia) who are at risk of auditory neuropathy that cannot be detected using the OAE test. The OAE test is faster and easier to conduct, but it has a larger false positive rate than the AABR. The ideal hearing procedure is still being developed. As a result, the hearing screening technique should be adapted to the specific demands of each centre.

RUDN Journal of Medicine. 2023;27(3):318-328
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Inflammatory response modulation by epinephrine and norepinephrine

Guryanova S.V., Ferberg A.S., Sigmatulin I.A.


Relevance. Inflammation is a defense response of an organism to a pathogen. It appears in order to maintain homeostasis and is regulated by the immune, nervous, and endocrine systems. The hormones epinephrine and norepinephrine are produced in the adrenal medulla and in the brain, and are universal messengers that trigger the transmission of nerve impulses at synapses, and also have a receptor-mediated effect on immunocompetent cells. The aim of this study was to investigate adrenergic pathway regulation of inflammation on the neutrophil granulocytes in the presence of activators of innate immunity receptors. Materials and Methods. Neutrophil granulocytes were obtained from peripheral blood of healthy volunteers in a density gradient of Histopaque 1077 and Histopaque 1119 (Sigma Aldrich, Steinheim, Germany), and cultured in the presence of LPS, GMDP, epinephrine and norepinephrine. The amount of human neutrophil peptides 1-3 (HNP1-3) was examined using an enzyme-linked immunosorbent assay; the gene expression of TLR4, NOD2, ATF3 and A20 was determined using RT-PCR. Results and Discussion. Norepinephrine (noradrenaline) was found to decrease the synthesis of human neutrophils peptides 1-3 (HNP 1-3 defensins, alone and in the combination with agonists of TLR4 and NOD2 receptors - LPS and GMDP respectively. It was found out that there was no a statistically significant effect of epinephrine (adrenaline) on the production of HNP 1-3, including when combined with LPS and GMDP. As a result of the study, an increase in the levels of expression of the genes TLR4, NOD2 and regulator of inflammatory reactions A20 both in LPS- and GMDP- induced neutrophil culture were uncovered, while ATF3 was increased only in LPS-induced neutrophil culture. Epinephrine demonstrated the absence of a statistically significant effect on the expression of the studied genes. While norepinephrine significantly increased the expression of A20 genes. Conclusion. The data obtained shows that norepinephrine can reduce the synthesis of HNP 1-3, including the one induced by LPS and GMDP. Moreover, the ability of norepinephrine to induce the expression of A20 may play a significant role in modulation of inflammation.

RUDN Journal of Medicine. 2023;27(3):329-341
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The effectiveness of assisted reproductive technologies immunological prediction

Matveeva L.V., Fominova G.V., Gromova E.V., Alyamkina E.A., Galynya A.S.


The high frequency of infertility is a significant medical and social problem in many countries of the world; assisted reproductive technologies (ART) are actively used to solve it. Given that immune responses play an important role in the development and maintenance of pregnancy, the study of changes in immune parameters is relevant in different trimesters of pregnancy, as well as at the stage of preconception preparation. It is believed that the maternal-fetal relationship is not limited to the development of maternal tolerance to fetal antigens, but is complemented by complex cytokine interactions that control selective immune regulation, control of adhesion and vascularization processes during embryo implantation and pregnancy. The purpose of the review was to analyze the available scientific data on the use of immune parameters to predict the effectiveness of ART. A review of Russian and foreign scientific papers on prevalence, immunopathogenetic mechanisms, and infertility diagnostics was carried out. A multi-criteria search was carried out for inventions, abstracts of patent documents on immunological prediction of the effectiveness of ART. As predictors, immunocompetent cells (CD3+-, CD4+-, CD3-CD16+56+-venous blood lymphocytes, CD95+ macrophages of endometrial biopsy), cytokines, pregnancy glycoproteins, autoantibodies, immunogenetic markers are presented. The study of the quantitative level of cytokines in blood serum, ovarian follicular fluid and endometrium as mediators of intercellular and intertissue interactions is of undoubted scientific and practical interest in terms of establishing their discriminatory levels specific to different trimesters of a normal pregnancy, the threat of miscarriage, and infertility. There was an association with non-occurrence of pregnancy due to in vitro fertilization of an increased content of interleukin (IL)-2 and interferon (IFN)-γ in the follicular fluid, and a soluble receptor IL-2-α, IL-8 and lactoferrin in the blood serum. The immunosuppressive effects of pregnancy-associated α2-glycoprotein, trophoblastic β1-glycoprotein, α-fetoprotein, α2-macroglobulin contribute to the development and maintenance of pregnancy, but their prognostic value is not unambiguous. The study of the content of immunoglobulins G to α2-macroglobulin, lactoferrin, progesterone, estradiol, cardiolipin in the follicular fluid and blood serum makes it possible to predict the result of ART. Conclusion. The study of immune parameters, especially in combination with sex hormones and characteristics of the state of the embryo, in infertile women has diagnostic value and prognostic significance, and can contribute to the timely correction of therapy and the ART program.

RUDN Journal of Medicine. 2023;27(3):342-353
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The Bashkir state medical university, Ufa, Russian Federation

Ismagilov R.R., Bilalov F.S., Sharafutdinov M.A.


The study of patient satisfaction with the conditions of medical care in «COVID» hospitals, which were mainly repurposed from specialized medical organizations within the shortest time, is of particular relevance. The purpose of the study was an assessment of satisfaction with the conditions of medical care for patients with a new coronavirus infection. Materials and Methods. The study was conducted by questionnaire. The questionnaire was developed by the authors included 29 questions. The questionnaire consisted of 3 groups of questions: the first group was related to the socio-demographic characteristics of the respondents (gender, age, marital status, education, etc.); in the second group, respondents assessed their health status at the time of the survey; in the third group - respondents answered questions regarding satisfaction with the conditions of care and the need for additional care. The results of a survey of 341 patients diagnosed with U07.1 Coronavirus infection COVID-19 included in the study were divided into 2 groups: 1 group - patients treated in outpatient care (173; 50,9 %); group 2 - patients of « COVID « hospitals (167; 49,1 %). The total number of examined men was 20.8 %, women - 79.2 %. The median age was 43,2 ± 12,1 years. Most of the women were persons aged 40-49 years (38.2 %), among men - aged 50-59 years (43.7 %). Results and Discussion. At the time of the survey, patients of the «covid» hospital rated their health on average by 3,58±0,11 points, and patients who applied to the clinic by 3,72±0,09 (p < 0.05) points. The level of availability of diagnostic studies, free drug provision and the attitude of doctors, patients of the clinic rated slightly lower. On the contrary, patients of the clinic rated the conditions of stay in the medical organization higher than patients of the «covid» hospital. After suffering from COVID-19, the interviewed patients noted the need for additional assistance. The most frequent of them were: spa treatment - 39.3 %; additional diagnostic care (examination) - 15.0 %; preventive care (professional examinations) - 15.0 %. Conclusion. A sociological survey made it possible to establish and compare the level of satisfaction with the provision of medical care for patients with a new coronavirus infection in medical and preventive institutions. It is important to further monitor patients’ opinions on their satisfaction with the organization of medical care and identify needs that can serve as the basis for planning, providing and maintaining the quality of services during the COVID-19 pandemic and other emergencies.

RUDN Journal of Medicine. 2023;27(3):354-367
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Modern osteoplastic materials

Salekh K.M., Dymnikov A.B., Mukhametshin R.F., Ivashkevich S.G.


Relevance. Bone tissue regeneration and the development of methods for directed influence on the processes of bone healing are of the most urgent problems of modern medicine. Defects in the jaw bones are widespread, which in turn leads to the search for modern bone - replacing materials that meet the basic characteristics of the bone. Information was searched based on the PubMed and E-library databases, using the keywords: “bone tissue” AND “bone regeneration” AND “osteoplastic materials” AND “osteoinduction” AND “osteoconduction”. Autologous bone is considered the clinical gold standard and the most effective method of bone regeneration. It is the autograft that has three main characteristics: osteogenicity, osteoinductive and osteoconductive. The autograft has limitations due to the limited amount of bone tissue and the soreness of the donor site. A viable alternative to autologous bone is an allograft. The most widely used allograft is demineralized freeze - dried bone allograft (FDBA). The freeze - drying process promotes damage to osteoblasts, which limits its osteoinductive potential, but it is a profitable alternative in terms of convenience, abundance of choice and absence of pain due to the absence of additional surgical intervention. The main component of xenogeneic materials is collagen, which has the ability to resorb in tissues and stimulate regenerative processes. The material has osteoconductive properties and is capable of bone ingrowth, with the formation of a new bone directly from the xenomaterial bed with the deposition of bone cells on its surface. Subsequently, the xenomaterial undergoes resorption with complete replacement with new bone tissue. Alloplastic materials are fully synthetic materials synthesized from inorganic sources. Alloplastic materials have the property of osteoconduction, and when various growth factors are added to their composition, the property of osteoinduction is added to osteoconductive. The clinical use of bone substitutes is limited by their fragility as well as their unpredictable rate of resorption, which render these materials generally less favorable in clinical outcomes. Conclusion. Until now, a scientific search for various materials capable of replacing an autogenous transplant is being carried out. At the moment, none of the currently available materials has all the desired characteristics and the choice of materials directly depends on the specific clinical situation in the oral cavity.

RUDN Journal of Medicine. 2023;27(3):368-378
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Antibacterial activity of Clove Syzygium aromaticum L. and synergism with antibiotics against multidrug-resistant uropathogenic E. coli

Marouf R., Ermolaev A.A., Podoprigora I.V., Senyagin A.N., Mbarga M.J.


Relevance. Urinary tract infections pose a growing threat to humanity due to the rise of antibiotic resistance in uropathogens. Exploring natural sources for alternative treatments has become a prominent approach. The aim of the research was to investigate the antibacterial effects of clove (Syzygium aromaticum L.) against uropathogenic Escherichia coli (E. coli). Materials and Methods. The research was performed on three clinical multidrug-resistant uropathogenic E. coli isolates and E. coli ATCC 25922. Clove hydroalcoholic extract was obtained by cold maceration technique. To evaluate the antibacterial activity of the extract, agar well diffusion method was performed. Minimum inhibitory and minimum bactericidal concentrations of the extract were determined by microbroth dilution method. Light microscopy was used to investigate morphological changes in uropathogenic E. coli after exposure to clove extract. Checkerboard assay was used to assess synergism between clove extract and antibiotics. All obtained data were statistically processed. Results and Discussion. In well diffusion method, bacterial responses to clove extract were concentration-dependent with inhibition zone diameter of 7-10/10-15 mm for uropathogenic strains and E. coli ATCC 25922, respectively. Minimum inhibitory and minimum bactericidal concentrations of clove extract against uropathogenic strains were 25 mg/mL. The extract showed a lower minimum inhibitory concentration against E. coli ATCC 25922 (6.25 mg/ mL) with minimum bactericidal concentration being 25 mg/mL. Minimum inhibitory and minimum bactericidal concentrations ratio showed that clove extract tends to be bactericidal agent. Synergy test revealed that the combination of clove extract and nitrofurantoin or ciprofloxacin resulted in no interaction. However, minimum inhibitory concentrations of all tested agents in combinations exhibited varying degrees of decrease. Incubation of uropathogenic strains with the extract transformed them to unstable spherical L-form in percentage of 96-99 %. Conclusion. This study highlights clove as a potential natural antibacterial agent against multidrug-resistant uropathogenic E. coli, warranting further investigations into its antibacterial properties.

RUDN Journal of Medicine. 2023;27(3):379-390
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Long exposure impact of antibiotics subinhibitory doses and silver nanoparticles on uropathogenic bacteria

Mbarga M.J., Marouf R., Podoprigora I.V., Anyutoulou K.L., Chapurin Y.V., Sharova I.N.


Relevance. Although the primary purpose of using antibiotics is to treat infectious diseases, their misuse gradually leads to loss of their effectiveness. The aim of the current investigation was to explore the changes that occur in uropathogenic bacteria after long exposure to antimicrobials. Materials and Methods. We compared the effects of long-term exposure to ampicillin, cefazoline, kanamycin and silver nanoparticles (AgNPs) on susceptibility, biofilm formation and planktonic bacteria in 4 clinical uropathogenic strains namely Escherichia coli (UPEC), Staphylococcus aureus (S. aureus), Enterococcus faecalis (E. faecalis) and Streptococcus agalactiae (St. agalactiae). The minimum inhibitory concentrations (MIC) were determined using the microplate mircodilution method and bacteria were exposed to increasing concentrations of each antimicrobial (from MIC/2 to MIC) prepared in the brain heart infusion broth for 8 days. The susceptibility of bacteria to antibiotics was assessed using the Kirby Bauer disc diffusion method and the biofilm formation was assessed using crystal violet bacterial attachment assay. Results and Discussion. The data in this investigation highlight that long-term exposure to antimicrobials may induce changes in susceptibility to other antibiotics and biofilm formation in Uropathogenic strains. Indeed, exposure to ampicillin made E. faecalis resistant to ceftazidime and St agalactiae resistant to tetracycline, ceftazidime/clavulanate and ceftazidime. Following exposure to cefazolin, a significant decrease in susceptibility was observed in E. coli to ceftazidime/clavulanate and ceftazidime while S. aureus became resistant to ceftazidime/clavulanate, ceftazidime and to ceftriaxone. Similar variations were observed on St agalactiae and E. faecalis, which in addition to the 3 antibiotics above-mentioned, have become resistant to tetracycline. The most significant variations in susceptibility to antibiotics were observed following exposure to kanamycin: E. coli developed resistance to ceftazidime and a decrease in sensitivity was noted on ceftazidime/clavulanate while S. aureus, E. faecalis and St. agalactiae all 3 became resistant to ceftazidime/clavulanate and ceftazidime. In addition, except for E. coli all the bacteria in this investigation which had undergone successive passages in AgNPs developed resistance to ceftazidime/ clavulanate and ceftazidime. Bacteria exposed to ampicillin and cefazolin produced more biofilms than their respective controls. Conclusion. Long term exposure of uropathogens to antibiotics and AgNPs induces significant changes in susceptibility to other antibiotics and biofilm formation and antibiotics should therefore only be used when necessary.

RUDN Journal of Medicine. 2023;27(3):391-402
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