Репозиторий Университета

© 2018 Stolichnaya Izdatelskaya Kompaniya. The article presents a clinical observation of the left atrial appendage thrombosis in a 51-year-old female patient with a paroxysmal form of nonvalvular atrial fibrillation which occurred despite long-term anticoagulant therapy with apixaban in a full dose (5 mg b.i.d.), and the patient's management. The patient was admitted with recurrent symptomatic paroxysm for more than 48 hours, because of which, in accordance with the recommendations, transesophageal echocardiography was performed before an emergency rhythm restoration. Thrombus in the left atrial appendage 0.5×1.03 cm in size was detected. It was decided to refrain from the immediate restoration of the rhythm due to the very high risk of thromboembolic complications. In connection with the categorical refusal of the patient from warfarin, it was decided to replace apixaban with another direct oral anticoagulant - dabigatran 150 mg bid for a period of 4 weeks followed by performing a control transesophageal echocardiographic study. As a result, no thrombus was found on control echocardiography. The particularity of this observation is concomitant hypertrophic cardiomyopathy and diabetes mellitus type 1 in this patient..

© Ivan M. Chizh, Igor V. Karpenko, Maria S. Sergeeva, Ilya V. Fedoseikin. The article covers a little-known episode from World War I, concerning the work of one of the foreign detachments (hospitals) in the Russian Tsarist army. The large-scale sanitary losses and epidemics of infectious diseases, which accompanied the war, required special efforts from the medical service of the Russian army. The Russian Red Cross Society (RRCS), which had monopoly rights to organize medical care during the war, did not cope with the problems that arose. In connection with this, the international community, primarily the medical personnel of neutral and allied states, in particular, England and America, played a big role in the provision of medical care to the wounded Russian army. The activities of foreign doctors, nurses and hospitals were carried out under the auspices of the RRCS in the framework of the humanitarian assistance that allies provided to Russia during World War I. Based on archival documents and materials from RRCS periodicals for 1914–1917, the activities of the medical unit of the North American United States in the Caucasian theater of military operations and the American hospital organized by it on the territory of Persia (the town of Khoy) are investigated. The materials under review single out a number of problems in the provision of medical assistance to the troops of the Caucasian Front, requiring special urgency and unprecedented work from the American specialists in Khoy. Throughout the period under review, anti-epidemic, clinical, evacuation and charitable activities predominated the detachment’s work. Doctors and nurses of the detachment risked their lives in performing their duties during typhus epidemics. It is noted that in addition to American doctors and nurses, Russian doctors and nurses worked at the hospital.

© 2018 Izdatel'stvo Meditsina. All rights reserved. This research was aimed at the pharmacological analysis of dermotropic activity ofCaragana jubata (Pall.) poiraqueous extract on the model of atopic contact dermatitis induced by 2,4-dinitrochlorobenzene in male rats. It was found that the aqueous C. jubata extract exhibited expressed dermotropic activity as manifested by reducing thickness of the skin fold by 47% (p = 0.05) and decreasing severity of the onset of contact dermatitis on the average by 38% (p = 0.05). Histological examination showed positive trends in the regeneration of skin lesion. Hematologic examination showed normalization of peripheral blood parameters in animals affected by contact dermatitis. Calculations of the index of inhibition of the inflammatory response confirmed anti-inflammatory effect of the aqueous C. jubata extract.

© 2018, Media Sphera Publishing Group. All Rights Reserved. Objective. To develop therapeutic programs for treatment of depression with panic attacks on the basis of their clinical and psychopathological features. Material and methods. A total of 100 in-and outpatients, aged from 18 to 60 years, with depression of mild and moderate severity with panic attacks were studied. The investigation was carried out using clinical, psychopathological and psychometric (the Atypical Depression Diagnostic Scale (ADDS), the Montgomery—Asberg Depression Rating Scales (MADRS), and the Sheehan Anxiety Rating Scale (ShARS)) methods. The patients were assessed on admission, on the 1st, 2nd, 4th and 8th weeks with subsequent processing and defining standard indicators. Three therapeutic groups were formed: the 1st group received therapy combining an antidepressant and a tranquilizer; the 2nd group an antidepressant, a tranquilizer and a mood stabilizer; and the 3rd group an antidepressant, a tranquilizer and an antipsychotic agent. The time course of expression of the signs of depression, anxiety and frequency of panic attacks was analyzed. Results. The highest efficacy in the form of reduced signs of depression and anxiety was observed in the 3rd group on the 1st week of therapy. No significant differences in reduction of depression and anxiety were found between the 1st and 2nd groups. In the 1st therapeutic group, there was an increase in the frequency of panic attacks together with the reduction in their expression and decrease in the severity of depression as compared to the 2nd and 3rd groups. At the same time the 3rd therapeutic group was characterized by a maximally expressed decrease in the frequency of panic attacks already on the 1st week of therapy. Conclusion. The study has shown that the use of antipsychotic drugs in addition to therapy with antidepressants and tranquilizers is the most effective way to stop depression.

© Bionika Media Ltd. Objective. To carry out a systems analysis of the data available in the current literature on the impact of vitamin D deficiency on the risk of endometriosis and reproductive cancer, as well as on the possibilities of vitamin D supplementation in order to treat and prevent these diseases. Material and methods. The review includes the data of foreign and Russian articles published in the past 10 years and found in Pubmed on this topic. Results. The paper describes the mechanisms by which vitamin D is involved in the processes of inflammation, immunomodulation, and proliferation, as well as the role of its deficiency in pathogenesis of pathological proliferation and inflammation in endometriosis, breast cancer, and ovarian cancer. It gives the data of clinical trials confirming the role of vitamin D deficiency in the progression and negative effects of endometriosis and carcinogenesis, the possibility of vitamin D supplementation for the prevention and adjunct therapy of reproductive cancer and endometriosis. Conclusion. It is necessary to conduct further studies to experimentally and clinically evaluate vitamin D deficiency in endometriosis and cancer. Currently, vitamin D supplements should be prescribed to patients with this pathology if they have been found to have a low blood level of 25(OH)D3.

© 2018 Center for Ancient Philosophy and the Classical Tradition. All rights reserved. The article is devoted to the analysis of the evident scientific method of Galen, which establishes the necessity of correct diagnosis of diseases, determination of true symptoms and causes of diseases, which results in the choice of the exact method of treatment. The article focuses on how Galen seeks to achieve reliable knowledge based on an undeniable logical necessity. Logical reliability is contrasted with "dialectical", that is, probabilistic judgments, often leading to the opposite of what was originally asserted in them. Probabilistic judgments were characteristic of the Stoic philosophical school, with which Galen hotly argues, asserting his understanding of truth. Truth, in his opinion, is achieved through facts based on true premises. The criterion of truth for Galen is the study of the device of a living organism, and the logical conclusions depend on the accuracy of knowledge of human anatomy. Thus, the nature of the proof judgments of Galen depends on their practical content and not on the formal and logical structure offered by the Stoics when studying the functions of the human body, which ultimately leads to incorrect methods of treatment.

© 2018 Dynasty Publishing House. All rights reserved. Post-partum depression arises following pregnancy and childbirth, it is a severe disorder threatening the wellbeing of both mother and baby. In the affected families, there is a higher risk of the child's impaired emotional, social and cognitive development. Post-partum depression is one of the most common complications of the postnatal period. The disease prevalence varies from 6.5 to 12.9% and more in countries with low and middle levels of income and life. We analysed 62 Russian and worldwide literature sources published in the PubMed, Google Scholar databases and in Russian medical periodicals over the period 2002-2017 on this theme, we also translated the original Edinburgh Postnatal Depression Scale. This systematic review presents current ideas of the causes of postpartum depressions, methods of treatment and prevention.

© 2018 Dynasty Publishing House. All rights reserved. Objective: Development and justification of a differentiated approach to diagnosis and treatment of ectopic extratubal pregnancies. Patients and methods: 37 patients with histologically verified diagnosis «Ectopic pregnancy» were examined, in whom the ovum was located outside the uterine tubes. In 26 cases it was cervical pregnancy, in 8 - ovarian pregnancy, and 3 pregnancies within a caesarean scar. Diagnostic and treatment methods: 2D- and 3D-transvaginal echography, including power Doppler sonography; hCG testing in blood and urine, laparoscopy, hysteroresectoscopy. Results: A system of examining and treating patients with rare ectopic pregnancies has been developed, in which step-by-step measures for optimization of diagnostic and therapeutic processes are presented. The main attention is paid to organ-sparing technologies, including metroplasty and intrauterine surgery in caesarean scar ectopic pregnancy, and also intrauterine surgery in cervical pregnancy. Conclusion: The presented system permits to optimize diagnosis and treatment of patients with ectopic extratubal pregnancies with preservation of the reproductive function.

© 2018, Stolichnaya Izdatelskaya Kompaniya. Aim. To study the erythrocyte electric charge (EEC) in patients with metabolic syndrome (MS) depending on glycemia levels. Material and methods. 112 patients (45 men and 67 women, age 61.4±7.2 years) with MS (MS duration 8.7±5.2 years) were studied. EEC level was detected by the method of adsorption of a positive cationic dye (cationic blue O) on the surface of the erythrocyte plasma membrane up to the complete neutralization of their negative charge, followed by photometry of the solution and calculation of the number of charges on the erythrocyte cell surface. All statistical analyses were done using Statistics 10.0 software. Results: Abdominal obesity was registered in 100% of patients, hypertension - in 73%, fasting hyperglycemia - in 75%, dyslipidemia - in 80% of patients. Mean glycated hemoglobin (HbA1c) level in patients with MS was 7.3±1.9%. The mean EEC level in group of MS patients (1.59±0.05×107) was significantly lower than in the control group (1.67±0.03×107), p < 0.05. In patients with MS and fasting hyperglycemia the EEC levels were significantly lower than in those without fasting hyperglycemia (1.58±0.05×107 vs 1.64±0.03×107, respectively; p < 0.001). Significant negative correlations between EEC and age (r=-0.43, p < 0.05), average duration of MS (r=-0.87, p < 0.05), average plasma glucose concentration (r=-0.6, p < 0.05), average duration of fasting hyperglycemia (r=-0.83, p < 0.05), and blood HbA1c level (r=-0.56, p < 0.05) were found in patients with MS. Conclusion: Significantly lower values of EEC are observed in MS patients with increasing age, duration of MS, and duration of hyperglycemia. Negative correlation between HbA1c and EEC was also shown.

© 2018 Dynasty Publishing House. All rights reserved. The objective. To determine age-related specificities of microcirculation-tissue systems in children from varied age groups. Patients and methods. We analysed the results of examining healthy children aged 3 to 17 years and also young people under 25 years of age with the use of nail-fold capillaroscopy (n = 65) and laser Doppler flowmetry(n = 50). Results. According to capillaroscopy, no significant differences in microcirculation parameters in children of varied age have been obtained, but as has been found, diameters of all parts of capillaries and the width of perivascular spaces increased to some extent with children's age. Also, the density of first-line capillaries increased with age in the examined patients. The average microcirculation values obtained by LDF did not show any statistically significant difference between children from the age group 7 to 13 years and children aged 13 to 18 years. Microcirculation parameters are not dependent on a patient's age. The average values of PI may be used as reference parameters for diagnosing microcirculation impairments in children with varied pathologies. Conclusion. The capillaroscopy values and basal microcirculation values that we have obtained may be used in practically healthy children for comparison with such values in children with varied pathologies, which might be helpful in diagnosing various diseases and disorders at early stages and exercising control over treatment with selection of individual pharmacotherapy.

© 2018 Publishing House of the Union of Pediatricians. All rights reserved. The rational use of antibacterial drugs in children implies an adequate choice of the necessary medication, its dosing regimen, and the duration of treatment in order to achieve maximum efficacy and minimize toxic effects. The knowledge of pharmacokinetic and pharmacodynamic profiles of the antibacterial drug plays a crucial role for optimizing the dosing regimen. The strategy of individual choice of the dosing regimen, taking into account the principles of pharmacokinetics and pharmacodynamics, can be especially effective in patients with the expectedly changed parameters of pharmacokinetics and in infections caused by bacteria strains with low sensitivity to antibiotics. The review presents a contemporary view of pharmacokinetic and pharmacodynamic profiles of antibacterial drugs most commonly used in pediatrics and their relationship to the clinical efficacy of the administered therapy.

© 2018, Media Sphera Publishing Group. All rights reserved. Objective. To study the formation and dynamics of development of suicidal behavior (SB) in medical students based on a personality/psychological approach. Material and methods. Two hundred and seventy-two students with- (n=75) and without SB (n=197) were examined. Psychopathological and psychological methods, and several questionnaires and scales were used. Results and conclusion. Personality and environmental characteristics as well as family loading were the leading factors of SB formation. Based on the results obtained, the authors developed a complex of preventive measures in the frames of three types of prevention (common, selective and indicative).

© 2018, Media Sphera Publishing Group. All rights reserved. This article was designed to overview the scientific and historical legacy left by Aleksandr Osipovich Armfeld, a Russian expert in forensic medicine and outstanding educationalist whose activities date back to the first half of the 19th century. А.О. Armfeld did brilliantly at the defense of his doctorate thesis which allowed him to soon occupy the position of the head of the Department of the Art of Medical Science in which capacity he was able to fully bring his pedagogical talent to light. The unprecedented capabilities of А.О. Armfeld enabled him to create a literary monument to E.O. Mukhin, the founder of forensic medicine in this country. This biographical sketch written by А.О. Armfeld thus far remains an important source of information of unique historical and scientific value and continues to be used in the studies devoted to the history and development of the Russian school of forensic medicine during the pre-reform period.

© 2018 GEOTAR Media. All rights reserved. A rare case of orbital nodular fasciitis in young female is presented. This case is of interest not only because of diagnosis but also due to localization of the mass with inferior orbital wall destruction and extension into maxillary sinus. The efficacy of surgical treatment is demonstrated. Excision of the mass was two-staged, the first performed by ophthalmologist and the second performed by ENT-specialist. Orbital implant was used to close bone defect after the mass was removed.

© VV Romanova, YA Shulatov. During the Korean War (1950–1953), China and North Korea accused the US of waging bacteriological warfare, including the use of biological weapons developed Japanese war criminals from Unit 731, who had been convicted during the Khabarovsk Trials in 1949. The Soviet Union did not immediately join in the allegation campaign against the Allies, with the Soviet Foreign Ministry initially taking a restrained stance. However, with Moscow’s backing and active involvement in international orga-nisations and the media, a powerful propaganda campaign was unleashed against American-led UN troops in Korea, as well as the political leadership of the US. The campaign was markedly political in nature and it involved many prominent individuals, including public figures from Western countries. An extensive action plan was developed, although its implementation was incoherent, which was a reflection of both the lack of evidence and a rapidly changing international environment. The article demonstrates how the Soviet stance on the use of biological warfare during the Korean War changed and reveals how the extensive campaign was launched amid the Cold War.

© SD Batoev. The formation of the health care system in Transbaikal after the revolution of 1917–1918 had a number of essential features that will be covered in this paper. In 1919, the organization of medical care in Transbaikal retained its pre-revolutionary structure. In connection with the tense political situation in eastern Russia and the serious danger of a military conflict with Japan, in the spring of 1920, a buffer state was created – the Far Eastern Republic (FER). The FER Ministry of Health was established within the framework of the administrative territorial unit. During this period, the Ministry of Health had to fight epidemics, organize medical and sanitary assistance for the population and provide medical support for the People’s Revolutionary Army. Throughout the FER’s territory, free access to all types of medical care (outpatient, inpatient, sanatorium and dental) was introduced for all working groups of the population. From that point on, the state medical authorities consolidated and directed all the FER’s medical and sanitary and veterinary affairs. The Ministry of Health consisted of a civilian and military administrative unit, a medical and veterinary council and local health institutions for the indigenous population. The institutions were involved in the organization of health care and conducted medical and preventive activities and statistical studies. Despite Soviet Russia’s comprehensive assistance, the FER’s economic situation remained dire and unstable. The deficit of skilled health workers and medical institutions prevented the improvement of the health care situation. Radical changes in the public health system became possible only after the accession of Transbaikal to the RSFSR. In the territory of Transbaikal during the existence of the FER (from the spring of 1920 to the end of 1922), the formation of a health care system aimed at providing all segments of the region’s population with access to qualified medical care was an ongoing process.

© 2018 National Academy of Pediatric Science and Innovation. All rights reserved. Relevance. Statistical indicators are the basis for planning of the organization of medical care for children with cancer, as well as analysis of the effectiveness of medical care. Materials and methods. The authors have analyzed operational reports for 2017 of the executive authorities in the field of health care of 18 objects of the Russian Federation being part of the Central Federal District. Results. There 9 pediatric oncology departments, there are 464 children’s oncological beds, the bed occupancy per year is 319.3. There are 91 doctors providing medical care to children with cancer, 64 (70.3%) of the doctors have a certificate of pediatric oncologist. In 11 subjects there are no Departments for Pediatric Oncology. There are 821 primary patients with malignant neoplasms. There are 156 deceased patients, 66 of them were diagnosed in 2017. 52 (6.3%) patients are revealed actively. There were 12 (per 100 thousand for the age group of 0–17 years) cases of incidence of malignant neoplasms, mortality is 2.3 (per 100 thousand for the age group of 0–17 years), one-year mortality is 8%. The average time taken to diagnose and to verify the diagnosis before the beginning of treatment remains unknown. Conclusion. Operational reports contain non-matching indicators, thus, the information is not completely reliable. Incidence rates are significantly lower than those in countries with high reliability of statistical data. The percentage of patients identified actively remains extremely low. In order to eliminate the noted defects, it is necessary to introduce a single database of children with cancer in the Russian Federation.

2019 © Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All Rights Reserved. The goal of study was the epidemiological substantiation of optimization measures of a vaccinal prevention of whooping cough in the Russian Federation. Materials and methods. The retrospective descriptive epidemiological research has been conducted by analysis of the official statistical data on the whooping cough case rate (form No. 2) in 2005-2017 in the Russian Federation, as well as the data about preventive whooping cough inoculations (forms No. 5, No. 6) in 2005-2017 and about epidemic outbreakes in 2017 (form No. 23-17). The assessment of an economic damage from whooping cough in 2005-2017 has been carried out. Results. The following adverse characteristics of a modern epidemiological situation on whooping cough in Russia are shown: long-term recurrence of epidemic process, tendency of rising of a case rate of children of 0-2 years; high percentage of children of preschool and school age among whooping cough cases; prevalence among the patients with whooping cough of the children who have been vaccinated against this infection previously, epidemic outbreakes in children's collectives, the stability of a case rate of teenagers and adults with prevalence of the mild and the erased clinical forms of this infection. The risks due to weaknesses of the whooping cough vaccinal prevention are noted: the insufficient immunization coverage owing to falce contraindications and refusals of parents of vaccinations of children, noncompliance with terms and intervals between inoculations, lack of domestic vaccine for revaccination of children at the age of 5 years and older. Conclusion. It is necessary to introduce in the national vaccination schedule a preschool booster dose for children at the age of 6 and adolescents at 14 years with the combined reduced antigen content tetanus-diphtheria and acellular pertussis vaccines as well as the inoculations of this vaccine according to epidemiological indications to health workers, employees of educational institutions. A revaccination against whooping cough is recommended as “cocoon” for the persons contacting to not vaccinated child under 1 year of age.

© 2018 ABC-press Publishing House. All rights reserved. The objective is to perform comparative analysis of intra- and postoperative complications of retroperitoneoscopic radical nephrectomy (RRN) and laparoscopic radical nephrectomy (LRN) for large tumors. Materials and methods. The study includes examination and treatment data for 108 patients with stage T1–3a renal cell carcinoma. Results and conclusion. A number of advantages of RRN compared to LRN were demonstrated associated with shorter surgery duration with fast processing of the renal pedicle, lower blood loss, lower use of analgesics in the postoperative period, shorter duration of hospitalization, and quick recovery after the surgery. The rate of intra- and postoperative complications for RRN was 19.2 and 17.3 %, for LRN – 33.9 and 37.5 %, respectively. Complications associated with abdominal organs were absent for RRN. After LRN, the rate of serious complications was significantly higher than after RRN.

Copyright: © 2018 Sapelnikov et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 License. Mitral valve disease, including dysfunction of the mitral valve, is often accompanied by atrial fibrillation. Among the patients with prosthetic mitral valves, atrial fibrillation occurs in 30-50% cases. Development of atrial arrhythmias and incisional tachycardia in the early and late postoperative periods can significantly influence patients' rehabilitation and prognosis. Our clinical case describes a patient with a mechanical mitral valve and incisional tachycardia, which led to progression of heart failure and reduced left ventricular systolic function. The patient underwent catheter ablation with non-invasive myocardium mapping. The case reveals the potentials of treatment of incisional tachycardia and atrial fibrillation, which do not respond to drug therapy. Modern methods of visualization enable the cardiac surgeons to reduce possible intraoperative risks and development of complications in this group of patients.