Репозиторий Университета

© 2018 Ima-Press Publishing House. All Rights Reserved. The brain is a natural target organ in hypertension and, as shown by some clinical observations, it is affected earlier than other organs and systems. Due to the specific features of the anatomy of cerebral circulation, hypertensive microangiopathy leads primarily to damage to the sub-cortical basal ganglia and deep white matter. Clinically, this is manifested by a concuirence of predominantly subcortical cognitive impairment and emotional and behavioral disorders as depression, emotional lability, and apathy. Some features of depression, such as the prevalence of anhedonia and fatigue and the significant severity of cognitive and somatic symptoms in an elderly person with vascular disease, suggest its organic nature (vascular depression).

© 2018 S. Karger AG.All right reserved. We present a clinical case of a 34 years old female patient who simultaneously developed two rare conditions: microscopic polyangiitis and atypical hemolytic uremic syndrome (aHUS) associated with a polymorphism in diacylglycerol kinase-ε gene (DGKE), which seems to be the first case of aHUS associated with DGKE mutation in an adult patient. We suggest that the patient experienced chronic subclinical course of thrombotic microangiopathy (TMA) since adolescence, because persistent proteinuria and slowly progressive chronic kidney disease were first found when she was at the age of 13. She developed ANCA-associated vasculitis at the age of 34 with dialysis-dependent renal failure and alveolar hemorrhage that were accompanied by an acute episode of TMA. Treatment with high-dose of corticosteroids, cyclophosphamide and plasmapheresis was initiated. Alveolar hemorrhage have been resolved. However, severe hypertension, hemolytic anemia and thrombocytopenia persisted despite treatment. Plasma resistance was considered to be an indication for treatment with eculizumab, which proved to be beneficial. However, kidney function did not recover. Possible interactions between complement system, DGKE and their possible role in the pathogenesis of TMA are discussed.

© 2018 Nutritec. All Rights Reserved. A number of studies have shown the relationship between the regular consumption of cruciferous vegetables and the risk of malignant tumors in certain localizations, the activation of mechanisms of alimentary adaptation of the organism under conditions of alien loads, by inducing enzymes of the biotransformation system of xenobiotics. The cruciferous vegetables are distinguished by the presence of minor components, such as indole-3-carbinol, formed during the hydrolysis of glucosinolates. The aim of the investigation was a retrospective study of the content of indoles in students' diet with subsequent quantitative analysis in different comparison groups. The study involved 250 students from a medical university aged 21 to 27 years. To assess the actual nutrition, the developed questionnaires were used, which included the most common products in the Moscow region, sources of indole glucosinolates. It was found that 44% of the respondents didn't include cruciferous vegetables in the diet, and of those who consumed sources of indoles (56% of respondents), only about half received them in the recommended amount. It should also be noted that as in men, in women the most commonly used in the diet product as a source of indoles was cabbage, it was included in the diet of 68% of the respondents who used cruciferous vegetables, rarely pekin cabbage was used (16.3%) and broccoli (16.3%). Cauliflower, radishes, Kale and horseradish was included in the diet of 7.8-14.9% of the students. Less often turnip was consumed - only by 2.1% of the students. No significant differences in the consumption of indoles in the student with deficient, normal or overweight was revealed. Also, there was no correlation between excess weight and the consumption of various indoles sources. The obtained results testify to the extremely low level of alimentary intake of indole-3-carbinol.

The tendency to anxiety is a characteristic feature of alcohol abusers, and anxiety can be a symptom of alcohol withdrawal as well as comorbid disorder. The frequent comorbidity of alcohol use disorders and anxiety is due to a number of reasons including general hereditary predisposition, mutual conditioning and similar pathogenesis. Pharmacological therapy of anxiety disorders in alcohol-dependent patients is carried out on the basis of general principles of anxiety treatment and involves the use of benzodiazepines, antidepressants and, in some cases, antipsychotics as second-line medicines.

© 2018, Media Sphera Publishing Group. All rights reserved. Mucocele of the paranasal sinuses is a rare disease not infrequently associated with massive bone destruction, orbital and intracranial complications. The authors report a patient presenting with the giant post-traumatic frontal mucopyocele associated with the erosion of the posterior and inferior sinus walls that was clinically manifested as hypo- and exophthalmos and has caused the inferolateral eye deviation and orbital decompression. The patient displayed the ophtalmological symptoms 8 years after the frontal sinus fracture. The mucopyocele was treated effectively with the combination of the endoscopic trans-ethmoidal and open trans-frontal approaches. The noticeable intraoperative finding in this patient was the absence of complaints as well as the combination of dura mater defects in the form of its erosion and the leakage of the cerebrospinal fluid together with the presence of purulent discharge in the sinus in the absence of intracranial complications.

© 2018, Media Sphera Publishing Group. All rights reserved. The main cause of reflectory cough is neurogenic hyperventilation. The clinical signs of reflectory cough include its dry and back-breaking character, the gradual increase and abrupt beginning, impossibility to stop the coughing fit, and the feeling of shortness of breath. The triggers of a coughing attack can be a deep breath, a talk, physical and/or psycho-emotional stress, fatigue, and other sensations. The typical laryngological signs of the condition in question include the broad glottal aperture (up to 20 mm and more in contrast to its normal maximum width of 15 mm) and the spasm of the vocal cords in response to inspiration. The clinic of Diseases of Ear, Throat and Nose affiliated with I.M. Sechenov First Moscow State Medical University has gained the extensive experience with the treatment of more than 500 patients presenting with reflectory cough. All these patients received the combined treatment including 10 procedures for intracutaneous novocaine blockade of the Zakhar’in- Geda zones in the larynx in the combination with auricular reflexotherapy and respiratory gymnastics intended to eliminate hyperventilation and sedative medications and myorelaxants to remove the pathologically enhanced muscle tone as well as calcium-containing preparations if indicated.

© 2018, Media Sphera Publishing Group. All rights reserved. This publication was designed to report the experience gained by the Department of ear, nose and throat diseases at I.M. Sechenov First Moscow State Medical University in the matters concerning professional medical education in the framework of the clinical residency. The main factors that contribute to the adequate shaping of the future ENT-doctor are considered. These include the continuity of generations and conservation of the traditions in the combination with the development of the leading areas of scientific, clinical and educational work.

© 2018, Media Sphera Publishing Group. All rights reserved. The article presents a clinical case that reflects the difficulties of postoperative management of patients after the removal of the jugular glomus tumor.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To specify the frequency and species composition of vaginal bacterial carriage in pregnant women at the term of gestation 35–37 wks. Patients and methods. We examined 800 pregnant women, who were followed-up on an outpatient basis at terms of gestation 35–37 wks. Cultural examination of the content of the posterior vaginal fornix was performed. Species identification of microorganisms was performed by the method of direct protein profiling with the help of MALDI-TOF mass spectrometry, FLEX series, Bruker Daltonic GmbH, Germany. Results. The growth of flora was obtained in 761 patients (95%). Bacterial vaginosis (n = 71), Candida vulvovaginitis (n = 83) were diagnosed in 154 patients (19%). Lactobacillus spp. were found in 80% (n = 637) of examined women, of them in 161 (20%) in monoculture. Bacterial carriage was diagnosed in 55.8% of cases. The prevalence of Enterococcus faecalis, Escherichia coli, Streptococcus agalactiae, Staphylococcus epidermidis and Staphylococcus haemoliticus was noted. They were much more rarely detected in monoculture: E. faecalis (1%), S. agalactiae (0.1%), S. epidermidis (0.1%), Candida albicans (0.1%). In 39 (5%) patients, no growth of flora was found. In 17 patients we found extended-spectrum B-lactamase-producing bacteria: E. coli (n = 15), Klebsiella pneumoniae (n = 2). Conclusion. Taking into account a high prevalence of vaginal bacterial carriage in pregnant women in the 3rd trimester, it might be expedient to consider inclusion of microbiological examination of vaginal discharge in the basic spectrum of antenatal observation and screening examination of pregnant in the Russian Federation.

© 2018, Dynasty Publishing House. All rights resvered. Abnormal uterine bleeding (AUB) is a collective term uniting various disorders of the menstrual cycle of structural and nonstructural genesis. The causes of AUB are united in the acronym PALM-COEIN (Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not otherwise classified). Not infrequently, AUB (PALM), especially in case of associated severe menstrual bleeding, is accompanied by the development of iron-deficiency anaemia (IDA), the basic pathogenetic therapy for which is administration of iron preparations (IP). The choice of an IP should be guided not by the total amount of iron compounds, but by the amounts of elemental iron. A medical practitioner has two groups of IP at his or her disposal – iron salts (IS) and iron-containing complexes (ICC). A comparative analysis of these groups of IP proves the effectiveness of ICC: absence of the impact of food and medication on absorption, slow absorption rate, rapid elimination from blood serum to reserves, absence of oxidative stress, a comparatively rare frequency of side effects on the part of the gastrointestinal tract. Since in female patients with AUB IDA is conditioned by continuing iron losses that exceed the amount of dietary iron intake, administration of IP is obligatory. Additionally, not only the effectiveness but also the safety of an iron-polymaltose complex should be taken into consideration. The good tolerance of Maltofer and a convenient schedule of its dosing ensure a high compliance of patients to therapy.

© 2018, Dynasty Publishing House. All rights reserved. The article discusses a clinical case of necrotizing enterocolitis in a newborn girl with a high risk for intrauterine infection, respiratory distress syndrome, cerebral depression, prematurity grade 2, intrauterine growth restriction. Literature data of the possible risk factors for the development of this disease, causes and mechanisms of its appearance, and also modern treatment options are given.

© 2018, Dynasty Publishing House. All rights reserved. Today the «Surrogate motherhood» programme is actively developing and every year becomes a more and more needed method of assisted reproductive technologies. But the findings of recent scientific research have shown that the course of pregnancy in surrogate mothers is associated with an increased incidence of obstetric complications. A clinical case of antenatal fetal death and development of sepsis in a 32-year-old woman, whose pregnancy occurred after IFV under a surrogacy programme is presented.

© 2018, Dynasty Publishing House. All rights reserved. The objective. A comparative study of the dose uniformity, dose reproducibility, imprint areas on a planar simulation model as indicators of dispersion of spray-aerosol pharmaceutical forms of various trademarks for treatment of diseases of the mouth cavity and throat. Materials and methods. As objects of study we selected 10 drugs manufactured in the «aerosol» and «spray» forms. Test for dose uniformity was performed in accordance with articles of the State Pharmacopoeia of the Russian Federation «Aerosols and sprays», comparison of dose reproducibility was performed by comparing average dose mass dispersions according to Fisher. The test for the width of dispersion was performed by imprints obtained of a single release of drugs on filter paper with Dragendorff’s reagent and plates for thin-layer chromatography. Results. All metered-dose sprays successfully passed the test for dose mass uniformity. The test for dose mass reproducibility showed a high enough stability of dosage in all the examined drugs: the percentage error of the average dose mass was at the level 1–3%. The test for dispersion width performed on planar simulation models showed significant differences in the character of drug dispersion. For comparing the width of dispersion we calculated imprint areas from a single-dose release on PSM, which permitted to determine drugs with wide and fine dispersion as the most effective with respect to the way of drug delivery to the focus of inflammation – on the mucous membranes of the throat and mouth cavity. Conclusion. The optimal combination of the examined spray characteristics was found in the spray Tantum® Verde, which permits to recommend it as a drug of choice in paediatrics for local therapy of inflammatory diseases of the throat in children beginning from the age of 3 years.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To determine vitamin D status in children with rheumatic disease who live on the territory of Russia. Patients and methods. A pilot study was conducted that included 52 children (35 girls and 17 boys) aged 5 to 17 years (11.88 ± 0.48 years), among them 29 children with systemic connective tissue disorders (SCTD) and 23 children with juvenile idiopathic arthritis (JIA). All patients underwent complex clinical-laboratory and instrumental examination in order to confirm the diagnosis and assess the patients’ health. Vitamin D status was assessed by 25(ОН)D serum levels using the method of chemiluminescence immunoassay. Results. Sufficient levels of 25(ОН)D (>30 ng/l) were found only in 5 (9.5%) children, vitamin D insufficiency (25(ОН)D 21–30 ng/l) was observed in 6 (11.5%) children, deficiency (25(ОН) <20 ng/l) in 41 (79.0%) children, among them in 7 (13.4%) it was severe (25(OH)D <10 ng/l), in spite of a long-term intake of low-doses of cholecalciferol (100–400 U/day) by 40 (76.9%) patients. Average levels of 25(ОН)D in patients with SCTD were significantly higher than in patients with JIA (20.86 ± 2.15 ng/l vs. 14.98 ± 0.91 ng/l, p = 0.0151), deficiency was more rarely found in these patients (69.0% vs. 91.3%), which was to a certain degree conditioned by more intensive vitamin D therapy. Conclusion. Insufficiency/deficiency of vitamin D is noted in an overwhelming majority of children with RD. Standard therapy with low doses of cholecalciferon offered to patients with RD is not sufficient for obtaining optimal 25(ОН)D levels and needs correction.

© 2018, Dynasty Publishing House. All rights resvered. The objective. A comparative study of components of the quality of life of parturient women, whose pregnancy developed both after in vitro fertilisation (with the use of donor or own oocytes) or spontaneously. Patients and methods. We assessed the quality of life of 160 parturient women. In 40 women pregnancy developed after IVF with the use of donor eggs, in 40 women – after IVF with own eggs, 40 patients participated in the programme «Surrogate motherhood», and 40 women had a spontaneous pregnancy. The standard SF-36 questionnaire was used. Results. Surrogate mothers demonstrate a somewhat higher self-assessment of their physical condition, underestimate their limitations on physical activities (daily self-care, walking, climbing stairs, carrying heavy objects, etc.), estimate their health at the moment of the survey higher than respondents of other groups and overestimate their mental health (mood, absence of depression and anxiety, the general index of positive emotions) as compared with respondents of other groups. Conclusion. Preventive psychological diagnostics, psychological follow-up of women during preparation to pregnancy, during carrying a baby and in the postpartum period have favourable effects on the successful outcome of the «Surrogate motherhood» programme.

© 2018, Dynasty Publishing House. All rights resvered. The article presents a clinical case of vaginal hysterectomy in the absence of genital prolapse in a patient with adenomyosis and anaemia, who before surgery complaint of discomfort in the vagina after local treatment with metronidazole medications. Before and after surgery vaginal lavage with a solution of benzydamine hydrochloride (Tantum® Rosa) was performed. Symptoms of discomfort were alleviated within the first 24 hours of the postoperative period. A marked anaesthetic effect of the drug was noted. No adverse effects were recorded. The conclusion is made of the appropriateness of using Tantum® Rosa in the postoperative period after vaginal hysterectomies.

© 2018, Dynasty Publishing House. All rights reserved. A clinical case of a giant vulvar tumor in a puerperal of 38 years is presented. Tumor removal was performed using thermal ligation.

© 2018, Dynasty Publishing House. All rights reserved. At present the incidence rates of urogenital chlamydiosis maintain the leading positions among sexually transmitted infections. Special attention to this infection is conditioned by a high risk for development of complications on the part of the reproductive system in both women and men. The ability of Chlamydia to affect various tissues accounts for a broad spectrum of clinical manifestations of urogenital pathologies: urethritis, vulvovaginitis, cervicitis, endometritis, salpingitis, epididymitis, prostatitis, proctitis, and also extragenital forms of disease. Taking into account a possibility of transition of Chlamydia infection into a latent stage with subsequent development of a chronic persisting course, early and adequate management of infection is of considerable importance. Etiotropic therapy of Chlamydia infection employs antibacterial drugs capable of penetrating into cells. Tetracycline antibiotics are the most effective drugs of choice administered as part of complex therapy. Minolexin is a tetracycline antibiotic that demonstrates the best effectiveness in the fight against infectious agents affecting the urogenital tract. The article presents the author’s clinical experience of using minolexin for management of urogenital chlamydiosis in 60 patients.

© 2018 Media Sphera Publishing Group.All rights reserved.  Contribution of diseases of the circulatory system to total mortality of the population remains high. Therefore it is necessary to study factors with most substantial impact on regional morbidity and mortality for elaboration of targeted programs of preventive measures aimed at definite population groups. Purpose of this study was to perform analysis of differences of mortality from cardiovascular diseases (VVD) of Moscow region inhabitants of various gender and age. Materials and methods. Data on 2016 mortality of Federal Service of State Statistics (Rosstat) and territorial service of state statistics of the Moscow Region were used in this analysis. Analysis was conducted for men and women divided in age groups ≤50, 50-59, 60-69, and ≥50 years. Diseases were classified in accordance with 10 th Revision of International Statistical Classification of Diseases (ICD10). Results. Population of the Moscow Region territory on January 1, 2016, amounted 7 318 647 (men 46.2, women 53.8%, persons of working age 58.9%). Contribution in the mortality structure of chronic ischemic heart disease (IHD) and cerebro-vascular diseases in women was greater than in men (80 vs. 68%, respectively, р<0.0001). Contribution of acute IHD, IHD unrelated heart diseases, and vascular diseases in men was significantly greater than in women (30 vs. 18%, respectively, р<0.0001). In the age group over working age mortality indexes were substantially higher compared with those in working age. In men these indexes became 10-20 times while in women - 30-130 times higher. Conclusion. Despite positive dynamics of mortality from diseases of the circulatory system (45.3% lowering from 2008 to 2016) it is necessary to strengthen efforts directed to correction risk factors of IHD and implementation of timely diagnostics and correction of IHD unrelated diseases.

© 2018, Media Sphera Publishing Group. All rights reserved. Antidepressants are among the most commonly prescribed drugs due to their effectivenes in treating depression and anxiety disorders. One of the reasons for early discontinuation of taking antidepressants are side-effects. Agomelatine is a relatively novel antidepressant with high efficacy and good tolerance. Clinical effects of agomelatine include a reduction in symptoms of depression, anti-anxiety and hypnotic effects, as well as the rapid elimination of anhedonia, which determines high adherence to therapy, restoration of normal social functioning, and complete remission of disease.