Репозиторий Университета

© 2018, Dynasty Publishing House. All rights reserved. The objective. Was to develop echographic and Doppler prognostic markers of lesions of the central nervous system (CNS) in premature newborns. Patients and methods. In accordance with the objective of the study we conducted a complex prospective examination of 196 pregnant women diagnosed with threatened preterm labour. The treatment group consisted of 166 women, whose pregnancy ended with spontaneous births at terms 22–36 wks, and premature newborns later developed various disorders of CNS. Results. We found morphological ultrasound and Doppler ultrasound specificities of fetal CNS against the background of threatened preterm labour depending on the term of gestation at the moment of birth and subsequent neurological disorders in premature infants. The most significant were changes of the ventriculo-cranial index, width of anterior horns of lateral ventricles, thalamo-occipital distance, systolic-diastolic ratio between vertebrobasilar vessels of the brain. Conclusion. Such a detailed prenatal diagnosis contributes to noninvasive prognostication of the severity of neurological lesions of CNS in premature infants. The results showed interrelations between perinatal outcomes and initial blood flow impairment of fetal CNS in 97% of observations.

© 2018 Izdatel'stvo Meditsina.All rights reserved. Studied the diagnostic and prognostic significance of N-terminal precursor of natriuretic peptide C-type (NT-proCNP) and brain natriuretic peptide (NT-proBNP) in patients with COPD with pulmonary hypertension (PH). The study included 47 patients with COPD (II-IV degrees of severity, 2016 GOLD, men-44, women-3, mean age 59, 3±9.12 years, disease dura-tion of 13.7±5.93 years, the index of Smoking at 23.1±10, 93 pack-years, BAH of 27.2±12, 06 m!kg2.). Criteria of pulmonary hypertension on the basis of the doppler-echocardiography was an increase ofpulmonary artery systolic pressure (PASP) > 40 mmHg alone. Depending on the presence and degree of enhancement PASP patients were divided into three groups: I-without pulmonary hypertension (PASP < 40 mmHg, n=168), 2-moderate pulmonary hypertension (PASP 40-55 mmHg, n=101), 3-group with severe pulmonary hypertension (PASP > 55 mmHg, n=19). There was a statistically significant intergroup differ-ences (p. 2 0, 001, p J} 0, 001, pl3< 0, 001) values of NT-proCNP and NT-proBNP. There was a significant correlation relation-ship SDLA with the concentration of NT-proCNP (r=0, 53, p<0, 05) and NT-proBNP (r=0, 67; p=0, 05). A high diagnostic value of determination of NT-proCNP and NT-proBNP to predict the development and severity of PH in patients with COPD. Cox regression analysis showed that elevated levels of NT-proCNP and NT-proBNP in COPD patients ofPH c are the predictors of hospital mortality.Grant: The study had no sponsor support.

© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. The key to successful treatment in patients with acute coronary syndrome is maximally early revascularization of the coronary arteries. Treatment of multifocal atherosclerosis with lesions of the coronary and peripheral arteries requires coordinated work of the multidisciplinary team of doctors. Critical ischemia of the lower limbs requires urgent revascularization in order to prevent limb amputation. However, it is not always possible to perform revascularization using specialists of the same profile – endovascular or surgical. The use of hybrid methods of treatment (surgical and endovascular) allows to significantly improve the prognosis in saving the limb. The article presents a clinical observation of successful multistep treatment of a patient with acute coronary syndrome in combination with critical ischemia of the lower limb. The first stage was performed by multiple stenting of the coronary arteries with bioabsorptive scaffolds; the second stage was the hybrid treatment – femoral-tibial bypass with simultaneous recanalization and angioplasty of the lower leg arteries with good postoperative and long-term outcome.

Lutein and zeaxanthin are carotenoid pigments that affect the function of the visual analyzer. They selectively accumulate in the yellow spot of the retina, form macular pigment and determine the density of the retina macula. Lutein and zeaxanthin slow down the progression of age-related macular degeneration, a leading cause of senior-age blindness. The main food sources of non-vitamin carotenoids are green leafy vegetables, zucchini, pumpkin, green peas, broccoli. The aim of the study is a retrospective assessment of the levels and sources of alimentary intake of lutein and zeaxanthin in young people and research of the effect of lutein and zeaxanthin in the diet on macula density. A specially designed questionnaire was used to quantify the content of lutein and zeaxanthin in the diet, reflecting the amount of consumption of the main sources of these carotenoids on the day preceding the survey. A non-invasive non-contact method of optical coherence tomography of the retina was used to determine the density of the macula. The study involved 96 students of Sechenov University at the age of 21-27 years. The study found that only 6.25% of the respondents had daily intake of lutein and zeaxanthin of 6 mg or more, 8.33% had 4.6-5.9 mg, 8.33% had 3.0-4.5 mg, in 18.75% - 1.5-2.9 mg, in 45.83% <1.4 mg 12.5% of respondents didn't include sources of lutein and zeaxanthin in the diet. The more common sources of lutein and zeaxanthin in the diet were eggs and fresh tomatoes. Retinal density indices corresponded to the age standards in the majority of the examined. In 8.3% surveyed the thickness of the retina was decreased, and 4.2% had higher thickness of the retina in comparison with the standards. Significant differences in the Central subfield thickness in men and women were revealed. There was no dependence of the levels of lutein and zeaxanthin coming from food sources on the retina thickness indicators.

© 2018, Silicea-Poligraf. All rights reserved. Pregnancy is a physiological condition that takes a defined period of time in a woman’s life. For nine months, the mother’s heart works under conditions of daily additional load, which is necessary to ensure placental blood flow. In this regard, structural and functional adaptation of the heart develops in a healthy woman with a normal pregnancy. A pregnant woman with some heart diseases is less likely to adapt. That leads to greater susceptibility to stress resulting in pathological changes of pregnancy. In addition, each pregnancy may develop new heart diseases, which in some cases may be relatively innocent, but in others — fatal. In this regard echocardiography (EchoCG) is a necessary procedure for assessing a woman’s health status that needs before bearing a fetus, during and after pregnancy.

© 2018 The Author(s). Background: Cornea protects the eye against natural and anthropogenic ultraviolet (UV) damage and mechanical injury. Corneal incisions produced by UV lasers in ophthalmic surgeries are often complicated by oxidative stress and inflammation, which delay wound healing and result in vision deterioration. This study trialed a novel approach to prevention and treatment of iatrogenic corneal injuries using SkQ1, a mitochondria-targeted antioxidant approved for therapy of polyethiological dry eye disease. Methods: Rabbit models of UV-induced and mechanical corneal damage were employed. The animals were premedicated or treated with conjunctival instillations of 7.5 μ M SkQ1. Corneal damage was assessed by fluorescein staining and histological analysis. Oxidative stress in cornea was monitored by measuring malondialdehyde (MDA) using thiobarbituric acid assay. Total antioxidant activity (AOA) was determined using hemoglobin/H2O2/luminol assay. Glutathione peroxidase (GPx) and superoxide dismutase (SOD) activities were measured using colorimetric assays. Results: In both models corneas exhibited fluorescein-stained lesions, histologically manifesting as basal membrane denudation, apoptosis of keratocytes, and stromal edema, which were accompanied by oxidative stress as indicated by increase in lipid peroxidation and decline in AOA. The UV-induced lesions were more severe and long healing as corneal endothelium was involved and GPx and SOD were downregulated. The treatment inhibited loss of keratocytes and other cells, facilitated re-epithelialization and stromal remodeling, and reduced inflammatory infiltrations and edema thereby accelerating corneal healing approximately 2-fold. Meanwhile the premedication almost completely prevented development of UV-induced lesions. Both therapies reduced oxidative stress, but only premedication inhibited downregulation of the innate antioxidant activity of the cornea. Conclusions: SkQ1 efficiently prevents UV-induced corneal damage and enhances corneal wound healing after UV and mechanical impacts common to ocular surgery. Its therapeutic action can be attributed to suppression of mitochondrial oxidative stress, which in the first case embraces all corneal cells including epitheliocytes, while in the second case affects residual endothelial cells and stromal keratocytes actively working in wound healing. We suggest SkQ1 premedication to be used in ocular surgery for preventing iatrogenic complications in the cornea.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Investigation's history and nomenclature's evolution of the IgA-vasculitis are presented in the article. Pathogenesis of the renal and skin damages is discussed in details, particularly abnormalities of the IgA-immunity and systemic endotoxemia. Relevant world's literature is cited.

Numerous studies have demonstrated the efficacy of anti-VEGF medications for exudative (wet) age-related macular degeneration (AMD). Significant IOP elevation is one of the side effects of anti-VEGF intravitreal injection. PURPOSE: To study the changes in the parameters of anterior segment of the eyeball against acute IOP elevation after repeated intravitreal injections (IVI) of anti-VEGF medication. MATERIAL AND METHODS: The study was conducted on a random sample of 45 patients (45 eyes) diagnosed with exudative (wet) form of AMD. All patients received two 0.05 ml intravitreal injections of ranibizumab with one-month interval. Measurements of IOP were performed with rebound tonometer Icare-Pro (ICare, Finland) before intravitreal injection, then one minute, 30 minutes and 3 hours after. The parameters of the ocular anterior segment, namely thickness and optical density of the cornea, volume and angle of the anterior chamber were evaluated by Scheimpflug imaging (Pentacam HR, Oculus, Germany) before IVI, and 15 minutes after. RESULTS: Statistically significant (p<0.05) elevation of IOP to 40 mm Hg (confidence interval 32-48 mm Hg) was recorded one minute after injecting 0.05 mL of ranibizumab solution into the vitreous cavity with IOP having the tendency for gradual normalization. When measured 15 minutes after IVI, the following parameters of the ocular anterior segment structures had reliably changed in the setting of elevated IOP: corneal thickness had increased to 27 µm (confidence interval 14-38 µm), corneal optical density - to 16.7 (confidence interval 10.4-19.5). No significant changes of either volume or angle of anterior chamber were revealed. Comparative analysis showed no significant changes of parameters after the 1st and the 2nd IVI. CONCLUSION: The revealed changes were transient in nature and did not require any corrections since all parameters returned to baseline after each injection.

The article reviews the results of using optical coherence tomography (OCT) - a non-invasive non-contact examination method for obtaining a tomographic slice image of the site of glaucoma surgery. The method helped reveal the functional relationships between the newly created outflow pathways and various parameters of the filtering bleb such as its linear dimensions, wall structure, presence of microcysts, position of drainage, etc. Due to its high resolution and noninvasiveness, OCT can be reliably used to examine the structure of aqueous outflow pathways in different postoperative periods with accuracy close to morphometric. The amount of data that had been obtained with the method has allowed the creation of new classifications and clarification of OCT-relevant prognostic signs for glaucoma surgery site.

The article presents a clinical observation of ocular thrombotic microangiopathy in atypical hemolytic-uremic syndrome - a rare genetic disease characterized by systemic thrombosis caused by uncontrolled activation of alternative complement pathway. A typical manifestation of this ocular lesion in this disease is bilateral Purtscher-like retinopathy. Timely diagnostics of atypical hemolytic-uremic syndrome, including ophthalmologic examination, determines the early start of a highly effective pathogenetic therapy with complement inhibitor eculizumab.

© 2018 Media Sphera Publishing Group.All Rights Reserved. Aim. Determination of desialized apolipoprotein-B-100 (apoB-100) and lipoprotein-containing circulating immune complexes in patients with chronic kidney disease (CKD) in program hemodialysis with type 2 diabetes mellitus. Materials and methods. We examined 81 patients with CKD (50 men / 31 women) treated with program hemodialysis, of which 36 (17/19) with type 2 diabetes mellitus, 45 (33/12) non-diabetic patients. The levels of total cholesterol, triglycerides and desialylated apoB-100 in blood plasma and lipoprotein-containing circulating immune complexes. A color duplex scan of brachiocephalic arteries was used to assess the extent of development of atherosclerosis with the determination of the thickness of the intima-medial complex. Results and discussion. Patients with diabetes had high values of total cholesterol, triglycerides (p<0.05). Duplex scan of brachiocephalic arteries showed an increase in the thickness of intima-medial complex in all patients for program hemodialysis, however, in patients with diabetes, the thickness was 13% higher (p<0.05). In patients with diabetes, plaques with stenosis up to 50% prevail, compared with non-diabetic patients, p<0.05. The incidence was significantly higher for desialized apoB-100 by 46% in patients with diabetes on hemodialysis compared non-diabetic patients (p<0.05). An increase in the level of lipoprotein-containing circulating immune complexes by 39%, (p<0.05) in patients with diabetes mellitus was observed, compared with patients non-diabetic patients. The correlation between desialized apoB-100 and duplex scan of brachiocephalic arteries parameters (r=0.325), as well as between the cholesterol level and stenosis up to 50% (r=0.465) in patients with diabetes mellitus, was found to be of medium strength. The patients with diabetes and CKD, myocardial infarction developed 79% more often than in patients without diabetes (p<0.05). Thus, immunogenic lipid markers of atherosclerosis can be considered both as mechanical factors of atherogenesis and diagnostic and prognostic characteristics in type 2 diabetic patients with impaired renal function and chronic renal insufficiency. The conclusion. Accelerated development of atherosclerosis with diabetes and CKD, confirmed with the help of duplex scan of brachiocephalic arteries, may be associated with an increase in the level of modified low density lipoprotein.

© 2018, Media Sfera. All rights reserved. At present, phacoemulsification and trabeculectomy are the most widespread surgery methods in cataract and glaucoma treatment, generally recognized as the gold standard. Among elderly patients, comorbid glaucoma and cataract are extremely prevalent, so the order of the two surgeries and the time interval between them are pivotal choices when planning treatment strategy. The reason for it is that almost any eye surgery is considered a risk factor for long-term trabeculectomy effectiveness. In attempts to solve this problem, numerous studies have been conducted on the impact of cataract surgery on filtration bleb scarring. The problem of determining the time interval between surgeries, as well as other treatment nuances, remains relevant despite the long history of research and publications. Some results are cited as general recommendations on treatment tactics (increasing the time interval between operations, using antimetabolite and anti-inflammatory therapy, minimizing intraoperative traumatism). However, currently there are no specific recommendations for one of the most important factors - the time interval between cataract extraction and trabeculectomy.

© 2018 Media Sphera Publishing Group.All Rights Reserved. In the modern clinic of internal diseases, the specific gravity of the infectious pathology, manifested by various clinical syndromes, is increasing. Infectious pathology is represented by diseases of the respiratory system, heart disease (infective endocarditis, cardioimplant infections, viral myocarditis), infectious arthropathies, extrahepatic manifestations of viral hepatitis, cytopenic syndromes, various manifestations of sepsis and some other conditions.In most cases, the diagnosis and management of such patients is the responsibility of the internist, who must be able to suspect the infection and carry out its verification. In the process of diagnostic search and management of patients, close interaction of the internist with a clinical microbiologist, clinical pharmacologist and other related specialists is necessary.

© The authors team, 2018.All Rights Reserved. Purpose: to evaluate effectiveness of Oscillococcinum in the treatment of acute respiratory viral infections (ARVI) in children of different age groups. We observed 140 children from 1 to 14 years with mild to moderate-severe acute respiratory viral infection. 80 children (Group 1) were treated with Oscillococcinum, 60 children (Group 2) were treated symptomatically. Group 1 was divided into Subgroup 1А (40 children of 1-5 years old) and Subgroup 1B (40 children >5-14 years old). Group 2 was divided into Subgroup 2А (30 children of 1-5 years old) and Subgroup 2B (30 children >5-14 years old). The follow-up period was 7-10 days. Clinical efficacy was assessed by the severity of ARVI symptoms in scores from 0 to 2. All adverse events of the therapy were recorded. Also we evaluated disappearance of ARVI symptoms within 48 hours after the beginning of the therapy. Results: Oscillococcinum reduced the duration of ARVI in children of different age groups. During the first two days the symptoms of acute respiratory viral infection disappeared in 13 (16.3%) children of Group 1 receiving oscilococcinum and in 4 (6.7%) patients from Group 2 (OR = 2.7, 95 % CI 0.8-8.8, p <0.001). Conclusion: Oscillococcinum is an effective and safe drug to treat ARVI in children of different age groups.

© 2018, Dynasty Publishing House. All rights reserved. Literature data about biomechanical foundations of the development of foot pathologies in children and adolescents are analysed. The development and formation of anatomical structure of the foot as a flexible movable arch, and biomechanical specificities in human standing and walking are also considered. As has been noted, correct development and formation of the anatomical skeleton of the foot, its ligamentous-muscular apparatus and sole skin ensure its reliable functioning. As has been pointed out, understanding of the biomechanics of walking is extremely important for an orthopaedist when choosing a method of foot pathology correction, in particular, in rehabilitation of paediatric patients. The main functions of the foot have been specified – spring, balance, and propulsion. Most methods of diagnosing foot injury and disease, as a rule, are aimed at evaluating the spring function of the foot based on analysis of its anatomical structures. The conclusion has been made that the problem of correction and management of foot dysfunctions and pathologies should be solved as early as in childhood, which is possible only on the basis of complex consecutive implementation of a number of measures that include: diagnostics, choice of a way of correction, design and manufacturing of an individual orthosis (conservative method) or surgical treatment. Large-scale clinical testing of modern methods of podology and biomechanics in diagnosing and treatment of foot pathologies and correction of disorders of its stance function will contribute to progress in solving such a significant medico-social problem as foot disorders in childhood and adolescence.

© 2018 Stolichnaya Izdatelskaya Kompaniya. All rights reserved. Obesity is one of the leading and the most serious risk factors of cardiovascular diseases. Overweight provokes many metabolic and hemodynamic disorders. About 30% of inhabitants of the planet have overweight and prevalence of obesity increases by 10% every 10 years according to the WHO data. The probability of arterial hypertension in obese patients is 50% higher than in people with normal body mass. Framingham study showed that obesity is an independent, significant risk factor of ischemic heart disease, myocardial infarction, cerebral stroke and diabetes mellitus. The most dangerous is the central obesity with the preferential fat deposition in the abdomen. Combination of visceral obesity, violation of carbohydrate and lipid metabolism, arterial hypertension, and close pathogenic relationship between these factors underlie the isolated symptom complex known as metabolic syndrome. J. Vague was the first to describe relationship between abdominal obesity with cardiovascular disease and mortality in 1947. In our country G.F. Lang noticed common combination of arterial hypertension with obesity, lipid and carbohydrate metabolism disorders. Thus, metabolic syndrome significantly increases risk and severity of cardiovascular disease. Within last decades criteria of metabolic syndrome stays constant. The factors of insulin resistance and endothelial dysfunction as stages of the pathogenesis of the metabolic syndrome have been studied in detail. The mechanisms of insulin resistance and endothelial dysfunction are discussed in detail in this article as well as inflammatory markers and the significance of highly sensitive C-reactive protein.

© Ima-Press Publishing House. All rights reserved. Surgical treatment as accelerated functional recovery for discogenic radiculopathy has been proven to have advantages over medical treatment, the efficiency of which remains debatable. Objective: to investigate the efficiency of combination conservative treatment in patients with discogenic lumbosacral radiculopathy. Patients and methods. Thirty patients (12 men and 18 women; mean age, 39.5±2.2 years) with discogenic lumbosacral radiculopathy confirmed by magnetic resonance imaging were followed up. All the patients underwent combination conservative treatment (epidural glucocorticoid administration, analgesic therapy, and motor mode correction). They were surveyed using questionnaires (numeric pain rating scale (NPRS), Oswestry disability index, Hospital Anxiety and Depression Scale, the 12-Item Short Form (SF-12) of Quality of Life (QoL) Questionnaire on admission to the clinic, at 7-14 days after treatment (pain intensity and functional status), and in the long-term period (at 3, 6 and 12 months) after discharge. At baseline, the patients were severely disabled due to pain syndrome. The average Oswestry index was 57.9±3.7%, the back and leg pain intensity scores were 6.5±0.6 and 6.9±0.5, respectively, as evidenced by NPRC. The majority of patients were found to have the combined musculoskeletal sources of pain, such as a myofascial component in 56.7% and sacroiliac joint dysfunction in 43.3%. In these cases, nonsteroidal anti-inflammatory drugs and muscle relaxants were additionally used. Results. The conservative treatment resulted in a statistically significant clinical improvement with a preserved positive effect in the long term: at 1 year, the average Oswestry index was equal to 16.6±3.9%, the back and leg pain intensity scores were 1.7±0.5 and 1.6±0.5, respectively, as shown by NPRC (p<0.001 vs baseline). Within a year, only one female patient required surgical treatment; regression of large extrusions and sequesters, the average initial size of which reached 11.1 mm, was observed in 9 cases. Conclusion. The findings reflect the efficiency of conservative treatment and the expediency of detecting mixed musculoskeletal disorders and their correction in discogenic radiculopathy.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. In this article we have described clinical pharmacology and data of clinical studies of an innovational drug valsartan + sacubitril in patients with chronic heart failure (CHF). The use of supramolecular complex valsartan + sacubitril allows to elevate quality of life and improve prognosis of patients with CHF. High efficacy of valsartan+sacubitril relative to impact on composite primary end-point (cardiovascular death + hospitalization due to CHF) was demonstrated in the clinical trial PARADIGM-HF in which it was compared with angiotensin converting enzyme inhibitor enalapril. Advantages of the use of valsartan + sacubitril for the budget were demonstrated in pharmacoeconomic studies. These advantages are maximally realized at long-term administration. Cost-efficacy of the use of valsartan+sacubitril in pharmacotherapy of CHF is comparable with that of statins in the treatment of ischemic heart disease or implantation of a cardioverter-defibrillator in prevention of sudden cardiac death. Thus, introduction of the drug into practice can be expected to reduce budget expenditures.

© ABC-press Publishing House. All rights reserved. Objectives to enhance the morphological diagnostic complex in order to predict postoperative outcomes in a more accurate way and to optimize patients with non-muscular invasive bladder cancer treatment. Materials and methods. The study included 34 patients from 25 to 71 years old underwent laser en-block resection, the most of them were males - 28. In 9 cases multiple carcinomas (2 or more) were found. Huge tumors (2 cm or more in one dimension) were resected in 6 patients. Results. The major part of tumors removed (n = 22) histologically appeared to be papillary urothelial carcinomas with low grade of malignancy and PUNLMP; in 6 cases G2 was verified, one tumor with high malignancy potention - G3. In 3 patients intramuscular invasion was found (invasive carcinoma T2) excluding them from the study. Discussion. Laser en-block resection of non-muscle-invasive bladder cancer appears to be the most optimal approach in operative treatment that provides representative histological material. For correct morphological estimate we recommend either to expand the resection zone to 1 cm which allows to remove circular resection margin or to take extra pinch biopsy from tumor crater (vertical margin). In 3 patients from our study positive circular margin was revealed histologically whereas foci of perineural and perivascular invasion were found in one case. A new subgrading of stage T1 depending on intramuscular invasion depth was suggested whereas the main criteria is the muscularis mucosae involvement. Conclusion. Morphological estimate of circular resection margin provides an ability to predict postoperative outcomes and correct the treatment in one or another way. Subgrading for T1-stage tumors is recommended for following correct postoperative prognosis and possibility of tumor recurrence.