Home – Home – Jornals – Siberian Scientific Medical Journal 2020 number 5

The study of the phenomenon
of a combination of several diseases at the same time in an individual,
actualized in the second half of the 19th century, is being actively
analyzed 150 years later using genetic approaches. We present an
overview of the results of such studies in relation to allergic
diseases, in particular, a special variant, the so-called «atopic
march», the sequential development of eczema, allergic rhinitis and
asthma («atopic march» syntropy). The data of genetic and
epidemiological studies were summarized, the analysis of genome-wide
associative studies was carried out, and the role of mutations in the
filaggrin gene ( FLG ) in the development of the «atopic march» syntropy
was considered.

Urinary tract infections in pregnancy are common in obstetric practice. This urological pathology is recorded in about every third pregnant woman. There is no trend forward to decline the disease prevalence. Moreover, the number of pregnant women with kidney diseases has increased 4 times over the last 20 years. The best practice for diagnosis of urinary tract infections is urine culture test, which is considered to be the most reliable and accurate diagnostic. According to Order No. 572n by the Ministry of Public Health of the Russian Federation dated 01.11.2012, the procedure is carried out for all pregnant women started from 14 weeks of pregnancy. The necessity for early diagnostics and treatment of urinary tract infections in pregnancy is obvious, since there is a risk of the infection negative impact on a mother and a fetus, course of pregnancy, childbirth and postpartum period. Antibacterial therapy is a method of choice and should be administrated taking into account criteria of safety and tolerability (Food And Drug Administration criteria). Taking into account that antibiotics administration is often empiric, the constant dynamic monitoring of the structure of uropathogens and antimicrobial resistance having specific local features is required.

The present review aims to summarize the activities of vitamin D effects on the nervous system and to clarify a vitamin D role in brain diseases, in the pathogenesis or as a serum biomarker for the disease development and severity. Objective: correlation between chronic nervous system diseases and vitamin D level. Methods: a literature research in PubMed and in Russian electronic resources by keywords: vitamin D, brain diseases, chronic nervous system diseases. Results. Vitamin D as a neurosteroid hormone stimulates cerebral activity in both adult and embryonic brain regulates the activity of neural circuits which are responsible for locomotor, reward-dependent and emotional behavior. Patients with autism spectrum disorders, schizophrenia, Alzheimer disease, multiple sclerosis, Parkinson disease and sleep disorders have been shown to have low level of vitamin D. Discussion. Data are controversial, a further study of vitamin D hypovitaminosis significance is essential for the nervous system chronic diseases manifestation and evaluation of the vitamin D dietary supplement efficiency in patients with the nervous system pathology.

The study of immune mechanisms in inflammatory diseases of the male reproductive system, androgen deficiency and male infertility continues. The relationship of the content of a particular component of seminal plasma with the indicators of ejaculate fertility - concentration, mobility and morphological features of spermatozoa was revealed. A prominent representative of the group of proinflammatory cytokines is interleukin-6 (IL-6), whose main functions are activation of the immune response in the acute phase of the systemic inflammatory response, stimulation of the expression of adhesive molecules on endothelial cells and leukocyte chemotaxis, activation of T - and B - lymphocyte proliferation, and stimulation of the granulocyte growth of hematopoiesis. In the male reproductive system, IL-6 is produced by Sertoli cells; it is found in the tissues of the testicles, in the ejaculate. It was found that an increase in the level of IL-6 is observed in some pathological conditions of the male reproductive system. An increase in the concentration of IL-6 in the seminal plasma is associated with the development of inflammatory processes in the organs of the male sexual system - it may indicate acute and chronic prostatitis, non-specific urethritis, and chronic pelvic pain syndrome. The fact of active production of IL-6 in the ejaculate in patients with leukocytospermia was revealed. In the case of viscous sperm syndrome, the level of IL-6 in the ejaculate also increases, presumably due to a reaction to the occurrence of oxidative stress in the male reproductive system. There was a negative relationship between the level of IL-6 in the ejaculate and spermatogenesis indicators - the concentration of spermatozoa, the progressive mobility of spermatozoa in men from infertile couples.

Research Institute of Clinical and Experimental Lymphology has developed an innovative drug based on a complex of lithium citrate, polymethylsiloxane and aluminum oxide (LOAP). Lithium-based drugs are effective in treating bipolar disorders. However, the toxic effects of lithium cause a “narrow therapeutic window”, which limits its clinical use. The creation of the drug LOAP was aimed at creating a prolonged form with a slow release of lithium to reduce toxic properties and use lithium citrate as an active pharmacological agent. At the moment, the lithium complex has no analogues. The purpose of the study was to study the parameters of acute toxicity of the LOAP. Material and methods. When studying acute toxicity, drugs were administered once intragastrically to mice and rats at doses of 12000, 10000, and 5000 mg/kg. Results. A single administration of drugs intragastrically through a probe in the maximum possible doses to mice and rats did not cause the death of animals and did not cause a locally irritating effect on the gastric mucosa. LOAP can be assigned to hazard class 4 (GOST 12.1.007-76).

Aim of the study was to investigate the distribution features of HLA alleles and multilocus haplotypes in potential donors of hematopoietic stem cells recruting in the Sverdlovsk, Saratov, Yaroslavl and Vladimir regions. Material and methods. Sequence Based Typing technology was used to identify human leukocyte antigen (HLA)-A, -B, -C, -DRB1 alleles from 2683 Russian unrelated bone marrow volunteers living in the Sverdlovsk ( n = 1018), Saratov ( n = 825), Yaroslavl ( n = 604) and Vladimir ( n = 236) regions. HLA allele and haplotype frequencies were estimated via maximum-likelihood analysis from genotypic data through an expectation-maximization (EM) algorithm for unknown gametic phase. Results and discussion. In all studied populations, 16 HLA-A, 13 HLA-C, 13 HLA-DRB1 alleles were selected. In the locus HLA-B, 28 alleles were detected in the populations of the Sverdlovsk and Yaroslavl regions, 27alleles - in the Saratov region, 25 alleles - in the Vladimir. Seventeen alleles, HLA-A*02, HLA-A*03, HLA-A*01, HLA-A*24, HLA-B*07, HLA-B*35, HLA-С*07, HLA-С*06, HLA-С*04, HLA-С*03, HLA-С*12, HLA-DRB1*15, HLA-DRB1*07, HLA-DRB1*01, HLA-DRB1*13, HLA-DRB1*04, HLA-DRB1*11 exhibit frequencies over 10 %. The highest frequency extended haplotype in the all studied populations HLA-A*01-B*08-C*07-DRB1*03, was observed frequencies of 4,4 % - in the Sverdlovsk region, 3,2 % - in the Saratov region, 4,9 % - in the Yaroslavl region and 4,2 % - in the Vladimir region. Routine HLA typing allowed us to define four new HLA alleles in the populations of the Sverdlovsk and Saratov region.

Aim. To assess the aspects of interpretation of pre-transfusion tests in patients with hematological diseases. Material and Methods. We performed an analysis of the results of serological studies of ABО, Rh blood groups in blood samples of 857 patients with oncohematological diseases. ABO blood group determination and typing of D, C, c, E, e, К antigens were carried out using a gel agglutination test. Results. The decrease in strength of the agglutination of standard red blood cells by the patient’s anti-A and/or anti-B antibodies was observed in 112 patients (13.07% of the total number of patients). Abnormal agglutination strength in ABO and Rh antigens testing was observed in 17 patients (1.98% of the total number of patients), among them were 7 patients with acute myeloid leukemia (AML), 6 - with сhronic myeloid leukemia (CML), 2 - myelodysplastic syndrome (MDS), 2 - polycythemia vera (PV). Double populations of red blood cells were mainly detected in patients with MDS (45.61 %), aplastic anemia (AA) (27.27 %), primary myelofibrosis (PMF) (22.73 %), acute leukemia (AL) (22.2 %). In most cases double populations were associated with previous transfusions of blood products, meanwhile, three patients from this group (two patients with CML and one patient with PV) had never received blood transfusions before. Conclusion. Differences in anti-A and anti-B antibodies content were much more common in patients with lymphoproliferative disorders (LPDs) than in patients with myeloproliferative neoplasms (MPNs) (85.71% and 8.04%, respectively), while decrease of expression of red blood cell antigens was more typical for MPNs and did not occur in patients with LPDs.

Aim of the study was to investigate the content of matrix metalloproteinases 2, 3, 9, in the intraocular fluid of patients with a developed stage of primary open-angle glaucoma. Material and methods. The study included 47 patients with advanced stage of primary open-angle glaucoma. The diagnosis is based on ophthalmological examination, including visual acuity, binocular ophthalmoscopy, spheroperimetry, echoophthalmography, optical coherence tomography, intraocular pressure measurement. Exclusion criteria were acute and exacerbation of chronic inflammatory diseases of the organ of vision, diabetic retinopathy, neovascular glaucoma, uveitis, hemophthalmia, autoimmune and tumor processes of any localization, as well as acute and exacerbations of chronic inflammatory diseases of any organs and systems. Patients who took for normalization of intraocular pressure drugs containing analogues of prostaglandins, that could activate the inflammatory process, were excluded from the study. 26 patients with a diagnosis of uncomplicated cataract made up a comparison group. All patients underwent determination of matrix metalloproteinases (MMP) 2, 3, 9 in the intraocular fluid. Results. Concentration of MMP-2 but not MMP-3 or MMP-9 is statistically significantly higher in the intraocular fluid of patients with a developed stage of primary open-angle glaucoma compared to individuals with uncomplicated cataracts. This may indicate importance of MMP-2 in the development of a local aseptic inflammatory process, impaired extracellular matrix and «remodeling» of the tissue structures of the organ of vision, leading to disruption of the outflow of intraocular fluid, which is an important factor in the pathogenesis of primary open-angle glaucoma.

Fine needle aspiration cytology (FNAC) is documented to be a good tool in the diagnosis of thyroid lesions. It has good diagnostic accuracy and is an inexpensive investigation. Although a good instrument it does have its own limitations especially when it comes to distinguishing a follicular adenoma from follicular carcinoma thyroid. Objectives of the study was the evaluation of FNAC in the diagnosis of thyroid lesions by determining its sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value. Material and methods. This is a retrospective study of 580 cases of thyroid swelling admitted to our hospital and undergone thyroidectomy over a period of 5 years from 2015 to 2020. After thyroidectomy, FNAC reports (Bethesda system for reporting) of those patients were collected and were compared and analyzed with the histopathology reports. Category 1 and category 3 cases were excluded from calculation due to uncertainty in reporting. Data were analyzed to calculate the sensitivity, specificity, diagnostic accuracy, positive predictive value and negative predictive value of FNAC. Results. Our study included a total of 580 cases of thyroid swellings. The male to female ratio was 1:18.2 and the median age was 43 years. On FNAC, 428 cases (73.7 %) were benign, 35 cases (6 %) were indeterminate, 39 cases (6.7 %) were follicular neoplasm, 30 cases (5.1 %) were suspicious for malignancy and 34 (5.8 %) were malignant. 14 (2.4 %) cases were unsatisfactory. Cytology report was then compared with histopathological reports. FNAC had a sensitivity of 84.2 %, specificity of 97.2 % and a diagnostic accuracy of 94.5 %. The positive predictive value and negative predictive value were 88.3 and 96 % respectively. Conclusions. FNAC is a more specific than sensitive when distinguishing between benign and malignant lesions of thyroid. It has good diagnostic accuracy and hence should be used in all tertiary care hospitals prior to surgery in diagnosing thyroid lesions.

Aim of the study was to investigate the role of myocardial muscular «bridges» (MMB) in the pathogenesis of acute coronary syndrome (ACS). Material and methods. The study comprised of 27 patents with ACS: 21 (77,8 %) with diagnosed unstable angina pectoris (UA) and 6 (22,2 %) with acute anterior myocardial infarction with ST elevation (STEMI). Results. All patients with STEMI had positive qualitative troponin test. The serum level of creatine phosphokinase (CPK) was 857.7 ± 495.5 U/l, the CPK MB level was 46.5 ± 42.4 U/l. The patients’ age varied from 32 to 68 years (on average, 52.4 ± 4.6 years). Selective coronary angiography (CAG) revealed systolic functional obstruction of the LAD with vessel’s lumen recovery to the norm during diastole in all 27 patients, which is typical for MMB. In all cases with UA, the clinical aggravation was associated with ECG signs of transitory or permanent myocardial hypoxia in the territory supplied by the LAD, while the patients with STEMI had ECG, biochemical and EchoCG signs of myocardial damage and kinetics disturbances in the left ventricular areas supplied by the LAD. All patients underwent intravascular instrumental investigation. During in-hospital stage all patients received conservative therapy including β-adrenergic receptors or CA-channels blockers; ACE inhibitors; disaggregants. Upon 12 months all patients underwent repeated outpatient examination. In all cases, the conducted therapy resulted in the improvement of the patients’ condition. Conclusion. This study allows concluding that MMB play an essential role in the pathogenesis of ACS, including STEMI.

Background. Rheumatoid cachexia is a pathological condition which appears in patients with rheumatoid arthritis with low fat-free mass and normal or high body mass index. Bone mass loss is one of the components of rheumatoid cachexia. Fetuin-A, a major noncollagen protein of bone tissue, regulates bone remodeling. Aim of the study was to investigate the prevalence of rheumatoid cachexia and the association of serum fetuin-A level with body composition components in patients with rheumatoid arthritis. Material and methods. 110 patients (8 male and 102 female) with rheumatoid arthritis were enrolled in our study. Serum fetuin-A level was determined by ELISA. Dual-energy X-ray absorptiometry with Total Body program was performed. The diagnosis of rheumatoid cachexia was based on the next criteria: fat-free mass index less than 10th percentiles with fat mass index above 25th percentiles. Results and discussion. We observed rheumatoid cachexia in 25 patients (22,7 %). According to the literature, such patients have an increased risk of developing metabolic syndrome, arterial hypertension and mortality. Positive significant ( p < 0,05) correlations were observed between serum fetuin-A levels and right and left lower limb, trunk, gynoid region, both lower limbs and total body bone mass. No statistically significant relationships with other indicators were identified. Fetuin-A negative dynamic in patients with rheumatoid arthritis may be accompanied by the loss of bone mass, which requires the improvement of therapeutic approach. Conclusions. Almost a quarter of patients with rheumatoid arthritis have rheumatic cachexia. Positive correlation between serum fetuin-A levels and lower limbs, trunk, gynoid region and total body bone mass was observed.

Skin and soft-tissue infections (SSTI) take the lead in surgical disorders. Changes of local and systemic immunoreactivity highlight the SSTI and hinder treatment due to disease chronicity. The immunotropic therapy could be the useful tool in SSTI treatment. The aim of the study was to assess the dynamics of local changes and and duration of wound healing during the use of alpha-glutamyl-tryptophan (AGT/Thymogen) in the combination therapy of SSTI patients. Material and methods. A sample of 77 individuals aged 18-55 years with moderate SSTI of different localization and with signs of infectious intoxication participated in the randomized, double-blind, parallel group, placebo-controlled clinical trial. The patients were divided into the main (39 people) and control (38 people) groups. The combination therapy of the main group included 100 μg of AGT by intramuscular injection daily during 7 days, whereas the control group received placebo (0,9 % sodium chloride) along the same schedule. Results and discussion. The combination therapy of SSTI patients with AGT significantly decreased the local inflammation, i.e. pain intensity, hyperemia, edema ( p = 0,022), infiltration within damage area ( p = 0,03). Besides, AGT treatment leads to statistically and clinically significant reduction in the duration of septic wound healing by an average of 2 days as compared to control group. Thus, statistically, and clinically significant superiority of efficacy of alpha-glutamyl-tryptophan in comparison with placebo in reducing the time of healing of purulent wounds of patients with SSTI has been established.

Objective was to determine the presence and the main manifestations of professional burnout syndrome among intensive care doctors and nurses from the department of anesthesiology and intensive care. Material and methods. Resuscitators and secondary medical staff were asked to pass a questionnaire, which included a survey by V.V. Boyko «Emotional burnout», a test by C. Spielberger in the modification Y.A. Hanin, the technique of Munsterberg. Results and discussion. Professional burnout syndrome is typical for 55 % of resuscitators and 35 % of mid-level medical staff of the department of anaesthesiology and intensive care of the pediatric University clinic. As for the respondents of the first group, the presence of the «resistance» phase is characteristic, while the second group has the «resistance» and «exhaustion» phases. According to the Spielberger scale, both groups have a middle degree of situational and personal anxiety. The Munsterberg method found that selectiveness and concentration of attention before and after the daily shift is more decreased in resuscitators. Conclusion. High rates of susceptibility of specialists of the department of anaesthesiology and intensive care to the formation of professional burnout syndrome, which affects their psychological health, were established. It is necessary to develop appropriate measures to prevent this occurrence.

The aim is to study the prevalence of gastroesophageal reflux disease (GERD), gastroduodenal erosions and ulcers and their association with a family predisposition for ulcer disease in Siberian schoolchildren. Material and methods. We have examined schoolchildren aged 7-17 years in three regions of Siberia (Republic of Tyva, Evenkia and Buryatia) in localities identical to their socio-economic level. Data collected using a cross-sectional method using standardized questionnaires on the presence of gastroenterological complaints and information about ulcer disease of relatives in the 1st and 2nd generations in 1535 schoolchildren in Tuva, 790 in Buryatia and 1369 in Evenkia. Diagnosis of GERD was based on the presence of complaints of heartburn, in accordance with international consensus in the pediatric population. We performed gastroscopy randomly method in each region at schoolchildren with gastrointestinal complaints (283 children in Tyva, 110 in Buryatia, 205 in Evenkia). Results. There was an increase in the GERD frequency among Siberian children with anamnesis data on the presence of peptic ulcer in relatives (9.9 and 5.9 %, respectively, p = 0.0025). The most unfavorable situation has been observed in the population of schoolchildren of the Republic of Tuva (10.6 % with a burdened history and 9.3 % without it, p = 0.5389). We have not revealed the significant increase of gastroduodenal erosions and ulcers in children with a poor family history of peptic ulcer disease (12.6 and 10.4 %, respectively, p = 0.5263), including Tuva schoolchildren where they were more often detected. The GERD association with erosive ulcerative process in the mucous membrane of the stomach and duodenum was ambiguous and had population (regional) features in schoolchildren with a burdened family history of peptic ulcer disease. Conclusion. Siberian schoolchildren with a family predisposition to peptic ulcer disease have certain regional features in the association of gastroduodenal erosions and ulcers with GERD.

Purpose of research. To study the dynamics of the death rate of the population of the Siberian Federal District (SFD) as a result of accidental acute alcohol poisoning for the period from 2009 to 2018, as well as a comparative analysis of the death rates of the population of the SFD regions with general district indicators. Materials and methods. The analysis of mortality of the population of the Russian Federation, Siberian Federal District and regions of the Siberian Federal district (Altai Republic, Tuva, Khakassia, Altai, Krasnoyarsk, Irkutsk, Kemerovo, Novosibirsk, Omsk, Tomsk region) as a result of accidental alcohol poisoning, the comparison of regional indicators with county mortality rates have been carried out. Traditional methods of calculating extensive and intensive indicators, the average error of the indicator, and evaluating the reliability of differences have been used in statistical processing of the material. Results and discussion. The death rate of the SFD population as a result of accidental alcohol poisoning has decreased by 2.0 times for the period from 2009 to 2018. The decrease in population mortality due to accidental alcohol poisoning has been revealed in all regions of the Siberian Federal District, with the exception of the Tomsk region, where the three-fold increase in death rate has been registered. The most rapid decrease in the death rate due to accidental alcohol poisoning occurred in the Krasnoyarsk territory (4.4 times) and the Republic of Altai (3.5 times) in the period from 2009 to 2018. The study of the dynamics of population mortality in the regions of the Siberian Federal District as a result of accidental alcohol poisoning allows us to identify the features of the toxicological situation at the regional level and determine strategic directions for regional chemical safety in the future.