ISSN (print): 0136-1449, ISSN (online): 2687-1408 Founder: Perm State Medical University named after. ak. E.A. Wagner Editor-in-Chief: Eugene G. Furman, Corresponding Member of the Russian Academy of Sciences, MD, PhD, professor, Frequency / Access: 6 issues per year / Open Included in: Higher Attestation Commission List, RISC
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READ the details online (tap to see in details) Author’s license agreement (public offer) on the publication of an article in a scholarly journal “Perm Medical Journal” Eco-Vector, represented by its CEO Evgeniy Schepin and acting on the basis of the Charter (hereinafter referred to as the Publisher), on the one hand, offers an indefinite circle of persons (hereinafter referred to as the Author), and on the other hand, hereinafter jointly referred to as the Parties, to execute this agreement (hereinafter referred to as the Agreement) on the publication of scientific article (hereinafter referred to as the Article) in a scholarly journal “Perm Medical Journal” (further-the Journal) in accordance with the conditions stated below. I. 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Potential application of continuous pulse oximetry in cardiac rehabilitation programs: scientific review
Real-time monitoring of patients' vital signs and feedback in virtual rehabilitation can be achieved through the use of remote technologies. Wearable sensors during training allow monitoring of heart rate, electrocardiography, and blood pressure. Oxygen saturation indicators are measured less frequently, although they may have greater diagnostic value. The search was conducted in PubMed, Scopus, Web of Science, PEDro, and Google Scholar databases. As of January, 62 sources, including Cochrane and systematic reviews, had been selected. Blood oxygen saturation can only be measured using a pulse oximeter, which operates on the Bouguer-Lambert-Beer law and emits two wavelengths; the measurement can be carried out by transmission and reflective methods. In medically certified devices, the data are transmitted to the technological system and evaluated by trained medical personnel. Bracelets and rings have shown the greatest convenience and reliability for fixing pulse oximeter. Continuous monitoring of oxygen saturation during stress tests and physical training ensures their safety and allows the load adjustment. When connected to a telemedicine platform, the system should ensure direct interaction between the doctor and the patient with monitoring of vital parameters. When conducting cardiac rehabilitation, a reliable certified medical device able to provide a continuous monitoring is required. Monitoring of vital parameters is carried out using a device with the necessary sensors, a patient feedback system and a telemedicine platform accessible to medical personnel for storing and analyzing the obtained data.
Phenotypes of non-alcoholic fatty liver disease in people with normal and increased body mass: issues of epidemiology and etiology, clinical and pathogenetic features and diagnostic approaches. Literature review
Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver disease worldwide, affecting 20-40% of the population, and its prevalence continues to steadily increase. However, some individuals with overweight and obesity maintain normal intrahepatic fat content, while others with normal weight develop NAFLD even in the absence of metabolic risk factors. Therefore, recent terminology has introduced a distinct NAFLD phenotype in individuals with normal body weight, the pathophysiology and clinical manifestations of which remain insufficiently studied. This review summarizes literature and original data on the prevalence of NAFLD phenotypes in individuals with normal and increased body weight, risk factors, clinical and pathogenetic features, and diagnostic approaches. There is a need to develop screening algorithms that are less dependent on BMI and liver transaminase levels, to implement more accurate treatment strategies based on the pathogenesis of the disease, and to include individuals with normal body weight in NAFLD-related clinical trials to identify factors modulating the risk of liver steatosis, including in the absence of clinically significant metabolic dysfunction.
Application of artificial intelligence in mathematical modeling of coronary blood flow
Cardiovascular diseases (CVD) are the leading cause of death and disability worldwide. In 2021 alone, there were more than 20 million deaths attributed to CVD, accounting for about a third of all deaths worldwide. An important factor influencing the mortality rate from cardiovascular diseases is the diagnostic and therapeutic strategies used to treat coronary heart disease. Investments in this area over the past 25 years have led to a reduction in the death rate from cardiovascular diseases in countries with a high socio-demographic index. Accurate diagnosis is the first step to choosing the appropriate treatment method. The objective of the research is to study the literature data on the possibility of using artificial intelligence and mathematical modeling of medical research, in particular coronary angiography, for the analysis and development of computer programs for modeling cardiovascular and endovascular surgical interventions. The search for Russian and foreign literature in Yandex and Google search engines, medical research websites PUB.MED was conducted using keywords: coronary angiography and artificial intelligence, mathematical modeling, fractional blood flow reserve, 3D modeling, coronary artery disease, percutaneous coronary intervention. The practical application of AI to create mathematical models will allow reconstructing 3D pictures of coronary arteries, modeling blood flow, which significantly optimizes the treatment of coronary artery disease. This will make it possible to effectively plan endovascular interventions based on the patient's data in the absence of the patient himself. Further study of this issue promises great prospects for the development of mathematical modeling of coronary blood flow, making effective decisions during interventional procedures, which will reduce the incidence and mortality from cardiovascular diseases.
Analysis of the causes of lethal outcome in patients infected with human immunodeficiency virus
Over 37 million HIV-infected people live in the world and many of them die due to the progression and decompensation of somatic diseases. The aim of the study is to determine the rating of fatal outcomes causes of HIV-infected patients according to the data of the authors from different countries of the world. Data from 287 full-text articles were analyzed, from which 32 sources most relevant to the purpose of the study were selected. The leading causes of death in HIV-infected patients were infectious complications and opportunistic infections characteristic of the AIDS stage, along with concomitant tuberculosis infection (55.1 %). Cardiovascular diseases ranked second (20.6 %), followed by cancer (14.6 %), liver diseases, including alcoholic and viral hepatitis and cirrhosis (8.5 %), and only 1.1% are accounted for by all other diseases. Mortality from infective endocarditis, myocardial infarction, sudden cardiac death, acute cerebrovascular event, pulmonary embolism and acute decompensation of chronic heart failure together account for 82.5 % of all cardiovascular causes of mortality. Monitoring of patients with HIV infection should be comprehensive, involving infectious disease specialists, therapeutic and cardiology services, with increased cancer vigilance. The challenges of HIV infection concerning early development of cardiovascular pathology and elevated mortality from cardiovascular diseases should not be ignored.
The role of nutrition in the formation of hearing disorders: literature review
The article briefly highlights the main pathogenetic aspects of the indirect effect of macro– and micronutrients on the functional state of the hearing organ. It has been shown that the nature of nutrition can have a dual effect on hearing loss (HL). Thus, foods with a high glycemic index and elevated cholesterol, trans fats, and polyunsaturated fatty acids levels statistically significantly correlated with a higher risk of developing age-related and/or occupational HL. While balanced diets which include plant-derived fiber (whole grain products, legumes, vegetables, fruits, mushrooms, etc.) and natural omega-3 polyunsaturated fatty acids (fatty fish, seafood), as well as intake of antioxidant vitamins (A, E, C) and a number of B vitamins (folic acid, cobalamin) in their deficiency or insufficiency, increase hearing acuity and statistically significantly reduce the risk of hearing impairment due to presbycusis, exposure to noise or ototoxic agents. The analysis of contemporary scientific literature indicates the significant potential of a healthy diet in the prevention and possible restoration of cochlear dysfunction when no irreversible changes are present. The latter requires additional large-scale longitudinal studies and an in-depth study of the relationship of HL with nutrient intake and dose-dependent effects of vitamins for the scientific justification of therapeutic and preventive dietary programs.
Prevalence of learning skills development disorders among primary schoolchildren in the city of perm
Objective. To study the prevalence of writing and reading skills disorders in children of the 2nd–3rd grades in comprehensive schools of Perm. Materials and methods. A continuous survey method of 160 parents was used in two schools – a comprehensive school and a school with advanced study of German. A screening test for dyslexia (Colorado Learning Disabilities Questionnaire – Reading Subscale: CLDQ-R) and a questionnaire for checking writing/hand­writing skills (Handwriting Proficiency Screening Questionnaire: HPSQ) were used. To study the features of visual perception and scotopic sensitivity syndrome (Scotopic Sensitiviti Syndrome – SSS), the Ian Jordan questionnaire modified by E. Kiseleva was used. Results. The results of the screening tests revealed a slow reading rate and numerous various errors in writing, which were combined with impaired graphomotor skills, difficulties in copying text from a standard, frequent corrections and cross outs in the text. Some children still had pronunciation problems and difficulties with naming letters, which indicated challenges with phoneme-to-grapheme conversion, and a disorder of sound-letter correspondence. The identified features necessitated additional assistance in the learning process for 10 % of schoolchildren in grades 2–3 of comprehensive schools in Perm, including the school with advanced study of German. In 3.8 % of children with deviant variants of educational skills development, features of visual perception were revealed. Conclusions. Perm schoolchildren demonstrated a high prevalence of writing (15.6 %), reading (7.5–9.0 %) and handwriting (9.4–10.6 %) development disorders.
Assessment of dental care level in pediatric palliative care unit
Objective. To determine the level of dental care provision based on the analysis of dental hard tissue condition in children with severe somatic diseases. Materials and methods. An analysis of the oral cavity condition was conducted in the palliative care department among 48 children aged from 1 month to 18 years. Results. The assessment of the dental status revealed an insufficient level of therapeutic measures aimed at reducing the activity of the carious process. Conclusions. The level of dental care for children in need of palliative care is low. Therefore, it is necessary to modernize the existing staffing standards for the care of this category of patients in order to improve their quality of life.
Colostomy for acute tumoral large intestine obstruction in an on-call surgical hospital: clinical recommendations and real-world clinical practice
Objective. To analyze the immediate and long-term results of colostomy in patients with acute tumor intestinal obstruction. Materials and methods. The study includes the results of examination and treatment of 552 patients with the diagnosis of acute malignant intestinal obstruction and tumor localization in the descending colon and sigmoid colon, who were hospitalized in on-duty surgical wards in the Samara region from 2015 to 2020. The study is of a non–randomized multicenter retrospective continuous sequential controlled type. Two groups of patients were identified from the general group of patients with colostomy. Upon discharge, the patient was referred for further examination and treatment to a regional oncology center. Results. It is necessary to change the principles of the organization of oncological care in terms of reducing the time of preoperative examination, timely diagnostic evaluation at the initial visit to the oncology center. On the other hand, a possible solution to this problem may be primary resection based on the oncological principle with a single-barrel colostomy formation in an urgent surgical hospital. This will allow the patient to get a time reserve and reduce the frequency of complications related to the intestinal stoma even in case of a delay in admission to the oncological center. Conclusions. Decompressive proximal colostomy remains the leading intervention aimed at resolving intestinal obstruction in patients with tumors of the descending colon and sigmoid colon, even in the patient's operability. The delay in hospitalization for a specialized stage of oncological care is associated with both medical and organizational aspects, and social and domestic factors of a non-medical nature, and affects the subsequent outcome of a radical surgery.
Comparative analysis of survival rates in patients with renal cell carcinoma and level i-ii tumor thrombus of the renal vein and inferior vena cava undergoing open versus laparoscopic surgical treatment
Objective. To compare recurrence-free survival and long-term oncological outcomes in patients with Renal Cell Carcinoma (RCC) and level I–II tumor thrombus of the renal vein and inferior vena cava undergoing laparoscopic versus open nephrectomy with thrombectomy. Materials and Methods. 100 patients with histologically confirmed RCC and level I–II tumor thrombus of the renal vein and inferior vena cava (according to Mayo classification) treated at the A.M. Granov Russian Research Center for Radiology and Surgical Technologies from 2007 to 2024 were included into this retrospective study. Fifty patients underwent open surgery and in fifty patients laparoscopic procedures were performed, with stratification based on clinical and morphological parameters. Progression-free survival served as the primary endpoint. Kaplan – Meier analysis and Cox proportional hazards regression were used to assess prognostic factors. Results. Mean progression-free survival was 58.9±4 months in the open surgery group versus 59.1 ± 4 months in the laparoscopic group; the differences were not statistically significant (c2=0.2916; p=0.5892; HR=0.84; 95% CI: 0.43–1.61). Lymph node metastasis (N1) was associated with significantly worse survival (HR=24.80; p<0.0001). Advanced thrombus (level II) was an independent negative prognostic factor (HR=7.79; p<0.0001). Conclusions. Laparoscopic nephrectomy with thrombectomy for RCC patients with level 0-II venous tumor thrombus demonstrated oncological outcomes comparabl to open surgery and may be considered an acceptable alternative when adhering to oncological principles. Lymph node involvement and thrombus extent remain key prognostic factors affecting recurrence-free survival.
Laboratory markers for predicting critical obstetric conditions
Objective. To identify early laboratory markers of the risk for developing critical obstetric conditions (COC). Materials and methods. As a retrospective analysis, the medical and birth histories of both favorable and adverse obstetric outcomes that occurred in medical organizations of all levels in Perm and the Perm Region in 2007–2018 were used. The comparative analysis included clinical and laboratory characteristics of the examination results and the course of pregnancy, delivery and the postpartum period. The risk of COC was assessed using the Kruskal – Wallis test. The relationship between quantitative variables was determined using the linear correlation coefficient (r). The data were analyzed in the Excel® 2016 spreadsheet processor using the author's [1] Stat2015 package. The LII was assessed (in conventional units – c. u.), according to the Ya.Ya. Kalf-Kalif formula [2] at different stages of pregnancy and in the postpartum period, which allowed us to determine the dynamics of changes depending on the risk group and gestation period. Results. Early laboratory markers of COC were established (iron deficiency anemia, high levels of LII, elevated levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST), urea and creatinine, decreased fibrinogen, prothrombin index (PI) and prolonged thrombin time (TT)). Conclusions. Reliably significant laboratory markers of the risk for developing COC have been identified.
Clinical and epidemiologic aspects of differential diagnostics of neoplastic, inflammatory and parasitic diseases localized in the maxillofacial region
Objective. To study clinical and epidemiological features and develop an algorithm for differential diagnostics of neoplastic, inflammatory and parasitic maxillofacial diseases (exemplified by dirofilariasis). Materials and methods. Retro- and prospective analysis of case histories of patients undergoing treatment for dirofilariasis in the Clinical Dental Hospital of Ye. A. Vagner PSMU since 2013. Results. 35 cases of dirofilariasis were recorded in Perm Krai between 2013 and 2024, with 10 of them involving the soft tissues of the upper and middle facial thirds. These patients were hospitalized in the CDH of PSMU. Among the observed cases, the initial diagnosis correlated to the clinical one in only 50% of patients, in other cases it was established after surgical intervention. The criteria for differential diagnosis of dirofilariasis forms with neoplastic and inflammatory diseases were formulated in the course of the comparative analysis. Conclusions. Dirofilariasis remains a rare and insufficiently studied pathology, including in the Perm region. In this regard, when patients complain of the development of tumor-like formations in the maxillofacial region, it is important to take the medical history thoroughly, focusing on the migration, sensations of moving and itching while moving. Take into account the seasonality, the presence of mosquitoes in the patient`s area of residence, pets, especially dogs. The need for multicenter research, which will raise the specialists` awareness in general and optimize the quality of medical care for patients with helminth infections, is obvious.
Gastric barium sulfate bezoar: clinical observation
A clinical case of a patient with a foreign body of the stomach (barium sulfate bezoar) is presented. The research was based on the medical history data of a patient from the First Republican Clinical Hospital of the Ministry of Health of Udmurt Republic in Izhevsk. The method of Fourier-transform infrared (FTIR) spectroscopy was used to study the composition of a gastric foreign body using the FSM 2201 apparatus. A possible etiopathogenesis of a barium sulfate bezoar has been proposed. The molecular composition of a sample of a foreign body (barium sulfate bezoar) of the stomach was studied. A rare complication, i.e. the formation of a barium sulfate bezoar of the stomach during a barium transit study (Schwartz test) against the background of paralytic intestinal obstruction in a patient with infected pancreatic necrosis is described.
A case of recurrent course of acute obstructive laryngitis with severe relapses in a 6-month-old baby
A clinical case of severe acute obstructive laryngitis (AOL) with a recurrent course in a 6-month-old baby is presented. The main factors influencing the severity of the first episode were the age-inappropriate dosage and the route of a glucocorticosteroid administration at the pre-hospital stage, as well as the untimely hospitalization. The recurrent course was due to the peculiarities of a premorbid background and a concomitant pathology, that is an anatomical formation in the subglottic space, the removal of which prevented further recurrences. This clinical case demonstrates the importance of adherence to current protocols of AOL treatment regarding the dosage and routes of administration of drugs used to manage urgent symptoms of young children. Due to the rare incidence of severe acute obstructive laryngitis, it is necessary to keep pediatricians informed about the main factors that may alter the course of the pathological process towards increased disease severity or recurrence.
“Her profession is her life”: on the 85th birthday of doctor of medical sciences, professor Faina Ilyinichna Kislykh
The article is dedicated to the outstanding scientist, surgeon and teacher Faina Ilyinichna Kislykh, who made a significant contribution to the development of dental and maxillofacial surgery. Born into a large working-class family, Faina Ilyinichna overcame a challenging life path, graduating with honors from a medical college and entering the Faculty of Dentistry at Perm Medical University. After defending her PhD and doctoral theses, she became the head of the Department of Dental Surgery and Maxillofacial Surgery and the Dean of the Faculty of Dentistry. She trained dozens of students and introduced an innovative carbon composite material (Uglekon-M) into medical practice. The author has an extensive scientific heritage, more than three hundred publications, monographs and patents. Her professionalism and selfless work were highly appreciated by the government and colleagues.