Vol 93, No 6 (2012)
- Year: 2012
- Articles: 44
- URL: https://journal-vniispk.ru/kazanmedj/issue/view/122
50 years in search of the «longevity» gene
Abstract
In many countries of the world mean life expectancy has lately significantly increased from 50 to 70-80 years. Twin studies have shown that genetic differences account for about 25% of the variance in adult human lifespan. However, the association with the life expectancy was proven for the only candidate gene - apolipoprotein gene, playing a great role in regulating lipoproteins metabolism. E2 allele of this gene is much more prevalent compared to E4 allele in people over 100. In animal models, single-gene mutations in genes involved in insulin/insulin-like growth factor-1 abnormal activation pathway and target of rapamycin signaling pathway have considerably extended the lifespan. The key link in regulating the insulin/insulin-like growth factor-1 abnormal activation pathway is the human forkhead box O3A transcription factor. A clear rel ationship between the lifespan and GG genotype of this gene in Japanese, German and French population was found. However, although candidate longevity genes are defined, their effects on the lifespan are still to be confirmed. Questions of gene products’ mutual influence and gene penetration are still undecided. Ethnical and geographical associations of different polymorphic alleles with aging and longevity are not completely clear. Therefore, further search and genetic and phenogenetic markers examination determining the lifespan is needed. Na+-Li+-сountertransport speed in the erythrocyte membrane, which is a genetically determined intermediate phenotype, may be one of those markers.
Kazan medical journal. 2012;93(6):849-854
849-854
Theoretical and clinical medicine
Comparative analysis of echocardiography, multispiral computed tomography, myocardial perfusion scintigraphy in left ventricular mass evaluation
Abstract
Aim. To perform a comparative analysis of multispiral computed tomography, echocardiography and myocardial perfusion scintigraphy in the evaluation of left ventricular mass. Methods. The study included 44 patients (15 female, 29 male) aged of 21 to 73 years (mean age was 55±11 years). Left ventricular mass was assessed by noninvasive multispiral computed tomography coronary angiography using the 64-slice «Aquillon 64» (Toshiba, Japan) scanner. Echocardiographic evaluation was performed on the «Vivid-7» (GE, USA) ultrasound system. Scintigraphic analysis of left ventricular mass was performed on the single-detector gamma camera «Millenium-MPR» (GE, USA) using the «4-D MSPECT» (University of Michigan Medical Center) software. Results. A comparative analysis of left ventricular mass showed that the differences in median values were statistically significant between all the methods presented. The differences in left ventricular mass calculated using the Bland-Altman method were as follows: between multispiral computed tomography and echocardiography -32±41 gr, between multispiral computed tomography and myocardial perfusion scintigraphy «4-D MSPECT» 34±48 gr. Conclusion. Multispiral computed tomography, echocardiography, myocardial perfusion scintigraphy assess left ventricular mass differently, with myocardial perfusion scintigraphy giving the lowest and echocardiography giving the highest mass. Results gained at multispiral computed tomography lies in between the myocardial perfusion scintigraphy and echocardiography.
Kazan medical journal. 2012;93(6):855-858
855-858
Under-24-hour mortality from acute coronary syndrome in emegrency hospital
Abstract
Aim. To identify the factors influencing the strategy and tactics of treating patients with acute coronary syndrome; to define the impact of various stages of emergency care in total rate of under-24-hour in-patients mortality. Methods. The retrospective analysis of the in-patients medical charts, ambulance accompanying sheets and autopsy protocols of 303 patients who died during the first 24 hours after admission to the department of cardiology at Municipal Emergency Hospital №1, Kazan from January 1st, 2009 to December 31th, 2011. Results. The level of under-24-hour in-patients mortality in the emergency hospital remains considerably high without a tendency to fall. In economically active group of population male to female mortality ratio exceeds 1,8. Most patients are being brought to the hospital by ambulance crews which are not enough qualified and equipped to care for patients in a critical condition. Only 48.3% of admitted patients get medical aid before admission, although the share of patients admitted in a poor, critical or agonal condition is 89.8%. Conclusion. Decreasing under-24-hour mortality is a multidimensional and multifactorial problem, which demands a complex approach in all stages of providing medical care to be solved.
Kazan medical journal. 2012;93(6):859-864
859-864
Prediction of community-acquired pneumonia complications in military men
Abstract
Aim. To develop diagnostic algorithm to predict the risk of community-acquired pneumonia development. Methods. 2000 patients with community-acquired pneumonia (male conscripts aged 18 to 22 years, mean age 19.2±0.19). A comparative analysis of two groups of patients to assess the algorithm for toxic shock syndrome, acute respiratory failure and acute kidney injury prediction was performed. In the comparison group (n=782, 1998 to 2003), prediction of complications was based on doctors’ personal knowledge and experience without using the prediction algorithms. In the main group (n=1218, 2003 to 2008), the established prediction algorithm was used. Results. The introduction of community-acquired pneumonia complications prediction algorithm allowed to decrease the incidence of such complications significantly. Toxic shock syndrome was diagnosed in 8.8% of patients in the comparison group and in 3.7% of patients of the main group (р <0.05), acute respiratory failure - in 43.1% of patients of the comparison group and in 19.5% of patients of the main group (р <0.05). The effectiveness of the algorithm for toxic shock syndrome prognosis was 90.8%, sensitivity - 91.8%, specificity - 89.7%, accuracy - 94.5%. The effectiveness of the algorithm for acute kidney injury prognosis was 90.7%, sensitivity - 90.7%, specificity - 90.8%, accuracy - 95.1%. Conclusion. Offered prediction algorithms can help a physician to suspect a possibility of potentially dangerous and lethal complications development in patients with community-acquired pneumonia at the early stages of the disease. It allows to adjust the treatment, to simplify the estimate for transportation need, to detect the indications for patients admission, including the admission to intensive care unit, and improve the results of treatment.
Kazan medical journal. 2012;93(6):864-870
864-870
Influence of dynamic and static physical activity features on respiratory system of junior schoolgirls
Abstract
Aim. To study the influence of different types of physical exercise on components of gases convective transport in junior schoolgirls. Methods. Twenty two 9 year old schoolgirls were included. The functional condition of respiratory system was estimated based on pulmonary function tests and respiratory volumes. Isometric physical exercise test was performed by the left hand compression of a dynamometer with the effort equal of 50% from maximum possible effort within 1 minute. Dynamic physical load was dosed as 1,0 W per 1 kg of body weight while pedalling a stationary exercise bicycle ergometer. Statistical difference between groups was determined using Student’s t-statistics. Results. Influence of dynamic and static physical exercise on respiratory function tests in 9 year old schoolgirls was studied at the beginning, in the middle and at the end of the school year. The comparative analysis of respiratory function tests in 9 year old schoolgirls at the beginning of academic year showed that isometric physical exercise caused the breath rate increase, and dynamic physical exercise led to decrease of this parameter. At the same time both types of physical exercise caused decrease in expiratory time to total breath cycle time ratio. In the middle of the academic year isometric physical exercise caused the breath rate decrease and maximum voluntary ventilation increase. As a whole, both in the middle and at the end of the academic year the respiratory system of 9 year old schoolgirls reacted adequately in reply to different types of physical exercise to optimize the performance. Conclusion. The most unfavorable reaction of respiratory system in 9 year old schoolgirls in reply to static and dynamic physical exercise at the beginning of the academic year was registered as a decrease of expiratory time to total breath cycle time ratio. The optimal reaction of respiratory system in 9 year old schoolgirls in reply to dynamic physical exercise was registered both in the middle and at the end of the school year, to static physical exercise - at the end of the school year.
Kazan medical journal. 2012;93(6):870-874
870-874
The modern way to prevent complications in laparoscopic antireflux surgery
Abstract
Aim. To improve the results of surgery on patients with hiatus hernia. Methods. Case histories of patients who underwent surgeries at the department of gastric and esophageal surgery from 1996 to 2011 were analyzed. 626 laparoscopic fundoplications in patients aged form 15 to 78 years were performed, among them - 57 using transillumination with fiber optic sensor tube. All patients were present with signs typical for hiatus hernia and gastroesophageal reflux disease (heartburn, belching, early satiety, epigastric discomfort etc.). Pre-surgical examination included X-ray and esophagogastroduodenoscopy. Most patients underwent Nissen fundoplication. The surgery duration varied from 30 to 180 minutes (mean time 65 minutes). Results. Surgical complications such as hollow organs perforation were registered in 4,3% of cases (27 cases out of 626 surgeries). No such complications were registered in group where surgery was performed using transillumination with fiber optic sensor tube. In 12 cases laparotomy for perforation closure was required, in other 15 cases perforation was closed using laparoscopy. No serious events were registered in early post-surgical period, with all patients discharged from the hospital at days 5-7. Such complications as dysphagia and gas-bloat syndrome were predominant in early post-surgical period after laparoscopic fundoplication. The incidence of the early post-surgical complications in patients who underwent surgery without transillumination with fiber optic sensor tube was: dysphagia - 28,8% (164 out of 569 patients), gas-bloat syndrome - 23,7% (135 patients). In cases when transillumination with fiber optic sensor tube was used, dysphagia was diagnosed in 1 case (1,8%), gas-bloat syndrome - in 9 (15,8%) cases. The incidence of late post-surgical complications including dysphagia, relapses and situations when fundoplication becomes undone over time: without transillumination with fiber optic sensor tube - 10,2% (58 out of 569 patients), using transillumination with fiber optic sensor tube - 3,5% (2 out of 57 patients). Conclusion. Preliminary results show that using transillumination with fiber optic sensor tube in laparoscopic fundoplication in patients with hiatus hernia reduces the incidence of post-surgical complications.
Kazan medical journal. 2012;93(6):875-879
875-879
The experience of polyradiomodification with the use of ozone-oxygen mixture in complex treatment of the squamous cell cervical cancer
Abstract
Aim. To improve the results of complex treatment of stage IIb squamous cell cervical cancer. Methods. 53 patients with stage IIb squamous cell cervical cancer were included. All patients underwent combined radiotherapy (teletherapy plus brachytherapy) and were treated with intravenous cisplatin followed by hysterectomy by Wertheim. As a pre-surgical treatment 31 patients (main group) underwent rectal insufflations of ozone-oxygen mixture as a radio modifier. The original method and machine pulse oxymetry of the tumor tissue oxygenation were used. 22 (41.5%) who were included in the control group underwent combined chemoradiotherapy without use of ozone-oxygen mixture. A comparative analysis of tumor tissue post-treatment pathomorphism, chemoradiotherapy side effects rate and post-surgical complications rate was performed in both of the groups. Results. All complications were transient and could be easily managed symptomatically. Hence, there was a tendency of side effects rate and complications rate decrease in the main group. Cystitis as a complication of radiotherapy was observed in 1 (3%) patient of the main group and in 2 (9%) of the control group, proctitis - in 5 (16%) patients of the main group and in 4 (18%) patients of the control group. Leukocytopenia (I-II degree) as the most frequent hematological chemotherapy complication was registered in 7 (22%) patients of the main group and in 17 (72.2%) patients of the control group. Flu-like syndrome was observed in 1 (3%) patient of the main group and in 2 (9%) patients of the control group. There were no grade III and IV toxicity events. Proposed pre-surgical chemoradiotherapy of the localized stage IIb cervical cancer with an ozone-oxygen mixture as a radio modifier was characterized by high (grade IV) tumor tissue post-treatment pathomorphism level reaching 44.8%. Conclusion. The use of rectal insufflations of ozone-oxygen mixture allowed to decrease the rate of chemotherapy and radiotherapy complications, but the difference was not statistically significant. To increase the power of the study, more subjects are needed to be recruited with a longer follow-up.
Kazan medical journal. 2012;93(6):879-883
879-883
Role of selenium in development of tumors
Abstract
Aim. To investigate the possible relationship between content of selenium in environmental objects (soil and foods) and prevalence of tumors in the Republic of Azerbaijan. Methods. Atomic absorption spectroscopy was used for quantitative determination of selenium in soil of some economical regions of the country and in foods of every day’s local diet that are the natural nutritional sources of selenium. Serum selenium level in patients with tumors was assessed using X-ray fluorescence spectroscopy. Results. Soil and food analysis revealed low contents of selenium in them. Difference in selenium concentrations in soils from studied economic regions and in food products farmed in these regions was discovered. The serum selenium level of patients with malignancies was 37.3 μg/l (38.6 μg/l - females, 34.3 μg/l - males). There was a reverse relationship found between selenium concentrations in soils and food of the region and prevalence of tumors, as well as with serum selenium level in patients with tumors and tumor stage and malignant potential. Conclusion. The territory of Azerbaijan Republic may be considered as the region with selenium deficiency. Our research supposes that selenium deficiency can be associated with increased prevalence of malignancies in the region.
Kazan medical journal. 2012;93(6):883-887
883-887
Atomic-force microscopy in studyng hard tissues of orofacial area
Abstract
Aim. To study the use of atomic-force microscopy for morphological diagnosis of a bone tissue and hard tooth tissue pathology. Methods. Dental occlusion, enamel crowns and bony tooth sockets shape and size, as well as embrasures’ size and their depth, and crown height were estimated by the means of atomic-force microscopy. 30 teeth and bony fragments removed due to blunt maxillofacial trauma with signs of connective tissue hypermobility and 27 removed teeth and bony fragments from the control group were analyzed. Results. Abnormal collagen structure in hypermobility syndrome was associated with the increase of inter-fiber space to 98 nm and decrease of mineral matrix content in the bone. Enamel crowns shape and size alterations [(5.5±0.3)×(5.4±0.1) μm] as well as inter-crown space increase to 1.5±0.1 μm were found out. At the bone tissue analysis, the main distinctive feature between the control group and the patients with hypermobility syndrome was the presence of cystic lesions in the hypermobility syndrome group, accompanied by change of bone mineral structures disposition, trabeculae formation and changes of bone mineral density. In patients with hypermobility syndrome low mineralization of hydroxyapatite crystal structure, changes in spatial crystal structure as well as organic matrix disposition, all leading to enamel structure malformation due to change of interrelation between enamel organic and mineral components which is not typical for that certain period of teeth ontogenesis were found at enamel examination. Thus, in patients with connective tissue hypermobility signs of bone and enamel mineralization and structure change were found. Conclusion. The use of atomic-force microscopy allows to study the native cell cultures, including bone and hard tooth tissues, that can be used as a basis to diagnose connective tissue hypermobility as well as for identification of personality.
Kazan medical journal. 2012;93(6):887-891
887-891
Complex rehabilitation of patients with cleft lip and palate at the Kemerovo center of maxillofacial area congenital pathology prevention and treatment in children
Abstract
Aim. To increase the quality and access of children with a congenital pathology of maxillofacial area living in the Kemerovo region to the dental aid in the specialized center. Methods. Actions for reorganization of structure and activity of the Kemerovo Regional Center of maxillofacial area congenital pathology prevention and treatment in children were developed and an estimation of the efficiency of their introduction was performed using the most relevant indicators of medical, social and economic activity by the comparison of these indicators in two periods: 1999-2003 and 2005-2009. Also the quality of life of over than fifty 15-18 year old patients who have completed the treatment course in the centre was assessed using standard questionnaires. Physical, mental, social and economical well-being was assessed. Results. The structure of the Kemerovo Regional Center of maxillofacial area congenital pathology prevention and treatment in children was improved and the objectives of the Centre were corrected. The system for the patients’ account and monitoring was created, adequate diagnostic, medical and rehabilitation technologies were developed and introduced. Up to 95% of the disabled children are registered in a center’s database within the first months of life, the age of children in whom corrective surgeries (cheiloplasty and palatoplasty) are performed decreased, corrective surgeries in patients 15-18 years of age are completely over in 84.5% of the cases, 2.2% of patients still have physical disability at the age of fifteen, 48.0% of children are completely satisfied by a treatment course, their appearance and social adaptation. Conclusion. The introduction of the proposed measures allowed to provide a high quality healthcare for children with a congenital pathology of maxillofacial area, their early rehabilitation, decrease of physical disability and reduction of the state payments.
Kazan medical journal. 2012;93(6):891-895
891-895
Herpes simplex infection as a risk factor for dental caries progression
Abstract
Aim. To determine the individual risk of caries debut and specific features of the primary caries in patients infected with herpes simplex virus. Methods. 51 patients with primary caries (112 teeth), ICD-10 diagnosis K02.0 (Caries limited to enamel) aged 18 to 49 (female - 42) were examined, all patients were divided into two groups: patients infected with herpes simplex virus and with clinical symptoms of herpes simplex infection (main group, 33 patients), patients infected with herpes simplex virus and without any clinical symptoms of herpes simplex infection (comparison group, 18 patients). Clinical, biochemical, immunological, laser (laser fluorescence spectroscopy) diagnostic techniques were applied. Results. High titers of blood immunoglobulin G to herpes simplex virus were found in 98% of patients examined with initial caries (K02.0). The medium risk was defined in 45% of patients of the main group and in 44% of the comparison group. The navy blue indicator color was the sign of the high risk in 49% in the control group and in 50% of the comparison group. Among the patients with high risk of caries debut the mean local enamel demineralization value according to DIAGNOdent pen was 11.5±1.6 (main group) versus 7.2±1.2 (comparison group). Conclusions. The risk of further caries progression in patients with clinical manifestations of herpes simplex infection is higher compared to patients with persistent infection without signs of active virus reproduction. Biochemical rapid test Clinpro Cario L-Pop (3M ESPE) helps to obtain objective data on oral microflora activity. The use of KaVo «DIAGNOdent pen» device is necessary for the further monitoring of caries progression.
Kazan medical journal. 2012;93(6):896-899
896-899
Clinical features of rosacea in combination with demodicosis
Abstract
Aim. To study the features of the clinical course of rosacea in combination with demodicosis. Methods. The study included patients aged 19 to 59 years with rosacea (n=71), in whom Demodex mite were identified. Gender and age-comparable patients with rosacea and without demodicosis (n=68) were examined as comparison group. The disease duration in both groups ranged from 2-3 weeks to 7 years. Clinical examination, Demodex folliculorum identification were performed. Diagnostic criteria for clinical forms of rosacea were used for diagnosis and staging of the disease. Results. The pustular form of the disease was more prevalent in patients with rosacea, complicated by demodicosis. The combination of erythema with skin edema was found in all patients with a pustular form of the disease, bigger grouped skin rash elements having an infiltration bed were revealed in a greater degree. In patients with papular form of rosacea, complicated by demodicosis, skin rash elements were localized all over the face in 33.3% of cases, in comparison group similar rash was noted in 12.5% of cases. In patients with rosacea, complicated by demodicosis, most of the patients suffered relapses at least twice a year and more. In cases of rosacea without demodicosis relapses were significantly less frequent. Conclusion. In patients with rosacea, complicated by demodicosis more severe clinical course of the disease was observed with a prevalence of pustular forms and the greater skin area involved.
Kazan medical journal. 2012;93(6):899-902
899-902
Gender motivational traits of the disabled with lower limbs structural and functional deficiencies
Abstract
Aim. To define the motivational and gender differences in patients with limb loss. Methods. 318 patients [male - 267 (83.3%), female - 51 (16.7%)] with lower limbs structural and functional deficiencies admitted for prosthetics surgery to prosthetic and orthopedics center «Reabilitaciya invalidov», Kazan, Russia, from 2008 to 2010 were included in the study. Empiric data on motivational features were gained using questionnaires and test examinations of 191 patients aged form 18 to 66 years. Quality of life, personality traits, emotional and motivational health, natural, and social and cultural environment were assessed. Results. Marked need for affiliation was typical for patients with high anxiety levels (r=0.15, p <0.05) and emotive (r=0.17, p <0.01) personalities and is decreased in rigid personalities (r=-0.26, p <0.01). There was a negative correlation between the urge of being accepted by others and the need for success (r=-0.19, p <0.05). Affiliate need in women was relevantly higher compared to men (t=2.87, p <0.05). The strong negative correlation of the need to be accepted by others and motivation for achievement was noticed in women (r=-0.46, p <0.01), in men the difference was not significant (r=-0.11). Demonstrative (r=0.21, p <0.05) and hyperthymic (r=0.24, p <0.01) personalities were more often focused on achievement and success. Pedantic (r=-0.23, p <0.01), anxious (r=-0.28, p <0.01) and cyclothymic (r=-0.28, p <0.01) traits were associated with the motivation for tranquility. Motivation for achievement was relevantly higher in men (t=-2.82, p <0.05). High personal anxiety (r=-0.38, p <0.05) and depression (r=-0.36, p <0.05) were characteristic for women with predominant tranquility motivation. A negative correlation of degree of motivation for achievement and situational (r=-0.23, p <0.01) and personal (r=-0.19, p <0.05) anxiety, as well as depression (r=-0.36, p <0.001) was found in men. This concludes that depression and anxiety decrease the willingness to success in patients of both genders. Conclusion. When planning a rehabilitation program for disabled, gender differences should be taken into account, because connection between motivation for achievement, affiliation, personal traits, emotional traits and physical activity parameters are different in men and women.
Kazan medical journal. 2012;93(6):902-906
902-906
Influence of the local anesthetics solutions’ temperature on muscular action potential amplitude decrease at brachial plexus block
Abstract
Aim. To study influence of temperature of local anesthetics solutions on effectiveness of brachial plexus block using axillary access. Methods. Patients who underwent arm and hand surgeries were randomized either to the main group (n=25) or to the control group (n=25). In the main group, 1% lidocaine (20 ml) and 0.25% ropivacaine (40 ml - males, 30 ml - females) at 38 °C were used for brachial plexus block using axillary access. In the control group, anesthetics at room temperature were used. Brachial plexus block was performed using the axillary access at m. pectoralis major margin above the a. axillaris pulsation point. To register provoked muscular action potentials, a portative neurodiagnostic system «Nicolet One» was used. The percentage of provoked muscular action potential amplitude decrease was counted with results of a measurement before the block as a baseline. For additional analgesia and sedation phentanylum 0.005% was used until Ramsay sedation score II was achieved. «EZSAT-E» software package was used for data analysis. Results. In the main group brachial plexus block was achieved 14.2±3.4 minutes earlier than in the control group. Phentanylum dose required to provide psychic and emotional comfort was 45.4% lower in the main group (3.0±0.9 μg/kg per hour) compared to the control group (5.5±1.7 μg/kg per hour). Conclusion. The use of local anesthetics solutions at body temperature increases the efficiency of brachial plexus block and reduces the time of it’s achievement, increases it’s analgesic potential and decreases the need for narcotic analgesics to provide psychic and emotional comfort for the patient.
Kazan medical journal. 2012;93(6):907-910
907-910
Features of population’s addressing for the emergency care because of the «heart attack» and its promptitude
Abstract
Aim. To study the nosological structure of ambulance calls because of the «heart attack» and factors influencing the care promptitude. Methods. Statistical data of ambulance calls because of the «heart attack» and factors influencing the care promptitude were analyzed. Ambulance charts of 4074 patients aged 18 and older who called an ambulance because of the «heart attack» in January 2011 in Kazan were analyzed. Results. Females were found to call the ambulance because of the «heart attack» more often (60.9%) compared to males (39.1%). The share of the cardiovascular emergencies was 47.0% in females, 40.1% in males. Among the cardiovascular diseases the most prevalent were angina in males (37.2%), hypertensive emergency - in females (44.2%). The waiting time for the ambulance to come in patients who called the ambulance because of the «heart attack» did not depend on the diagnosis, but was related to the time of the day. Conclusion. The revealed features give a basis for further adjustment of the set of questions the patient is asked when he/she is calling an ambulance, and its introduction by the ambulance coordinators. It will add to the proper call classification and improve the care promptitude in cases of cardiovascular emergencies.
Kazan medical journal. 2012;93(6):910-912
910-912
Reviews
Predictors of epileptic seizures - retrospective analysis
Abstract
The article surveys the data from domestic and international studies regarding the evolution of thoughts and contemporary point of view at epileptic seizure predictors, considering data from experimental and laboratory studies as well as from clinical studies. The provisional epileptic seizure predictors classification is proposed. The characteristics of the included predictors is given, the need for direct comparison considering results of laboratory studies on biological models as well as clinical trials on biologic objects is underlined.
Kazan medical journal. 2012;93(6):913-915
913-915
Clinical pharmacology - one of the world health organization strategies in promoting rational use of medicines
Abstract
The review covers the history of Clinical Pharmacology discipline origin from the thirties of the twentieth century until now. Establishment of the research group on clinical pharmacology by the World Health Organization in 1969 is surveyed. The current status of clinical pharmacology in Russia is described with emphasis on potential impact of the discipline on health system in the rational use of medicines and access to medicines. The connection between clinical pharmacology development and pharmaceutical regulation and «thalidomide tragedy» of the sixties is traced. The main developing sections of the discipline of Clinical Pharmacology: pharmacoepidemiology, pharmacoeconomics, pharmacogenetics, pharmacovigilance and drug clinical trials are presented. The objectives and phases of clinical trials, the current problems of their conduction - global and Russian - are presented. Perspectives for the clinical pharmacology development using the evidence-based medicine approach are reviewed. Review reveals the multidisciplinary nature of clinical pharmacology, its bridging role between the fundamental and practical clinical disciplines, and a close connection with the development of healthcare system. Problems of clinical pharmacologists’ training and employment are discussed. The review presents the current status and development of the discipline in different countries and in the Russian Federation with reference to the federal regulations and laws. The potential of clinical pharmacology as a research, teaching and practicing medical discipline allowing the healthcare system to ensure the rational use of medicines providing drug efficiency, safety and affordability for the population is described. The results of the own authors’ research of the impact of clinical pharmacology services introduction in the practice of internal diseases departments of Kazan municipal hospitals on the outcome of coronary heart disease are presented with consideration of the various confounding factors. Review explains the need for wide use of clinical pharmacology potentials on all levels of healthcare system, particularly for administrative decision-making
Kazan medical journal. 2012;93(6):916-920
916-920
Clinical observations
Sleep apnea in real clinical practice
Abstract
The article is addressed to attract the attention of the physicians mainly dealing with out-patients to the actual problem - sleep apnea. This condition is commonly masked by widespread internal diseases and other conditions, like cardiovascular and respiratory diseases, obesity, diseases of pharynx and larynx. At the same time, its’ timely diagnosis and treatment are extremely important, because it may lead to non-responsiveness to arterial hypertension treatment, increases the risk of arrhythmias and other fatal complications. The article presents the case report of primary diagnosis of sleep apnea (from author’s practice) and its possible treatment options.
Kazan medical journal. 2012;93(6):932-934
932-934
Actual problems of ophthalmology
Past, present and future of the department of ophthalmology of the Kazan state medical academy (to the 90th anniversary of the foundation of the department)
Abstract
The history of the department of ophthalmology of the Kazan State Medical Academy for the 90-year period was analyzed. The department was founded in September, 1922. The reason for the foundation of the department was the trachoma that was rampant at that time in the Volga region. Academician V.V. Chirkovskiy (1874-1956), who headed the department from 1922 to 1928, was the founder and the first director of the first in USSR Trachoma Institution based in Kazan. From 1929 to 1932 professor Valentin Yemel’yanovich Adamyuk (1877-1950), the honoured Scientific researcher of the republic of Tatarstan was the head of the eye clinics of the medical academy and of the Scientific and Research Trachoma Institution. In 1932 professor, the honoured Scientific researcher of the republic of Tatarstan Alexandr Nikolaevich Murzin (1885-1954) has won the elections and headed the department. He secured the merging of the Scientific and Research Trachoma Institution and the eye clinics of the medical academy into the one institution. Thanks to the proper healthcare management and treatment and prevention measures trachoma was eliminated in republic of Tatarstan in 1964. Later, the department was chaired by Alexandr Nikiforovich Kruglov (1952-1964), Kamilya Islamovna Gafarova (1964-1967), Moisey Bencionovich Wufgart (1967-1987), Liyuda Bakhtigareevna Galiaskarova (1987-1996), Marina Vladimirovna Kuznetsova (1996-2012). Since March 2012 the department is headed by PhD, Principal out-of-staff ophthalmologist of the Ministry of Health of the Republic of Tatarstan Aidar Nailevich Amirov. Nowadays the department staff completes over 5000 complicated eye microsurgeries yearly, and also consults the patients form Republic of Tatarstan and nearby regions with complicated cases of different eye diseases at the out-patients clinic and departments of the hospital.
Kazan medical journal. 2012;93(6):935-938
935-938
Laser trabeculoplasty - the first choice surgery for treatment of primary open angle glaucoma
Abstract
Aim. To analyze the results of laser trabeculoplasty in patients with first and second stage of primary open angle glaucoma with the disease duration over 6 years depending on nature of sclera sinus blockade. Methods. 251 patients aged 38 to 78 years (121 female, 130 males, 285 eyes) with primary open angle glaucoma were observed. The early stage of the disease was observed in 188 eyes, promoted stage of the disease - in 97 eyes. Hypertension, atherosclerosis, diabetes mellitus were among the comorbidities. Visual acuity testing, visual field testing, ocular tonometry and tonography, ophthalmoscopy were performed, sclera sinus blockade features were defined. Laser trabeculoplasty was performed with an argon laser using the universal three mirror lens (600 to 1000 mW, laser beam diameter 50 μm, exposure time 0.1 sec, average number of iterations - 100). Laser linear trabeculoplasty by Wise modified by Mamedov was performed. In case of narrow anterior chamber angle an additional laser gonioplasty by Krasnov and laser peripheral iridotomy were performed prior to trabeculoplasty. Results. In patients with the first stage of the disease in case of a functional blockade the remote hypotensive effect was reached in 81.7% of cases, in case of organic blockade - in 46.7% of cases. In the second stage of an open angle glaucoma decrease in intraocular pressure in functional blockade was reached in 65% of cases, in organic blockade - in 33.3% of cases. Visual acuity decreased in 22.1% of cases. In patients with sclera sinus functional blockade the remote hypotensive effect was twice as better compared to patients with organic blockade. Visual field stabilization in patients with organic blockade was achieved 5.5 times rarely compared to patients with functional blockade. Conclusion. Laser linear trabeculoplasty is still the first choice surgery for primary open angle glaucoma treatment. Defining the nature of sclera sinus blockade allows to predict the laser trabeculoplasty results.
Kazan medical journal. 2012;93(6):939-941
939-941
Sarcoidosis of the orbit as the first manifestation of systemic sarcoidosis (clinical case)
Abstract
A clinical case of sarcoidosis of the orbit as the first manifestation of systemic sarcoidosis is presented. A patient (born 1961) was referred with diplopia, gradual visual acuity of both eyes decrease during the last 8 years. The objective status at the ophthalmologist examination in 2009: temporal deviation of both eyes (10° right, 15° left), I degree left-side ptosis. Refraction -2,5 dioptre. Eye convergence and abduction impairment. Oculus Uterque - cornea is transparent, conjunctive appears normal, the anterior chamber is of medium depth, aqueous humor is transparent, iris is structured, the pupil is round, light reaction is normal, nuclear sclerosis. «String of pearls» opacity of vitreous body. The fundus of the eye: optic disc is pale pink with temporal discoloration, temporal border is not sharp, arteries are contracted, twisted, veins are of different caliber, macular reflex is fuzzy. Consolidation locus 0.9 mm with an acoustic above the optic nerve projection and posterior acoustic enhancement were found on the B-scan ocular ultrasonography. No signs of a mass were observed. Retroocular tissues are of normal density, with hyperintense 0.5-0.9 mm focuses in the internal segment (ultrasonographic signs of fibrosis). A diagnosis of orbital granulomas was proposed, the preliminary diagnosis: «Eye sarcoidosis, orbit sarcoidosis, sarcoid angiopathy». In June 2009 patient developed a nodular erythema on lower limbs, reported the joint pain, fever. Lung dissemination was determined on the chest X-ray, the patient was referred to phtysiologist and pulmonologist. The Mantoux test of 2 TU was negative, the diagnosis of tuberculosis was ruled out. The adequate therapy was administered. Thus, the eye involvement can be the first and only clinical feature of sarcoidosis and make the physician think about the systemic disorder debut.
Kazan medical journal. 2012;93(6):942-944
942-944
The influence of air pollution on children’s eye
Abstract
An intensive man-made emission is typical for a modern world. Air pollution has a great impact on public health. Children are the most vulnerable to the influence of unfavorable environmental factors that affect different organs and systems. Not only physical, but also mental health is affected. There are little data on the impact of environmental pollution on the eye diseases in children available. When analyzing the eye diseases in children living in unfavorable environment, functional and organic changes of visual system were found as an evidence of negative role of air pollution. Microcirculation and metabolism impairments affecting the characteristics of the sclera can occur. The influence of man-made pollution on children’s eye may be indirect and cause different eye diseases including development of refractive vision defect.
Kazan medical journal. 2012;93(6):944-946
944-946
Educational process at the department of ophtalmology of Kazan state medical university. Stages of establishment and set up
Abstract
In 2012 it will be 205 years since the teaching of ophthalmology was started in Kazan. Since that time the teaching methodic has passed different stages starting from simple passive teaching to complex interactive teaching using the curricula modules. The method was introduced at the department in 2010 according to the latest state educational standard. The curricula is formed by several modules (practical skills, emergencies in ophthalmology, terminology) that are scored separately. The approach allows to increase the students’ activity at the classes, motivates for advanced reading and out-of-class studying and helps to acquire all the skills and knowledge better.
Kazan medical journal. 2012;93(6):947-948
947-948
Eye sarcoidosis. Literature review
Abstract
A review of the literature devoted to eye sarcoidosis is presented. Sarcoidosis is a systemic granulomatous disease of unknown etiology, with a pathognomonic feature of non-caseous granuloma formed mainly by epithelium cells and single Langhans giant cells. Sarcoidosis has many synonyms: Besnier-Boeck-Schaumann disease, benign Schaumann’s granulomatosis, nodular reticular disease. Primary targets of sarcoidosis are lungs, intrathoracic lymph nodes, eyes and skin. During the last years eye sarcoidosis is registered more frequently, that is probably associated with better diagnosis. The frequency of the eye involvement in patients with sarcoidosis, according to different authors, is 5-69% (3rd or 4th among all the target organs involved). The eye manifestations of sarcoidosis are multiple with the uvea most frequently affected, especially iris and ciliary body. The involvement of the back of the eye includes granulomatous uveitis, vitreitis, periphlebitis. It is worth noticing that only minor non-granulomatous precipitates can be found in the acute stage of the disease. In case of chronic inflammatory process, precipitates become granulomatous. The treatment can influence both precipitates’ size and shape. In case of termination of the inflammation, precipitates are undergoing a complete resorption or decrease in size, become pigmented of transparent («precipitate shades»). The feature of sarcoidosis is the tendency to comissure formation, the pupil is hardly dilated by medicines, leading to the secondary glaucoma. Conjunctiva, extraocular muscles, retroocular tissues, lacrimal gland can be involved, as well as the optic nerve, chiasma, leading to meningovascular infiltrates formation. When diagnosed, a complex treatment with topic, symptomatic drugs and the drugs with the systemic action is used. The search of new effective treatment options is still ongoing.
Kazan medical journal. 2012;93(6):948-953
948-953
Complex treatment of retinal veins occlusion
Abstract
Aim. To assess the efficacy of complex treatment of retinal veins occlusion with anti-angiogenic - ranibizumab, and laser retinal photocoagulation. Methods. 36 patients (36 eyes) with occlusion of central retinal vein and its branches were included. Patients with central retinal vein occlusion (n=17) were included in the first group, patients with retinal vein branch occlusion (n=19) were included in the second group. All the patients underwent visual acuity testing, ocular tonometry, ophthalmoscopy, biomicroscopy, spectral optical coherence tomography, intravenous fluorescein angiography at the baseline, 1 and 3 months after treatment. Treatment included intravitreal ranibizumab injection (0.5 mg) and laser retinal photocoagulation 1 month after intravitreal injection. Results. In 94.4% of cases good treatment effect was observed. Visual acuity improved from 0.06±0.03 at baseline to 0.22±0.08 (p <0.05) at the end of treatment in the first group and from 0.31±0.06 to 0.64±0.05 (p <0.05) in the second group. Central retinal thickness reduced from 752.2±98.4 μm to 309.21±45.57 μm (p <0.05) in the first and from 689.12±64.08 μm to 235.37±46.07 μm (p <0.05) in the second group. Conclusion. The results indicate high effectiveness of suggested complex treatment of retinal vein occlusion with anti-angiogenic - ranibizumab and laser retinal photocoagulation.
Kazan medical journal. 2012;93(6):954-956
954-956
Features of tear production in patients with chronic hepatitis C
Abstract
Aim. To study the features of tear production in patients with chronic hepatitis C, depending on the duration of infection. Methods. 40 patients (80 eyes) with chronic hepatitis C infection (first group - 11 patients, chronic hepatitis C duration up to 3 years, second group - 10 patients, chronic hepatitis C duration 3 to 5 years, third group - 19 patients, chronic hepatitis C duration over 5 years). The control group consisted of 20 healthy subjects (40 eyes). All study subjects underwent standard ophthalmic examination, a set of clinical, epidemiological and laboratory studies; the level of total tear production was examined by the Schirmer’s test. Results. Eye pathologies were determined in patients with chronic hepatitis C. Total tear production in patients with chronic hepatitis C was 1.82±0.09 mm compared to 2.2±0.06 mm in the control group. At the early stages of chronic hepatitis C (duration up to 3 years) tear production has changed diversely: it increased in 27.2% of patients and decreased in 18.8% of patients. At the later stages of chronic hepatitis C (duration over 5 years) tear production increased only in 15.8% of patients and decreased in 52.6% of patients. Conclusion. In patients with chronic hepatitis C total tear production changes depending on the duration and the severity of infection, which should be considered in the diagnosis, monitoring and treatment of ophthalmic diseases in patients with chronic hepatitis C infection.
Kazan medical journal. 2012;93(6):956-958
956-958
Medical and social factors impact in myopia development
Abstract
Aim. To elaborate a mathematical model of individual myopia development and progression risk in school students who study using innovative programs. Methods. 372 students of №19 gymnasium, Kazan, Russia, were examined. Students were divided into two groups: the first group - students with emmetropia (180 subjects) and the second group - students with myopia (192 subjects). Age distribution (junior students aged 7-9 years - 111 subjects, middle school students aged 12-14 years - 147 subjects, senior students aged 16-17 years - 114 subjects) was taken into account. Results. Factors influencing the visual acuity deterioration in school students were combined into five groups: medical and biological, social and hygienic, visual load, behavioral and alimentary. The visual load had the highest impact (52.8% - for male students, 51.7% - for female students), with behavioral factors on the second place (39.0% - for male students, 41.61% - for female students), alimentary factors on the third place (36.46 and 41.38% accordingly), medical and biological factors on the fourth place (24.80 and 29.09%) and with social and hygienic factors at the bottom (20.69 and 27.74%). Conclusion. The overall sum of the prognostic coefficients allows to define the risk of myopia on case-to-case basis and to distribute the student to a prognosis group. Basing on this approach. it is possible to develop personalized recommendations for myopia prevention targeting on the most important unfavorable prognostic factors.
Kazan medical journal. 2012;93(6):958-961
958-961
Electrophysiological parameters in patients with the «dry» form of age-related macular degeneration treated with polarized polychromatic non-coherent light and dynamic electromyostimulation
Abstract
Aim. To study the electrophysiological parameters in patients with the «dry» form of age-related macular degeneration before and after combined treatment with polarized polychromatic non-coherent light and dynamic electromyostimulation. Methods. Two groups of patients with the «dry» form of age-related macular degeneration were examined. Patients in the main group (40 patients, 80 eyes) were treated with a combination of polarized polychromatic non-coherent light and dynamic electromyostimulation, patients in the control group (39 patients, 78 eyes) were treated conventionally. Mean age of the patients was 71.3±1.1 years. All patients underwent standard ophthalmic examination. To assess the functional status of the macula, electroretinography was performed using the «Neuro-MVP» device (Ivanovo, Russia). A-wave amplitude and latency on the red light stimulus were examined. Results. A-wave amplitude on macular electroretinogram was 11.9% lower and A-wave latency was 20.8% higher in patients with age-related macular degeneration compared to healthy subjects. A statistically significant improvement of the A-wave amplitude and latency was observed on macular electroretinogram after the combined treatment. A-wave amplitude increased from 13.22±1.36 to 17.17±1.59 µV (p <0.01) after 2 months and up to 17.80±1.60 µV (p <0.05) after 6 months of treatment. A-wave latency decreased from 19.32±0.41 to 18.51±0.36 ms (p <0.01) after 2 months and down to 18.31±0.45 ms (p <0.05) after 6 months of treatment. There was a relevant increase in A-wave amplitude from 13.15±1.09 to 16.3±1.09 µV (p <0.01) and decrease in A-wave latency from 19.23±0.30 to 18.64±0.30 ms (p <0.05) in patients of the control group 2 months after the end of treatment. Conclusion. There were relevant increase in A-wave amplitude and decrease in A-wave latency observed on macular electroretinography after treatment. The proposed treatment method does not cause any complications and can be used as a treatment option in patients with allergic reactions to standard drugs.
Kazan medical journal. 2012;93(6):961-965
961-965
Tear fluid vascular endothelial growth factor level as a marker of effectiveness of proliferative diabetic retinopathy combined treatment
Abstract
Aim. To assess the tear fluid level of vascular endothelial growth factor in patients with proliferative diabetic retinopathy in case of panretinal photocoagulation and intravitreal ranibizumab treatment. Methods. Panretinal photocoagulation was performed in 20 patients (40 eyes) with proliferative diabetic retinopathy (first group). In the second group, which included 20 patients (40 eyes) with the same stage of diabetic retinopathy, panretinal photocoagulation was combined with intravitreal ranibizumab treatment. 20 healthy subjects (40 eyes) were examined as a contol group. There were no adverse events registered during the treatment. At the follow-up, 4 patients from the first group were diagnosed with partial intraocular hemorrhage; a posterior vitrectomy was required in 1 eye, in 3 eyes intraocular hemorrhage has resolved spontaneously. A complex of clinical and laboratory examinations included visual acuity testing, biomicroscopy, indirect ophthalmoscopy using Mainster wide field lens, fluorescein angiography, optical coherence tomography, tear fluid ELISA. Results. There was a complete regression of retinal neovascularization (no blood flow in newly grown blood vessels) in 14 (35%) eyes of patients from the first group after the first procedure. In the second group a complete regression of retinal neovascularization was observed in 100% of cases after the first procedure. The tear fluid level of vascular endothelial growth factor increased from 398.6±112.2 to 668.2±102.2 pg/ml (p <0.05) in 40 (100%) eyes of patients from the first group, in the second group the level of vascular endothelial growth factor decreased after the angiogenesis inhibitor injections in 40 eyes (100%) from 332.1±98.2 до 314.6±44.4 pg/ml (p <0.05). 1 month after treatment the visual acuity in the first group the visual acuity improved in 40% of cases (16 eyes), was stable in 45% (18 eyes), decreased in 15% (6 eyes) with the mean value changed from 0.22±0.12 to 0.24±0.08 (p <0.05); in the second group the visual acuity improved in 40% of cases (16 eyes), was stable in 45% (18 eyes), decreased in 15% (6 eyes) with the mean value changed from 0.22±0.12 to 0.24±0.08 (p <0.05). Conclusion. The use of panretinal photocoagulation combined with intravitreal ranibizumab treatment in patients with proliferative diabetic retinopathy decreases the tear fluid vascular endothelial growth factor level, improves the visual acuity and thickness of the retina. There was a marked and prolonged effect after the combined treatment, that allows to recommend this treatment method to all patients with proliferative diabetic retinopathy.
Kazan medical journal. 2012;93(6):965-969
965-969
Pigment dispersion syndrome and pigmentary glaucoma treatment results
Abstract
Aim. To assess the pigment dispersion syndrome and pigmentary glaucoma treatment results. Methods. 22 patients (44 eyes) aged 16 to 38 years (male - 12, female - 10) were observed. Pigmentary glaucoma was diagnosed in 12 eyes, pigment dispersion syndrome - in 32 eyes. Visual acuity testing, visual field testing, biomicroscopy, ocular tonometry and tonography, ophthalmoscopy, gonioscopy, scanning laser ophtalmoscopy, computed perimetry were performed. The follow-up period ranged from 6 months to 10 years. All patients underwent laser iridotomy. All patients were treated with anti-glaucoma medications and antioxidants unless intraocular pressure was compensated. Results. Intraocular pressure was lowered to normal in 26 out of 44 eyes. Intraocular pressure was compensated on the rest of 18 eyes using treatment with local pressure-lowering medications and antioxidants. Laser iridotomy allowed to remove the anatomical predisposition (the main pathogenetic link) leading to additional pigment deposition and intraocular pressure increase. Prolonged use of antioxidants has resulted in tear outflow drainage and normalization level of intraocular pressure. Conclusion. Early diagnosis of the pigment dispersion syndrome and proper treatment tactics allows to prevent the pigmentary glaucoma development and to preserve the vision.
Kazan medical journal. 2012;93(6):969-972
969-972
Microcirculation disorders in bulbar conjunctiva of patients with chronic viral hepatitis
Abstract
Aim. To study the features of microcirculation in bulbar conjunctiva of patients with chronic hepatitis C depending on the duration of the infection. Methods. 40 patients (80 eyes) with chronic hepatitis C were observed: the first group consisted of 11 patients, chronic hepatitis C duration up to 3 years, second group - 10 patients, chronic hepatitis C duration 5 to 3 years, third group - 19 patients, chronic hepatitis C duration over 5 years. The control group consisted of 20 healthy subjects (40 eyes). The microcirculation in bulbar conjunctiva was assessed using biomicroscopy. Arterioles, veins and capillaries were distinguished by the direction and speed of the blood flow, the vessel diameter, configuration and branching, observed changes were scored. Liver enzymes levels were assessed, as well as levels of immunoglobulins M and G to hepatitis C virus, polymerase chain reaction was performed to define the presence of viral RNA. Results. Microcirculation disorders (perivascular, vascular and intravascular changes) in bulbar conjunctiva were found in all of the patients with chronic hepatitis C compared to the control group. There was a link between total conjunctiva index and the duration of the infection as well as liver enzymes levels. In the first group total conjunctiva index was scored as 11,52±0,7, 14,0±1,18 - in the second group, 19,3±0,84 - in the third group. Conclusion. Microcirculation disorders are present in all patients with chronic hepatitis C, that should be considered while monitoring and choosing the optimal treatment.
Kazan medical journal. 2012;93(6):972-974
972-974
Study of contact correction of vision among medical students
Abstract
Aim. To study the hygienic and medical aspects of refractive error correction in medical students. Methods. Ophthalmic examination and questionnaire poll of 80 5-year students of Kazan State Medical University diagnosed with myopia and using the contacts. The questionnaires included questions about the type of contacts, wear schedule, usage and care rules, adverse effects and complications, reasons for drop off. Results. Different myopia degree (low - 46%, medium - 51%, high - 3%) was diagnosed in the observed students. The term of contacts use differed from 6 months to 5 years, in 57% of students the term was over 3 years. Soft lenses (hydrogels - 40%, silicone hydrogels - 57%) were preferred with only 3% of students using rigid lenses. Students have often chosen lenses by themselves (49%). It was found out that 60% of students examined did not comply with terms of use, over 60% of students examined did not comply with hygienic regulations while wearing contacts. In 67% of cases the following eye disorders were diagnosed at examination: chronic conjunctivitis - in 32% of cases, initial stage of keratoconjunctivitis sicca - in 27% of cases, allergic conjunctivitis - in 8% of cases. Conclusion. The examination conducted and impairments diagnosed in students using the contacts have shown low level of education and neglecting basic hygienic rules for use of contacts, that requires the developing of novel educational programs for young people with refractive error.
Kazan medical journal. 2012;93(6):975-978
975-978
Effectiveness of 0.02% pentahydroxyethylnaphtoquinone (hystochrome) in patients with active and fibrous stages of retinopathy of prematurity
Abstract
Aim. To study the effectiveness and safety of pentahydroxyethylnaphtoquinone (Hystochrome) in patients with active and fibrous stages of retinopathy of prematurity. Methods. 281 prematurely born babies: first group - 63 patients with retinopathy of prematurity stages I-II and vast non-vascular area; second group - 201 baby with stage III retinopathy of prematurity and posterior aggressive form of retinopathy after the performed retinal laser photocoagulation; third group - 17 babies with subtotal intraocular hemorrhage - were followed up. In addition, 29 children with fibrous stage of retinopathy of prematurity were observed. Pentahydroxyethylnaphtoquinone (Hystochrome) was used as epibulbar instillations and peribulbar injections. To assess the treatment results, examination using the «RETCAM-120» system, B-scan ultrasonography using the «AVISO» scanner and visual evoked potentials examination with flash light stimulus using the «Neuro-MVP» device were performed. Results. In babies from the first group the improvement of electrophysiological parameters was observed in 20% of cases after treatment with pentahydroxyethylnaphtoquinone, compared to 4% in control group. In the second group pentahydroxyethylnaphtoquinone improved the electrophysiological parameters in 39% of cases. In the third group (17 babies with subtotal intraocular hemorrhage) the hemorrhage degradation was twice more rapid compared to controls. There was no effect from pentahydroxyethylnaphtoquinone treatment at the late stages of the disease. No adverse effects were registered. Conclusion. Pentahydroxyethylnaphtoquinone (Hystochrome) has shown good effectiveness and safety while treating patients with non-proliferative stages of retinopathy of prematurity and vitreous hemorrhage.
Kazan medical journal. 2012;93(6):978-981
978-981
Change of electrical impedance measurements on brain in patients with the «dry» form of age-related macular degeneration treated with polarized polychromatic non-coherent light and dynamic electromyostimulation
Abstract
Aim. To study the change of electrical impedance measurements in brain in patients with the «dry» form of age-related macular degeneration before and after combined treatment with polarized polychromatic non-coherent light and dynamic electromyostimulation. Methods. Two groups of patients with the «dry» form of age-related macular degeneration were examined. 40 patients (80 eyes) from the main group were treated using combined treatment and 39 patients (78 eyes) in the group of control who were treated conventionally. Results. Before the treatment, decreased blood flow in the internal carotid artery was found in 77.2%, and in the vertebral arteries in 82.2% of patients. Peak amplitude and the stress ratio index at rheoencephalography in the anterior cerebral circulation were 0.83±0.04 Ω and 27.46±0.40%, in the posterior cerebral circulation - 0.70±0.04 Ω and 23.78±0.35%. Peak amplitude values and the stress ratio index have improved significantly right after treatment and after 6 months in the main group compared to the control group. Mean visual acuity in the main group before treatment was 0.87±0.02, right after the treatment - 0.96±0.01 (p <0.001), 2 months after the treatment - 0.95±0.01 (p <0.001), 6 months after the treatment - 0.96±0.01 (p <0.001), 12 months after the treatment - 0.95±0.01 (p <0.001). In the control group mean visual acuity was 0.91±0.02 before the treatment, 0.95±0.02 (p <0.05) - right after the treatment. 2 months after the treatment - 0.94±0.02 (p <0.05), 6 months after the treatment - 0.92±0.02 (p >0.05). 12 months after the treatment mean visual acuity decreased and equaled 0.89±0.02. Decrease of anterior cerebral circulation was found in 77.2% of patients with the «dry» form of age-related macular degeneration, mean peak amplitude value was 0.83±0.04 Ω and the stress ratio index was 27.46±0.40%, decrease of posterior cerebral circulation was found in 82.2% of patients, mean peak amplitude value and the stress ratio index were 0.70±0.04 Ω and 23.78±0.35%. Conclusion. In patients with the «dry» form of age-related macular degeneration posterior cerebral circulation has improved significantly and visual acuity has improved 6 months after combined treatment with polarized polychromatic non-coherent light and dynamic electromyostimulation.
Kazan medical journal. 2012;93(6):981-984
981-984
Eye vessels doppler sonography and optical coherence tomography in assessing the effectiveness of treatment of patients with diabetic retinopathy
Abstract
Aim. To study the properties of eye vessels Doppler sonography and retinal optical coherence tomography in assessing the treatment effectiveness in patients with diabetic retinopathy. Methods. 122 patients (244 eyes) with type 2 diabetes mellitus and nonproliferative diabetic retinopathy aged 41 to 55 years were examined. The disease duration ranged from 2 to 15 years. All patients were treated with glibenclamide and supportive therapy: eye drops of 1% methylethylpiridinol - 1 drop 3 times a day, 20% pyracetam solution - 5 ml intravenously for 14 days. Patients were divided into 4 groups: 1st group included 30 patients who were administered with Hirudo powder, 2nd group consisted of 32 patients treated with Hirudo powder in combination with laser photocoagulation, 3rd group included 30 patients treated by laser photocoagulation and 4th group consisted of 30 patients who were treated with glibenclamide and supportive therapy only. All patients were examined before and 4 days after treatment, examination included standard ophthalmic examination, retinal optical coherence tomography and eye vessels pulsed color Doppler sonography. Results. Improvement of circulation parameters resulting in increased blood flow speed and decrease of vascular resistance index, as well as visual acuity improvement, reduction of macular edema were registered in the first group after the treatment. In the 2nd group, significant improvement of circulation parameters as increased blood flow speed and decrease of vascular resistance index, visual acuity increase, reducing of the area and height of macular edema were observed. In the 3rd group, deterioration of circulation parameters as decreased blood flow speed and increase of vascular resistance index, slight visual acuity increase and reducing of the area and macular edema height were observed. In the 4th group improvement of circulation parameters was non-significant as well as visual acuity change and retinal condition. Thus, combination of Hirudo powder and retinal laser photocoagulation was the most effective method, leading to improvement of circulation parameters, visual acuity increase, reduction of macular edema. Conclusion. Quantitative analysis of retinal optical coherence tomography and eye vessels Doppler sonography parameters and their link to visual acuity testing allows to assess completely the effectiveness of conducted treatment.
Kazan medical journal. 2012;93(6):985-989
985-989
Features of ophthalmic disorders in patients with chronic viral hepatitis C before and after antiviral treatment
Abstract
Aim. To study the features of ophthalmic disorders in patients with chronic viral hepatitis C before and after antiviral treatment. Methods. 40 patients (80 eyes) with chronic hepatitis C were observed (the main group). The control group consisted of 20 healthy subjects (40 eyes). To diagnose chronic hepatitis C infection and to assess liver damage a set of clinical, epidemiological and laboratory tests was performed. All patients underwent liver ultrasonography. The diagnosis of chronic hepatitis C was set up according to presence of immunoglobulin M and G to hepatitis C virus and presence of viral RNA on polymerase chain reaction in peripheral blood. Along with standard opthalmic examination, visual field testing using the white and chromatic light and visual lability testing were performed. Results. Color vision impairments were diagnosed in 50% of patients with chronic hepatitis C, with decreased visual lability for the red and green colors in 100% of cases. After 6 months of antiviral treatment restoration of visual function was observed. The durability of visual impairments in patients with chronic hepatitis C depended on the severity of the disease. Conclusion. In patients with chronic hepatitis C with the short term of the disease ophthalmic disorders such as decreased peripheral vision, color vision impairments, decreased visual lability are reversible.
Kazan medical journal. 2012;93(6):989-991
989-991
The study of vision correction options in athletes with myopia
Abstract
Aim. To study the options to correct vision in athletes with myopia. Methods. 100 athletes with myopia, going in for different sports, (male - 49, female - 51, aged 14 to 35 years) were examined and questioned. The questionnaire contained questions regarding following issues: sports type, myopia degree, type of vision correction, type of contacts, wear schedule of contact lenses, adverse effects. Ophthalmic examination included visual acuity testing, eye examination with automated refractor and anterior biomicroscopy. Results. Low myopia was diagnosed in all of the athletes examined. 49% of them did not used any vision correction because of the low degree of myopia - less than 0.75 dpt, the rest 51% used glasses in 18% of cases and contacts in 33% of cases. Athletes participating in injury-prone sports or sports requiring good long distance vision and good peripheral vision such as ice hockey, volleyball, football, used the contact lenses. Hence, the contact lens type did not complied with recommended for use in sports by their replacement schedule. 81% of questioned athletes wore lenses with 4-week replacement period or of longer use instead of daily disposable lenses that are preferable. In 18% of athletes wearing contacts a chronic conjunctivitis was diagnosed. Conclusion. For external eye complications prevention in athletes going in for injury-prone sports not only type of vision correction but the contact lenses replacement schedule matters.
Kazan medical journal. 2012;93(6):992-993
992-993
Blood antioxidant capacity change in patients with the «dry» form of age-related macular degeneration treated with polarized polychromatic non-coherent light and dynamic electromyostimulation
Abstract
Aim. To assess the antioxidant capacity in patients with the «dry» form of age-related macular degeneration before and after combined treatment with polarized polychromatic non-coherent light and dynamic electromyostimulation. Methods. Two groups of patients with the «dry» form of age-related macular degeneration were examined. 40 patients (80 eyes) from the main group were treated using combined treatment and 39 patients (78 eyes) in the group of control who were treated conventionally. The integral blood antioxidant capacity was measured by galvanometry. Results. Blood antioxidant capacity in healthy subjects is 26.0 kC/l. In patients of the main group blood antioxidant capacity before the treatment was equal to 22.81±0.27 kC/l, compared to 22.17±0.20 kC/l in control group (total mean value 22.49±0.27 kC/l). There was a relevant elevation of the blood antioxidant capacity at the late stages after the treatment - up to 12 months, compared to only 2 months in the control group. Visual acuity in patients of the main group before the treatment was 0.87±0.02, after the treatment was finished - 0.96±0,01 (p <0.001), 2 months after the treatment - 0.95±0.01 (p <0.001), 6 months after the treatment - 0.96±0.01 (p <0.001), 12 months after the treatment - 0.95±0.01 (p <0.001). Visual acuity in patients of the control group before the treatment was 0.91±0.02, after the treatment was finished - 0.95±0.02 (p <0.05), 2 months after the treatment - 0.94±0.02 (p <0.05), 6 months after the treatment - 0.92±0.02 (p >0.05). 12 months after the treatment the visual acuity deteriorated compared to the treatment start and was measured as 0.89±0.02. Conclusion. There is a decrease of blood antioxidant capacity (22.49±0.27 kC/l) in patients with the «dry» form of age-related macular degeneration; a relevant increase of blood antioxidant capacity and visual acuity can be observed up to 12 months after the treatment with polarized polychromatic non-coherent light and dynamic electromyostimulation.
Kazan medical journal. 2012;93(6):994-996
994-996
Comparative treatment results of non-penetrating surgeries for treating primary open-angle glaucoma
Abstract
Aim. To assess the effectiveness of combined non-penetrating surgery: non-penetrating deep sclerectomy and ab externo trabeculectomy in patients with primary open-angle glaucoma depending on type of aqueous humor retention. Methods. Results of surgeries on 72 patients (83 eyes) with primary open-angle glaucoma were analyzed. Patients were divided into 2 groups. Standard ophthalmic examination was added by fluorescein lymphography of the anterior eye to determine the surgery type as well as for hypotensive effect long-term prognosis. Non-penetrating deep sclerectomy and ab externo trabeculectomy were conducted in the first group (67 eyes). In the control group (16 eyes) standard non-penetrating deep sclerectomy was performed. A cytostatic was used as a subconjunctival injections in the post-surgical period. Results. Intraocular pressure was fully compensated in 52 eyes out of 67 (77.6%) in the long-term period after non-penetrating deep sclerectomy and ab externo trabeculectomy in the first group. In 15 eyes (22.4%) topical hypotensive drugs were required for complete compensation of intraocular pressure. Complete compensation of intraocular pressure was registered in patients with moderate aqueous humor flow reduction (trabecular and mixed with prevalence of trabecular forms). Topical hypotensive drugs were required in severe aqueous humor flow reduction (mixed form with prevalence of intrascleral). In the second group, compensation of intraocular pressure was achieved only in early post-surgical period in 12 eyes (75%) with further decrease of hypotensive effect after 4-6 months. There was no complete compensation of intraocular pressure at late post-surgical period. To normalize the intraocular pressure, topical hypotensive drugs were required in 15 eyes (93.8%), surgery was repeated in 1 (6.2%) case. Conclusion. Combined surgery (non-penetrating deep sclerectomy and ab externo trabeculectomy) is more effective compared to non-penetrating deep sclerectomy and is indicated in patients with open-angle glaucoma and moderate aqueous humor flow reduction.
Kazan medical journal. 2012;93(6):996-999
996-999
Jubilees
Professoru Renatu Abdullovichu Zulkarneevu - 80 let
Kazan medical journal. 2012;93(6):1000
1000
Professoru Vil'danu Khayrullaevichu Fazylovu - 65 let
Kazan medical journal. 2012;93(6):1001
1001
Assistance to the practicing physician
Clinical and epidemiological features of neonatal hepatitises
Abstract
Neonatal hepatitis is one of the most actual problems of children under 6 months of age. The term «neonatal hepatitis» includes infectious liver injury which develops in antenatal period or occurrs during first 3 months of life. The most common causes of liver damage in newborns are viral infections including cytomegalovirus, herpes simplex virus, enteroviruses, parvoviruses, hepatitis B and C viruses. Nowadays the most frequent perinatal infection is cytomegalovirus (1-2% of all newborns). It manifests clinically in 10-15% of cases, with liver involved in 40-63,3% of cases. Mother-to-infant transmission of hepatitis B and C viruses is usually intranatal, transplacental transmission is rare. Mother-to-infant transmission of other hepatotropic viruses (A, D and E) is very rare. A number of hereditary diseases associated with metabolic disorders (amino acids, carbohydrates, lipids, bile acids) and enzyme deficiencies (arginase deficiency, hemochromatosis), etc. can mimicry the clinical picture of neonatal hepatitis. Liver damage can be the only manifestation of perinatal infection (hepatitis B and C, herpes viruses) or come along with other organ damage (generalized herpes virus infection, bacterial infections, toxoplasmosis). Perinatal hepatitis B and C are usually chronic. Neonatal hepatitis caused by herpes simplex virus is usually an acute, possibly fulminant infection. Neonatal hepatitis caused by cytomegalovirus has a variety of clinical subtypes: from a non-jaundice type (with a good prognosis) to a cholestatic form (with possible formation of biliary atresia and liver cirrhosis). Thus, different neonatal hepatitises have their particular features. Wide spectrum of laboratory tests available nowadays allows to define the exact reason for neonatal hepatitis and its clinical course.
Kazan medical journal. 2012;93(6):921-926
921-926
Primary arterial hypertension in athletes
Abstract
Intensive sports does not exclude the development of primary arterial hypertension in athletes, even considering that physical activity is considered as one of the primary preventive factors for this disease. Key features of interrelation between blood pressure regulation and intense physical activity are surveyed, features of etiology and pathogenesis of arterial hypertension in athletes are covered, data on specific arterial hypertension factors for athletes are provided in the article. The international criteria of primary arterial hypertension diagnosis in athletes (according to 36th Bethesda Conference, 2005) are listed, as well as local 2011 recommendations. Medical treatment algorithms of primary arterial hypertension in athletes are given, considering international anti-doping requirements for different sports. The principles of athletes with primary arterial hypertension medical admission to competitive sports are described, criteria for physical exercise limitations and complete retirement from sports are provided.
Kazan medical journal. 2012;93(6):927-931
927-931
Obituary
Mirlya Gershkovna Berim
Kazan medical journal. 2012;93(6):1002
1002