Vol 7, No 1 (2015)
- Year: 2015
- Articles: 25
- URL: https://journal-vniispk.ru/vszgmu/issue/view/517
Reviews
PHARMACOLOGICAL AUGMENTATION OF LUNG RECRUITMENT EFFECTS LN THE THERAPY OF ACUTE RESPIRATORY DISTRESSSYNDROME AFTER CARDIAC SURGERY
Abstract
The aim. To estimate efficacious of combined application of lung recruitment maneuver (LR) and surfactant administration for the treatment of ARDS after cardiac surgery. Materials and methods. 33 cardiac surgery patients with ARDS were included in to prospective, controlled non-randomized study. LR technique was used in 14 patients, who were included into the "LR" group. In 19 cases LR were combined with endobronchial administration of surfactant (Surfactant-BL, ”Biosurf” Russia), these patients were included into the "LR and surfactant" group. Results. Significant difference from baseline FiO 2 observed after 12 h in "LR and surfactant" group and after 24 h in "LR" group. Significant decrease from the baseline PEEP was observed after 48 h in "LR and surfactant" group and after 72 h in "LR" group. The duration of respiratory support was shorter in the "LR and surfactant" group: 87,5 ± 35,3 h vs 175,3 ± 52,5, p <0,001. There was significant difference in the incidences of ventilator-associated pneumonia (VAP): 10.5% in the "LR and surfactant" group and 42.9% in the "LR" group, p <0,05. Furthermore, we found significant difference in the ICU stay period between groups: 132,5 ± 42,2 h in the "LR and surfactant" group vs 282,5 ± 110,2 h in the "LR" group, p <0,01. There was no significant difference between two groups In mortality rate: 3 (15.8%) in the "LR and surfactant" group and 3 (21.4%) in the "LR" group. Conclusions. The combination of LR and surfactant administration decrease the time of respiratory support and ICU stay, reduce the risk of VAP.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):7-14
7-14
COMORBID CONDITIONS IN PRIMARY OBESITY AS A POSSIBLEPREDICTOR OF METABOLIC SYNDROME IN CHILDREN
Abstract
Obesity and its attendant neurohormonal regulatory violations and play a leading role in the development and progression of insulin resistance (IR), which is the principal risk factors of the metabolic syndrome (MS). Identifying predictors of MS in childhood is of great clinical importance, since the adequate treatment of this condition is reversible. The aim of the study was to investigate the clinical manifestations, metabolic and hormonal disorders in primary obesity, depending on the presence of comorbid conditions in children. In the endocrinology department at Children's Hospital №1 of St. Petersburg in 2008-2011 observed 20 children aged 8 to 17 years (boys - 14, girls - 6) with primary obesity. The survey included children study of heredity; objective examination of the analysis of physical development, evaluation of blood pressure; study hemogram, biochemical analysis of blood parameters and hormonal status; the results of instrumental studies of the cardiovascular system and digestive tract. Patients have formed two groups: 13 children with primary obesity without comorbid conditions (group 1) and 7 children with complicated comorbidity primary form of obesity (group 2). Isolation of children in Group 2 of the total weight of obese patients was conducted taking into account the identification of IR. Studies have shown that the complicated form of primary comorbidity of obesity was more common in males and is characterized by hemodynamic and hormonal changes indicating a possible risk of developing MS. At the same time, the expression of lipid metabolism, the frequency of functional pathology of the cardiovascular system and digestive tract diseases did not differ among children in group 1 and group 2.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):15-21
15-21
CLINICAL SIGNIFICANCE OF SLC22A1 RS622342 GENETIC POLYMORPHISMIN TYPE 2 DIABETES MELLITUS PATIENTS, TAKING METFORMIN
Abstract
One of the key proteins that determine the pharmacokinetics of metformin is OCT1. rs622342 polymorphism in the gene SLC22A1 (OCT1) can reduce the expression of this protein. The aim of this study was to evaluate clinical significance of rs622342 in people with diabetes mellitus (DM) type 2, taking metformin. In 94 patients dynamics of the main indicators of glycemic control and body mass index were sudied over 6 months of treatment. At the end of the study 33 of 49 patients (67,3%) with wild-type variant of rs622342 (genotype AA) and 17 of 45 (37,7%) with polymorphic variants of the gene SLC22A1 (AC- and CC-genotypes) were taken metformin only and had Hb A1c levels less than 7,0%. Remaining patients required a second hypoglycemic agent or had Hb A1c levels 7,0% or more. Calculating odds ratios showed that the presence of AC- or CC- genotypes of rs622342 in the gene SLC22A1 increases the risk of poor clinical effect of metformin 3,4-fold (p = 0,004). Conclusion: The presence of a polymorphic allele C ( rs622342 ) in the gene SLC22A1 in patients with type 2 diabetes is associated with poor clinical effect of metformin monotherapy.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):22-27
22-27
EFFECT OF CYTOCHROME P450 2C9 GENE POLYMORPHISMS ON INDIVIDUAL SENSITIVITY TO GLICLAZIDE IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Abstract
Cytochrome P450 2C9, encoded by the gene CYP2C9 , is a key enzyme for the metabolism of most sulfonylurea (SU). It is known that the polymorphisms CYP2C9*2 and CYP2C9*3 are associated with decreased activity of cytochrome, which leads to an increase in plasma concentrations of SU and reduction in its clearance. The aim of the study was to assess the impact CYP2C9 polymorphisms on individual sensitivity to gliclazide in patients with type 2 diabetes. The study included 74 patients with newly diagnosed diabetes. For all patients gliclazide in a dose of 30 or 60 mg/day was prescribed. Dose titration was carried out for 6 months of observation. If necessary other glucose-lowering therapy (a combination of drugs or insulin) were prescribed. Following the results of study, all patients had achieved the target values of Hb A1c. In comparison with patients who had a polymorphic allele in the gene, patients with wild-type CYP2C9 had lower effective dose of gliclazide, more often required prescription of large (90-120 mg) doses of drug or other antihyperglycemic therapy. Conclusion: The presence of a polymorphic allele in the gene CYP2C9 in homo- or heterozygous state is associated with a decrease in the effective dose of gliclazide, used as monotherapy in patients with type 2 diabetes.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):28-33
28-33
LATERALIZATION CRITERIA IN ADRENAL VEIN SAMPLING IN PATIENSWITH PRIMARY ALDOSTERONISM BY HIGH EFFECTIVE LIQUID CHROMATOGRAPHY
Abstract
Analysis of the use of adrenal vein sampling for differential diagnosis of the main forms of primary aldosteronism is presented in the article. Coefficient of lateralization was specified by high effective liquid chromatography of blood corticosteroids. This data is useful for differential diagnosis of the main forms of primary aldosteronism in the cases with boundary values of coefficient of lateralization.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):34-39
34-39
EFFICIENCY OF THE LOW-DOSE FORMS ESTROGEN-GESTAGEN DRUG TREATMENTTO WOMEN WITH COMPENSATED HYPOTHERIOSIS AND EUTHYROIDISM
Abstract
The article presents research results of 61 perimenopausal and postmenopausal women with diffuse nodular nontoxic goiter and autoimmune thyroiditis, who in the 12 months received treatment low-dose combined estrogen-progestin drug, which includes a 1 mg 17-β estradiol and 2 mg drospirenone. The effect of hormone replacement therapy on coagulation and platelet hemostasis, lipid profile, pituitary-ovarian system, thyroid status were studied. Using of low-dose estrogen-progestin therapy does not worsen diffuse nodular nontoxic goiter and autoimmune thyroiditis flow, does not change the dose of thyroid medications and may be recommended for the treatment of menopausal symptoms in women with thyroid disease.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):40-45
40-45
ATRIAL FIBRILLATION IN PATIENTS WITH INFERIOR MYOCARDIAL INFARCTION
Abstract
Objective: To elucidate the mechanism of atrial fibrillation and evaluate left atrium function after restoration of sinus rhythm in patients with acute posterior wall myocardial infarction ( MI). Materials and Methods: The study included 53 patients with posterior wall MI.All patients were divided into 2 groups. The first group consisted of 33 a people with paroxysms of atrial fibrillation (AF), and the second included 20 control subjects without arrhythmia. All percutaneous intervention was performed within the first 24 hours. Patients were evaluated for time and duration of paroxysms, the size of the heart chambers and the recovery time of the left atrium (LA)function. Results: Patients with posterior wall myocardial infarction developed AF in the early stages of the disease (in 91% on the first day), with short duration of paroxysms, stopped spontaneously and often within 1 hour (in 11 people). There were no significant differences in the size of the heart chambers, left ventricular contractility and hemodynamic disturbances in patients of both groups. AF in most cases developed in patients without left ventricular failure (in 27 people; 82%). Wherein the proximal right coronary artery occlusion was observed more frequently in patients with atrial fibrillation, than in the control group (17 vs 2; p <0,001). Approximately half patients(16 ) with AF before the appearance of atrial fibrillation bradysystolya of atria (less than 50 in 1 min) was recorded, due to acute sinus node dysfunction. After the reversion of sinus rhythm mechanical function of the LA was absent in only 4 people with left ventricular failure. Effective systole of LA was restored only 7 days after reversion to sinus rhythm. The rare occurrence of mechanical dysfunction after discontinuation of arrhythmia indicates a low probability of thrombosis and embolism in the systemic circulation. Conclusion: In cases of patients with posterior wall localization of MI main causes of AF include acute ischemia of atria due to occlusion of the right coronary artery above the branches supplying atrium. Atrial bradysystolya due to acute sinus node dysfunction often contributes to the development of AF as a substitute atrial rate (acute syndrome of tachy-bradycardia). In case of patients with posterior wall MI AF episodes were rarely accompanied by hemodynamic disturbances and the risk of systemic thromboembolism after reversion to sinus rhythm was low.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):46-52
46-52
POSSIBLE ROLE OF GENETIC POLYMORPHISMS FOR INDIVIDUALSENSITIVITY TO SIMVASTATIN IN INITIAL THERAPEUTIC DOSE
Abstract
Despite proven benefits of statins their effects and tolerability differ significantly in different patients. Genetic polymorphisms in genes of metabolizing enzymes, especially CYP3A5, and transporter proteins, especially OATP1B1, represent important factor for these changes. In our study we investigated influence of genetic polymorphisms on effects and safety of simvastatin 20 mg daily in 60 patients with dislipidemia. We observed reverse correlation of effects and adverse effects of simvastatin in our patients. Among CYP3A5*1 carriers we observed a tendency to less pronounced lipid-lowering effects (1,2 vs 2,9 mcmol/l). Our data may indicate importance of genetic polymorphisms even when statins are use in minimal therapeutic doses.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):53-57
53-57
FEATURES OF INTRAHEPATIC MICROCIRCULATION IN PATIENTSWITH ISHEMIC HEART DISEASE AND ESSENTIAL HYPERTENSION
Abstract
This research is devoted to revealing features of the intrahepatic microcirculation in ischemic heart disease and essential hypertension. Disturbance of the liver microcirculation were found by polihepatography.Three group patients were examined: I group - patients with stable form ischemic heart disease in combination with hypertension; II group - patients with essential hypertension stage II without ischemic heart disease; III group - control - healthy people. There were found significant differences in the groups depending on the location intrahepatic blood flow disturbance. This research shows that necessary differentiated approach to treatment these diseases.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):58-63
58-63
HEMODYNAMICS IN THE BRANCHES OF THE AORTIC ARCHIN CHRONIC LIVER DISEASES
Abstract
With cirrhosis of the liver statistically significant violations of cerebral hemodynamic parameters observed in intracranial department due to hemispheric asymmetry of blood flow. Hemispheric asymmetry of blood flow is marked by the development of vascular resistance and lability of the process of atherosclerosis. Hemispheric asymmetry between blood flow and stages of hepatic encephalopathy observed a noticeable positive relationship.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):64-67
64-67
PREBIOTIC THERAPY IN COMPLEX TREATMENT OF PATIENTSWITH STEATOHEPATITIS MIXED
Abstract
The efficiency of the use of prebiotic eubikor in complex treatment of patients with steatohepatitis mixed (alcoholic and metabolic) etiology. The additional use of a prebiotic complex optimization by intestinal microbiota has led to reduced levels of serum cytokines (TNF-α and IL-1β), reduction of insulin resistance according index calculated QUICKI and HOMA-IR. The result of treatment was significant regression eubikorom severity of clinical symptoms (abdominal pain, flatulence), the positive dynamics of biochemical parameters of blood serum (AST, ALT, GGT), improved morphological picture of the liver (steatosis reduction in the degree of activity and hepatitis).
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):68-73
68-73
COMPARATIVE ESTIMATION OF LASER COAGULATION EFFICIENCY IN MACULAR AND MICROPHOTOCOAGULATION OF HIGH DENSITYIN DIABETIC MACULOPATHY TREATMENT
Abstract
The modern standard of treatment of clinically significant diabetic macular edema is macular laser photocoagulation was suggested in the reports of the Early Treatment of Diabetic Retinopathy Study (ETDRS, 1985-1990). Subthreshold microphotocoagulation (MicroPulase) leads to developing barely visible or invisible retinal burns and also has been shown to be effective in treating macular edema with no side effects comparing with ETDRS methodic (retinal pigment and choroidal atrophy, decreasing of retinal sensitivity). Effectiveness of microphotocoagulation may arise in high density laser applications, however in modern literature exists rare publications concerning this question.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):74-77
74-77
USE OF CROSS-SECTIONAL DATA TO ESTIMATE FORCE OF INFECTIONFOR HIV INFECTION AND HEPATITIS C - ABSENCE OF CONSTANT RISK
Abstract
Injecting drug users (IDU) have high risk of acquisition of HIV and other blood-borne viruses, because they frequently share needles, syringes and other injecting paraphernalia. The article describes methodology of estimating force of infection for blood-borne diseases from data on prevalence and injection length. Based on results from 5429 IDU surveyed between 2006 and 2013 it was found that force of infection is at maximum during first months after starting injecting - 0,38 (95%CI=0,24 .. 0,51) for HIV infection and 1,03 (95%CI=0,61 .. 1,46) for hepatitis C. After that risk of infection significantly decrease but is not zero. Also basic reproductive rate by regions and periods of study was estimates. Importance of this approach for public health is demonstrated.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):78-87
78-87
CONDITION OF RESPIRATORY MUCOSA AT CHILDREN WITH RESPIRATORY DISTRESS
Abstract
42 children with the diseases of respiratory organs complicated by respiratory failure have been examined to determine the nature of inflammatory changes of a tracheobronchial tree and a condition of mucoсiliary system . At children with acute diseases of respiratory organs the neutrophillic inflammation of tracheobronchial tree mucous has been revealed more often, at children with chronic diseases of lungs has been more often noted lymphocytic eosinophilic an inflammation of tracheobronchial tree mucous , obvious thaumatropy and dystrophy of ciliate epithelium. At 10% of children primary motor disturbance of the mucoсiliary system (total immobility of cilia) has been revealed.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):88-92
88-92
NEUROTROPHINS-MARKERS REPARATIVE-DESTRUCTIVE PROCESSESIN CHILDREN WITH CEREBRAL PALSY
Abstract
The article provides results of complex clinical and laboratory examination of 66 children with cerebral palsy (CP). It was found that the level of nerve growth factor (NGF) and ciliary neurrotrophic factor (CNTF) in blood serum are authentically higher in children with CP and syndrome of localization related epilepsy, thus brain-derived neurotrophic factor (BDNF) have no significant differences from the results of control group.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):93-96
93-96
MATHERNAL ANEMIA AND BIRTHWEIGHT
Abstract
Author has studied the average birth weight using the birth register from Syktyvkar and Vorkuta of Komi Republic. The prevalence of anemia was higher in Vorkuta. Infants born to woman with anemia were heavier than infants of non-anemic mothers were (Sykvyvkar, р<0,001). Babies of anemic mothers from the third or more deliveries were heavier than from the first deliveries (Vorkuta, p<0,001).
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):97-104
97-104
THE RESULTS OF WORK OF THE SPECIALIZED CENTER FOR MANAGEMENTOF PREGNANCY AND DELIVERY IN MINORS
Abstract
The article is devoted to the first results of the specialized Center for management of pregnancy and childbirth in minors «Little Mother» based in SPbGBUZ «Maternity Hospital №10». Results of the study generally confirmed the literature data on the high frequency of complications of pregnancy and childbirth in adolescents but for those who were regularly observed in the center, especially from the early pregnancy, severity of complications was lower (dominated by light level of preeclampsia and anemia); intrapartum frequency of rapid delivery, perineotomy, abnormal bleeding, forceps or vacuum - extraction of the fetus, as well as frequency of child birth in a state of asphyxia was significantly less. Since the establishment of the Center, no minor patient did not abandon the child in a maternity hospital. Improvement in the quality of medical care for adolescents is demonstrated if they are concentrated in one institution, where the atmosphere and organization of medical care takes into account clinical, social and psychological characteristics of pregnant adolescents.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):105-109
105-109
DYNAMICS OF CYTOKINS AND THEIR INTERRELATION IN LIVER CIRRHOSIS
Abstract
The research objectives are to determine serum interleukins (IL-2, IL-6) and tumor necrosis factor alpha (TNF - α) and evaluate their interrelation in liver cirrhosis (class A, B, C according to Chad - Pugh). 117 patients were examined and their cytokines levels were determined using enzyme-linked immunosorbent assay.Elevation of cytokine levels IL-2, I-6 and TNF-α within reference values was found in liver cirrhosis cases, expect for level IL-6 in liver cirrhosis cases of class C. In these cases IL-6 level exceeds reference values and is within the limit of 9,94 - 25,21 pg / ml with average concentration of 14,89±4,96 pg / ml. Correlation is found between TNF- α and IL-6 (r = - 0,499) in liver cirrhosis of class A and correlation between TNF- α and IL-2 (r = 0,421) is found in liver cirrhosis of class B.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):110-114
110-114
CYTOKINES PROFILE BRONCHOALVEOLAR LAVAGE PATIENTS WIHT BRONCHIAL ASTHMA
Abstract
To assess the extent of inflammatory process in 80 patients with bronchial asthma examined the content of several cytokines in bronchoalveolar lavage enzyme analysis. Found that the exacerbation of bronchial asthma accompanied by increase of IL-4, IL-6, IL-8 and GM-CSF in bronchoalveolar lavage. Production of cytokines in patients with atopic form bronchial asthma is higher than in patients with mixed form. After a course of antiviral therapy levels have declined, and the contents of cytokine IFN-γ.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):115-121
115-121
ASSESSMENT OF EFFICIENCY OF INTRODUCTION OF THE TARIFF FOR CARRYING OUT THROMBOLYTIC THERAPY IN WORK OF THE PRE-HOSPITAL STAGEOF THE EMERGENCY MEDICAL SERVICE
Abstract
In article the high importance of standardization and tariffing of services of an emergency medical service, and also statistics of successful introduction of tariffs at a pre-hospital stage of an emergency medical service in subjects of the Russian Federation, including, in St. Petersburg is proved. It is shown that existence of a specialized tariff for carrying out thrombolytic therapy in territorial subjects of the Russian Federation was the stimulating factor of introduction of this modern technology in work of an emergency medical service that promoted reduction of algorithm of delivery of health care by the patient with a sharp and repeated myocardial infarction in compliance with the approved standard, to improvement of quality of delivery of health care.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):122-127
122-127
PHARMACOECONOMIC ANALYSIS OF THE CONVENTIONAL PHARMACOTHERAPYOF dEEP VEIN THROMBOSIS
Abstract
The cost analysis of treatment of deep vein thrombosis was performed in conventional therapy. The estimation of the cost of treatment of DVT in conventional treatment was done, using clinical-economic analysis - the «cost of illness» (COI). The study took into account only the direct costs of state and patients during 6 month treatment course. The cost analysis of DVT in conventional treatment was held, the economic burden of DVT is 1,8 billion rubles, in structure of cost it is occupying 98%. The cost of purchase of warfarin is occupying only 2%. At the present stage DVT and its complications are the serious problem, spending resources. In the cost`s structure of DVT outgoings of hospital treatment are 83%, if we reduce hospitalization costs, we can reduce state costs of DVT treatment.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):128-133
128-133
THE PRESENT STATE OF NEUROPLASTICITY IN PSYCHIATRY AND NEUROLOGY
Abstract
The review describes morphological, biochemical and neuroimaging changes occurring in the disease process and the subsequent treatment of psychiatric and neurological diseases. Theoretical questions of the phenomenon of neuroplasticity with drug and non-drug therapies are also considered. Promising new directions in the treatment of patients, based on the phenomenon of neuroplasticity are discussed.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):134-143
134-143
THE CASE OF DIFFICULTY DIAGNOSIS OF ACUTE APENDICITIS IN ATYPICAL POSITION ON THE APPENDIX ON THE BACKGROUND OF THE MALFORMATION OF ABDOMINALCAVITY
Abstract
The article presents a clinical case of acute destructive appendicitis on the background of the anomalies of the abdominal cavity. This observation demonstrates the significant difficulties in the diagnosis of acute appendicitis occurring against the background of an atypical location of the appendix if you can not perform a diagnostic laparoscopy.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):144-146
144-146
RESISTANT HYPERTЕNSION PATIENT WITH PRIMARY ALDOSTERONISM
Abstract
Mineralocorticoid hypertension, including Conn's syndrome, occurs significantly more frequently than is recognized. Despite modern diagnostic capabilities and the availability of treatment methods, it cannot be diagnosed simply because (they) know little about it. Recall clinico-pathological variants of mineralocorticoid hypertension and the peculiarities of their management. Here is a fairly typical clinical case Conn's syndrome, recognized for many years later than it needed to be done. Pay attention to the fact that mineralocorticoid hypertension should be considered in patients with resistant nature of the response to treatment.
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):147-151
147-151
INSTRuCTION TO AuTOR
HERALD of North-Western State Medical University named after I.I. Mechnikov. 2015;7(1):152-154
152-154