Репозиторий Университета

© 2018 Hubail et al. Purpose: The aim of this study was to evaluate the progression of a case of a patient with epidermolysis bullosa (EB) since early age who survived to adulthood, presenting with recurrent skin blisters and disfiguring scars and disabling musculoskeletal deformities. Background: EB is a rare group of inherited diseases that affect the skin fragility causing it to blister in response to even minor trauma. Established novel treatments are limited in the literature due to its rarity, and more research is needed to set a global management approach. Clinical manifestations range widely from localized to generalized blistering. Methods: A rare case of EB surviving to adulthood despite the complications, which has been evaluated, treated during a relapse, and followed up. Conclusion: The described case is of considerable clinical interest due to its rarity and severity. Optimal management requires a multidisciplinary approach and revolves around the protection of the skin against slightest injury, use of careful wound care dressings, aggressive nutritional support, and early medical or surgical interventions if needed to manage any complications. Prognosis varies considerably depending on each case.

© 2018 Pirogov Russian National Research Medical University. All rights reserved. Early detection of dorsopathies is an urgent task for primary care physicians, since such conditions can combine with other chronic noncommunicable diseases (NСD) and adversely affect the course all comorbidities, consequently disimproving the quality of life of patients and increasing the frequency of their requests for medical assistance. This study aimed to determine the value of routine checkups in the context of detection of dorsopathies, NCD, and identification of risk factors (RF). We have retrospectively analyzed the patient records database of a rural outpatient clinic in the Tver region (years 2015 to 2017). The prevalence of dorsopathies and NCD RF were the subjects investigated. Fisher's exact test and Spearman's rank correlation coefficient (SRCC) were applied for the purposes of statistical processing of the results. We discovered that dorsopathy most often was a comorbidity to arterial hypertension and gastrointestinal tract diseases; it was strongly related to the NCD (SRCC = 0.506), age (SRCC = 0.383), slightly less so - to hypodynamia (SRCC = 0.146), type of the patient's occupation (intellectual or physical labor) (SRCC = 0.07). Routine checkups improve the rate of detection of dorsopathy: the more patients undergo such examinations, the more cases of dorsopathy are diagnosed. Thus, it is necessary to increase the number of working people attending the checkups in order to detect dorsopathies early and prevent them effectively.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. Background: Literature data on hepcidin (H) level - the main regulator of systemic iron homeostasis in patients with chronic heart failure (CHF) - are contradictory. Relationships of H with markers of inflammation elevated level of which is characteristic of CHF are insufficiently studied. The latter problem remains practically unexplored in elderly and very old patients with CHF. Aim: to study the role of H in formation of anemia of chronic disease (ACD) and iron deficiency anemia (IDA) in elderly and very old patients with CHF. Material and methods: We examined 65 elderly and very old patients with ischemic heart disease (IHD) (35 with CHF and ACD, 10 with CHF and IDA, 20 without CHF, ACD, and IDA [control group]). H level in blood serum was measured using competitive solid-phase immunoenzyme assay. Results and discussion: In patients with CHF and ACD mean H levels were significantly high relative to those in patients with CHF and IDA, while in the latter group H levels were insignificantly low relative to those in patients of control group. High H level, high level of inflammatory tests as well as positive correlations between them, and negative correlation between H and hemoglobin (Hb) are indicative of inflammation as a cause of H level elevation, which in turn facilitates development of anemia in elderly and very old patients with CHF and ACD. Low H level, normal levels of inflammatory tests, absence of links between them, as well as absence of correlation between H and Hb are indicative of lack of H role in development of anemia in these patients with CHF and IDA. We did not study influence on development of anemia of each of possible causes (inflammation, decompensation of CHF) separately, therefore contribution of each of them is unknown. The data obtained also do not exclude effect of other not investigated in this work and presently unknown factors. Received by us data indicate to necessity of precise identification of origin of anemia in every case in an elderly or very old patient with CHF with the aim of elimination of its cause and conduct of pathogenetically valid therapy.

© 2018 EBSCO Information Services. Background. Reported levels of hepcidin, the major regulator of systemic iron homeostasis in CHF patients, are controversial. Relationship of hepcidin with inflammation markers, which are typically increased in CHF, is understudied; this issue is practically unstudied in old and older CHF patients. Aim. To study the role of hepcidin in development of anemia of chronic disease (ACD) and the association of hepcidin with inflammation in old and older CHF patients. Materials and methods. Ninety old and older patients with IHD were evaluated. 35 of these patients had CHF and ACD and 35 patients had CHF without ACD. The control group (CG) consisted of 20 IHD patients without CHF and ACD. Serum concentration of hepcidin was measured using ELISA by the competitive binding principle. Results. Patients with severe, congestive FC IV CHF prevailed among CHF patients with ACD, and their CHF was characterized with longer duration, more frequent hospitalizations, and lower compliance with the treatment. Significantly higher mean levels of hepcidin, C-reactive protein (CRP), erythrocyte sedimentation rate, and insignificantly higher levels of ferritin were observed in CHF patients with than without ACD. The high hepcidin, indexes of inflammation tests, and a significant positive correlation of hepcidin with hemoglobin levels suggested inflammation as a cause for the increased hepcidin, which induced anemia in old and older CHF patients with ACD.

© 2018 Russian Electronic Journal of Radiology.All Rights Reserved. Purpose. A special place among liver diseases is occupied by various tumors and tumor-like lesions. In recent years in clinical practice the possibilities of correct diagnosis have increased significantly as a result of the introduction of advanced diagnostic equipment and wide usage of various contrast agents at studies of the abdominal cavity using the ultrasound method (US), multislice computed tomography (MSCT) and magnetic resonance imaging (MRI). In addition, the differential diagnosis of benign and malignant lesions has been simplified even when the size of the lesions is less than 1 cm. This scientific review describes the capabilities of the "routine" method of the liver diagnostics – US, as well as the latest techniques that are being introduced into the modern practice such as: US with intravenous contrast enhancement, US elastography and perfusion CT and MRI. The advantages of each method are presented as well as the limitations of their use in clinical practice.

© 2018 Nutritec. All Rights Reserved. A number of studies have shown the relationship between the regular consumption of cruciferous vegetables and the risk of malignant tumors in certain localizations, the activation of mechanisms of alimentary adaptation of the organism under conditions of alien loads, by inducing enzymes of the biotransformation system of xenobiotics. The cruciferous vegetables are distinguished by the presence of minor components, such as indole-3-carbinol, formed during the hydrolysis of glucosinolates. The aim of the investigation was a retrospective study of the content of indoles in students' diet with subsequent quantitative analysis in different comparison groups. The study involved 250 students from a medical university aged 21 to 27 years. To assess the actual nutrition, the developed questionnaires were used, which included the most common products in the Moscow region, sources of indole glucosinolates. It was found that 44% of the respondents didn't include cruciferous vegetables in the diet, and of those who consumed sources of indoles (56% of respondents), only about half received them in the recommended amount. It should also be noted that as in men, in women the most commonly used in the diet product as a source of indoles was cabbage, it was included in the diet of 68% of the respondents who used cruciferous vegetables, rarely pekin cabbage was used (16.3%) and broccoli (16.3%). Cauliflower, radishes, Kale and horseradish was included in the diet of 7.8-14.9% of the students. Less often turnip was consumed - only by 2.1% of the students. No significant differences in the consumption of indoles in the student with deficient, normal or overweight was revealed. Also, there was no correlation between excess weight and the consumption of various indoles sources. The obtained results testify to the extremely low level of alimentary intake of indole-3-carbinol.

© 2018, Dynasty Publishing House. All rights reserved. The objective. To specify the frequency and species composition of vaginal bacterial carriage in pregnant women at the term of gestation 35–37 wks. Patients and methods. We examined 800 pregnant women, who were followed-up on an outpatient basis at terms of gestation 35–37 wks. Cultural examination of the content of the posterior vaginal fornix was performed. Species identification of microorganisms was performed by the method of direct protein profiling with the help of MALDI-TOF mass spectrometry, FLEX series, Bruker Daltonic GmbH, Germany. Results. The growth of flora was obtained in 761 patients (95%). Bacterial vaginosis (n = 71), Candida vulvovaginitis (n = 83) were diagnosed in 154 patients (19%). Lactobacillus spp. were found in 80% (n = 637) of examined women, of them in 161 (20%) in monoculture. Bacterial carriage was diagnosed in 55.8% of cases. The prevalence of Enterococcus faecalis, Escherichia coli, Streptococcus agalactiae, Staphylococcus epidermidis and Staphylococcus haemoliticus was noted. They were much more rarely detected in monoculture: E. faecalis (1%), S. agalactiae (0.1%), S. epidermidis (0.1%), Candida albicans (0.1%). In 39 (5%) patients, no growth of flora was found. In 17 patients we found extended-spectrum B-lactamase-producing bacteria: E. coli (n = 15), Klebsiella pneumoniae (n = 2). Conclusion. Taking into account a high prevalence of vaginal bacterial carriage in pregnant women in the 3rd trimester, it might be expedient to consider inclusion of microbiological examination of vaginal discharge in the basic spectrum of antenatal observation and screening examination of pregnant in the Russian Federation.

© 2018 Media Sphera Publishing Group.All rights reserved.  Contribution of diseases of the circulatory system to total mortality of the population remains high. Therefore it is necessary to study factors with most substantial impact on regional morbidity and mortality for elaboration of targeted programs of preventive measures aimed at definite population groups. Purpose of this study was to perform analysis of differences of mortality from cardiovascular diseases (VVD) of Moscow region inhabitants of various gender and age. Materials and methods. Data on 2016 mortality of Federal Service of State Statistics (Rosstat) and territorial service of state statistics of the Moscow Region were used in this analysis. Analysis was conducted for men and women divided in age groups ≤50, 50-59, 60-69, and ≥50 years. Diseases were classified in accordance with 10 th Revision of International Statistical Classification of Diseases (ICD10). Results. Population of the Moscow Region territory on January 1, 2016, amounted 7 318 647 (men 46.2, women 53.8%, persons of working age 58.9%). Contribution in the mortality structure of chronic ischemic heart disease (IHD) and cerebro-vascular diseases in women was greater than in men (80 vs. 68%, respectively, р<0.0001). Contribution of acute IHD, IHD unrelated heart diseases, and vascular diseases in men was significantly greater than in women (30 vs. 18%, respectively, р<0.0001). In the age group over working age mortality indexes were substantially higher compared with those in working age. In men these indexes became 10-20 times while in women - 30-130 times higher. Conclusion. Despite positive dynamics of mortality from diseases of the circulatory system (45.3% lowering from 2008 to 2016) it is necessary to strengthen efforts directed to correction risk factors of IHD and implementation of timely diagnostics and correction of IHD unrelated diseases.

© 2018 American Leather Chemists Association. All rights reserved. Classification, mechanism of action, features of pharmacodynamics and pharmacokinetics, and indications for use of chondroprotectors (drugs promoting the regeneration of cartilage tissue) are presented. Comparative analysis of experimental and clinical studies of main representatives of this group of drug has been performed.

© 2018 Authors. The authors substantiate the need to develop a scientific and methodical approach to modernizing business processes of a pharmacy using information technologies. IK FARM LLC pharmacy has been chosen as a model object of the study. The IDEF0 (Integrated Definition Function Modeling) method adopted as a state standard in the US and recommendations of the State Standard of Russia R 50.1.028-2001 have been used for the analysis, systematization and reorganization of business processes. The article offers methodology for optimizing the pharmacy's activities, which includes the building of two models for managing business processes - before and after modernization (AS-IS and AS-WILL). The structure of the AS-WILL model includes new functions: "Plan the pharmacy's activities" (set the goals and objectives of the organization, plan target sales for the next period) and "Monitor the pharmacy's activities" (control the compliance with the rules of drugs' storage and layout, sanitary regime, and rules of property operation). The complex automation of the pharmacy's trading activities ensures these functions through the Magister software. Estimated efficiency of business processes' modernization based on the net present value has indicated that automation of processes will increase net unreduced profit.

© 2018, Dynasty Publishing House. All rights reserved. The article analyzes a favourable outcome of multiple pregnancy achieved after using assisted reproductive technologies and donor egg in a patient with recurrent pregnancy loss and combined thrombophilia.

AIM: To evaluate the results of selective approach for splenic flexure mobilization (SFM) after total mesorectal excision with low colorectal anastomoses. MATERIAL AND METHODS: Clinical data were obtained from the multicenter RCT database comparing ileostomy and colostomy in patients with rectal cancer who underwent total mesorectal excision from 2012 to 2017. Our clinic policy is performing paraaortic lymph node dissection with 'low' inferior mesenteric artery ligation, left colic artery preservation and use of sigmoid colon for colorectal anastomosis. SFM was used only in cases of inability to apply above-mentioned procedure (selective approach for SFM). RESULTS: SFM was performed in 15 (13%) out of 115 patients. The most frequent reasons for SFM were sigmoid colon diverticulosis, impaired blood supply or inadequate length of sigmoid colon. There were no differences in intraoperative and postoperative complications between TME without SFM and TME with SFM. CONCLUSION: Selective SFM in TME followed by advanced paraaortic lymph node dissection and left colic artery preservation is safe and may be considered as a viable option to routine SFM in rectal cancer surgery.

BACKGROUND: The relevance of this ensues from the fact that despite the numerous currently available health promotion training programs for the reduction of body weight, there is still the need for the development of the new forms of the efficacious physical training programs and the methods of motivation for compliance with them among the people of different age, sex and social status. AIM: The objective of the present study was to determine the role of motivational factors, including the assessment of the biological age, in the improvement of the effectiveness of the health promotion training programs for the reduction of the excess body weight. MATERIAL AND METHODS: A total of 82 students with overweight and first-degree obesity at the age from 17 to 21 years (average age 18.5±1.4 years) were examined. 42 girls included in the first (main) group spent 9 months performing health promotion training programs on an individual basis developed taking into consideration the motivational factors. The physical training programs included the aerobic exercise in the form of dance classes. 40 students in the control group were engaged in physical training envisaged by the academic curriculum of the university. The third group (the group of comparison) was comprised of 36 practically healthy girls having the normal body weight. We studied the components of the body composition with the use of bioimpedanceometry, evaluated the physical working capacity (the PWC-170 test) and the adaptive reserves of the body (heart rate variability test as proposed by R.M. Baevskyi, Garkavi test). In addition, the psycho-emotional status of the participants was estimated making use of the Lusher test and SAN. The biological age was determined by the original method based on the combination of the morphological and functional indices. RESULTS: The excess body weight in the students comprising group 1 was reduced by 10% on the average; simultaneously the physical working capacity among these students increased by an average of 24.5% while the level of emotional stability and self-esteem increased by 20% and 24%, respectively. We also documented a decrease in the initially increased biological age by 5 years on the average. The students included in group II did not experience any significant changes in the parameters of interest. CONCLUSION: The consideration of the motivational factors for the development of the training programs designed to promote the reduction of the excessive body weight significantly increases their effectiveness, as evidenced by the improvement of the morpho-functional and psychological characteristics in the students of the first group and its absence in their counterparts included in group II.

© 2018 Voprosy Sovremennoi Pediatrii - Current Pediatrics. All rights reserved. The problem of dosing drugs at an early age is conditioned by specific metabolism of medicinal products (MP) in the child's body. Currently, there are a few clinical trials on the study of physiological characteristics in different periods of childhood and systematised data. It is still relevant to understand the characteristic differences that affect the bioavailability, distribution and excretion of MP, especially in children over one month of life. The results of such studies are necessary in order to formulate the recommendations for use of MP in children taking into account their age and compensate for the lack of data from direct clinical trials in pediatrics. The possibility of using a dose calculation method regarding the fat content of the body in different periods of childhood and the chemical properties of the substance has been discussed.

© 2018 Vitebsk State Medical University. All rights reserved. Objective: To study the efficacy and to establish expedience of antibiotic treatment for diverticulitis. Methods: The retrospective analysis of 141 medical histories was made of patients with acute uncomplicated diverticulitis, who were treated during the period from 2013 to 2016 years. Antibiotics were prescribed to treat 85 (60.3%) patients (the main group), 56 (39.7%) patients (the control group) were not given antibacterial drugs. To assess the treatment effectiveness, a dynamic assessment of the clinical picture and laboratory indicators was performed. In the long-term period patients were questioned to determine the nature of the course and the occurrence of relapses of diverticulitis. Results: The duration of hospitalization of the main group patients was 10.8+3.2 days (M+o), control -11.2+2.6 days (M+o), p>0.05. During the treatment, disease progression was registered in none of the patients. In the main group the body temperature was normalized after 1.6 + 0.4 days, in the control group after 1.7+0.3 days, p>0.05. The level of leukocytes came back to normal in the main group at 2.7+0.8 days, in the control group at 2.9+0.7 days (p>0.05). Long-term results were evaluated in 82 (96.5%) of patients and 55 (98.2%) in the control group. Use of antibiotic treatment in diverticulitis had no effect in the remote period for redevelopment of complications (OR 1.19; CI 0.58-2.44), the need to seek medical care (OR 1.11; CI 0.52-2.34), need for hospitalization (OR 0.95, CI 0.3-2.96) and surgical treatment (OR 1.36, CI 0.34-7.69). Conclusions: The use of antibiotic treatment for diverticulitis does not affect the outcome of treatment and does not determine the further course of the disease. Taking into account the increasing resistance of microorganisms to antibiotics and the need to optimize costs with limited funding for health care, it is advisable to exclude the use of antibacterial drugs for the treatment of uncomplicated diverticulitis.

© 2018 Izdatel'stvo Meditsina. All rights reserved. Introduction of amendments to the registration dossier is the responsibility of the marketing application holder (MAH). Increased knowledge on pharmaceuticals, its manufacturing and control processes can reduce the number of documents submitted to the regulatory authorities. The existing requirements establishing the procedure for the introduction of amendments differ in terms of change classification, period of notification of regulatory authorities, ways of conformity validation of pharmaceutical properties, etc. ICH proposed draft guideline Q12 «Technical and Regulatory Considerations for Pharmaceutical Product Lifecycle Management» which covers the problem of harmonization of regulatory approaches to the changes provided in the «Quality» section of CTD during the commercial phase of drug life cycle. The new guideline can be considered as the continuation and elaboration of previous ICH documents. The article provides explanations on the main provisions and regulatory mechanisms introduced by the draft guideline ICH Q12: categorization of post-approval changes, established conditions, post-approval change management protocol, and drug product lifecycle management.

© 2018 Stolichnaya Izdatelskaya Kompaniya. The article presents a clinical observation of the left atrial appendage thrombosis in a 51-year-old female patient with a paroxysmal form of nonvalvular atrial fibrillation which occurred despite long-term anticoagulant therapy with apixaban in a full dose (5 mg b.i.d.), and the patient's management. The patient was admitted with recurrent symptomatic paroxysm for more than 48 hours, because of which, in accordance with the recommendations, transesophageal echocardiography was performed before an emergency rhythm restoration. Thrombus in the left atrial appendage 0.5×1.03 cm in size was detected. It was decided to refrain from the immediate restoration of the rhythm due to the very high risk of thromboembolic complications. In connection with the categorical refusal of the patient from warfarin, it was decided to replace apixaban with another direct oral anticoagulant - dabigatran 150 mg bid for a period of 4 weeks followed by performing a control transesophageal echocardiographic study. As a result, no thrombus was found on control echocardiography. The particularity of this observation is concomitant hypertrophic cardiomyopathy and diabetes mellitus type 1 in this patient..

© 2018 Pirogov Russian National Research Medical University. All rights reserved. Perioperative antimicrobial prophylaxis (PAP) involves administration of antimicrobial agents (AMA) to patients undergoing a surgical intervention and aims to reduce the risk of postoperative infectious complications, especially at surgical sites. In the present work we assess efficiency and safety of AMA used for prevention of postoperative infectious complications. In the course of our study we pre-analyzed 576 medical histories of post-op patients aged 18 to 87 years (mean age M ± SD was 57.4 ± 14.5 years), of which 347 (60.2%) were male and 229 (39.8%) female. Only 481 histories were selected for final analysis. We assessed the choice of antibacterial therapy, the frequency of adverse reactions (AR) and infectious complications and the type of the latter. PAP regimens were consistent with the official guidelines in 207 (43.04%) cases. PAP recommendations were ignored in 274 cases (56.96%), and the timing was wrong in 364 cases (75.7%). Incorrect dosages were administered in 225 cases (46.8%). We also discovered an association between irrational PAP regimens and 1) the length of patient's stay in the intensive care unit (p = 0.003 and p < 0.005), 2) the frequency of reoperations associated with infection (p = 0.001), 3) mortality rates (p = 0.002), and 4) isolation of strains with multidrug resistance (p = 0.016). We conclude that PAP regimens for the inpatients of surgical wards are often compromised by failure to comply with the official guidelines, wrong timing and incorrect dosage, which negatively affects hospital statistics.

© 2018 Medical Education. All rights reserved. Clinical signs and course of pulmonary disease of Fedor M. Dostoevskiy (1821 - 1881) has been analyzed in the article on the basis of memoirs of contemporaries and physicians who followed the writer up to the end of his life. Diagnostic hypotheses of the disease and the cause of death have been discussed.

© 2018 Limited Liability Company KlinMed Consulting. All Rights Reserved. The article discusses various mechanisms of developmentt and progression of arterial hypertension in young and middle aged adults. It emphasizes the predominant role of hypersympathicotonia in the development of the disease in this category of patients. Various mechanisms are considered, by means of which the increase of activity of the sympathetic nervous system leads to elevation of arterial pressure and potentiates early damage of target organs, first of all, damage of the heart. The data of numerous studies demonstrating pronounced cardioprotective effects of a highly selective representative of the class of β-blockers bisoprolol in young and middle aged hypertensive patients are presented.