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Vol 27, No 4 (2021)

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Oral microbiome

Kopetsky I.S., Pobozhieva L.V., Kopetskaya A.I., Shevelyuk J.V.


This study aimed to analyze the characteristics of the oral microbiome in dental caries and inflammatory periodontal diseases based on available data in the modern literature. This article is based on the analysis of materials from international and Russian studies in the PubMed, CyberLeninka, and MedLine databases over the past 15 years. An imbalance in the oral microbiome can develop dental caries and periodontal diseases. Normally, the oral microbiome contains Firmicutes, Proteobacteria, Actinobacteria, Bacteroides, Fusobacterium, and Spirochetes. With dental caries, S. mutans, Atopobium, Propionibacterium, and Lactobacillus are determined. The presence of Veillonella, Porphyromonas gingivalis, Tannerella forsythia, Aggregatibacter actinomycetemcomitans, Treponema, and Prevotella in the oral microbiome is associated with periodontal disease. The oral microbiome database comprises comprehensive data that describe bacterial species and the 16S rRNA that define the set of oral microbes. The microbiome is influenced by local and general factors.

Medical Journal of the Russian Federation. 2021;27(4):365-372
pages 365-372 views

Diagnostic and risk stratification aspects of liver fibrosis progression in chronic hepatitis B and C viral infection

Garbuzenko D.V.


The treatment strategy and prognosis for chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection largely depend on the presence and stage of liver fibrosis. This study aimed to reveal the diagnostic and risk stratification aspects of liver fibrosis progression in patients with chronic HBV and HCV infection. The PubMed database, the Google Scholar search engine, the Cochrane systematic reviews, and the scientific electronic library eLibrary.Ru, as well as the reference lists, were used to search for scientific articles. Relevant aims of the publication review were selected over the period from 2005 to 2021 using the keywords “chronic HBV infection,” “chronic HCV infection,” “liver fibrosis,” “diagnostics,” and “prognosis.” Inclusion criteria were limited to liver fibrosis diagnostics in chronic HBV and HCV infection. Considering biopsy as a gold standard for studying morphological abnormalities in the liver, its indications for serum biomarkers of liver fibrosis and imaging methods assessments are currently significantly limited. Additionally, noninvasive methods are required to monitor the progression of liver fibrosis. The combined use of two unrelated noninvasive methods, for example, transient elastography and one of the serum biomarkers, can improve the accuracy of clinically diagnosing significant liver fibrosis. Considering that the development of liver fibrosis is an unfavorable event in the natural course of chronic HBV and HCV infection, the distribution of patients by risk groups will increase the efficiency of antiviral therapy and improve the disease prognosis.

Medical Journal of the Russian Federation. 2021;27(4):373-384
pages 373-384 views

The use of hyperbaric oxygenation in neurological practice

Damulin I.V.


Hyperbaric oxygenation (HBO) is traditionally considered a widespread additional method of therapy for various diseases that are associated with impaired tissue metabolism. Its use in neurological diseases of various origins is based on the significance of cerebral hypoxia as one of the leading pathogenetic factors. HBO increases blood oxygenation, which intensifies redox processes in tissues, improves cellular metabolism, decreases cerebral edema and intracranial pressure, and, ultimately, improves treatment results for neurological diseases of various pathogenesis. The use of HBO can form highly active oxygen compounds, some of which have antiviral activity. Therefore, taking the increased tissue oxygenation into account, HBO is considered a very promising treatment method for patients with coronavirus disease-2019.

HBO is recommended for carbon monoxide poisoning, stroke and poststroke disorders, dementia (including vascular dementia), and craniocerebral injury, as well as in craniocerebral injury consequences and benign intracranial hypertension. The results of using this method for headaches of vascular origin, polyneuropathies of various origins (including diabetic polyneuropathy), multiple sclerosis, and infantile cerebral palsy are less conclusive.

The existing contradictory opinions regarding the HBO protocol and the indications for the use of this treatment method require further research in this field.

Medical Journal of the Russian Federation. 2021;27(4):385-393
pages 385-393 views

Mental disorders associated with the novel coronavirus infection coronavirus disease-2019

Bardenshteyn L.M., Aleshkina G.A., Pugacheva M.E., Kruglikova I.I.


This study presents data from recent publications on the occurrence of mental disorders during the coronavirus disease-2019 (COVID-19) pandemic and the specifics of providing mental health care under social isolation conditions. The issues of negative psychopathological outcome prevention in persons with high-risk mental disorders are considered, as well as the problems of organizing psychiatric care provision during the pandemic, including the possibility of remote counseling and follow-up. The questions of the pathogenesis of psychopathological symptoms in coronavirus infection are discussed. Particular attention is paid to the adverse effects of COVID-19 therapy, psychotropic drugs interactions, and drug treatment for patients with coronavirus infection. The research results and opinions of Russian and international specialists in the field of mental health that are presented in this review are relevant for medical practitioners working in the pandemic.

Medical Journal of the Russian Federation. 2021;27(4):395-406
pages 395-406 views

Neurological and psychological manifestations and consequences of an acute severe acute respiratory syndrome coronavirus 2 infection

Guryanova E.A., Deomidov E.S., Ilina M.K.


Vital activity restoration in patients with fatigue syndrome after coronavirus disease-2019 and myalgic encephalomyelitis/chronic fatigue syndrome is a priority in the medical rehabilitation of this category of patients. This study aimed to review the literature using Russian and international sources and present data from contemporary studies on symptoms, possible pathophysiology and proposed treatment for neurological manifestations of consequences after an acute severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The recovery level of vital activity after acute infection with SARS-CoV-2 is low, and neurological symptoms persist in many patients. Chronic fatigue syndrome gradually develops in patients with a history of the disease, which subsequently leads to mental disorders, due to decreased physical activity.

Medical Journal of the Russian Federation. 2021;27(4):407-418
pages 407-418 views

Clinical medicine

Optimizing the treatment approach for ST-segment elevation myocardial infarction in the chest leads

Gazaryan G.A., Tyurina L.G., Nefedova G.A., Gazaryan G.G., Zakharov I.V., Chestukhin V.V., Yermolov A.S.


BACKGROUND: The treatment of ST-segment elevation myocardial infarction (STEMI) in both chest and other leads chose a single course of mandatory use of percutaneous coronary interventions (PCI) in the first 12 h from the onset of pain. However, a significant proportion of patients, often older age groups, are hospitalized at later terms. Thus, studying the efficiency of primary PCIs in different age groups is of interest, considering the terms of hospitalization and characteristics of thanatogenesis in the absence of reperfusion therapy and with its use.

AIM: This study aimed to optimize the treatment approach of patients with STEMI in the chest leads using the primary percutaneous coronary interventions (PCI) during hospitalization in the first 12 h and subsequent 12–72 h, taking into account the initial risk of death at different ages groups.

MATERIALS AND METHODS: The study included 804 patients with anterior STEMI, who were admitted to the institute from 2008 to 2017. Early PCI was performed in the first 12 h in 311 patients, whereas 272 patients underwent delayed interventions at hospitalization after 12–72 h; additionally, 221 patients, including 124 cases with coronary angiography with late hospitalization, received drug therapy. In early PCI, the ratio of individuals under 65 years, 65–75 years, and over 75 years were 176, 73, and 62, whereas 164, 66, and 42 in delayed PCI, and 126, 47, and 48 without intervention, respectively. In 26 deceased patients after PCI and 39 patients without interventions, the state of the coronary arteries (CA), the area of left ventricular (LV) lesion, and the cause of death were determined.

RESULTS: The absence of reperfusion therapy in the form of PCI in anterior STEMI was established to lead to a progressive decreased myocardial contractile function and formation of an extensive LV aneurysm and high mortality rate, especially in older age groups. Early PCI preserves the contractile function, prevents the LV aneurysm, and significantly reduces mortality. The use of delayed PCI prevents LV dysfunction progression, limits the formation of LV aneurysm, and reduces mortality, which remains high in the absence of PCI. However, delayed PCI, contrary to early used interventions without age restrictions, is mainly performed for isolated lesions, much less often for multiple lesions that are more often present in elderly and senile people. Severe CA disease in these categories of patients increases the risk of intraprocedural complications. Nevertheless, without PCI, a lethal outcome is inevitable in many of them. Thanatogenesis in anterior STEMI is based on the proximal lesion of the anterior interventricular branch in combination with three-vessel CA disease, which causes an extensive infarction area with fatal complications.

CONCLUSIONS: The delayed PCI, by analogy with early used procedures without limitations, optimizes the treatment approach of MI with ST-segment elevation in the chest leads and minimizes mortality in all age groups.

Medical Journal of the Russian Federation. 2021;27(4):339-347
pages 339-347 views

«Conscious correction of scoliosis and posture disorders» in the complex rehabilitation treatment of degrees 1–3 thoracic spine idiopathic scoliosis

Levkov V.Y., Andronova L.B., Shavyrin I.A., Panyukov M.V., Butorina A.V., Polyaev B.A., Lobov A.N.


BACKGROUND: Severe functional disorders in the internal organs and systems of the body, increased fatiguability, and cosmetic body shape defects that lead to social and psychological problems, as well as the potential adverse effect of the progression of scoliotic deformity, necessitate the constant monitoring and timely treatment of sick children until their bone growth is completed. Thus, early diagnostics of scoliosis and timely combination therapy at the early stages of the disease are required.

AIM: This study aimed to compare the efficiency of spinal deformity correction and apical vertebrae derotation in pediatric patients with thoracic spine idiopathic scoliosis and justification of the use of physiotherapy exercise method, “Conscious correction of scoliosis and postural disorders” (DCS) in children and adolescents with degrees 1–3 thoracic spine idiopathic scoliosis (IS).

MATERIALS AND METHODS: This study included 98 patients with IS under supervision (78 (79.6%) females and 20 (20.4%) males). The average age of subjects was 12.5 years (9–16 years), namely 25 patients aged 9–11 years, 42 patients aged 12–14 years old, and 31 patients aged 14–16 years old. The anatomical type of deformity and its parameters were determined according to radiographs and clinical examination data (81 cases of right-sided thoracic scoliosis and 17 left-sided thoracic scolioses). The angular deformity was assessed according to J.R. Cobb, and the angle of curvature was 7°–36°. At baseline, all patients had active growth bone plasticity of the spine. Depending on the degree of deformity, they were distributed into groups of 37 patients with 7°–16°, 33 patients with 17°–22°, and 28 patients with 23°–36°. The radiograph analyses of the spine were performed in frontal and lateral projections in an upright position (frontal and sagittal plane curvature in degree measurements). Radiography was performed before the complex therapy and 2 years thereafter, which included individual isometric, derotation, respiratory, and other complexes of physiotherapy exercises according to the methods of DCS, K. Schroth, and Chêneau corsetting.

RESULTS: The changes over time of scoliotic deformity angle correction are closely related to the time of diagnosis, which was noted in all patient groups under study.

CONCLUSIONS: Early diagnostics of thoracic spine IS and the use of DCS remedial gymnastics within the program of timely conservative treatment eliminated the disease progression in patients with deformity up to 17°. In the case of IS of 20° and more, the combined use of the Chêneau corset and exercise therapy using the DCS method achieved significant stabilization and correction.

Medical Journal of the Russian Federation. 2021;27(4):349-354
pages 349-354 views

Clinical pharmacology and pharmaceuticals

Comparative pharmacokinetics of levofloxacin in the saliva and blood plasma of patients with pneumonia

Krasnykh L.M., Goroshko O.A., Tsyganko D.V., Berdnicova N.G., Krasnyanskaya V.G., Checha O.A.


BACKGROUND: Levofloxacin concentrations do not always reach desired levels when administered at a standard dose; therefore, measuring levofloxacin levels in the blood plasma or other alternative matrices, such as the saliva, can help clinicians make informed decisions concerning the dosage and mode of administration. Saliva, as an object of research, is of particular interest due to the simplicity and non-invasiveness of sampling for analysis.

AIM: This study aimed to determine the comparative pharmacokinetics of levofloxacin in the blood plasma and saliva of patients with community-acquired pneumonia (CAP) and assess the possibility of using saliva as an alternative sampling matrix in pharmacokinetic studies.

MATERIALS AND METHODS: Levofloxacin concentration in the blood plasma and saliva of patients with CAP and volunteers was determined using high-performance liquid chromatography on an Agilent 1200 liquid chromatography (Agilent, USA) with an ultraviolet detector. Sample preparation of bioassays was performed using protein precipitation. Patients and volunteers took 1 tablet (500 mg dose) of levofloxacin per os in the morning, on an empty stomach. Blood and saliva samples were taken at the initial blood sample and 0.5, 1, 1.5, 2, 3, 4, 6, 8, 10, and 24 h after taking the drug. The pharmacokinetic parameters were determined, namely Cmax as the peak concentration of the drug; Тmax as the time-to-peak concentration; AUC0–t as the area under the pharmacokinetic curve in the range from 0 to the last experimental point on the curve; AUC0–∞ as the total area under the pharmacokinetic curve from zero to infinity; t1/2 as half-life period; MRT as mean residence time of the drug in the blood (h); Cl/F as clearance; and Vss/F as the total distribution volume.

RESULTS: The maximum blood plasma and saliva concentration of patients was reached 1 h after taking the drug and amounted to Сmax=5.98±2.89 µg/ml and Сmax=4.41±3.83 µg/ml, respectively. Additionally, the maximum concentrations in blood plasma and saliva were recorded 1 h after taking the drug as 5.52±3.07 μg/ml and 3.25±0.85 μg/ml, respectively, in healthy volunteers. The correlation coefficient (r) between the mean values of the levofloxacin concentrations in the blood plasma and the saliva of patients with CAP was 0.953 and that of healthy volunteers was 0.977.

DISCUSSION: Pharmacokinetic parameters were calculated based on blood plasma and saliva concentrations. Their comparative analysis revealed almost the same absorption rate from the gastrointestinal tract in patients and healthy volunteers. Correlation-regression analysis revealed a high correlation between the average values of Cmax in saliva and plasma both in the patient (r=0.96) and healthy volunteer group (r=0.98).

CONCLUSIONS: With statistically significant differences in the areas under pharmacokinetic curves in blood plasma and saliva, the remaining pharmacokinetic parameters of saliva and blood plasma did not significantly differ between patients with CAP and healthy volunteers. A significant direct correlation was revealed between the mean concentration and pharmacokinetic parameters in saliva and blood plasma in both groups. The study demonstrated the possibility of using saliva as a biomaterial in the study of levofloxacin pharmacokinetics.

Medical Journal of the Russian Federation. 2021;27(4):355-364
pages 355-364 views

Health care organization and public health

Aspects of the quality of life of children born with the use of assisted reproductive technologies to women of late reproductive age

Kuzmichev K.A., Tyumina O.V., Chertukhina O.B., Polunina N.V.


BACKGROUND: In recent decades, an increasing number of women worldwide have been postponing childbearing, and the birth of children is possible with increasing frequency in late reproductive age only with the use of assisted reproductive technologies. The persistence of this tendency determines the relevance of studying the characteristics of the quality of life of children born as a result of assisted reproductive technologies by women of late reproductive age, as well as subsequent work with factors that affect the quality of life of this group of children.

AIM: This study aimed to analyze and determine the characteristics of the quality of life of children born with the use of assisted reproductive technologies by women of late reproductive age.

MATERIALS AND METHODS: The main group of subjects consisted of preschool children (4–6 years old) born to women over 35 years old (249 children), whereas 248 children of the same age were enrolled as a control group. Conception with the use of assisted reproductive technologies was the main distinguishing feature of the main and control groups. Informed consent was obtained from the parents for the participation of children in the study. The protocol was approved by the local ethics committee of the Samara State Medical University of the Ministry of Health of the Russian Federation. A survey was performed using the Pediatric Quality of Life Inventory (validated Russian version 4.0) parental form for age categories of 2–4 and 5–7 years, as well as a pediatric version for 5–7 years of age.

RESULTS: The quality of life of the main group had significantly lower indicators compared to the control group, with an average score in the general quality of life of 64.5±2.5 and 79.5±3.1 in the main and control group, respective, p=0.047. This is mainly due to the lower values of the communicative aspect and the quality of life in kindergarten. The average quality of life score in the field of communication was 70.4±4.3 and 83.9±3.4 in the main group and control group, respectively. Additionally, the average quality of life score in the kindergarten was 40.3±2.6 and 84.2±3.3 in the main and control group.

CONCLUSIONS: The quality of life of preschool children born with the use of assisted reproductive technologies to women of late reproductive age significantly differs from those in the control group. Children born with the use of assisted reproductive technologies have a comparable quality of life in physical activity and emotional state; however, this group experiences the greatest difficulties in the field of communication, especially in kindergarten with peers. These aspects of functioning require special attention from the parents and pediatricians, as well as adjustments within the health-improving measures that are performed in this group of children.

Medical Journal of the Russian Federation. 2021;27(4):325-332
pages 325-332 views

Retrospective analysis of patients with diabetes in a Multidisciplinary Clinic of the Tashkent Medical Academy in 2018–2020

Ergasheva Z.N., Nuruzova Z.A., Zalalieva M.V., Dustov F.A.


BACKGROUND: Diabetes mellitus (DM) represents a global problem that is characterized by a steady growth worldwide. In different countries and regions, DM prevalence significantly varies, and it is noteworthy that one patient is diagnosed with type II DM per one patient with an undiagnosed disease. The World Health Organization declares the importance of creating a DM register due to a significantly increased number of patients, for the availability of reliable information, such as the registration of new disease cases, and existing complications, laboratory results, and to ensure effective control and monitoring of health status of patients.

AIM: This study aimed to determine the structure of diagnosed DM in 2018–2020 through hospitalization of patients in the endocrinology department of the Multidisciplinary Clinic of the Tashkent Medical Academy.

MATERIALS AND METHODS: Retrospective analysis of medical records of patients with DM who are admitted to the endocrinology department of the Tashkent Medical Academy Multidisciplinary Clinic in 2018–2020.

RESULTS: The territorial-quantitative distribution of patients determined the prevalence of urban patients compared with regional ones. The incidence among males was 1.5 times lower than females. The age analysis showed a high value of morbidity in old age (60–74 years), patients (56%) with the disease period of 1–10 years prevailed in the disease duration, and more than half of patients (58.23%) had degrees 1, 2, and 3 obesity.

CONCLUSIONS: More than half of patients with DM who are hospitalized were residents of the city of Tashkent, and the fifth part of patients lived in the Tashkent region. Among all patients, females were 1.5 times more dominant than males. More than half of the hospitalized patients were elderly people (60–74 years old) and a third were individuals of middle working age (45–59 years old). An increased number of patients with obesity in 2019 and 2020 exceeded the figures in 2018 by 30%. Complications of diabetic foot were recorded on an average of 4.7% of cases for 3 years.

Medical Journal of the Russian Federation. 2021;27(4):333-338
pages 333-338 views

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