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Vol 28, No 3 (2022)

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Original Research Articles

Personalized approach to early diagnosis of acute schizophrenia: an observational comparative study

Pugacheva M.E., Aleshkina G.A., Bardenshteyn L.M., Beglyankin N.I.


BACKGROUND: An acute schizophrenic episode often meets the diagnostic criteria for the ICD-10 category acute and transient psychotic disorders (ATPD, F23), which includes clinically similar conditions of diverse etiologies. The presence of schizophrenic negative symptoms in ATPD signifies their nosological affiliation and determines the therapeutic tactics. Early recognition of the schizophrenic etiology in the first episode of psychosis may contribute to the development of a personalized approach for the management of patients with acute psychotic disorders.

AIM: To evaluate the relationship between the developmental characteristics of psychosis and identify the negative symptoms after its reduction in patients with ATPD with the symptoms of schizophrenia.

MATERIALS AND METHODS: This observational single-center selective comparative study was conducted during 2018–2020. The clinical-psychopathological method was applied to examine patients hospitalized in a psychiatric hospital with ATPD presenting with the symptoms of schizophrenia (F23.1). In order to objectify the results of the study, the positive and negative syndrome scale was used.

RESULTS: The study involved 60 patients (50 men, 10 women) aged 18–46 years (mean age: 21.4±6.0 years). Depending on the presence of negative symptoms after the psychosis reduction at 4 weeks of therapy, the study sample was divided into two groups: 1) the group with negative symptoms (NS+; n=41); 2) the group without any negative symptoms (NS–; n=19). Individuals presenting with negative symptoms were distinguished from those without it based on the more frequent presence of prodromal disorders, subpsychotic, and, particularly, mild negative disorders at the prodromal stage, prolonged development, and long-drawn course of psychosis. The likelihood of negative symptoms detection after the reduction of psychosis was associated with a family history of schizophrenia and other psychiatric disorders, low premorbid social adjustment, prodromal symptoms, and impaired functioning, as well as with a longer duration of psychotic symptoms and its slow development.

CONCLUSION: The likelihood of negative symptoms after the reduction of ATPD with symptoms of schizophrenia was associated with hereditary and premorbid characteristics of patients, prodromal psychopathological and functional abnormalities, as well as the clinical and dynamic characteristics of psychosis. The data obtained from this study may contribute to the early recognition of schizophrenia-spectrum disorders and to the development of a personalized approach for the management of patients with ATPD.

Medical Journal of the Russian Federation. 2022;28(3):181-192
pages 181-192 views

Transformation of the ambulance service during the COVID-19 pandemic: correlation and thematic analysis

Kulikova I.B., Moskvina S.S.


BACKGROUND: Ensuring the availability and quality of an ambulance service, including specialized ambulance, medical care, and specialized medical care in emergency and emergency form for fatal diseases, accidents, injuries, poisoning, and other conditions that require urgent medical intervention is an integral part of the national security system and one of the most important areas of health development in the Russian Federation. During the COVID-19 pandemic, such tasks appeared in the organization of emergency and emergency medical care for patients as a prompt distribution to inpatient departments, considering the severity of the patients’ condition, their covid status, and the availability of free places in medical organizations in a specific region, compliance with the waiting time prescribed for emergency medical care, and cutting off the «non-core» calls.

AIM: To determine the optimal organizational structure of the ambulance service in the subject of the Russian Federation.

MATERIALS AND METHODS: Collection and statistical processing of information regarding the work of ambulance services in a specific region were carried out. Correlation-thematic analysis using the Pearson’s coefficient was performed.

RESULTS: During the «under covid» period from 2016 to 2019, the overall mortality rate showed a clear downward trend. However, during the pandemic, even without taking into account the excess mortality, there was an increase, while, in 2020, when compared with 2019, the increase was >12%. Moreover, despite the increase in excess mortality in 2021 relative to that in 2020 by almost four times, the total mortality (excluding COVID) remained almost at the same level. In addition, it should be noted that, in regions where the ambulance service was represented by a single legal entity during the epidemic, excess mortality was lower in comparison with that in the regions where ambulance service was represented by departments within the Central District hospitals.

CONCLUSION: The period of the coronavirus epidemic has largely transformed the healthcare system. The presence of a Unified Dispatching Service or a unified ambulance service in a region has a positive effect on the quality indicators of its healthcare system. In addition, the formation of new units in the structure of the ambulance service, such as a department for remote counseling, allows not only to ensure more accessibility to patients but also to effectively use the financial resources of an institution.

Medical Journal of the Russian Federation. 2022;28(3):193-199
pages 193-199 views


Interleukin-18 and cardiovascular diseases: a literature review

Alieva A.M., Teplova N.V., Lyalina V.V., Shnakhova L.M., Arakelyan R.A., Skripnichenko E.A., Valiev R.K., Rakhaev A.M., Shavaeva M.Y., Nikitin I.G.


Cardiovascular disease is a serious problem of modern healthcare, which is one of the leading causes of general mortality, reduction and loss of ability to work, as well as disability. The search and the study of new cardiovascular biological markers can allow the optimization of the diagnosis of cardiovascular diseases, development of laboratory tools for assessing the effectiveness of a treatment, and improving the prediction of possible adverse clinical outcomes.

The purpose of this review was to promote the consideration of interleukin-18 (IL-18) as a diagnostic and prognostic marker in cardiovascular pathology. For the first time, K. Nakamura et al. in 1989, described IL-18 and interferon-gamma (IFN-γ-inducing factor, IFN-γ-inducing factor, IGIF) as a new, previously unknown factor that induces the production of IFN-γ. Data obtained from rodent models and clinical studies have demonstrated that IL-18 is involved in the pathogenesis of several diseases, immune-inflammatory rheumatic conditions, systemic vasculitis, cardiovascular diseases, malignancy, central nervous system pathologies, inflammatory bowel disease, psoriasis, and diseases of the kidneys and lungs. In animal models of acute myocardial infarction, pressure overload, and left ventricular dysfunction, IL-18 has been demonstrated to increase cardiomyocyte hypertrophy, induce cardiac contractile dysfunction, and extracellular matrix remodeling. It is therefore expected that further scientific and clinical studies can demonstrate the possibility of using IL-18 as an additional laboratory tool for the diagnosis, risk stratification, and prediction of cardiovascular events in patients with a cardiac profile. The effect of blockade of this cytokine on reducing morbidity and mortality in patients with cardiovascular diseases remains to be assessed for more detail, while considering reasonable economic costs and the side effects of drugs.

Medical Journal of the Russian Federation. 2022;28(3):201-214
pages 201-214 views

Relationship of proliferative diabetic retinopathy and severe stages of chronic renal failure

Golovin A.S., Belikova E.I.


Diabetic nephropathy, as a frequent complication in patients with diabetes mellitus (DM), is increasing due to the rapid increase in the prevalence of diabetes, which is considered one of the leading causes of chronic renal failure (CRF). Diabetic retinopathy (DR) and diabetic nephropathy are the two main microvascular complications of DM. Studies show that the prevalence and severity of visual pathology is significantly higher among patients with severe stages of CRF, which is associated with the following risk factors: hypertension, metabolic disorders, uremia, anemia, and the use of anticoagulant therapy. The leading forms of eye pathology in patients with DR and CRF are proliferative DR, macular edema, and vitreous hemorrhage. The main structural changes in the choroid and retina in patients with CRF are the thickness of the choroid, accompanied by a decrease in the density of vessels and the volume of perfusion in the surface capillary layer of the choriocapillaries, which is aggravated with the aggravation of the stage of the disease and is interconnected with impaired renal function. Literature data indicate a positive effect of the hemodialysis procedure on DR. It should be borne in mind that in patients with end-stage chronic renal failure, a hemodialysis session may be accompanied by pain in the eye associated with an increase in blood pressure. Interdisciplinary collaboration between nephrologists and ophthalmologists will ensure improved and adequate treatment of patients with CRF and proliferative DR.

Medical Journal of the Russian Federation. 2022;28(3):215-221
pages 215-221 views

Dysthymia: nosology, systematics, clinical and social significance: а literature review

Mashkova I.Y., Osipova N.N., Aleshkina G.A., Beglyankin N.I., Slavgorodsky J.M.


The issues of nosology, systematics, and clinical and social significance of dysthymia are a serious problem of modern medicine. Dysthymia significantly contributes to the structure of depressive disorders. Although its symptoms are mild, the disease is associated with high risks of disability, concomitant health problems, and mortality. There is no established system of classifying and diagnosing chronic mild depression. This review presents epidemiological data, historical review, and nosology, along with the assessment of persistent depressive disorder. Full-text articles and fragments of monographs selected by keywords in the databases Scopus, Web of Science, MEDLINE, RSCI, Psychiatrist, ScienceDirect were used for research.

Medical Journal of the Russian Federation. 2022;28(3):223-236
pages 223-236 views

Case reports

Kinesiotaping in cerebral palsy rehabilitation

Kiselev D.A., Andronova L.B., Levkov V.Y., Panyukov M.V., Tokhtieva N.V., Laisheva O.A., Milovskaya T.V., Lobov A.N., Polyaev B.A.


BACKGROUND: Cerebral palsy is a disease caused by a perinatal lesion of the central nervous system (CNS) characterized by a violation of static and dynamic functions. The combination of speech, motor, and mental disorders indicate the need for a comprehensive approach to disease treatment. Numerous studies have been devoted to functional disorder restoration and orthopedic correction in children with cerebral palsy. Among the publications devoted to the rehabilitation of children with cerebral palsy, there are no works with the leading role of kinesiotaping. This work is related to the need to revise the method application in cerebral palsy, considering the laws of regulatory activity of the CNS and the pathological disease physiology.

AIM: This study aimed to demonstrate a highly effective approach to kinesiotaping application from the physiology point of view and the laws of pathological regulatory dependence of the CNS in cerebral palsy.

MATERIALS AND METHODS: We have observed 157 patients diagnosed with: «Spastic diplegia (Little's disease), double hemiplegia, hemiparetic form of cerebral palsy, hyperkinetic form of cerebral palsy; atonic-astatic form of cerebral palsy (classification according to K.A. Semenova)". We used a clinical neurological and orthopedic examination with an assessment of motor development according to the scale of ontogenetic development, standard scales and tests for assessing the state of the muscles. Taping courses were conducted as a rehabilitation method.

RESULTS: The study results revealed numerous improvements in the clinical picture of cerebral palsy in completely different disease forms and the pathology severity. Some regularities of the method application have been developed and formulated at the Department of Rehabilitation, Sports Medicine, and Physical Culture of the Pirogov Russian National Research Medical University (Moscow) since 2011 and its effectiveness has been confirmed by interested specialists in improving the effectiveness of rehabilitation programs for cerebral palsy.

CONCLUSION: The kinesiotaping technique has a pronounced effect on many acts of physiological activity that are not related to the motor activity of the CNS. The taping method results have a long-lasting effect, fixed by changes in the work of the CNS over a subsequent long period (at least 3–6 months). From our point of view, teaching kinesiotaping to parents of children with cerebral palsy ensures the continuity of the rehabilitation treatment process, as well as the possibility of long-term dynamic monitoring of patients to assess the effectiveness of the method.

Medical Journal of the Russian Federation. 2022;28(3):237-248
pages 237-248 views

Historical Article

Formation and development of the Voronezh scientific and pedagogical school of hygienisits

Chernykh N.Y., Fertikova T.E., Skrebneva A.V., Melikhova E.P., Libina I.I.


This article is devoted to the history of the Voronezh hygienic school formation. The most important milestones defining the main component in the development of this hygienic scientific and educational direction are presented. The history of the school of hygienists formation is inextricably linked with the establishment of the Voronezh Medical University and the Department of General Hygiene. Across the years, the department was headed by Shepilevsky E.A., Shapshev K.N., Shtutser M.I., Protodyakonov M.M., Stepanov-Grigoriev I.I., Tkachev T.Ya., De-George L.V., Menin L.G., Pokrovsky V.A., and Faustov A.S. All of them made a significant contribution to the development of practical activities on the prevention and promotion of public health. For a long time, Professors Pokrovsky V.A., Faustov A.S., and Popov V.I. headed the Scientific Society of Hygienists and Sanitary Doctors. The Department of General Hygiene under the leadership of the corresponding member of the Russian Academy of Sciences, Professor V.I. Popov regularly held scientific and practical conferences for hygienists and sanitary doctors, accredited by the Ministry of Health of Russia, as well as actively participated in the publication of the intercluster scientific and medical journal Russian Bulletin of Hygiene. From the educational perspective, much attention needs to be paid for the development of a «hygienic way of thinking» among students and doctors.

The established scientific and pedagogical school of hygienists has created prerequisites for the opening of a preventive medicine faculty at the Voronezh Medical University, whose graduates are in demand both in the practical healthcare and education fields. The main task of trained specialists is to ensure the primary prevention of various diseases by minimizing the risk factors for human health.

Presently, the Department of General Hygiene continues to contribute to the established scientific traditions as well as to the development of the Voronezh Scientific and Pedagogical School of Hygienists through its active work in the fields of education, science, and establishment of relevant national and international organizations.

Medical Journal of the Russian Federation. 2022;28(3):249-258
pages 249-258 views


50 years in publishing

Romanov B.K.


2022 was the anniversary year of work at the Medicina publishing house for Tatyana V. Ivanova, the managing editor of the Medical Journal of the Russian Federation, a person of amazingly many accomplishments, a talented administrator, and a nice and charming woman who took a well-deserved rest on May 25.

Medical Journal of the Russian Federation. 2022;28(3):259-260
pages 259-260 views

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