Gene polymorphisms associated with lipid metabolism disorders in young adults with risk of ­sudden cardiac death

Aim. To study the frequency of polymorphisms in genes associated with lipid metabolism disorders in young people with risk of sudden cardiac death, to identify the relationships between gene polymorphisms and risk factors of sudden cardiac death, and to develop mathematical models to identify the probability of carrying mutations in these genes. Methods. The study included 436 young people (mean age 19.81.6 years). A standard examination and survey by questionnaire specially developed by us were conducted to identify an increased risk of sudden cardiac death. 59 individuals with a risk of sudden cardiac death were selected. The control group was 65 people, which was comparable to the study group. A blood test was performed to determine lipid profile and polymorphisms: Leu28Pro (rs 429358) in gene APOE, C3238G (rs 5128) in gene APOC3, Gln192Arg (rs 662) in gene PON1, Ser447Ter (rs 328) in gene LPL, G250A (rs 1800588) in gene LIPC. Statistical analysis was performed using the statistical package SPSS 17.0 and Statistica 6.0. The parametric KruskalWallis test, the MannWhitney U-test, the Pearsons chi-squared test, the Spearman rank correlation coefficient, and logistic regression analysis were used. Results. We revealed a high frequency of Gln192Arg (rs 662) polymorphism in the PON1 gene in the group of individuals at risk of sudden cardiac death and its correlation with the deaths in relatives under age 50 years. Mathematical models for predicting the presence of polymorphisms in genes associated with lipid metabolism disorders have been developed. Among the developed mathematical models, the models for identifying carriers of the minor allele of Gln192Arg polymorphism in the PON1 gene, Ser447Ter in the LPL gene, and 250 GA in the LIPC gene had the highest sensitivity, specificity, and accuracy. Conclusion. In persons at risk for sudden cardiac death, it is advisable to conduct a screening for mutations in genes associated with lipid metabolism disorders, especially in Gln192Arg polymorphism in gene PON1.

Chronic obstructive pulmonary disease: an urgent problem of health saving of modern medicine

Chronic obstructive pulmonary disease is one of the most urgent problems of the modern medical community. Despite the introduction of constantly updated schemes of early diagnosis and treatment into practical medicine, there is still an upward trend in the number of cases, under-examined persons, and prognostically unfavorable outcomes. The review highlights the findings of epidemiological studies confirming the widespread prevalence of the disease, accompanied by rapid disability progression, high mortality, and significant economic damage. The review lists the main exogenous and endogenous risk factors for the development of chronic obstructive pulmonary disease, including occupational etiology. Attention is drawn to the possibility of disease prevention in a professional environment with the proper motivation of the patient and the application of economic efforts. The article discusses the main causes of underdiagnosis and late diagnosis of the disease. Lifestyle modification makes an undeniable contribution to the prevention of chronic obstructive pulmonary disease and improving prognosis in the developed disease. Certain psychological characteristics that reduce adherence to treatment of such patients should be considered in organizing the management of this category of persons and creating special schools. It is important to create a classification of endotypes of chronic obstructive pulmonary disease, as well as sufficient public awareness about this disease with the aim of the earliest possible diagnosis.

Preventive esophagomyobronchoplasty as a method to prevent the failure of the bronchial stump in pneumonectomy for lung cancer

Aim. Comparative analysis of insufficiency rate of bronchial stump sutures in pneumonectomy for lung cancer, depending on suturing techniques. Methods. A patented technique for bronchial stump suturing has been introduced into the practice of the GOBUZ clinic Novgorod Regional Clinical Hospital based on the Department of thoracic surgery since 2015 for pneumonectomy for lung cancer. Before the introduction of the developed technique, various generally accepted methods of bronchial stump forming were used (mechanical suture, manual suture, their combination, bronchial stump coverage with mediastinal pleura, pericardial flap). A retrospective analysis of 173 case histories and operational protocols of patients with lung cancer who underwent pneumonectomy was carried out for the failure of bronchial stump sutures when using conventional suturing techniques between 2010 and 2014 (the first group of patients). We also performed a retrospective and prospective analysis of 204 case histories and operational protocols of patients in a similar clinical group when using a patented suturing technique between 2015 and 2020 (the second group of patients). Statistical analysis was carried out by using Statistica 10.0 software (StatSoft, Inc. 2011). The qualitative and quantitative indicators were analyzed by using the Pearsons 2-test with Yatess correction. Results. A retrospective analysis shows that the failure rate in the use of generally accepted bronchial stump suturing techniques for 20102014 was 10.4%. After the implementation of the method of preventive esophagobronchomyoplasty, complications as bronchial stump suture failure were not detected in any case between 2015 and 2020. Conclusion. The study shows high efficiency, a decrease in the incidence of complications as the failure of bronchial stump sutures in the use of the developed method of preventive esophagomyobronchoplasty in pneumonectomy for lung cancer.

Study of indicators of the immune status in HIV-infected patients with concurrent allergic pathology

Aim. To study the indicators of the immune status and manifestations of allergic diseases in HIV-infected patients in the Novgorod region. Methods. We studied the data of HIV-infected patients living in the Novgorod region for the years 20002021. A total of 1020 cases of HIV infection were studied, in which 121 (12%) patients were diagnosed with allergic reactions. In patients with allergic manifestations, the human immunodeficiency virus type 1 ribonucleic acid content was measured by the polymerase chain reaction method, and the indicators of the immune status (the content of lymphocytes, eosinophils, basophils, the levels of CD3+, CD3+CD4+, CD3+CD8+ cells, immunoregulatory index) were assessed. For statistical analysis, the Student's test (t) was used to assess the statistical significance of differences in immune status indicators, and the Pearson 2 test to assess the statistical significance of differences in allergic manifestations in patients with HIV. Results. The subjects of the study were divided into 2 groups based on the levels of HIV viral load. Analysis of these groups using the Pearson 2 test showed a statistically significant (p 0.012) correlation between high viral load and the development of drug hypersensitivity reaction in HIV-infected patients. The following etiology of allergic reactions was determined among the subjects: drug (59%), food (19%), pollen (5.7%), household (5.7%), chemical (1.9%), unspecified (6.7%). The study of the immune status in two groups did not reveal statistically significant differences (p 0.05). The study of the immune status indicators in HIV-infected patients with drug hypersensitivity reactions and different levels of viral load revealed a significantly higher level of CD3+ cells (p 0.003) in patients with drug hypersensitivity reactions and detectable viral load. Conclusion. The study revealed statistically significant differences in the immune status of HIV-infected patients with drug hypersensitivity reactions living in the Novgorod region compared with HIV-infected patients without drug allergies.

Viktor Vasilievich Trusov — organizer of endocrinology service of Izhevsk

The article is devoted to the 85th anniversary of Professor Viktor Vasilyevich Trusov (19362012), one of the prominent representatives of the therapeutic, scientific school of the Izhevsk State Medical Academy. In the range of diverse scientific interests and developments of Viktor Vasilyevich, a significant part was the issues of practical support to patients with endocrinological pathology, including patients with diabetes mellitus. Professor V.V. Trusov was a member of the Board of Russian Association of Endocrinologists, a member of the European Association for the Study of Diabetes, a member of the American Diabetes Association, worked on the problems of optimizing care for patients with diabetes. The article highlights the diabetology segment of the endocrinology service in Izhevsk on the materials of the endocrinological department of the State Clinical Hospital No. 6. The role of Professor Viktor Vasilyevich Trusov in the organization of the endocrinological center of Izhevsk, the viability of the methodological guidelines and recommendations laid down by him in the organization of care for patients with diabetes mellitus was noted. The organization of the work of the endocrinology center are considered. The analysis of the main indicators of the prevalence of diabetes mellitus was carried out according to the data of the endocrinology department (20172020). The special place of the diabetic foot clinic in the work of the center is highlighted. Modern and original methods of management of such complications of diabetes mellitus as diabetic foot syndrome are presented.

Standardization in regulating artificial intelligence systems in Russian healthcare

Artificial intelligence technologies in medical practice are a promising direction in the world. Artificial intelligence medical decision support systems, diagnostic and screening programs can help medical personnel in routine and complex tasks and improve the level of medical care provided to patients. At the same time, the development, production and distribution of artificial intelligence systems must be regulated without fail. Registration and subsequent control (post-registration monitoring) of artificial intelligence systems in medicine require the creation, adjustment of the legal framework and technological regulation. The Russian Federation has developed a promising development strategy in this area. Seven national standards have been developed by experts in the field of Artificial intelligence in healthcare. These standards establish the procedures for conducting clinical and technical trials, performance requirements and the concept of life cycle, a quality management system and risk management. Aseparate standards is devoted to dataset creation for training and testing the developed algorithms, requirements for them and a metadata format. There are plans to bring the developed national standards to the international level, which will allow Russian manufacturers of artificial intelligence systems implemented these national standards to comply with foreign counterparts and become more competitive at the international level. The international community has already supported the development of an ISO standard based on the national standard for clinical trials. The development will be performed based on the technical committee ISO/TC215 (Health informatics) in conjunction with ISO/IEC JTC1/SC42 (Artificial intelligence), this will allow bringing the national requirements for the Artificial intelligence to the international level. The cycle of these standards will summarize recognized methodologies, helping both manufacturers and medical organizations, doctors and patients to produce and use aquality, safe and effective product.

Results of osteopathic treatment of infants with psychomotor developmental disorders

Aim. To compare the effectiveness of osteopathic treatment of infants with psychomotor development disorders with standard treatment in terms of functional status. Methods. The study was conducted at the Yaroslav-the-Wise Novgorod State University and the Institute of Osteopathic Medicine named after V.L. Andrianov, between 2020 and 2021. The study included 49 children with delayed psychomotor development, of which: the main group consisted of 26 children receiving osteopathic treatment; the control group consisted of 23 children treated with standard therapies. Data gathered included the indicators of the functional health state, complaints of parents, assessed neurological, vegetative, and osteopathic statuses, the psychomotor development in the children according to the ZhurbaMastyukova scale, performed neurosonography. The results were processed using descriptive statistics followed by checking for the significance of the difference by using the Student's t-criterion for related samples. Results. A comparison of the effectiveness of osteopathic and standard treatment of infants with a delay in psychomotor development by indicators of the functional status was carried out. The need for an integrated approach to therapeutic and diagnostic procedures was substantiated. The number of subjective complaints about the health of children from parents in the main group decreased, while in the control group, it remained the same. Neurological status in children of both groups improved, but the changes are more pronounced in the main group (p 0.05). The outcomes of the treatments indicate for improving psychomotor development of the children in the main group, in the control group, such an increase was only 13.0% (p 0.001). Conclusion. The results of the study showed that osteopathic treatment of infants with psychomotor development disorders is more effective than standard complex treatment, which is reflected in the improvement of functional health indicators.

Concomitant diseases in COVID-19 and their impact on the risks of adverse outcomes

Aim. To analyze COVID-19 comorbidities and their impact on disease course and the risk for unfavorable outcomes. Methods. This study examined a group of 110 patients aged 32 to 97 who were admitted to the intensive care unit of the Pskov Regional Infectious Diseases Hospital in the period from October 7, 2020 to March 23, 2021. The mean age of patients was 65 years, 51% (56 people) were male. The study recorded age, comorbidities on a binary scale (yes no), course of the disease, the degree of lung injury, hospital length of stay, treatment outcome. The impact of comorbidities on the disease severity and outcomes was assessed by using logistic regression analysis. Results. It was shown that a regional sample of patients showed an increased hospital mortality rate compared with the data of the ACTIV registry (33.5 versus 7.6%). Chronic respiratory diseases in patients with COVID-19 regional cohorts affected the fatal outcome 2.7 times less than those registered in the Russian register. The presence of endocrine and thrombotic circulatory system diseases was generally close to the register. Concomitant cardiovascular diseases in patients of the regional cohort affected the mortality of COVID-19 outcomes two times less (in patients of the region, the risk of mortality increased by 2.066 times) than in the registry. The reliability of the conclusions is confirmed by testing statistical hypotheses and reliability coefficients below 5%. Conclusion. The study shows the statistically significant effect of comorbidities on the COVID-19 outcomes; the specificity of the results related to the sampling characteristics and the regional component.

Medicines and life (to the 100th anniversary of Professor Irina Vitalievna Zaikonnikova)

Irina Vitalevna Zaikonnikova is a well-known Soviet pharmacologist, headed the Department of Pharmacology of the Kazan State Medical Institute between 1968 and 1989. The topic of I.V. Zaikonnikovas Ph.D. thesis was The influence of dikain on blood vessels and its relationship with adrenaline. In her dissertation, Irina Vitalievna found that dicaine dilates blood vessels in low concentrations and causes their constriction in high concentrations. The thesis was successfully defended in 1947. In the 50s of the last century in Kazan, for the first time in the Soviet Union, the study of the biological activity of organophosphorus compounds was begun. A large experimental material concerning the correlation between the biological activity and chemical structure of compounds was summarized in his doctoral dissertation Pharmacological characteristics of a number of dialkylphosphinic acid esters, which I.V. Zaikonnikova defended in 1968. At the Department of Pharmacology, which she headed since 1968, a close-knit team was formed, united by a common interest the search and development of new potential drugs. This major work resulted in the creation of cidiphos, glycifon, phosphabenzide, and dimephosphon organophosphorus compounds of a new type, which mechanism of action is not associated with inhibition of the activity of acetylcholinesterase. In addition, drugs that did not belong to organophosphates were created the daytime tranquilizer mebikar, a regeneration stimulator with the immunomodulatory effect of xymedon. At present, the Department of Pharmacology of Kazan State Medical University continues the scientific traditions of our outstanding predecessors.

Neurological aspects of COVID-19

The coronavirus disease COVID-19 began to spread worldwide in December 2019 from the city of Wuhan (China). COVID-19 is often accompanied by fever, hypoxemic respiratory failure and systemic complications (for example, gastrointestinal, renal, cardiac, neurological, and hepatic lesions), thrombotic phenomena. Central nervous system damage is caused by the primary effect on it, direct neuroinvasion of the virus, and more often by secondary effect due to systemic hyperinflammation. Neurological manifestations include fatigue, headache, insomnia, and olfactory/taste disorders. Neurological manifestations and complications of COVID-19 are diverse: (1) cerebral circulatory disorders, including ischemic stroke and macro/microhemorrhages; (2) encephalopathy; (3) para/postinfectious autoimmune complications, such as GuillainBarre syndrome; (4) meningoencephalitis; (5) neuropsychiatric complications (psychosis and mood disorders). In terms of pathogenesis, neurological disorders in COVID-19 can be caused by neurotropicity and neurovirulence of SARS-CoV-2, cytokine storm, hypoxemia, homeostasis disorders, as well as their combined effects. COVID-19 adversely affects the course and prognosis of chronic neurological disorders in comorbid patients. The review highlights the need for vigilance to early neurological complications in patients infected with SARS-CoV-2 and other coronaviruses, especially since some neurological complications may precede respiratory manifestations.