THE STATE BUDGET EDUCATIONAL ESTABLISHMENT OF HIGHER PROFESSIONAL EDUCATION “STAVROPOL STATE MEDICAL UNIVERSITY” OF THE MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION
THE INTERNATIONAL SCIENTIFIC CONFERENCE FOR STUDENTS AND YOUNG RESEARCHERS IN ENGLISH «TOPICAL ISSUES OF MEDICINE»
Abstracts
Stavropol – 2016 УДК 611/620:802.0(082) ББК 5 я 431 А 43
THE INTERNATIONAL SCIENTIFIC CONFERENCE FOR STUDENTS AND YOUNG RESEARCHERS IN ENGLISH «TOPICAL ISSUES OF MEDICINE» (Abstracts). Stavropol: StSMU, 2016. – 108 p.
This book includes abstracts of the International Scientific Conference for Students and Young Researches of Stavropol State Medical University and other Russian and foreign educational institutions on topical issues of theoretical, practical medicine and medical biological sciences in English. Managing Editor: V.I. Koshel – Rector of Stavropol State Medical University, Head of the Department of Otorhinolaryngology, D.M.Sc., Professor.
Deputy Managing Editors: K.R. Amlaev – Viсe-Rector for International and Interregional Activities of StSMU, Head of the Department of Medical Prevention, Healthy Lifestyle and NID Epidemiology, D.M.Sc., Professor. E.V. Shchetinin – Vice-Rector for Scientific and Innovative Activities of StSMU, Head ofthe Pathological Physiology Department, D.M.Sc., Professor. A. Ameer Jahan – Patron & Adviser of All India Foreign Medical Graduates Association; Head of Ameer Speciality Clinics, New Delhi, Chennai, Madurai – India; Chairman of “A. J. Trust Educational Consultancy”, India; M.B.B.S, MD, FICA (USA), FRSH (Lond), FRSTM (Lond), PhD (USA), Honoured Professor of StSMU.
The Editorial Board Members: A.B. Hodzhayan – Vice-Rector for Academic Activities, D.M.Sc., Professor of Biology Department of StSMU. S.V. Znamenskaya – Dean of the Foreign Students’ Faculty, Head of the Foreign Languages Department of StSMU, C. Pedagog. Sc., Associate Professor. A. Najeerul Ameen, PhD, President of All India Foreign Medical Graduates Association; Managing Director of “A. J. Trust Educational Consultancy”, India; Managing Director of Ameer Speciality Clinics, New Delhi, Chennai and Madurai, India; President of the International Centre for Medical Education and Research, Chennai, India. O.I. Boyeva – Head of the Scientific Analytical Department of StSMU, D.M.Sc., Professor. V.A. Aksenenko – Head of the Obstetrics and Gynecology Department of StSMU, D.M.Sc., Professor. A. A. Korobkeyev – Head of the Anatomy Department of StSMU, D.M.Sc., Professor. O.V. Vladimirova – Head of International Activities and Marketing Department, C.M.Sc., Associate Professor of General Surgery Department of StSMU. E.V. Eliseyeva – Vice-Dean of the Foreign Students’ Faculty; C.M.Sc., Associate Professor of Normal Physiology Department of StSMU. N.A. Anisimova, C. Pedagog. Sc., Associate Professor of the Foreign Languages Department of StSMU.
Reviewers: N.V. Agranovich – D.M.Sc., Professor, Head of Outpatient Therapy Department, Stavropol State Medical University, the Ministry of Health of the Russian Federation. O. S. Shibkova – Doctor of Philology Sciences, Professor, Head of the Foreign Languages Department for Natural Sciences and Economics, North-Caucasian Federal University, Ministry of Education and Science of the Russian Federation.
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Recommended for publication by the Editorial Committee of Stavropol State Medical University ISBN 978-5-89822-439-4 © Stavropol State Medical University, 2016 Государственное бюджетное образовательное учреждение высшего профессионального образования «Ставропольский государственный медицинский университет» Министерства здравоохранения Российской Федерации
АКТУАЛЬНЫЕ ВОПРОСЫ МЕДИЦИНЫ: МЕЖДУНАРОДНАЯ НАУЧНАЯ КОНФЕРЕНЦИЯ СТУДЕНТОВ И МОЛОДЫХ УЧЁНЫХ НА АНГЛИЙСКОМ ЯЗЫКЕ
Сборник материалов
Ставрополь – 2016 УДК 611/620:802.0(082) ББК 5 я 431 А 43
АКТУАЛЬНЫЕ ВОПРОСЫ МЕДИЦИНЫ: МЕЖДУНАРОДНАЯ НАУЧНАЯ КОНФЕ- РЕНЦИЯ СТУДЕНТОВ И МОЛОДЫХ УЧЕНЫХ НА АНГЛИЙСКОМ ЯЗЫКЕ (сборник ма- териалов). Ставрополь: Изд-во СтГМУ, 2016. – 108 с.
В сборнике представлены тезисы работ Международной научной конференции студентов, молодых ученых Ставропольского государственного медицинского университета и других рос- сийских и зарубежных вузов, посвящённые актуальным вопросам теоретической, практической медицины и медико-биологических наук, на английском языке.
Ответственный редактор: В.И. Кошель – ректор Ставропольского государственного медицинского университета, заве- дующий кафедрой оториноларингологии с курсом ДПО, доктор медицинских наук, профессор. Заместители ответственного редактора: К.Р. Амлаев – проректор по международной и межрегиональной деятельности СтГМУ, заве- дующий кафедрой медицинской профилактики, здорового образа жизни и эпидемиологии НИЗ д.м.н., профессор. Е.В. Щетинин – проректор по научной и инновационной деятельности СтГМУ, заведующий кафедрой патологической физиологии, д.м.н., профессор. А. Амир Джахан – советник Всеиндийской Ассоциации выпускников зарубежных медицин- ских вузов; руководитель Ameer Speciality Clinics, Нью-Дели, Ченнай, Мадурай – Индия; предсе- датель «A.J.Trust Educational Consultancy», Индия; Почётный профессор СтГМУ. Члены редакционной коллегии: А.Б. Ходжаян – проректор по учебной деятельности, д.м.н., профессор кафедры биологии СтГМУ. С.В. Знаменская – декан факультета иностранных студентов, заведующий кафедрой ино- странных языков СтГМУ, к.п.н., доцент. А. Наджирул Амин – к.м.н., президент Всеиндийской Ассоциации выпускников зарубежных медицинских вузов; генералный директор «A.J.Trust Educational Consultancy», Индия; исполни- тельный директор Ameer Speciality Clinics, Нью-Дели, Ченнай, Мадурай – Индия; президент Меж- дународного центра медицинского образования и исследований, Ченнай, Индия. О.И. Боева – начальник научно-аналитического отдела СтГМУ, д.м.н., профессор. В.А. Аксененко – заведующий кафедрой акушерства и гинекологии СтГМУ, д.м.н., профес- сор. А.А. Коробкеев – заведующий кафедрой анатомии СтГМУ, д.м.н., профессор. О.В. Владимирова – начальник отдела международной деятельности и маркетинга, к.м.н., доцент кафедры общей хирургии. Е.В. Елисеева – заместитель декана факультета иностранных студентов, к.м.н., доцент кафе- дры нормальной физиологии СтГМУ. Н.А. Анисимова – к.п.н., доцент кафедры иностранных языков СтГМУ.
Рецензенты: Н.В. Агранович – д.м.н., профессор, заведующий кафедрой поликлинической терапии ГБОУ ВПО «Ставропольский государственный медицинский университет» Министерства здравоохра- нения Российской Федерации». О.С. Шибкова – д.филолог.н., профессор, заведующий кафедрой иностранных языков есте- ственнонаучных и экономических специальностей ФГАОУ ВПО «Северо-Кавказский федераль- ный университет» Министерства образования и науки Российской Федерации.
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Рекомендовано к печати редакционно-издательским советом СтГМУ.
ISBN 978-5-89822-439-4 © Ставропольский государственный медицинский университет, 2016 Dear Participants of the Conference!
It’s a matter of great pride and privilege to organize the International Scientific Conference for Students and Young Researchers in English “Topical Issues of Medicine” at Stavropol State Medical University. Such event became a good tradition for the past eight years. It effectively contributes to the development of scientific relations, stimulates and promotes innovative projects, increases the interest of students and young scientists to research work. The Conference brings together young people who are engaged in research work from both Russian and foreign universities. Research work of young people is one of the most important means of improving the quality of training of specialists with higher education; it is an effective method of formation and development of students’ motivation to creativity, responsibility and independence, as well as a way to realize individual approach in teaching and education of students. The main objective of the Conference is to bring the audience in the field of public health, to share information and experiences with colleagues from Russian and foreign medical institutions. I hope it will be useful to everybody in the future career and wish fruitful work, constructive dialogue and effective cooperation to all the participants and organizers of the Conference!
Koshel Vladimir Ivanovich, Doctor of Medical Sciences, Professor, Rector of Stavropol State Medical University, Russia
5 SCIENTIFIC ABSTRACTS OF STAVROPOL STATE MEDICAL UNIVERSITY STUDENTS AND YOUNG RESEARCHERS, RUSSIA
6 MODERN ASPECT OF MISCARRIAGE
Abhishek Singh, Nandini Kar, Praveen Roushan Stavropol State Medical University, Stavropol, Russia Department of Obstetrics and Gynaecology Scientific supervisor – C.M.Sc., Asst. E.M. Aleksanova
Objective: To analyse miscarriages in Regional Clinical Perinatal Centre, Stavropol 2015. Background: Miscarriage, also known as spontaneous abortion is the loss of pregnancy before 22 weeks of gestation. Materials and methods: Survey was done in Stavropol Regional Clinical Perinatal Center. We surveyed 414 case-histories of miscarriage in 2015. On the basis of our survey we have tried to analyse the main causes, risk age groups and trimesters in which it is highly prevalent. We had divided all the age groups with the interval of 5 years starting from 18 up to 42. Results: The most affected age group was from 28 to 32 years old which had 139 women (34%). The second most affected age group was from 23 to 27 years old which had 97 women (23%). Most cases of the miscarriages occurred in the 1st trimester in 312 women (75% of the total). 102 cases of miscarriages occurred in the 2nd trimester (25% of the total). According to the survey, we found 95 (23%) women with poor gynaecological anamnesis in the past, including multiple miscarriage (39 women), uterine polyps (19 women), previous infection (17 women), ectopic pregnancy (7 women) and combined cause (18 women). The common causes were: missed abortion in 128 (31%) women, molar pregnancy in 37 women (9%). The common maternal causes were: anti-phospholipid syndrome in 33 women (8%), anatomical defect of uterus in 21 women (5%) which included septate uterus (9 women, arcuate uterus (6 women) and bicornuate uterus (5 women). Cases of endocrine pathology were in 29 (7%) women which included PCOD (4 women), luteal phase defect (6 women), hyperthyroidism (9 women), hypothyroidism (3 women), diabetes (7 women). There were 25 women (6%) with infection which included 21 women with bacterial infection (staphylococcus – 7, Neisseria gonorrhoea – 4, chlamydia – 5, mycoplasma – 3, morganella morgana – 2 and 5 women with viral 7 infection (cytomegalovirus – 2, HSV – 1, hepatitis C – 1). The common fetal cause was: congenital defect of the fetus in 33 women (8%) which included CNS defect (14 women), heart defect (9 women) and Non- immune hydrops (10 women). The cases of unknown etiology were in 13 women (3%). Conclusion: From the survey it is concluded that women in 1-st trimester with poor gynaecological anamnesis, infection and endocrine pathology are under high risk of miscarriage. Highest number of miscarriages was seen within the age group of 28-32 years old (34%). Certain steps should be taken for the prevention of miscarriages in women with poor gynaecological anamnesis. Prior to pregnancy women should be examined and treated for anti-phospholipid syndrome, anatomical defect of uterus, endocrine pathology and infection. During pregnancy getting prenatal care, treatment of any bacterial and viral infection helps in reduction of the risk of miscarriages. Keywords: miscarriage; pregnancy; poor gynaecological anamnesis.
MODERN SURGICAL TREATMENT METHODS OF EPILEPSY
Abhishek Singh, Praveen Roushan Stavropol State Medical University, Stavropol, Russia Department of Neurology, Neurosurgery and Medical Genetics Scientific supervisor – C.M.Sc., Associate Professor I.N. Dolgova
Objective: To get to know about the modern surgical treatment methods of epilepsy and their effectiveness. Background: Epilepsy is a disorder characterized by recurrent seizures. Seizures are caused by abnormal activity of the neurons of the brain. Causes of epilepsy can be genetic, imbalance of neurotransmitters, abnormal nerve connections that form after an injury such as head trauma, tumour or stroke. Methods: The primary objective of most epilepsy surgical procedures is to accurately localize and then excise the epileptogenic region without causing cognitive or neurologic deficit. The newest method of localizing cortical function with functional MRI is used. There are 8 other functional neuroimaging techniques included: positron emission tomography (PET) scanning, single-photon emission computerized tomography (SPECT) scanning, magnetic resonance spectroscopy (MRS), magnetic source imaging (MSI).The type of treatment that a patient requires depends upon the type of seizures that a patient suffers. The modern surgical methods are: 1. Lesionectomy – It involves removal of lesions. 2. Temporal resections – It involves temporal lobe resection. 3. Extra-temporal resections – It involves parietal and occipital lobe resection. 4. Hemispherectomy – It is a form of cortical excision that is limited in patients with congenital hemiplegia, chronic encephalitis, hemi- megalencephaly or Sturge-Weber syndrome. 5. Corpus Callosotomy – It prevents spreading and reverberation of seizures activity between hemispheres. 6. Multiple Subpial Transections – In patients with seizure onset or epileptic zones located in eloquent cortex, multiple vertical subpial transections have been recommended as an alternative to cortical resection. 7. Cerebellar stimulation – It has been used to treat generalized focal, myoclonic seizures and spasticity of cerebral palsy. 8. Vagus nerve stimulation – It involves implantation of vagus nerve stimulator. Results: The success or failure of the surgical treatment of epilepsy depends on large part of the proper investigation of patients and selection of surgical method. All the above listed methods are best in their own ways and have individual advantages. Conclusion: Recent advances in imaging and long term EEG monitoring have allowed a greater accuracy in the localization of the seizure focus with overall surgical results better than those of the prior decades. Continued investigation into the basic mechanisms of the epilepsies as well new forms of medical and surgical therapy is necessary in order to help the many patients with severe and disabling intractable seizures. Keywords: surgical treatment methods; epilepsy; functional neuroimaging techniques.
9 REPERFUSION INJURY IN ACUTE MYOCARDIAL INFARCTION DURING PERCUTANEOUS CORONARY INTERVENTIONS
L.A. Adzhieva, A.A. Chotchaeva Stavropol State Medical University, Stavropol, Russia Department of Hospital Therapy Scientific supervisor – C.M.Sc., Asst. A.V. Rybas
Background: In some patients the myocardial perfusion of the affected area doesn’t restore or restores incompletely after the restoration of the coronary blood flow through the major subepicardial vessels. This is due to the affection of the small blood vessels and capillaries and the progress of the reperfusion myocardial lesion. Objective: To estimate the incidence and the nature of reperfusion injury in acute myocardial infarction (AMI) during percutaneous coronary interventions (PCI). Material and methods: 110 patients with AMI aged 50 ± 4,7 years were examined. All the patients underwent PCI - balloon angioplasty and / or stenting of coronary arteries. Statistical analysis “SPSS-11.0” was used. Results: The reperfusion injury progressed in 78 patients (70.9 %) with AMI. 66,7% of the patients underwent balloon angioplasty and stenting of the anterior interventricular artery, PCI of the right coronary artery was performed in 24.4 % of cases, the balloon angioplasty or stenting of the circumflex artery were performed in 0,9% of the patients. The frequency of the reperfusion syndrome didn’t depend on the sex, age or time of the course from the beginning of the painful syndrome. The following arrhythmias developed the most: ventricular premature beats (58, 9%), paroxysmal ventricular tachycardia (39,7%), atrial fibrillation (26,9%), supraventricular arrhythmias (62,8%), atrioventricular block (17.9 %). We analyzed the presence of the previous therapy: administration of the antiplatelet (aspirin and/or clopidogrel) and beta-blockers. We did not obtain any significant differences in the groups with prior treatment and without it (p> 0.05). With patients diagnosed with anterior septum apical-lateral infarction reperfusion syndrome was significantly more developed compared with posterolateral diaphragmatic localization infarction (p>0.05). The reperfusion syndrome was significally more developed with patients diagnosed anteroseptal apical lateral MI compared with posterolateral 10 diaphragmatic localization of myocardial infarction (р>0,05). It was found that the presence of comorbidity has no effect on the incidence of reperfusion syndrome. Conclusion: The reperfusion syndrome was more developed with patients diagnosed with anterior lateral localization of the AMI; the incidence of the reperfusion syndrome didn’t depend upon the sex and the age of the patients and the performance of the previous treatment. Keywords: reperfusion injury, balloon angioplasty, acute myocardial infarction.
EMBROGENESIS AND ABNORMAL DEVELOPMENT OF THE THYROID GLAND
Anupam Kumar Mishra, Vikash Kumar Stavropol State Medical University, Stavropol, Russia Department of Anatomy Scientific supervisor – Asst. E.B. Alisheva
Objective: on the basis of literature data, to know embryogenesis and abnormal development of the thyroid gland. Background: We know that the problem of congenital hypothyroidism is clearly delineated in recent years; one of the reasons is a violation of its embryogenesis. 3-4 weeks of embryonic development there is the germ of the thyroid gland. It is formed as a thickening of endoderm bottom throat between the first and second pair of pharyngeal pouches. Further thickening is formed in protrusion, which has a bipartite structure, and is connected with the pharynx by means of ductus thyreoglossus. It and its remnants can serve as a source of further formation of medial neck cysts, to the 12th -14th week of fetal development, the whole right lobe of the thyroid gland becomes follicular structure, and the left – 2 weeks later. Violation of embryogenesis process at various stages leads to the development of various types of abnormalities. Anomalies of the thyroid gland are: aplasia of the thyroid gland; thyroid hypoplasia, aplasia or hypoplasia of one of the lobes, median and lateral cyst of the neck. Additional (aberration) thyroid gland and thyroid prehistory: Aplasia (absence) of the thyroid gland is found at an early age. By ultrasound thyroid gland in a typical place is not visualized. Hypoplasia of the 11 thyroid gland is characterised by the decrease in the total volume below the lower limit of the age norm with intact tissue. Cysts and fistulas neck are observed both in infants and in adults and develop from remnants of embryonic structures. Medial and lateral cysts and fistulas are distinguished. Additional thyroid gland, glandulae thyroideae accessoriae, similar in structure to the thyroid gland, cannot be associated with or connected to small thin strands. Dystopia is caused by faulty lying of the body, and therefore changes the location of the prostate. Conclusion: among thyroid developmental abnormalities most frequently its digenesis is found, which ranks first among the causes of primary congenital hypothyroidism, clinical manifestations which can completely neutralize with timely diagnosis and treatment of these conditions.
COMPLEX INTRA ARTERIAL TREATMENT IN FEMORAL ARTERY COMPLICATED FORM SYNDROME OF DIABETIC FOOT
Attar Ruby Mohamed Nazir, Ramiz Raza Stavropol State Medical University, Stavropol, Russia Department of Faculty Surgery with Urology Scientific supervisor – C.M.Sc., Associate Professor, E.V. Pechyonkin
Background: Diabetic foot is one of the most significant and devastating complication of diabetes, and is defined as a foot of diabetic patients with ulceration, infections and/or destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. These wounds take a long time to heal, infection may set in the lower limb and amputation may be necessary. Objectives: To study the effect of complex intra-arterial treatment on patients with diabetic foot and reduce the risk of amputation. Inclusion criteria: 300 patients (62% females and 38% males) with diagnosis of diabetic foot (mean age of females from 40 to 80 and males – from 32 to 92) were admitted in Stavropol city hospital No.3, Surgery department, Department of diabetic foot. 12 Description of the research: The research started 10 years ago on large number of patients diagnosed with diabetic foot. The course of treatment is conservative therapy. It includes 10 injections of No- Spa 2ml (Drotaverine) spasmolytic, antibiotic Cephalosporin III/ IV generation 1gm/ Gentamicin, Nicotinic acid 2ml, antioxidant Actovegin 5ml, anticoagulant Heparin 1ml with Novocain 5ml is injected into the femoral artery, 1 time a day for 10 days. Control: Asking patients about allergy regarding Novocain. Complication: localized hematoma but it was recovered soon. Results: The complex intra-arterial therapy had shown very good results. By this therapy lethal rate was zero. It had reduced the rate of inflammatory process, open microcirculation which had provided a proper blood circulation and prevented necrosis. It had also reduced the rate of amputation by 4-5%. Conclusion: Diabetic foot is a very serious problem but the use of complex intra-arterial therapy can delay the amputation by 4-5%. This treatment can be used as a prophylaxis also without inclusion of antibiotics. Keywords: diabetic foot; diabetic patients; complex intra-arterial therapy.
EFFECT OF NUTRITION ON FOREIGN STUDENTS IN RUSSIAN FEDERATION
Chehaitli Ali Stavropol State Medical University, Stavropol, Russia Department of Normal Physiology Scientific supervisor: C.M.Sc., Associate Professor E.V. Eliseyeva
Background: Nutrition plays an important role in both physiology and psychology of the human being. It is not only important for meals to be divided according to the food pyramid but also according to the chronological time that we used to eat. Objective: Our purpose is to study the effect of nutrition change on foreign students in the Russian Federation on both physiological and psychological levels. Results and discussion: So we reported that 50 random foreign students were applied and we came to the following results: 1. Students who had been here for more than a year started to adapt 13 the nutritional habits of Russia but they used the similar to that in their countries products to cook food. 2. New students brought with them supply of their own food that is absent in Russia they depend on those products mostly. 3. Almost 20% of the students depend on fast food because they don’t have the time to cook and they don’t care whether there are products similar to those in their native countries or no. 4. Some students adapted the Russian nutrition style with adding a personal touch to it. We see that several students suffer from seasonal depression, there is increase in the sugar level in blood, they also said that they got minor illness more often than when they were in their countries, we also can see increased total body weight and anemia. Conclusion: The best way is gradual adaptation to the style of nutrition based on available products without depending on fast food, several diseases are associated with unorganized nutrition, and they are result of mismanagement from the students and inability to adapt to the new dietary style. Keywords: nutrition, adaptation, physiology, psychology, depression.
MORPHOMETRIC INVESTIGATION OF THYROID GLAND IN THE CASE OF AUTOIMMUNE THYROIDITIS
Chehaitli Ali Stavropol State Medical University, Stavropol, Russia Department of Pathological Anatomy Scientific supervisor: Asst. G.D. Dzhikayev
Introduction: Autoimmune thyroiditis was first described by a Japanese scientist Hashimoto in 1912 also known as Hashimoto’s thyroiditis. It is a case where the immune system attacks the thyroid gland and sometimes its products. It is also called chronic lymphocytic thyroiditis. Objective: To study the effect of autoimmune thyroiditis on the thyroid gland due to the complexity that this disease causes, and to know the exact mechanism of decreasing how to decrease the risk of such disease and its possible cures. 14 Materials and methods: We examined two thyroid glands macroscopically and microscopically to compare the differences between them. So we were able to define what the microscopical changes of the thyroid gland are in the case of this disease. There is a diffuse process consisting of a combination of epithelial cell destruction, lymphoid cellular infiltration and fibrosis. The thyroid cells tend to be slightly larger and assume an acidophilic staining character; they are called Hurthle or Ashkenazy cells are packed with mitochondria. The follicular spaces shrink, and colloid are absent or sparse. Fibrosis may be completely absent or present in degrees ranging from slight to moderate. The lymphoid infiltration in the interstitial tissue is accompanied by actual follicles and germinal centers plasma cells are prominent. The quantity of parenchymal tissue left in the thyroid is variable. In some instances it is actually increased, perhaps as a compensatory hyperplastic response to inefficient iodide metabolism. The gland, involved by thyroiditis, tends to lose its ability to store, produce and secrete iodine. Iodo-proteins that circulate in plasma are inefficient in making hormone. Thus, the thyroid gland under increased TSH stimulation, fails to respond to exogenous TSH, and has a rapid turnover of thyroidal iodine. Keywords: autoimmune, thyroiditis, Hurthle or Ashkenazy cells, fibrosis, acidophilic staining, TSH, iodo-proteins, exogenous, hyperplastic response.
EFFECTIVENESS OF AN INTEGRATED APPROACH IN REHABILITATION OF CHILDREN WITH I DEGREE SCOLIOSIS
I. Ermakova Essentuki Branch of Stavropol State Medical University, Essentuki, Russia Scientific supervisor: Associate Professor V.V. Malinenko
Introduction: Urbanization and technological progress contribute to the rapid growth of the vertebral and articular pathologies. Most health problems arise from the spine of the patient. Scoliosis usually appears 15 in childhood. The disease without the supervision of a specialist and the proper treatment is progressing rapidly, and the risk of serious complications increases. Objective: To evaluate the effectiveness of a comprehensive rehabilitation program for scoliosis I degree at children in the conditions of sanatorium. Materials and methods: The study was conducted on the basis of the Medical Center “Youth” of Yessentuki for 21 days. The study involved 20 children between the ages of 7 and 14 years, they were divided into two groups of 10 people: A – control, B – experimental. All children have as a primary disease scoliosis I degree. At the beginning of the experiment testing using standard indicators was conducted. In group A rehabilitation includes climatotherapy and physiotherapy, in group B – rehabilitation program has been supplemented by a medical massage and exercises on special trainers. On completion of the program check measurement using the same standards as the experiment at first was made. Results and discussion: The analysis of the data revealed that in group A at children there was a slight improvement in performance, while in group B ratios showed significant positive changes, as well as the patients themselves reported an improvement in overall health and increase vitality. Under the conditions of sanatorium treatment it is necessary to apply a variety of methods of medical rehabilitation of patients with scoliosis of 1 degree. Conclusion: This study proves the expediency of an integrated treatment of scoliosis in children (a combination of medical gymnastics, medical massage and exercise on special simulators). Keywords: scoliosis, medical massage, physiotherapy, rehabilitation.
THE TREATMENT OF ACUTE HEMATOGENOUS OSTEOMYELITIS
N. V. Filipieva Stavropol State Medical University, Stavropol, Russia Scientific Supervisor – D.M.Sc., Professor, Head of Department of Children Surgery S.V. Minayev
Background: Osteomyelitis is infection and inflammation of the bone and bone marrow. It can be usefully subclassified on the basis 16 of the causative organism (pyogenic bacteria or mycobacteria) and the route, duration and anatomic location of the infection. Objective: To evaluate the outcomes of treatment of acute hematogenous osteomyelitis (AHO) in children. Methods: The study included 93 children with AHO aged from 3 to 16. The number of boys equaled to 57 (or 61.3%) and girls to 36 (or 38.7%). Particular importance was given to an adequate technique of surgery with complete drainage of primary infections focus and preventing pathways of burrowing pus (based on CT scanning and MRI). The most frequently isolated pathogen was S. aureus (n=81; 87.1 %, of which 2.2% were MRSA). The main culture sources of primary pathogens were intraoperative bone aspirates and blood. All patients received postoperative antibiotic therapy. Combinations of Cephalosporins II-III generations with Amikacin were most frequently used. Also patients had a monotherapy (Vancomycin or Daptomycin). Results: The clinical success was achieved in most patients. We observed no cases of mortality. Duration of hospital stay equaled to 19±0.7 days. Complications of AHO were noted in a transition to a chronic form in 3 (3.2%) patients, fistula formation in 2 (2.2%) patients and pathological fracture in 1 (1.1%) patients. Conclusion: Based on the results of our experience, integrated approach was found to be effective and safe in patients with AHO. Keywords: Acute hematogenous osteomyelitis, children, treatment of osteomyelitis.
CONGENITAL DISLOCATION OF THE HIP JOINT
Fayemi A. Florence Stavropol State Medical University, Stavropol, Russia Department of Anatomy Scientific supervisor: C.M.Sc., Associate Professor M.A. Lysenko
The relevance of the study of congenital dislocation of the hip joint is great, as the biomechanics violation of the hip joint in a result of dysplasia can lead to serious disorders of the lower extremities and 17 disability both from the first steps of the child, and in adult life. Previously it was thought that congenital dislocation of the hip – is the result of an injury, or some of the inflammatory process. Modern research has shown that the basis of congenital dislocation of the hip is dysplasia, i.e., disruption of the normal development of the hip joint elements in pre-natal period. These primary disorders cause secondary- hypoplasia of the pelvis, the displacement of the femoral head, slowing down the bone ossification of the joint elements. The location of the hip joint is deeper than other joints, surrounded by the larger muscle layer, so it is inaccessible for research even in lean children. At recognition of the diseases it is necessary to be based on indirect signs. Most often the disease occurs in girls (80%); family history of the disease is approximately one-third. Dysplasia is often detected during pregnancy, complicated by toxicosis. In 60% of cases the left hip joint is affected, at least up to 20% right joint or up to 20% of both joints. Dysplasia of the hip joint can be manifested in many different forms. There are three main forms: 1. Dysplasia of cotyloid cavity – acetabular dysplasia. 2. Dysplasia of the proximal femur. 3. Rotary dysplasia. At hip dislocation the femoral head completely loses contact with the acetabulum, at the subluxation – only partially. Dysplasia in the confined sense is characterized by impaired development of the hip joint without displacement of the mating elements. In such cases, the classification of the pathology degrees should be based on clinical and radiographic indicators. The diagnosis of “hip dysplasia” implies the probability of hip dislocation and the need for immediate treatment. Thus, congenital dislocation of the hip, which is a serious disease, requires thorough examination. Real dysplasia can lead to disturbances of gait, bearing, and may be factor in the development of hip osteoarthritis at the adult.
18 THE STUDY OF THE INFLUENCE OF MINERAL WATER “ESSENTUKI-17” ON CARBOHYDRATE EXCHANGE OF PATIENTS WITH INSULIN NON-DEPENDENT DIABETS MELLITUS
A.S. Funtova, L.G. Voskanyan Essentuki Branch of Stavropol State Medical University, Essentuki, Russia Scientific supervisor:E.V. Pomazanova
Introduction: According to the world health organization the diabetes will be the 7-th cause of mortality in the world by 2030. Nowadays 347 million of people suffer from this disease. One of the correction methods of carbohydrate exchange are the factors of nature and in particular, taking the drinking mineral water. In certain, it can increase the resistance of insulin and strengthen its secretion, thereby improving the carbohydrate exchange. This unique property has curative water “Essentuki-17”, with high mineral content, which is recommended by specialists to take in such diseases as gastro-intestinal tract and metabolism. Objective: To analysis the effect of taking of mineral water “Essentuki-17” on the level of glycaemia in patients with diabetes. Materials and methods: The study was conducted on the basis of Sanatorium “Victoria”. 16 people took part in the study at the age of from 20 till 67 with the diagnosis of diabetes type 2. The participants were divided into 2 groups of 8 people; the patients were in control group. In this group there was medical treatment and also intake of mineral water “Essentuki-17” in the amount of 100-150 ml before meals (30-40 min). The research was conducted during 2 months. The following methods were used: interview, conversation, watching the blood test for sugar, tolerance test for glucose. Results and discussion: All these findings suggest that intake of mineral water “Essentuki-17” in diabetes had good results on state different functional systems, including the improving of the carbohydrate metabolism (decrease of glycaemia) and general well-being. Conclusion: This study confirms that intake of mineral water “Essentuki-17” as additional methods of treatment of disorders of carbohydrate exchange improves objective and laboratory parameters, 19 shows the positive trend in the treatment of diabetes and its complications, improves the quality of patient’s life. Keywords: insulin non-dependent diabetes, mineral water “Essentuki-17”, metabolism disorders, carbohydrate exchange.
THE SPECIAL FEATURES OF THYROID STATUS OF PATIENTS IN DIFFERENT STAGES OF CHRONIC KIDNEY DISEASES (CKD)
Z. Grigoryan, K. Sheludko, A. Goncharova, K. Kalashnikova, L. Yakusheva ANMO “Nephrological Center”, Stavropol, Russia
Background: In Russian and foreign medical literature there is a lot of information about secondary hyperparathyroidism, the state of the calcium-phosphorus metabolism in patients with CKD. But there is not enough information about the condition of the other endocrine glands in CKD patients. Objective: to compare thyroid status of patients in different stages of CKD. Materials and methods: there was evaluated the thyroid gland state of the 94 patients in different stages of CKD, which have been admitted and treated in ANMO “Nephrological center” in Stavropol in 2015, and been included in the study by random selection. Patients were divided into 3 groups: the I group included 44 patients with CKD of the I-IV stage, the mean age 50.9 years (18; 77), mean / women ratio 14:30. The II group included 23 pts with CKD V st., without hemodialysis treatment on that moment; with the mean age – 53,8 (19; 73) years, m/w ratio – 11:12. The III group included 27 pts with CKD V st., treated by dialysis the mean age of 53,5 (18; 78) years, m/w ratio – 14:16, the middle period of HD-treatment – 3 years (0,5; 14). We measured thyroid-stimulating hormone (TSH), total T3, total T4, thyroid gland volume by ultrasonography. Glomerular filtration rate (GFR) was calculated by CKD-EPI. Results: By the time of hospitalization 13,6% pts in the I group; 21,7% – in the II group and 14.8% in III group had already had thyroid gland disease. During our investigation we found different pathological 20 conditions of the thyroid gland in 6,8%, 8,7%, 7/4% of pts respectively. TSH levels of total T3 and total T4 in the I group were 2.67 (0.1; 24.5) mcМЕ/ml; 1.44 (0.25; 1.9) ng/ml; 85.2 (4.3; 158.6) nmol\l; in the II group – 2.64 (0.3; 42.8) mcМЕ/ml; 0.94 (0.3; 1.6) ng/ml; 97.8 (50; 169.3) nmol\l; and in the III group – 1.96 (0.11; 5.4) mcМЕ/ml; 1.2 (0.4; 2.2) ng/мml 77.1 (2.4; 160.9) nmol\l respectively (р>0.05). There were no significant differences in the thyroid gland volume between the groups during ultrasonography. There were moderate correlations between estimated GFR and TSH level in the I group (r= 0.37, р ≤0.05) and in the II group (r= 0.37, р ≤0.05), without correlations between TSH and keratinize and urea levels. There were moderate correlations between TSH level and edematous syndrome in patients with CKD 1-4 st. (r= 0.48, р ≤0.05). We didn’t notice the same correlations in the other groups. Conclusions: the thyroid gland pathology is quite common in patients with CKD. General symptoms as edema, hypertension can significantly worsen the clinical signs, especially in patients on early stages of CKD. It is necessary to be alert and estimate thyroid status of patients in different stages of CKD. Keywords: thyroid status, chronic kidney disease, glomerular filtrations rate.
HPV AS A FACTOR IN THE DEVELOPMENT OF CERVICAL PRECANCERS
A.S. Guseva Stavropol State Medical University, Stavropol, Russia Department of Obstetrics and Gynaecology Scientific supervisor – AssistantE.B. Lavrinenko
Background: Dysplasia is a pathological process that develops in the lining of the cervix, which, in the absence of appropriate treatment, may go to her malignancy. The leading role in the etiology of cervical cancer belongs to the human papilloma virus (HPV). Objective: Identify the connection between HPV infection and dysplasia, as well as the search for possible ways of treatment in the early stages of development. 21 Materials and methods: A retrospective analysis of 30 case histories of women aged 18-50 years, with the bulk of the age 18-25 years - 23 (76.7%), with exposed diagnosis of cervical dysplasia for 2015 according to the gynecological department of the Clinic “Dr. Keith.” Results: A comparative retrospective analysis of medical records revealed that HPV infection occurred in 23 women (76.7%). Candida albicans is also found – 8 (26,6%), Ureaplasma urealyticum – 3 (10%), Gardnerella vaginalis – 3 (10%), Mycoplasma hominis – 2 (6.6%). Early onset of sexual activity (14-15 years) found in 9 (30%) patients in the older age (26-30 years) – 5 (18.5%), the remaining 16 (59, 3%) of women sex life began at the age of 18-25 years. Analyzing, gynecological diseases studied patients, we found: in 7 (23.3%) patients had previous cervical ectopia, in 3 (10%) women leukoplakia occurred in 3 (10%) cases of cervical dysplasia has been identified, in 2 (6.67%) – a true cervical erosion, ectropion in 1 (3.33%) patients, erythroplakia also in 1 (3.33%) women. The remaining visible pathological changes in the cervix are not revealed. In a survey of all patients was performed colposcopy, according to its information, epithelial dysplasia of the vaginal part of the cervix (LSIL, HSIL) in 24 (80.0%), abnormal colposcopic signs in 20 (66.7%), leukoplakia was detected in 16 (53.3%) women. In order to confirm the diagnosis of all patients was performed a biopsy of the cervix, the following data: at 100.0% of the patients identified endocervicitis phenomenon, in 23 women diagnosed with CIN was clarified various degrees of severity (CIN I – 11 (47.8%), CIN II – 9 (39,1%), CIN III – 3 (13.0%) hyperkeratosis – 15 (50.0%), acanthosis – in 10 (33.3%), koylotsitoz – in 8 (26.7%), Nabothian cyst – in 8 (26.7%) women. Conclusion: Thus, our results suggest a direct connection with the revealed signs of dysplasia, and the presence of HPV infection. In this connection, for reproductive health in these patients should be advised that a multidisciplinary approach, timely treatment, and careful follow-up and prevention: to conduct research on HPV QUANTUM 21 with smears on oncocytology smear all patients after 2 years after onset of sexual activity. In identifying the virus, to carry immunocorrection and antiviral therapy, and detection of atypical cells, carry out colposcopy followed by biopsy for cervical disease in the early stages and thus early treatment. Keywords: HPV, epithelial dysplasia of the vaginal part of the cervix, reproductive health. 22 NUTRITIONAL COMPARISON OF INDIAN AND RUSSIAN STUDENTS AND THEIR ADAPTATION
Habib Mohamed Ahamed Thahir, Arya R. Kurup Stavropol State Medical University, Stavropol, Russia Department of Normal Physiology Scientific supervisor – C.M.Sc., Associate Professor E.V. Eliseyeva
Objective: To analyze the nutritional changes of Indian students studying in Russia, their causes and adaptations. Materials and methods: Survey was given to 1st and 2nd year foreign students which consisted of 20 questions related to different aspects of their food style. The survey included 40 students (20 males and 20 females). The questions were grouped into three main categories such as nutritional value, food routine and general problems; they compare their food style in India and Russia. Results and discussion: According to the survey the commonly used foods are grouped into six categories. Staple Indian foods are grains, fruits, vegetables, meat, dairy products, others. Daily food routine of students in India used to be 3 – 4 meals a day which consist of 2021 kilocalories, 55.4 grams of proteins and 47.4 grams of fat. Whereas in Russia students take only 1 – 2 meals a day which consists of approximately 1580 kilocalories, 20 – 30 grams of proteins, 30 – 35 grams of fat. Remote outcome: Due to lack of proper diet, students often lose the body weight, in spite of their daily nutritional requirements, loss of appetite, changes in menstrual cycle, depression, heart disease, diabetes, etc. Conclusions: Students who cannot follow their daily nutritional requirements may take supplements such as multi-vitamins, cod liver oil, etc. Main factors affecting the diet of the students are lack of timing and family economical background. Keywords: nutrition, adaptation, food habits, students.
23 FEATURES OF THE COURSE OF CORONARY HEART DISEASE AT THE BACKGROUND OF TYPE-2 DIABETES IN OLDER MEN
Hussein Omar Sattar Hussein Stavropol State Medical University, Stavropol, Russia Scientific Supervisor: C.M.Sc., Associate Professor of the Department of Hospital Therapy I.A. Znamenskaya
Objective: to study the features of clinical course of coronary heart disease (CHD) in patients with diabetes mellitus (DM) in the older age groups. Material and methods: The study included 64 patients with diagnosed CHD, (mean age 69,8±0.5 years). The first group consisted of 32 patients with coronary artery disease and type-2 diabetes. The comparison group consisted of 32 patients with CHD without diabetes. Both groups matched for age. All patients underwent a comprehensive clinical and instrumental examination, including the study of blood biochemical indices, ECG and EchoCG, ECG by Holter, AD monitoring. The study results were statistically processed with the use of software “Microsoft Office Excel 2007”. Differences at p<0.05 were considered statistically significant. Results: In the main group, CHD, exertional angina of II and III FC were diagnosed in 26,3% and 42.4% of patients respectively; silent myocardial ischemia – in 31.3%, myocardial infarction (MI) in anamnesis – in 9.3%. II CHF FC according to NYHA – in 35,4%, III – in 64,6% of patients. In the comparison group coronary artery disease, angina II and III FC were diagnosed in 59.4% and 28.1% of patients respectively, silent myocardial ischemia – in 12.5%, myocardial infarction in anamnesis – in 28.1%. CHF II FC according to NYHA – in 43.8%, III – in 56,2% of patients. By analyzing the features of clinical course of CHD in the main group and the comparison group, it can be noted that in the latter group anginal form of the disease was dominated to 68.8% and 87.5%, respectively, (p=0.04), myocardial infarction in anamnesis (p=0.03). Silent myocardial ischemia was significantly more frequently observed in patients with type-2 diabetes (p=0.04). Both groups were comparable in distribution of degrees of hypertension 24 (p>0.05) and functional classes of CHF (p>0.05). In addition, according to the results of ECG monitoring by Holter, among patients of the main group violations of the heart rhythm (68,4%) were significantly more frequently recorded versus (41%) the patients from the comparison group, p<0,5. Conclusions: thus, type-2 diabetes is a predictor of an unfavorable course of coronary heart disease, the most frequent development of cardiac arrhythmias and silent myocardial ischemia in older men. Keywords: coronary heart disease (CHD), diabetes mellitus (DM), type-2 diabetes, myocardial infarction (MI), silent myocardial ischemia.
HEALTH FINANCING SYSTEM IN NIGERIA
Iyalomhe O. E. Stavropol State Medical University, Russia Department of Economics and Social Sciences Scientific supervisor: C.M.Sc., Associate Professor Yu.I. Germanova
Background: Health care in Nigeria is financed through different sources and mechanisms. However achieving an optimum blend of these resources still remains a problem. Hence, its health care system has failed in providing universal health coverage and better health services for its populace. Objective: to critically review the Nigerian health financing system, to highlight the challenges and problems facing it and recommend ways of tackling them. Method: Search terms that included, but were not restricted to health care financing Nigeria, public health financing, financing health and financing policies were used in obtaining relevant information for the study from the PubMed, Medline, Google and Yandex search engines. Introduction: The main wealth of a nation is the health of its people. There is empirical evidence that the health care system of a nation plays a significant role in enhancing its economic development, and vice versa. The purpose of a financing system is represented in a process by which revenues are collected from primary and secondary sources, e.g., direct payments by patients, indirect and direct taxes, donor funding, 25 co-payment, voluntary prepayments, mandatory prepayment and those used to purchase goods and services from public and private providers for identified needs of the population, e.g., fee for service, budgeting and salaries. A health care financing system involves the means by which funds are generated, allocated, and utilized for health care. It has three basic functions of collecting revenues, pooling resources, and purchasing services. There are four essential methods of funding health care services; they include general taxation, social health insurance, private health insurance and direct payments by patients. Different combinations of these exist in practice. The organization of health services in Nigeria is complex. It includes a wide range of providers in both public and private sectors (private providers, non-governmental organizations, community-based organizations, religious and traditional care providers). In the public sectors, Nigeria operates a decentralized health system run by the Federal Ministry of Health (FMH), State Ministry of Health (SMH), and Local Government Health Department (LGHD). The Federal Ministry of Health is the overall health policy formulating body. It coordinates and supervises the activities of the other levels. In addition, it provides tertiary care through teaching hospitals and federal medical centers. The State Ministry of Health provides secondary care through the state hospitals and comprehensive health centers while the Local Government Health Department provides primary health care services through the primary health centers. Although the local governments have the main responsibility of managing PHC, all the three tiers of government and various agencies participate in the management of primary health care. This at times results in duplication, overlap, and confusion of roles and responsibilities. Health care in Nigeria is financed by different sources including not limited to tax revenue, direct payments by patients, donor funding, and health insurance (social and community). Unfortunately, in Nigeria, achieving the correct blend of these sources remains a challenge. Tax-based revenue: Health financing systems where government revenues are the main source of health care expenditure are referred to as tax-based systems. The health system is generally funded from 26 the federation account to the states and local government areas, both of which generate about 20% internal revenue from taxes, rates and levies. The allocation of federal revenues is fixed by the Revenue Mobilization Allocation and Fiscal Commission (RMFC) and the allocation formula assigns 48.5% to the federal government, 24% to the states and 20% to local government, with 7.5% retained for “special” federally determined projects. Donor funding: This refers to financial assistance given to developing countries to support socioeconomic and health development and may be in the form of loans or aid grants. The donor countries were required to give 0.7% of their gross national product as Official Development Assistance (ODA) to developing countries. Although the international assistance to the Nigerian health sector is increasing, it still accounts for a small proportion of public health expenditures. Social health insurance: Health insurance stands for a pooling of health risks, in order for the participants to get benefits due to the uncertainty underlying ill-health occurrence and payments for treating such ill-health. This is because the need for health care is often highly unpredictable and very costly for the individual although it is predictable for large groups. It is a system of financing health care through contributions to an insurance fund that operates within the framework of government regulations. The National Health Insurance Scheme (NHIS) aims to reduce the financial burden of direct payments by patients for health care services. Unfortunately, at this time, it only covers 4-5% of Nigerians. Community-based health insurance: Community-based health financing is referred to as a mechanism, whereby households ina community finance or co-finance the costs associated with a given set of health services, at the same time participating in the management of the community financing scheme and the organization of the health services. It is designed for people living in the rural area and people in the informal sector who cannot get adequate public, private, or sponsored insurance. It is usually voluntary. National primary health care development fund (NPHCDF): Primary health care is the cornerstone of the Nigerian health system. However, in the last decades it has been in shambles, with its dismal state having a direct consequence on the overall performance of the 27 health system. Poor financing is one of the problems of primary health care in Nigeria. Thus, addressing the perennial underfunding that has stifled primary health care is high on the policy agenda as evident by the National Primary Health Care Development Fund proposed in the recently passed national health bill. The National Primary Health Care Development Fund aims to pool resources for primary health care from the government, international donors, and private sectors. There are guidelines on how the obtained funds should be allocated. Conclusion: The Nigerian government has put in place various policies and plans addressing health care financing. These documents focus on how to move closer to universal health coverage with issues related to how and from where to raise sufficient funds for health; how to overcome financial barriers that exclude many poor from accessing health services; and how to provide an equitable and efficient mix of health services. These policies and plans include the National Health Policy, Health Financing Policy, National Health Bill and National Strategic Health Development Plan (2010-2015). The Nigerian government uses different mechanisms for public health care financing. However, the health financing system is characterized by low investment by the government, extensive direct payments by patients, limited insurance coverage and low donor funding. Thus, achieving the objectives of universal health coverage, good health outcome, equity is very challenging. However, there may still be a way forward for Nigeria. This will require strengthening the health care financing system. The system should ensure that everyone who requires health care services is able to access them and is not denied due to inability to pay. Citizens must be able to benefit from at least one of the financing mechanisms in accessing health care services. Direct payments by patients should be replaced with more equitable modes of financing, there should be clarity as to the roles of different levels of government in financing primary health care, the government should give high priority to health in their budget allocations and explore innovative ways of mobilizing funds and financing health. Keywords: budget, health financing system, source, tax, funds, direct payments by patients, primary health care. 28 TREATMENT OF HEMANGIOMAS IN INFANTS
A.A. Ivchenko Stavropol State Medical University, Stavropol, Russia Department of Children Surgery Scientific supervisor – D.M.Sc., Professor S.V. Minayev
Objective: to investigate the efficacy of propranolol in the treatment of hemangiomas in infants. Methods: We observed 28 children at the age from 1 month to 1 year with maxillofacial hemangiomas of mixed type (d from 0.5 cm to 5.0 cm) for the treatment of which the propranolol in a dose of 1,5- 2,5 mg/kg per day was used. The therapy process includes 3 stages. The first stage – individual selection of propranolol doses in hospital environment with a daily training of mother to control blood pressure and heart rate of the child (7-10 days). The second stage – it was carried out at home: medication under the control of blood pressure and heart rate according to body weight increasing with recalculation of the dose (3-22 months). The third stage was gradual withdrawal of medication during 2-3 weeks under the control of blood pressure, heart rate and ECG tracing. Results: In all 28 cases propranolol provided stable and fast effect on vascular formation. Improvement was observed as early as 4-5 days after the treatment started. During the first month the most marked changes were registered. After 6 months of treatment in 80% of cases the complete or almost complete regression was observed. The most pronounced effect was noted in children treated with propranolol in the first 4 months of life, who did not receive any other treatments. Conclusions: Our investigation showed that propranolol treatment of hemangiomas in children should be started immediately after diagnosis (since the first months of life).
29 MODERN MORPHO-FUNCTIONAL PARAMETERS AND ARTERIAL FOUNDATION OF THE HEART (CASE STUDIES)
Jitendra Sharma, Surabhi Stavropol State Medical University, Stavropol, Russia Department of Human Anatomy Scientific supervisor – C.M.Sc., Associate Professor O.Y. Lezhnina
Background: Disorders and circulation of the heart appear to be an actual medical problem in today’s day and age. Objective: The purpose of the work is to present morphological and functional parameters such as coefficient of constriction (Kc) and dilation (Kp) of the total clearance of the arterial apparatus, the share of the total summated outflow of the longitudinal section of the arterial bed in the total square area of circulation and the vascular structure of the arterial bed in the normal and postero-lateral diaphragmatic infarct of the myocardium in the people of senile age groups with right coronary branching of the coronary artery. Methods: Research carried out by morphological methods suggested that subepicardial branching of the coronary artery were found in 5 hearts. 6 corono-angiograms were also evaluated with the help of modern computer programs. Discussion: Based on the data, it was concurred that the constriction coefficient in normal was equal to zero on a considerable distance of the initial and the middle thirds of the right half of the coronary groove whereas in postero-lateral diaphragmatic myocardial infarct it reached zero in its initial course. In pathologies of the constriction coefficient the derivatives of right coronary artery were characterized by unequal increase of the signs, gradually increasing in the initial third of the right half of the coronary groove from zero to 0,62 ±0,02 with the further decrease to 0,02 ± 0,01. In postero-lateral diaphragmatic myocardial infarction, it was stated that the expressed volume of dilation constant was up to 0,71 ± 0,05 in the middle third of the right half of the coronary groove. In hearts without disturbance of coronary circulation of dilation coefficient branching of right coronary artery exceeds zero amount in all directions of postero-lateral diaphragmatic myocardial infarction spasmodically increases its initial and middle thirds with expressed volume correspondingly up to 0,39 ± 0,02 and 0,47 ± 0,04. Coefficient 30 of dilation increases from 0,74 ± 0,05 to 1,14 ± 0,05 in the latter thirds of the right half of the coronary groove. Observation: In the coronaroangiogram in PLDMI it was observed that an inconsiderable increase of the given parameters up to 0,06 ± 0,01 in the initial course of RHCG occurred. The study of DSPS states that its value constituted 0,017 ± 0,001 in subjects with PDLMI. In hearts without visible pathology but with given pathologies it was somewhat lesser – 0,011± 0,001. In hearts without abnormalities the coronary circulation’s distance between branching of the right coronary artery constituted the mean of 92,7 ± 1,6 mm. It was also seen in the presence of PLDMI the given parameters were reduced by 1.5 times constituting 60,4 ± 1,3 mm. Results: Thus, modern morphofunctional parameters reflect the specificity of the coronary vascular system in heart without disturbance of blood circulation in the reservoirs of coronary artery and myocardial infarction. Keywords: Morphofunctional parameters, right coronary artery, myocardial infarction, senile aged people.
PECULARITIES OF STRABISMUS TREATMENT IN ADULT PATIENTS
S. Ladanova, E. Muradova Stavropol State Medical University, Stavropol, Russia Department of Ophthalmology Scientific supervisor – C.M.Sc., Associate Professor G. Korenyak
Background: Strabismus in adults has not been studied as much as in children. However, it accounts 0.5% - 1.5% of cases; it may be of various origin and takes mostly surgical intervention. Besides, such operations in adults have rather low risk and complications are extremely rare. Objective: To evaluate indications and outcomes of strabismus treatment in adults by surgery. Materials and methods: A retrospective analysis of 24 medical records and operation protocols of patients with strabismus, based on the data from the Ophthalmology Microsurgery Clinic of Stavropol 31 State Medical University (during period of 2013-2015) was carried out. A group of 11 male patients (46.15%) and 13 women patients (53.85%), from 19 to 35 years old (mean age – 25 years) participated in the study. Results and discussion: The following indications for strabismus treatment were: 14 patients (58.33%) patients had strabismus diagnosed in childhood but they had no consistent and regular treatment; 3 patients (12.50%) had never any treatment at all, while 7 patients (29.16%) had undergone operations for strabismus. The main indication for seeking assistance in adult age included cosmetic defects (78%) and eyesight discomfort (22%). The following clinical data were obtained prior to the operations – monolateral strabismus (76.92%), divergent – 60.00% (right eye – 50.00%, left eye – 50.00%), convergent – 40.00% (right eye – 25.00%, left eye – 75.00%); alternating strabismus – 23.08%, of them: divergent – 100%, convergent – 0%. The angle of deviation was 15 – 45(15 – 38.46%, 20 – 7.69%, 30 – 23.08%, 35 – 7.69%, 40 – 15.38%, 45 – 7.69%). Type of vision (4-dot test): without glasses – monocular – 92.31%, simultaneous-7.69%; with glasses (in case of refraction anomalies) – monocular – 71.43%, simultaneous – 28.57%. The following operations were performed: resection of the internal rectus muscle of the eye – 57.14%, recession of the internal rectus muscle of the eye – 14.29%, exploration of the internal rectus muscle of the eye – 7.14%, resection of the lateral rectus muscle – 14.29%, recession of the lateral rectus muscle – 7.14%. The outcomes of the operations included the following: deviation angle from 0 to 40 (0 – 53.85%; 3 – 15.38%; 5 – 15.38%; 15 – 7.69%; 40 – 7.69%). Type of vision (4-dot test): without glasses – monocular-23.08%, simultaneous-38.46%, binocular unstable-38.46%; with glasses (in case of refraction anomalies) – simultaneous – 57.14%, binocular unstable – 42.86%. Long-term results: residual angle of strabismus up to 5 (12%), extraocular movement – sufficiently preserved, type of vision – binocular (76%), satisfactory cosmetic effect (89%). Conclusion: The group of patients described had strabismus diagnosed in early childhood; the main complaints included cosmetic defect and eyesight discomfort. After the operations the patients had smaller angle of deviation; the type of vision changed from monocular to simultaneous and binocular. No post-operative complications were registered. It was concluded that surgical intervention to correct 32 strabismus in adult patients resulted in stabilization and improved functions and may be recommended as method of treatment. Keywords: strabismus, deviation angle, type of vision, resection, recession.
ADAPTION OF STUDENTS FROM GHANA TO NUTRITION IN RUSSIA
Lois Nana Ofosua Okoree Stavropol State Medical University, Stavropol, Russia Department of Normal Physiology Scientific supervisor – C.M.Sc., Associate Professor E.V. Eliseyeva
Background: Nutrition as an essential part in human life has been an area of discussion especially with students living in other countries, finding the right ingredients to meet their various nutritional needs, habits and adapting to new habits and lifestyle is always a concern. Objective: To compare the nutrition of Ghanaian students in Russia to their nutrition in their home country and their subsequent adaptations. Materials and methods: Total of 5 Ghanaian students consisting of 3 girls and 2 boys were given questionnaires asking about their eating habits and how they are adapting to the nutrition in Russia. We made comparison of their eating habits at home to those in Russia. Results and reviews: During the survey most students revealed that on an average day in Ghana they have breakfast (even if not made at home, it is bought from cafes or cafeterias in theirs school). Mostly it is tea with milk and bread (some will go further to add either butter to the bread or take some fried eggs). According to National Nutrition Organization, one cup of tea with milk has 30 calories; white bread (which is normally eaten in Ghana), contains 46 calories and of the eggs 15cal. Mostly all of these calories are lost here in Russia partly due to students busy schedule of going to school early and partly due to students late acclimatization and orientation in Russia. Lunch in Ghana would normally consist of rice with stew (406 cal) but in Russia students opt for pastries or eat pilau from the hostels canteen (390 cal). Supper is the time, when Ghanaian’s students are able to cook something nutritious and eat, although on the other side this food habit 33 leads to overeating and overcompensate for the nutritional loss that occurred during the day. Fruits and vegetables in Russia is also an area of concern. Most of the students complained that the most of the fruits and vegetables are artificially grown and processed thus the required nutrients are not gained even though they seem to eat more fruits and vegetables here than at home, where tropical fruits and vegetables are mostly naturally grown. Due to this most of them experience changes in their metabolisms, reflecting on their skins, hair, dizziness and weakness, during their first year in Russia, but after a short period of time they learn to know how to eat, what to eat and when to eat in order to adapt. Conclusion: Our human body is constantly subjected to changes in different forms and is capable of adapting and adjusting to different situations, concerning nutrition finding the right foods and making a good balanced diet is most important for a healthy life. Keywords: nutrition, adaptation.
THE STUDY OF THE PHYSICAL PROPERTIES OF NIOSOMAL FORM OF DOXORUBICIN FOR THE TREATMENT OF SKIN CANCER
V.V. Lukinova Stavropol State Medical University, Stavropol, Russia Scientific supervisor: D.M.Sc., Professor, Head of the Microbiology Department I. A. Bazikov
Background: Niosomal form of doxorubicin allows the antibiotic not to get into the healthy tissues, and to penetrate only through the defective capillaries of the skin tumors, reducing its cardiotoxicity. Due to the gradual release, niosomes maintain a high concentration in blood for a long time and enhance the efficacy of the drug. Objective: In this regard, the aim of this work was to study the physical properties of niosomal forms of doxorubicin. Material and methods: For designing dosage forms of doxorubicin as nanocontainers we used niosomes of silicone nature: PEG-12 Dimethicone. The dispersion of the niosomes resistance to doxorubicin was announced at a frequency of 20 kHz, power of 34 200 W. Drug samples were subjected to scanning on atomic-force microscope NTegra Life brand (NT-MDT). According to the received data about the surface topography, through the use of software tools (NovaPX), a histogram of the dependence of the mean size (Average Size) was made.
Fig. 1. Photomicrographs of samples of niosomal forms of doxorubicin and quantification of their sizes.
Results and conclusions: It is shown that niosomes have a well- defined spherical shape. In the aquatic environment they are notin contact with each other and do not form a homogeneous mass, what is essential when used to deliver doxorubicin to the tumor cells. The majority of niosiomes has a size of 80-120 nm, which will provide them the opportunity to pass through small capillaries and the intercellular space (Fig. 1). Keywords: niosomes, doxorubicin, tumor cells.
35 ANTIMICROBIAL ACTIVITY OF NIOSOMAL OPHTHALMIC GEL “REGENERIN”
N. A. Malinin City Clinical Hospital of Health Prevention, Stavropol, Russia Scientific supervisor: D.M.Sc., Professor, Head of the Microbiology Department I.A. Bazikov
Objective: The need of technology development for producing antimicrobial ophthalmic external means for its regeneration properties is due to large number of infectious complications of the cornea burns. In this regard, the aim of this work was to investigate antimicrobial efficiency of the developed niosomal ophthalmic gel “Regenerin”. Material and methods: The study of bactericidal activity was performed by the disk diffusion method (DDM) in the study of their sensitivity to bacteria isolated from the cornea.
Fig. 1. Zone of growth inhibition of epidermal Staphylococcus using discs impregnated with ophthalmic gel “Regenerin”.
Results: The results of bacteriological analyses showed that in microbiocenosis of the conjunctiva cavity and the cornea the epidermal Staphylococcus takes place up to 65 %. The study of bactericidal activity of the gel showed that processing disks with the gel “Regenerin” led to the formation of sterility zones with a diameter of 12 mm (figure 1). Conclusions: In this connection we can conclude that niosomal gel “Regenerin” has bactericidal action and its use shown earlier accelerates and stimulates the regeneration of damaged cornea and conjunctiva. Keywords: niosomal gel “Regeneron”, bactericidal activity, cornea. 36 EFFECT OF BREAST FEEDING ON THE FUNKTIONAL STATE OF GASTROINTESTINAL TRACT OF THE CHILD
U. Mirzaeva, N. Kharitonova Essentuki Branch of the Stavropol State Medical University, Essentuki, Russia Scientific supervisor:N.A. Belyakova
Background: Nowadays young mothers refuse full breast feeding because of different reasons. More than 50% of children of 2-3 month age get different infant milk formulas instead of breast milk, which then negatively affects on functional state of their not strong enough digestive system. Objective: to analyze the effect of breastfeeding on the functional state of the gastrointestinal tract of the child. Material and methods: The study was conducted on the basis of Essentuki State Budget Health Institution “Children’s Hospital” among 14 young mothers which have children at the age from 6 month to 1 year. Study participants were divided into 2 groups of 7 people. At the first group mothers breast-feed their children and at the second group the children were given artificial milk formulas. The frequency of references to the primary care pediatrician about child digestive disorders, the nature of these disorders and their relation to feeding as well as assessment of the weight gain nature were analyzed. The following methods were used: questionnaire, inquiry, interview and analysis of individual case history of child development (from the period of preceding 3 months from the beginning of the study). The findings suggest that children which were breast-fed had such functional disorders as flatulence, intestinal colic, stool disorders, regurgitation and other dyspepsia disorders 6 times less than children which were given artificial milk formulas. It should be noted that children which were breast-fed had normal weight while children with artificial feeding had overweight or deficiency of weight. Conclusion: The results of research work demonstrate positive effect of breast feeding on functional state of gastrointestinal tract and as a result total physical and psychomotor child development. Keywords: breast feeding, dyspepsia, functional state of gastrointestinal tract. 37 METHODS OF PREECLAMSIA PREDICTION
Mohamed Arsath, Nitin Thomas Stavropol State Medical University, Stavropol, Russia Department of Obstetrics and Gynaecology Scientific supervisor – Asst. C.M.Sc. A.A. Dubovoy
Objective: The sFlt-1/PlGF ratio has been evaluated as a diagnostic marker for preeclampsia (PE). The aim of this study was to explore the use of the sFlt-1/PlGF ratio as an aid in prediction for PE. Background: Preeclampsia is a multi-system disorder of pregnancy, which is characterized by new onset of hypertension (systolic and diastolic blood pressure of ≥ 140 and 90 mm Hg, respectively, on two occasions, at least 6 hours apart) and proteinuria (protein excretion of ≥ 300 mg in a 24 h urine collection, or a dipstick of ≥ 2+), that develop after 20 weeks of gestation. The ratio of soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) is elevated in pregnant women before the clinical onset of preeclampsia, but its predictive value in women with suspected preeclampsia is unclear. Materials and methods: A meta-analysis of 30,000 cases using the PubMed, Embase, and Cochrane Library was conducted for human studies without language restriction. We included the studies reported with sufficient data to reconstruct the diagnostic 2×2 table of sFlt-1/ PlGF with testing of PlGF and sFlt-1 in serum or plasma. Result: PE was confirmed in 72% cases, in which 32% early deliveries occurred. Isolated IUGR was diagnosed in 9% early cases and 1% late case, while the remaining 10 % cases were late deliveries without PE or IUGR. In pregnancies in which PE and IUGR were excluded, the sFlt-1/PlGF ratio was normal in 100%. In early PE, sFlt- 1/PlGF was abnormal in 100% with IUGR and 96% without IUGR. In late PE, the sFlt-1/PlGF ratio was abnormal in 50% with IUGR and 26% without IUGR. The sFlt-1/PlGF ratio was significantly higher in pregnancies complicated by PE up to 4 weeks before clinical diagnosis compared to controls (106.7±47.7 vs. 21.0±4.1; P=0.02). Levels of the sFlt-1/PlGF ratio were higher throughout pregnancy in women with IUGR compared to PE/control patients (intercept 1.57 vs. 1.30/0.67; P<0.05). The slope for the sFlt-1/PlGF ratio was significantly higher in PE and IUGR pregnancies compared to controls, indicating that a steep increase of the sFlt-1/PlGF ratio correlates with pathologic pregnancy outcomes. 38 Conclusion: The sFlt-1/PlGF ratio can identify pathologic pregnancy outcomes such as IUGR and PE before clinical diagnosis. Repeated measurements are necessary to assess the dynamics in serum values. The time-dependent slope of the sFlt-1/PlGF ratio is predictive for future pregnancy outcome and risk of developing preeclampsia. Keywords: preeclampsia, sFlt-1, PlGF.
IMPACT OF ALCOHOL ON FOETUS
Muringasseril Mathew Jeffin Stavropol State Medical University Department of Biology Scientific supervisors: C.M.Sc., Associate ProfessorE.N. Makarenko, Asst. T.S. Kopteva, Asst. N.V. Erina
Maternal consumption of alcohol during pregnancy can result in a continuum of embryonic developmental abnormalities. Alcohol is a teratogen, an environmental agent that impacts the normal development of an embryo. In general, drinking alcohol during pregnancy can cause miscarriage, preterm birth and stillbirth. HOW DOES ALCOHOL AFFECT THE GROWING EMBRYO? According to Dr. Raja Mukharjee, (survey and borders partnership NHS Foundation Trust): “When a pregnant woman drinks, the alcohol goes across the placenta to the foetus via bloodstream. The foetus liver is not fully developed, so it relies on the mother’s liver to metabolize the alcohol. When the alcohol passes from the mother onto the foetus body it lacks oxygen and the nutrients needed for its brain and organs to grow properly. White matter in the brain that is responsible for speeding up the processing of information is sensitive to alcohol. So when a mother drinks it affects the development of her baby’s white matter”. Alcohol can affect the way the baby develops at any stages of the pregnancy and may cause lifelong disabilities called fetal alcohol spectrum disorders (FASD). So FASD is a spectrum of abnormalities. In this spectrum of disorders, the extremely lying one is a fetal alcohol syndrome (FAS). It’s first described in the 1970’s, first discovered by 2 doctors in the US in 1973, how serious is the condition depends on how 39 much alcohol a mother drinks during pregnancy. The WHO quotes a 2005 US study which estimated that one in every 1000 children is born with FAS. Babies with FAS can tend to have: ● Facial defects like mouth, teeth problems ● Poor muscle tone and coordination ● Be born small ● Epilepsy ● Liver damage ● Weak immune system ● Kidney and heart defects ● Hormonal disorders ● Height and weight loss ● Low IQ ● Social and behavioral problems
PREVALENCE OF FASD AND ITS CONSTITUENT DISORDERS IN COUNTRIES ACROSS THE WORLD Table 1
COUNTRY / REGION FASD FAS Australia 0.26/1000 live birth 0.06/1000 live birth Canada (in a single rural 16.9/1000 school children region) Ireland (Dublin) 0.05 / 1000 total births Italy 36/1000 school children 6.2/1000 school children South Africa 72/1000 school children 50/1000 school children
135/1000 1st grade 55/1000 1st grade students students
Conclusion: 1. Fetal Alcohol Syndrome (FAS) is the leading cause of preventable mental retardation. 2. Awareness about dangers of drinking alcohol during pregnancy can help to prevent FAS. 3. Consistency in diagnoses can lead to better outcomes for children with FAS. Keywords: foetus; alcohol; embryonic developmental abnormalities. 40 MOLECULAR BASE OF ALZHEIMER’S DISEASE (AD)
Nameirakpam Malemnganba Meitei Stavropol State Medical University Department of Biology Scientific supervisors: C.M.Sc., Associate ProfessorE.N. Makarenko, Asst. T.S. Kopteva, Asst. N.V. Erina
Alzheimer’s disease is one of the molecular diseases. It accounts for 60% to 70% of dementia. It is a chronic nuerodegerative disease that usually starts slowly and gets worse over time. In 2015, there were approximately 48 million people worldwide with AD. It most often begins in people over 65 years of age, although 4% to 5% of cases are early-onset Alzheimer’s disease which begins before this. It affects about 6% of people aged 65 years and older. In 2010, dementia resulted in about 486,000 deaths. It was first described by, and later named after German psychiatrist and pathologist Alois Alzheimer in 1906. In developed countries, AD is one of the most financially costly diseases. Cause The cause of AD is poorly understood. About 70% of the risk is believed to be genetics with many genes usually involved and other risk factors including history of head injuries, depression, or hypertension. And also there are several competing hypotheses exist, trying to explain the cause of AD like Cholinergic, Amyloid, tau and other hypotheses.
41 Symptoms The most common early symptoms are difficulty in remembering recent events. As the disease advances symptoms can include problems with language, disorientation, mood swing, loss of motivation, not managing self care and behavioral issues. Diagnosis Alzheimer’s disease is usually diagnosed based on the person’s medical history, history from relatives, and behavioral observations. The presence of characteristic neurological and neuropsychological features and the absence of alternative conditions are supportive. Advanced medical imaging with computed tomography (CT) or magnetic resonance imaging (MRI), and with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) can be used to help exclude other cerebral pathology or subtypes of dementia. Prevention At present, there is no definitive evidence to support that any particular measure is effective in preventing AD. Global studies of measures to prevent or delay the onset of AD have often produced inconsistent results. Epidemiological studies have proposed relationships between certain modifiable factors, such as diet, cardiovascular risk, pharmaceutical products, or intellectual activities among others, and a population’s likelihood of developing AD. Only further research, including clinical trials, will reveal whether these factors can help to prevent AD. Keywords: Alzheimer’s disease; computed tomography (CT); magnetic resonance imaging (MRI); positron emission tomography (PET).
PREVENTIVE MEASURE OF THE DEVELOPMENT OF CARIES
D.M. Papshuova, L. R. Kossova Stavropol State Medical University, Stavropol, Russia Department of Therapeutic Stomatology Scientific Supervisor – Asst. O.V. Kuznetsova
Background: The problem of dental caries (tooth decay) in modern dentistry is very relevant. It affects approximately 90-95% of population 42 and has tendency to grow [1]. This problem is interesting both in theoretical and practical aspects. Therefore, taking into consideration present situation in dentistry the Dentist Association of Russia pays a great attention of looking for effective ways and means of preventing caries and finding methods of application them into practice. The basic measure in dentistry aimed to prevent dental diseases, to treat patients with maxillofacial defects based on intensive implementation of the latest scientific innovations, experience and scientific arrangements of the dental work, professional training of medical staff [2]. Objective: The purpose of this paper is to give knowledge to young people in educational and practical forms in the field of caries and its complications prophylaxis, and show the efficiency of preventive measures in practice [3]. The participants: random group of young people aged 18-20. Results and discussion: We have started our paper with discussion of causes and complications of caries. At first we visually determined with the help of tablets “DINAL” how well the participants brushed their teeth. Fedorova and Volodkin’s hygienical index was estimated between 1,6 and 2,6, that means between satisfactory and bad hygienical care [4]. Out of 100 examined participants 78 had a risk of appearance and development of caries. The basic principles for prevention of the growth of dental diseases were developed: the maintenance of oral cavity’s hygiene; the limit of carbohydrates intake; vitamin intake (after consulting the doctor); the intake of medicaments containing calcium. The following suggestions for oral cavity’s hygiene were made: floss, a toothpaste containing fluorine, the remineralizing gel “R. O. C. S. MEDICAL MINERAL” upon each participant’s choice. Several mouth rinses were also selected. We have suggested to use 3M ESPE company’s products: 1. Powder “CLINPRO PROPHY POWDER” – it is extremely effective for removal of plague and pathogenic bacteria from dentogingival pocket 5mm deep; 2. Abrasive paste “CLINPRO PROPHY PASTE” which is available in three different grits, releases fluoride and reduces sensitivity during polishing procedure; 3. “CLINPRO XT VARNISH” coating is a light-cured RMGIC product that has long-term durability with fluoride release. 4. “CLINPRO SEALANT” that contains and releases fluoride, seals enamel pits and aids in the prevention of caries. Such aspects of a healthy diet were also suggested: to decrease calorific value in food; to avoid foods containing high level of carbohydrates; 43 to include products high in protein into daily diet; to follow diet; to follow diet regiment; mandatory maintenance of oral cavity’s hygiene with the use of toothpaste, floss and mouth rinse. The check-ups were done every 2 weeks within 4 months. As a result of performed treatment during 4 months period, all participants have improved their Fedorova and Volodkin’s hygienical index: up to 1,3 and 1,4 which indicates a good hygienical care [5]. When checked by a dentist, no teeth affected by caries have been found; general physical and psychological states of the group have also been improved. Therefore, the relevance of the problem of hygienical state of oral cavity that can lead to appearance of caries has been proved. Conclusion: after performing the work described above, we came to the conclusion that preventive and restorative measures improve the level of person’s dental health. By applying preventive measures one can avoid the appearance of caries. References ● Godgiev R. S. “Lifestyle of Teenagers in Conditions of Big City”, Healthcare of the Russian Federation, 2008. ● Zherebik V. M. “Population’s Level of Life”, M. Unity, 2002. ● Leontiev V. K. Caries and Processes of Remineralization: a doctoral dissertation for Postdoctoral Deg, 1978 – page 45.
CARDIAC ARRHYTHMIAS AND PREGNANCY: THE STRUCTURE AND THE FREQUENCY OF OCCURRENCE
A.V. Prutskova, А.Sh. Kuramshina Stavropol State Medical University, Stavropol, Russia Department of Faculty Therapy Scientific supervisor: C.M.Sc., Associate Professor O.V. Sergeyeva
Introduction: Cardiovascular diseases take the 1st place among all extragenital pathology in pregnant women. During a normal pregnancy women undergo multiple cardiovascular physiologic changes. Arrhythmia is a change in the basic electrophysiological functions of the heart, leading to disruption of coordinated contraction of the entire 44 heart. The occurrence rate and structure of different arrhythmia types during pregnancy have not been studied yet. Objective: The purpose of the study is to specify the rate and structure of cardiac rhythm disturbance in women with a normal pregnancy. Materials and methods: 92 pregnant women (aged 20 to 38) have been studied within survey (the average age 21 years). The inclusion criteria were a normal pregnancy with period of gestation I and II trimester. The exclusion criteria were cardiovascular system complaints, presence of concomitant diseases which predispose to development of arrhythmic syndrome. The survey comprised two main stages: the analysis of ECG in motionless state and Holter monitors’ analysis. Statistical processing of the obtained data was carried out as a supplementary aspect of the study. The processing was carried out with Microsoft Office Excel 2003. Results: According to the ECG the following types of cardiac rhythm disturbance have been identified: sinus tachycardia – 13,3%; sinus arrhythmia – 16%; single premature ventricular contractions – 5,5%; single premature supraventricular contractions – 3,3%. According to the Holter Monitors the following types of cardiac rhythm disturbance have been identified: single premature supraventricular contractions – 83,7%; single premature ventricular contractions – 25%; rare single ventricular contractions – 6,3%. According to the ECG the following types of irregular heartbeat have been identified: right bundle branch block – 17,4%, and the syndrome of short interval – 3,3%. The Holter Monitors have revealed the following types of irregular heartbeat: AV blocks – 8,7%, first degree of AV blocks – 62,5%, Mobitz type II block – 37,5%. Conclusions: Cardiac rhythm disturbance is quite common in a normal pregnancy. According to the Holter Monitors the following types of cardiac rhythm disturbance have been identified: single premature supraventricular contractions in each woman, single premature ventricular contractions in each fourth woman. According to the ECG the following types of irregular heartbeat have been identified: right bundle branch block and the syndrome of short interval. The Holter Monitors have revealed the following types of irregular heartbeat: AV blocks, the first degree of AV blocks, Mobitz type II block. Keywords: Cardiovascular diseases, arrhythmic syndrome, pregnancy, the Holter Monitors. 45 MALARIA
Rajanna Bhartath Stavropol State Medical University Department of Biology Scientific supervisors: C.M.Sc., Associate ProfessorE.N. Makarenko, Asst. T.S. Kopteva, Asst. N.V. Erina
Malaria is a mosquito-borne infectious disease of humans and other animals caused by parasitic protozoans (a group of single- celled microorganisms) belonging to the Plasmodium type. Malaria causes symptoms that typically include fever, fatigue, vomiting, and headaches. In severe cases it can cause yellow skin, seizures, coma, or death. Symptoms usually begin ten to fifteen days after being bitten. If not properly treated, people may have recurrences of the disease months later. In those who have recently survived an infection, reinfection usually causes milder symptoms. This partial resistance disappears over months to years if the person has no continuing exposure to malaria. Main symptoms of malaria The signs and symptoms of malaria typically begin 8-25 days following infection; however, symptoms may occur later in those who have taken antimalarial medications as prevention. Initial manifestations of the disease – common to all malaria species – are similar to flu-like symptoms, and can resemble other conditions such as sepsis, gastroenteritis, and viral diseases. The presentation may include headache, fever, shivering, joint pain, vomiting, haemolyticanemia, jaundice, haemoglobin in the urine, retinal damage, and convulsions. The classic symptom of malaria is paroxysm – a cyclical occurrence of sudden coldness followed by shivering and then fever and sweating, occurring every two days (tertian fever) in P. vivax and P. ovale infections, and every three days (quartan fever) for P. malariae. P. falciparum infection can cause recurrent fever every 36-48 hours, or a less pronounced and almost continuous fever. Prevention An Anopheles stephensi mosquito shortly after obtaining blood from a human (the droplet of blood is expelled as a surplus) is a vector of malaria, and mosquito control is an effective way of reducing its incidence. 46 Methods used to prevent malaria include medications, mosquito elimination and the prevention of bites. There is no vaccine. The presence of malaria in an area requires a combination of high human population density, high anopheles mosquito population density and high rates of transmission from humans to mosquitoes and from mosquitoes to humans. If any of these is lowered sufficiently, the parasite will eventually disappear from that area, as happened in North America, Europe and parts of the Middle East. However, unless the parasite is eliminated from the whole world, it could become re-established if conditions revert to a combination that favours the parasite’s reproduction. Furthermore, the cost per person of eliminating anopheles mosquitoes rises with decreasing population density, making it economically unfeasible in some areas. Keywords: symptoms of malaria, yellow skin, seizures, coma, death.
MUTIPLE SCLEROSIS IN INDIA
Rashema Christopher Stavropol State Medical University, Stavropol, Russia Department of Neurology, Neurosurgery and Medical Genetics Scientific supervisor: D.M.Sc., Professor: S.M. Karpov
Introduction: Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a range of signs and symptoms, including physical, mental, and sometimes psychiatric problems. Multiple sclerosis is the most common autoimmune disorder affecting the central nervous system. In 2013, about 2.3 million people were affected globally with rates varying widely in different regions and among different populations. That year about 20,000 people died from MS, up to 12,000 in 1990. Objective: To determine the spreading of multiple sclerosis in different region of the world. Background: A person with MS can have almost any neurological symptom (or) sign, with autonomic, visual, motor, and sensory problems 47 being the most common. The specific symptoms are determined by the locations of the lesions within the nervous system, and may include loss of sensitivity or changes in sensation such as tingling, pins and needles or numbness, muscle weakness, very pronounced reflexes, muscle spasms, or difficulty in moving; difficulties with coordination and balance (ataxia); problems with speech or swallowing, visual problems (nystagmus, optic neuritis or double vision), feeling tired, acute or chronic pain, and bladder and bowel difficulties. MS is the most common autoimmune disorder of the central nervous system. As of 2010, the number of people with MS was 2-2.5 million (approximately 30 per 100,000) globally, in India, on prevalence day, 16 clinically definite cases of MS were counted, 14 in Bombay and 2 in Poona, from a total population of 50,053 and 3,399, respectively. The crude prevalence ratio was 26 per 100,000 for Bombay and 58 per 100,000 for Poona. The age-adjusted prevalence ratio for Bombay was 24 per 100,000, with 95% confidence limits of 13.1 to 40.3. These are much higher than the low rates believed to be prevalent in India, and are comparable with those found in parts of Europe and the United States. Results: In 2013, about 2.3 million people were affected globally with rates varying widely in different regions and among different populations. Fifty-four patients with multiple sclerosis from North- West India are described. This included two pathologically proven cases of multiple sclerosis. Five patients conformed to the definition of neuromyelitis optica (Devic’s syndrome). This study is in agreement with the other series reported from Asia regarding the special clinical features of multiple sclerosis described from this part of the world Conclusion: There is ongoing research looking for more effective, convenient, and tolerable treatments for relapsing-remitting MS; creation of therapies for the progressive subtypes; neuroprotection strategies; and effective symptomatic treatments. During the 2000s and 2010s, there has been approval of several oral drugs that are expected to gain in popularity and frequency of use. Several more oral drugs are under investigation, including ozanimod and laquinimod. Keywords: multiple sclerosis, autoimmune disorder, population, nervous system, prevalent.
48 MODERN SURGICAL TREATMENT METHODS OF MULTIPLE SCLEROSIS
Richa Verma, Alpha Sanal Stavropol State Medical University, Stavropol, Russia Department of Neurology, Neurosurgery and Medical Genetics Scientific supervisor: C.M.Sc., Associate Professor I.N. Dolgova
Objective: To know about the modern surgical treatment methods of epilepsy and its effectiveness. Background: Multiple sclerosis (MS), also known as disseminated sclerosis or encephalomyelitis disseminata, is a demyelinating disease in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This damage disrupts the ability of parts of the nervous system to communicate, resulting in a wide range of signs and symptoms, including physical, mental and sometimes psychiatric problems. Method: It is neurologic disorder of chronic inflammation and demyelination of the CNS cause is unknown; however, both genetic and environmental factors are believed to be involved. Although there is no cure for MS, drug treatments are available with the goal of decreasing relapses and further disability. Nine agents with interferon and glatiramer established as first-line therapies are currently approved for MS. The modern treatment era for multiple sclerosis began in 1993 with the approval of the first disease-modifying agent. Since then the field has greatly expanded, with 10 therapies currently approved for treatment of MS. These treatments are effective to reduce relapses and changes on MRI, and slow disability. New molecules with novel mechanisms of action and targets are being explore. As more aggressive therapies are available to treat MS, the goals and expectations of treatment are also likely to change. Some of the emerging therapies, including alemtuzumab, daclizumab, rituximab, ocrelizumab, laquinimod, estriol, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG- CoA) reductase inhibitors (statins), Ampyra (dalfampridine ),vitamin D, and stem cell transplantationAvonex (interferon beta-1a) Betaseron (interferon beta-1b), Plegridy (peginterferon beta-1a); Rebif (interferon beta-1a) cytoxan therapy. Result: These treatments are effective to reduce relapses and changes on MRI, and slow disability. However, despite these medications some 49 patients continue to have exacerbations, accumulate disability, and develop progressive disease due to partial effectiveness but it can also be cured. Conclusion: In the future, therapies with different mechanisms may be combined, but this will need to be evaluated in clinical trials. Neuroprotection and repair definitely warrant further study. The future of MS treatment is very exciting, especially as our armamentarium expands. Keywords: multiple sclerosis, autoimmune disorder, nervous system, relapse, MRI.
PECULIARITIES OF PROTECTING OF THE OCULAR SURFACE IN PATIENTS WHO USE SPECTACLE CORRECTION AND CONTACT LENSES
Saad Jabrane Department of Ophthalmology Stavropol State Medical University, Stavropol, Russia Scientific supervisor – C.M.Sc., Associate Professor G.V. Korenyak
Background: Disturbances in the stability of the corneal lachrymal film have many causes. In adolescents and young adults these conditions are often caused by “office” or “computer” syndrome, wearing glasses, contact lens and after kerato-refractive operations. The changes that arise due to disturbances in the stability of the corneal lachrymal film lead to permanent visual discomfort, blurred vision and feelings of a foreign body. These changes are the current problems of ophthalmology. Objective: To analyze the condition of the organs of vision in patients wearing spectacle correction and contact lenses on the background of local corrective treatment using tear substitutes. Material and methods: We analyzed 58 patients (116 eyes) aged from 15 to 45 who are contact lens and spectacle correction wearers receiving the drug “Artelac-Vsplesk”. From the anamnesis we found out that 87% of the patients had complaints of sensation of a foreign body, 58% complained of redness, cramps and burning and 62% complained of feeling of dryness in the eyes. We evaluated the clinical picture of 50 the organs of vision, Schirmer’s test and the time of rupture of the tear film. The drug “Artelac-Vsplesk” was used as a moisturizing agent based on hyaluronic acid created for protection and hydration of the ocular surface. 1 drop was instilled 3 times a day. The product provides a stable tear film protection against drying, promotes epithelialization of the cornea, hydrates the ocular surface and eliminates discomfort. Results: The patients reported complaints of discomfort and dryness in 79% of cases, mucous discharge in the form of filaments in 23% of cases; dot plots in xerosis were present in 43% of patients. The size of the main indicators of tear production to an average of treatment was 85% of 5.6+ 1.3 mm in 5 minutes of treatment. Artelac was administered for 3 months. By the end of 2 weeks after the prescription of Artelac the above complaints decreased in 73% of cases, in 87% of cases by the end of 2 months, and by the end of the 3rd month the complaints were almost absent. Conclusions: Based on the analysis of the above data we come to the соnclusion that the administration of Artelac drug is advisable with the purpose of a long eye surface moisturizing and eliminating the symptoms of discomfort. Keywords: “office syndrome”, “computer syndrome”, spectacle correction, contact correction, eye surface corneal film.
PREGNANCY AND LIPID STATUS IN VIEW OF HEREDITY BURDENED BY EARLY CARDIOVASCULAR DISEASE
Sadiki Jhagroo, Sasha-Gaye Graham Stavropol State Medical University, Stavropol, Russia Scientific supervisors: D.M.Sc., Professor, Head of Department of Faculty Therapy M.E. Evsevyeva; C.M.Sc., Associate Professor O.V. Sergeyeva
Relevance: Hypercholesterolemias is one of the major risk factors for cardiovascular (CV) disease. At the same time some authors considered increased level of cholesterol during pregnancy as physiological. However, number of studies allows us to consider elevated level of 51 cholesterol during pregnancy as a predictor of future CV events. The importance of objective assessment of fluctuations of atherogenic lipids during gestation is very relevant due such reason as existing prohibition of receiving statins during pregnancy and lactation. Objective: To study the dynamics of total cholesterol and triglycerides in different trimesters of pregnancy in view of features of negative heredity for early CV disease. Materials and methods: The 58 individual cards of pregnant women aged from 21 to 38 years (mean age 29,3 ± 1,5) was analyzed. In view of the presence / absence of family history two groups were identified: 1st group (n = 28) - pregnant women with burdened family history of early CV disease and 2ndgroup (n = 30) - pregnant women without such family history. Results: The groups were matched for age (29,8 ± 1,3 and 28,3 ± 1,5, respectively, in groups 1 and 2). Baseline BMI values in both groups did not differ in the same -23.89 ± 1.5; 23,98 ± 1,3 kg \ m2 respectively. Cholesterol levels in I-trimester in both groups were normal values: 4.6 ± 0.2 and 4,7 ± 0,15mmol/l (p> 0,05). In the II-trimester the mean value of cholesterol in the group with burdened family history was significantly higher compared with the comparison group - 6.2 ± 0.3 and 5.1 ± 0.2 mmol / l, respectively. The values of the analyzed indicator in III-trimester amounted to 5,6 ± 0,4 in 1stgroupand 5,8 ± 0,3mmol / l in 2nd group (p> 0,05). Dynamics of triglycerides in group with favorable heredity was characterized by significant increase in values with increasing gestational age. In another group with negative family history maximum value of this indicator was recorded in II trimester and improvements over baseline was 80%. Conclusions: Higher level of cholesterol was recorded in pregnant women with history of early cardiovascular disease in close relatives in the II trimester and triglyceride level was compared with women who have not burdened heredity. Probably, significant hormonal changes that occur during pregnancy, contribute to improvement of these indicators in the presence of unfavorable heredity. It is also possible that described lipid changes can detect predisposition to their increasing in the future life of this group of women. It is needed further prospective studies to address the question of possible relationship of the detected biochemical abnormalities with increased cardiovascular risk in these women in the future. 52 EPIDEMIOLOGY OF DIABETES MELLITUS (TYPE 2) IN INDIA
Saleem Mohamed Arsath Buhari Stavropol State Medical University, Stavropol, Russia Scientific supervisor – D.M.Sc., Professor, Head ofDepartment of Neurology, Neurosurgery and Medical Genetics S.M. Karpov
Introduction: Diabetes Mellitus type 2 is a long term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, feeling tired, and sores that do not heal. Symptoms are often developed slowly. Long-term complications such as heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations are developed because of high blood sugar. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon. Objective: To discuss the epidemiology of Diabetes Mellitus type 2 in India and people who are among the risk groups. Background: According to the Diabetes Atlas 2016 published by the International Diabetes Federation, the number of people with diabetes in India is currently around 56.1 million. It is expected to rise to 69.9 million by 2025 unless urgent preventive steps will be taken. The so called “Asian Indian Phenotype” refers to certain unique clinical and biochemical abnormalities in Indians which include increased insulin resistance, greater abdominal adiposity i.e., higher waist circumference despite lower body mass index, lower adiponectin and higher high sensitive C-reactive protein levels. This phenotype makes Asian Indians more prone to diabetes and premature coronary artery disease. At least a part of this is due to genetic factors. However, the primary driver of the epidemic of diabetes is the rapid epidemiological transition associated with changes in dietary patterns and decreased physical activity as evident from the higher prevalence of diabetes in the urban population. Even though the prevalence of micro vascular complications of diabetes like retinopathy and nephropathy are comparatively lower in Indians, 53 the prevalence of premature coronary artery disease is much higher in Indians in comparison with other ethnic groups. Conclusion: According to the Diabetes Atlas 2016 published by the International Diabetes Federation, the number of people with diabetes in India is currently around 56.1 million. It is expected to rise to 69.9 million by 2025 unless urgent preventive steps will be taken. The most disturbing trend is the shift in the age of onset of diabetes to a younger age in the recent years. This could have long lasting adverse effects on nation’s health and economy. Early identification of at-risk individuals using simple screening tools like the Indian Diabetes Risk Score (IDRS) and appropriate lifestyle intervention would help greatly in preventing or postponing the onset of diabetes and thus reducing the burden on the community and the nation as a whole. Keywords: diabetes mellitus, metabolic disorder.
THROMBOCYTOSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS
Sarithala Vijaya Jawahar Stavropol State Medical University, Stavropol, Russia Department of Hospital Therapy Scientific supervisor – D.M.Sc., Professor P.V. Koroy
Background: Thrombocytosis is usually an unexpected laboratory finding in the analysis of peripheral blood. The most common reason for the increase in platelet count in peripheral blood is a reactive or secondary process. Secondary thrombocytosis is seen in patients with acute or transient situations (trauma, surgery) that can cause thrombocytosis or more sustained thrombocytosis as if in chronic inflammatory diseases, rheumatoid arthritis. Increasing in thrombocytes in rheumatoid arthritis was a result of activation of pro-inflammatory cytokines with megakaryocytopoetic properties. It was proposed that in rheumatoid arthritis haemopoietic cytokines, thrombopoietin partially may participate in inflammatory reaction as a result of thrombocytosis. Objective: The aim of the research was to study the range of thrombocytosis in patients with rheumatoid arthritis. 54 Materials and methods: The study involved 70 patients with rheumatoid arthritis at the age of 20 to 77 years (mean age 50.63±13.0 years), who were examined and treated in the rheumatology department of city hospital, Stavropol. Inclusion criteria: male and female gender, age 18 years or older, presence of rheumatoid arthritis, consent to participate in research. Exclusion criteria: presence of other diseases resulting in thrombocytosis. The control group consisted of 15 people of similar age, physical development and concomitant pathology and did not have rheumatoid arthritis and other autoimmune diseases. In laboratory investigation, in addition to determining the levels of thrombocytes in blood, study included hemoglobin, C-reactive protein, rheumatoid factor IgM and antibodies to cyclic citrullinated peptide in blood. Statistical processing of the data was done using ANOVA with the computation of multiple comparisons test (Student’s t-criteria) and correlation analysis. Results: The level of thrombocytes was increased in patients with rheumatoid arthritis in comparison with the control group (p<0.001). Thrombocytosis, higher than the upper limit of the norm was found in 11.5% of the patients. A positive correlation was seen in thrombocytes and C-reactive protein (p<0.001) defining its increase with increasing in the inflammatory activity. Negative correlation of thrombocytes was seen with the levels of hemoglobin (p<0.001). Thrombocytosis was correlated with significant increase in the level of rheumatoid factor (p<0.001) and the level of antibodies to cyclic citrullinated peptide (p=0.016). Thrombocytosis was also seen positively correlated with the disease activity by the index DAS28 (p<0.001). Blood analysis showed no significant difference in the level of thrombocytosis in comparison between men and women diagnosed with rheumatoid arthritis. Conclusion: In patients with rheumatoid arthritis, thrombocytosis was positively correlated with C reactive protein, rheumatoid factor, antibodies to cyclic citrullinated peptide and the activity of the disease according to DAS28, defying its incidence with increasing in disease activity. An inverse relation was seen in between the level of thrombocytes and the concentration of hemoglobin. Keywords: rheumatoid arthritis, thrombocytosis, hemoglobin, C-reactive protein. 55 CONCENTRATION OF OSTEOCALCIN IN THE BLOOD OF WOMEN WITH RHEUMATOID ARTHRITIS
Sarithala Vijaya Jawahar Stavropol State Medical University, Stavropol, Russia Department of Hospital Therapy Scientific supervisor – D.M.Sc., Professor P.V. Koroy
Background: Osteoporosis is considered as a systemic skeletal disease characterized by decrease in bone mass and micro-architectural violation of bone tissue, resulting in an increased risk of fractures and deсline in the quality of life of patients. In rheumatoid arthritis, osteoporosis, as a decrease in bone mineral density is not only formed locally in the area of inflamed joints, but also systemically. The basis of the development of osteoporosis in rheumatoid arthritis is increased production of mediators of bone resorption, including those resulting from the use of glucocorticoids, whereas the impact of the disease on markers of bone formation is not fully established. Objective: The aim of the research was to study the concentration of blood osteocalcin in women with various clinical variants of rheumatoid arthritis. Materials and methods: The study involved 50 patients with rheumatoid arthritis at the age of 22 to 64 years (mean age 47.6±1.77 years), who were examined and treated in the rheumatology department of city hospital, Stavropol. Inclusion criteria: female gender, age 18 years or older, presence of rheumatoid arthritis, consent to participate in research, the absence of steroid treatment. Exclusion criteria: presence of other diseases affecting bone metabolism. The control group consisted of 15 people of similar age, physical development and concomitant pathology and did not have rheumatoid arthritis and other autoimmune diseases. In laboratory investigation, in addition to determining the serum levels of osteocalcin, study included C-reactive protein, rheumatoid factor IgM, antibodies to cyclic citrullinated peptide in blood. Statistical processing of the data was done using ANOVA with the computation of multiple comparisons test (Student’s t-criteria), correlation analysis with the computation of criteria of Spearman and Pearson. Results: Concentration of osteocalcin in the group with rheumatoid arthritis and in the control group correspond to the norm range, but the level of the mediator of bone metabolism in rheumatoid arthritis was significantly lower than in controls (p = 0.012). Osteocalcin level, 56 less than the lower limit of the norm was observed in 22% of patients. Significant dependence of indicators of bone metabolism on the presence of rheumatoid factor and antibodies to cyclic citrullinated peptide were not found. The concentration of osteocalcin in blood was in association with clinical stage (p = 0,024), significantly decreasing with increasing in duration and severity of the disease. In cases of highly inflammatory activity, according to index DAS28, serum osteocalcin concentration was significantly lower (p = 0.023), than with minimal to moderate activity of rheumatoid arthritis. Indicators of osteocalcin were not depended on the presence of systemic manifestations, the severity of x-ray changes of joints, including the presence of erosions and were also not correlated with the level of erythrocyte sedimentation rate and C-reactive protein. High level of functional class of the disease was characterized by significantly lower values of osteocalcin in the blood (p = 0.033). Analysis of markers of bone metabolism with the presence or absence of menopause showed that osteocalcin content was similar in both groups of patients. Conclusion: In women with rheumatoid arthritis, disorder of bone tissue metabolism in the form of decrease in the level of marker of bone formation, osteocalcin, associated with duration, activity and functional class of the disease was observed. Reduced levels of osteocalcin indicate insufficient intensification of the process of bone formation in response to the activation of its resorption in women with rheumatoid arthritis. Keywords: rheumatoid arthritis, osteocalcin.
SURGICAL TREATMENTS OF ATHEROSCLEROSIS IN LOWER LIMB ARTERIES
G.V. Sazanov, D.I. Zolotukhina, O. Bulda, N.V. Pisarenko Stavropol State Medical University, Stavropol, Russia Department of Surgery and Endosurgery with the Course of Vascular Surgery and Angiology Scientific supervisors: C.M.Sc., Associate ProfessorR.A.Chemurziev; C.M.Sc., Head of Regional Vascular Center M.V. Gasparyan; Specialist in X-ray-Endovascular Diagnostics and Treatment of Stavropol Regional Clinical Hospital A.Yu. Krasnov
Introduction: Atherosclerosis of abdominal aorta and the arteries of the lower extremities is one of the most common diseases leading to high morbidity and mortality of patients. 57 Objective: To analyze the immediate results and the effectiveness of aorto-femoral and femoral-popliteal-tibial segment reconstruction using open and endovascular surgery. Materials and methods: The study included 441 patients with the coronary atherosclerosis of the femoral and popliteal-femoral- tibial segments treated in the Stavropol State Clinical Hospital during 2014-2015. There were 69% of males (305 patients), 31% of females (137 patients). The average age of patients was 59.5 years. The degree of arterial ischemia was IIb-IIIb by Saveliev’s classification. Reconstruction of the aorto-iliac segment was performed in 157 (35.5%) cases, of them in 131(83.4%) cases open surgery was performed (group 1), endovascular correction – balloon angioplasty (BAP) / stenting of the iliac arteries was performed in 26 (16.6%) cases (group 2). Infrainguinal reconstruction was performed in 284 (64.5%), of these patients open surgery performed for 201 (70.8%) patients (group 3), intravascular surgery performed for 83 (29.2%) patients (group 4). Groups were comparable according to the degree of arterial ischemia. Results: In the first group aorto-femoral bifurcation bypass was performed in 78 (59.6%) cases, aorto-linear / iliac-femoral bypass in 30 (22.9%), endarterectomy of iliac segment in 5 (3.8%), reconstruction of distal anastomosis after aorto-femoral bypass in 18 (13.7%) cases. There were the following complications: thrombosis were in 7 (5.3%) cases, secondary amputation of limbs was performed in 4 (3%) cases, patients a hematoma in the area of access was in 2 cases(1.5%), death in 2 (1.5%) cases. In the second group balloon angioplasty (BAP) of iliac arteries was performed in 6 (23%) cases, stenting – in 20 (77%). Access was via the radial artery in12 (46.2%) cases, via the brachial artery in 3 (11.5%), via the right femoral artery in 11 (42.3%). There were the following complications: restenosis of the operated vessel was in 1 (3.8%) case, one (3.8%) patient had a migration of the stent to the abdominal aorta, hematoma at the area of access were diagnosed in 2 (7.7%) patients and one (3.8%) patient had a secondary amputation. In group 3 femoro-popliteal bypass above the knee gap was performed in 75 (37.2%) cases, femoro-popliteal bypass gap below the knee in 43 (21.4%), femoral-tibial bypass in 21 (10.5%), profudoplasty in 21 (10.5%) cases, endarterectomy of the superficial femoral artery in 41 (20.4%). The following complications were diagnosed: thrombosis was in 9 (4.5%) cases, hematoma at the area of access was diagnosed in 4 (2%) cases. Surgical treatment was not possible in 4 (19%) cases, 58 restenosis / thrombosis of the operated segment of the vessel in 3 (14,2%). There were the following complications after endovascular intervention: restenosis /thrombosis of the operated segment of the vessel was in 5 (8%) cases, a hematoma at the area of puncture diagnosed in 2 (3.2%) cases and secondary amputation had 1 (1.6%) patient. In the fourth group the BAP of the femoral artery was performed in 11 (13%) cases, stenting in 9 (11%). BAP of the popliteal artery was performed in 39 (47%) cases, BAP of the tibial arteries of feet (including the foot) in 11 (13%), stenting was in 13 (16%). It should also be noted that the revascularization of the arteries of the foot is a very complex operation, and performed by endovascular BAP in most cases. Conclusion: These surgeries are effective and relatively harmless methods of choice for treatment of acute arterial insufficiency of the lower limbs. The correct choice of the surgery determines the outcome of the treatment and the quality of life of the patient. Keywords: atherosclerosis, abdominal aorta, femoral and popliteal- femoral-tibial segments, anastomosis, stenting.
BREAST CANCER AWARENESS AMONG WOMEN IN INDIA
P. Shiva Prasad, N. Mranalee Stavropol State Medical University, Stavropol, Russia Department of General Surgery Scientific supervisor: C.M.Sc., Assoc. Professor.O.V. Vladimirova
Background: Breast cancer is the most common female cancer worldwide including India, where advanced stages at diagnosis and rising incidence and mortality rates make it essential to understand cancer literacy in women. Objective: To provide the awareness about breast cancer among women in India and to help them to know the facts of breast cancer screening. Material and methods: A structured literature search using combined keywords was undertaken on bibliographic databases including MEDLINE, Cochrane Database of Systematic Reviews, Cumulative Index to Nursing and Allied Health (CINAHL) and SCOPUS. Searches were restricted to research published in English language peer-reviewed journals through December, 2015 in India. 59 Results: A total of 7066 women aged 15-70 years showed varied levels of awareness on risk factors such as family history (13-58%), reproductive history (1-88%) and obesity (11-51%). Literacy levels on risk factors did not improve over the 8-year period (2007-2015). On average, nurses reported higher, though still varied, awareness levels for risk factors such as family history (40.8-98%), reproductive history (21-90%) and obesity (34-6%). Awareness levels were not consistently higher for the stronger determinants of risk. Conclusion: Indian women need to be aware of both modifiable and non-modifiable risk factors for breast cancer to adopt appropriate practices for prevention. There is an urgent call for more effective nation- and state-wide cancer literacy programs, as well as engagements with community-level organizations and the health system: providing lectures in college, universities and in working places. With wide variations in the state-level burden, a coordinated, intensive health promotion intervention program on risk factors, prevention, screening and management for breast cancer is prudent. Keywords: breast cancer, awareness, risk factors, women, India.
ASSESSMENT OF THE CHANGING IN NATURE OF NUTRITION IN STUDENTS AFTER ADMISSION TO THE UNIVERSITY
A.V. Simonyan Stavropol State Medical University, Stavropol, Russia Normal Physiology Department Scientific supervisor – C.M.Sc., Associate Professor E.V. Eliseyeva
Background: a balanced diet is the most effective combination of proteins, fats, carbohydrates and the optimum level of calories in a human diet. Nutrition is not just of biological and medical, but also of a great socio-economic importance. The proper nutrition today is one of the most acute problems in the world. Physical and mental activity of a person depends on his properly nutrition, which determines the efficiency of all the activities, affects the length and quality of life. Poor nutrition can lead to the deficiency of essential nutrients, vitamins and minerals on the one side and to the development of overweight and alimentary obesity on the other – this is one of the most important problems nowadays. 60 Objective: to assess the nature, quality and energy value of the students food after their admission to the University. Materials and methods: the analysis of the nature and the quality of food was enrolled in 25 students of SSMU in the basis of the developed questionnaires. Results and discussion: 5 boys and 20 girls aged from 18 to 21 years participated in the survey. 8 students marked the weight reducing after admission (2 kg average), 10 persons’ weight increased (5 kg average), and the weight of the rest has not changed. The ratio of food intake of the respondents varies from 2 to 4 times per day, this indicator decreased after admission. All students marked a decrease in physical activity at the same time. On the basic dishes consumed per day we calculated the approximate content of proteins, fats, carbohydrates and calories. All the interviewed persons did not follow rules of rational nutrition, both before admission and after it. It is revealed that after beginning the university study received calories increased and the content of proteins and fats decreased. Thus, the daily protein intake was 40-50 g, for fats – 34-55. The Calories value was 880-1300 Cal (a normal rate in accordance with the level of activity is 2000-2450 Cal). Conclusion: the nature, quality and value of the food of students have deteriorated after their admission to the University; the imbalance of basic food ingredients is marked; younger students need recommendations on the organization of a balanced diet. Keywords: nutrition, balanced diet.
ANTIMICROBIAL ACTIVITY OF FIBROBLASTS
A.V. Simonyan Stavropol State Medical University, Russia Scientific supervisor: D.M.Sc., Professor, Head of the Microbiology Department of Stavropol State Medical University I.A. Bazikov
Background. The use of fibroblasts in the treatment of various diseases is experimentally substantiated. The current study assesses the ability of fibroblasts to inhibit the development of pathogenic microflora. Objective. In this regard, the aim of the study was to assess the antimicrobial activity of fibroblasts isolated from the placental tissue. 61 Methods and materials. Study of antimicrobial activity of fibroblasts was carried out by disk diffusion method (DDM). Paper discs were previously impregnated with the obtained culture of fibroblasts. Fibroblasts were obtained by the original technology we have developed (patent RF 2310461). As a result of work the fibroblasts in monolayer have been isolated and they were as a homogeneous cell culture (Fig. 1).
Fig. 1. Cultured fibroblasts in monolayer × 90.
Results. Study of bactericidal activity of placental fibroblasts against various species of bacteria showed that fibroblasts inhibit the growth of all strains of Staphylococcus and Streptococcus microorganisms taken for the study (Fig. 2). So, areas of stunted growth in the radius of 21.6 ± 0.13 mm were observed against Streptococcus spp (experiment 1). For Staphylococcus aureus the zone of stunted growth was 13.6 ± 0.12 mm (experiment 2). The zone of stunted growth of Staphylococcus epidermidis was 11.2 ± 0.07 mm (experiment 3).
Fig. 2. Control experiment 1 experiment 2 experiment 3
Conclusion. Thus, we have established that these fibroblasts had antimicrobial activity against strains of Staphylococcus and Streptococcus microorganisms. Keywords: fibroblasts, antimicrobial activity, disk diffusion method. 62 FEATURES OF VASCULAR AGE OF THE UNIVERSITY FEMALE STUDENTS
Suren Vlasyants Stavropol State Medical University, Russia Scientific supervisors – Head of Department of the Faculty Therapy, D.M.Sc., Professor M.E. Evsevyeva; Asst. E.N. Fursova
Background: Vascular age (VA) is regarded as a possible predictor for development of cardiovascular complications in the future. However, to date, this parameter is estimated mainly from middle-aged adults. There is evidence of early atherosclerotic changes in the arteries of young people and even children. Still VA features of students according to their social status and, in particular, with regard to the faculty of education at the university has not been studied. Objective: To evaluate VA rate of the university female students and differences with their passport (chronological) age (PA) in conjunction with the faculty of education in medical school. Materials and methods: 187 medical female students aged 16 to 22 years old were screened for the presence of major risk factors and tested with the help of special diagnostic device “Angioscan 01” (production of Russia, Moscow) on the basis of Student’s Health Medical Center of Stavropol State Medical University. Such indicators as stiffness index (SI), reference stiffness index (RSI), reflection index (RI), augmentation index (AIp), augmentation index with HR=75, Aging index (AI), vascular aging (VA), and others were analyzed. All surveyed were divided into 3 groups according to the faculty of training: 1st group – 76 students of General Medicine faculty; 2nd group – 37 students of Dentistry faculty; 3rd group – 73 students of Pediatrics faculty. In addition to the above-mentioned indicators in three observation groups the difference between the passport and the vascular age (Δ) were evaluated. The results are presented as M ± m. Statistical analysis was carried out by means of “STATISTICA 6.0” program. Results: The results showed that 93 % of female students have vascular age higher than passport one; only 6% have equal vessel and passport age; 1% of students have lower vessel age than passport one. VA indicators in girls at General Medicine, Dentistry and Pediatrics faculties averaged 28,1±0,8; 31.2± 1.3, and 28,9±0,9 years, while PA 63 of surveyed at these faculties amounted to 18,2±0,4; 17,5±0,1 and 17.6±0.1 years. That is, the excess of VA over PA (Δ) in girls at the medical, dental and pediatric faculties was 9.9, 13.7 and 11.3 years. Conclusion: The results indicate the presence of the vascular wall aging already at a young age in a significant proportion of girls aged 16 to 22 years old, studying at different faculties of the university. These data indicate the need for targeted implementation of motivational and educational technologies aimed at forming positive behaviours among students and integrated into the current educational process. The maximum level of the vascular age increase in girls of Dentistry faculty requires a differentiated approach in conducting awareness and recreation activities with a particular attention to early detection of cardiovascular risk factors and their timely correction among future dentists in the first place. Keywords: vascular age, passport age, cardiovascular risk factors.
ANXIETY-DEPRESSIVE DISORDERS AND ARTERIAL HYPERTENSION IN YOUNG MEN: ASPECTS OF CIRCADIAN BLOOD PRESSURE
Yadav Desh Pal Singh, Mohit Stavropol State Medical University, Stavropol, Russia Scientific supervisors: D.M.Sc., Professor, Head of the Faculty Therapy Department M.E. Evsevyeva; C.M.Sc., Asst. C.M.Sc. Z.V. Kumukova
Introduction: Anxiety-depressive disorders in arterial hypertension mainly have been studied in the elderly population. The literature data on the occurrence and possible interaction of these disorders with hypertension in young age are valuable for society and very scarce. Objective: to determine characteristics of relationship of parameters in daily dynamics of blood pressure (BP) and some indicators of neuro- psychiatric status of young people. Materials and methods: 118 students of Stavropol State Medical University at the age 18-25 years old and 30 young patients with primary arterial hypertension (AH) from cardiological department of regional hospital. Such formation of groups reflects the main stages 64 of cardiovascular continuum of AH. BP monitoring was performed on outpatient basis whith the unit MDP-NS-01 “Advanced Technology” (Russian Federation, Moscow) for 24 ± 1,5 hours. Average daily rates, night BP and others (30 indicators) were estimated. Assessment of severity of anxiety-depressive disorders (ADD) was carried out using the hospital scale HADS. Results: An examination of students has shown that with onset of ADD and increase in their intensity the young people were found to have higher indicators such as: pulse, ВР and reduced levels of ambulatory SBP and DBP. It was established that ADD is associated with decreased number of persons showing normal nocturnal dip in ВР and a greater number of persons with pathological types of diurnal rhythm of circadian BP. Maximal number of persons with signs of ADD take place among hospital patients with manifested AH. Conclusions: The examination findings confirm the role of ADD in development of circulatory dysregulation in very early stages of the cardiovascular diseases. Keywords: anxiety-depressive disorders; arterial hypertension; blood pressure; cardiovascular disease.
THE FREQUENCY AND OUTCOMES OF ECTOPIC PREGNANCY AFTER IN VITRO FERTILIZATION
D.I. Zolotukhina, G.V. Sazanov Stavropol State Medical University, Stavropol, Russia Scientific supervisors: D.M.Sc., Professor, Head of Obstetrics and Gynecology Department V.A. Aksenenko; Asst. S.A. Neredko
Introduction: 17% of couples are infertile in Russia and needed in Assisted Reproductive Technologies. There is an opportunity to have In Vitro Fertilization paid by compulsory health insurance since 2013, so this method is becoming more affordable and common in the treatment of infertility. It should be noted that the use of IVF is considered being one of the causes of ectopic pregnancy. There are mentions of heterotopic pregnancies after transfer of two and more embryos. Nowadays there is a method of conservative treatment of ectopic pregnancy in the early stages using methotrexate. In case of its ineffectiveness surgical 65 treatment – laparoscopy or laparotomy are implicated. Depending on the clinical situation organ preserving or radical surgery performs. The modern method of bloodless removal of the ovum with a prior Uterine Artery Embolization allows avoiding complications in many cases of ectopic pregnancies. Objective: To find out cases of ectopic pregnancy after IVF and explore outcomes. Materials and methods: A retrospective analysis of 200 cases of pregnancies after IVR in Stavropol State Clinical Perinatal Centre for the period 2013-2014. Results: During 2013-14, 628 infertile couples were treated with IVF at the ART department of SSCPC. 200 patients had got pregnant. Ectopic pregnancy was diagnosed in 5 (2,5%) cases. 2(1%) of them were tubal. Laparoscopy and tubectomy were done in both cases. Cervical pregnancy progressed in 1 case (0,5%). Methotrexate in total dose 150 mg was ineffective. Superselective UAE with the following evacuation of gestational sac without blood flow in its vessels were performed. Two patients had multiple pregnancies at the age of 5-6 weeks. In the first case one gestational sac was in the upper third of the uterine cavity, the second one in the isthmic part of uterine tube. Laparoscopy, dextral tubectomy were performed. In the second case gestational sacs were in the upper third of the uterine cavity and uterine cervix. In the operating theater under the US control the gestational sac was reduced from the uterine cervix with the 4% KCl intake with the next surgical removal of gestational sac and its bed coagulation. Both patients had full-term planned abdominal delivery. Newborn girls’ weight was 3400g and 3200g respectively, Apgar score was 9-10. Conclusion: The analysis showed that ectopic pregnancy after IVF is a rare complication that adversely affects the health of women of reproductive age. However, there are also cases of a combination of heterotopic uterine and cervical or tubal pregnancy. Timely diagnosis of progressing ectopic pregnancy allows performing necessary surgery and preserving fertility of patients, prolonging uterine pregnancy if it’s present and getting healthy babies. But there is a high risk of complications despite the positive outcomes in these cases. In this regard the cycles of two embryos transfer are being reduced reducing now and selective transfers of one embryo are increasing. So the risk of multiple and heterotopic pregnancy is getting lower significantly. Keywords: ectopic pregnancy; heterotopic pregnancy; In Vitro Fertilization. 66 SCIENTIFIC ABSTRACTS OF PATICIPANTS FROM OTHER MEDICAL UNIVERSITIES OF THE RUSSIAN FEDERATION
67 THE TREATMENT OF CONGENITALLY MISSING MAXILLARY LATERAL INCISORS: AN INTERDISCIPLINARY APPROACH
A. Dolgalevа, T. Timoshenko I.M. Sechenov First Moscow State Medical University, Moscow, Russia Scientific supervisor: D.M.Sc., Professor, ITI memberA. Dolgalev
Background. Nowadays congenitally missing lateral incisors is a common clinical occurrence. Successful dental treatment is always the main purpose for patients and dental practitioners. In this paper the authors introduce an approach to using dental implants to solve the problem of congenitally missing lateral incisors. In most cases, a plan of multidisciplinary treatment plan has to be developed and executed. Currently, a single implant supported crown is a predictable method for the treatment of bilateral missing incisors. Objective: To determine the indications and contraindications for the treatment of edentulous maxilla lateral incisors, according to clinical guidelines for the treatment of this disease with the use of dental implants. Materials and methods: This study presents the clinical results of treatment of patients with edentulous maxilla lateral incisors, who were treated at the “North Caucasian Medical Education Center” from 2009 to 2014. We observed 12 patients. All patients were women aged 18 to 32 years old. Recommendations: 1. Implant treatment of this pathology is recommended after 18 years of age, when the growth of the facial skeleton is finished. If orthodontic treatment is performed at a younger age, this group of patients needs to use removable prosthesis until the facial skeleton has been completely formed. Such prosthesis should be adjusted every six months. 2. When the space between the central incisors and canines is expanded enough using orthodontic treatment, implant treatment should not be started earlier than 6 months after orthodontic treatment is finished. 3. The minimum distance between the central incisors and canines should be 5.5 mm. 4. Preference should be given to CAD / CAM technologies when 68 manufacturing implant fixed prosthetic constructions in such clinical cases. Conclusion: An interdisciplinary approach must be applied for planning of the treatment of patients with edentulous maxilla lateral incisors. Installation of single implants in such situations is a predictable treatment, while remaining the method of choice for clinicians. Keywords: adentia, lateral incisors, upper jaw.
PSYCHOLOGICAL ADAPTATION OF THE 3RD-YEAR STUDENTS OF NORTH OSSETIAN STATE MEDICAL ACADEMY TO PROFESSION
G. N. Enaldiev, Z. Panahov North Ossetian State Medical Academy, Vladikavkaz, Russia Department of Internal Diseases No. 1 Scientific supervisor – C.M.Sc., Associate Professor Z. S. Dzhikaeva
Introduction: The article describes the essence and peculiarities of professional adaptation of students enrolled in medical Academy. The process of professional adaptation of students of the 3rd course of SOHMA is described. The results of research to identify the level of formation of the 3rd year students as future doctors are presented. The necessity of development and implementation in the operation system of the University’s dynamic program of pre-University training is given. Successful professional adaptation of students enhances the effectiveness of the educational process in the University is to prepare competitive specialist. Objective: The aim of the study was to ascertain the level of professional adaptation of students. Materials and methods: At the end of the 3rd course in 2011, 2012 and 2013, the Medical and Pediatric faculties held a series of lectures and practical classes at the Department of propaedeutics of internal diseases. The mismatch of perceptions and expectations of former students with the real conditions of professional work, facing medical students at the completion of clinical disciplines, makes them psychologically unprepared for the meeting with difficulties in learning, the development of practical skills and entry into the profession. The 69 aim is to develop methods in adapting students to the profession and informing the applicants about the essence of the medical profession. The poll of the students’ opinions was surveyed. Conclusion: we can conclude that young people need to have assistance in choosing a career, and assistance in adapting to it. Keywords: professional adaptation, student of medical school, the labour market, the level of professional adaptation, professional adaptation of students.
PROFESSIONAL LANGUAGE OF MEDICINE AS AN INTERDISCIPLINARY SUBJECT LANDMARK
S.A. Hugaev, G.M. Gabaraev, G. N. Enaldiev North Ossetian State Medical Academy, Vladikavkaz, Russia Scientific supervisor: Head of the Chair of Foreign Languages D.T. Khatsaeva, Associate Professor G.V. Shurakova
Background: The professional language of medicine is an interdisciplinary subject, which is conceived in its essence by nature. It has an especially close relationship with cognitive science, linguistics and semiotics, actually science, standardization and language planning, knowledge engineering. Objective: The purposes of this study are technical terms in the interdisciplinary communication in medical science. We need the terminology of teaching the science of specialized vocabularies (terminology) to conduct research in conjunction with linguistics; they strongly influenced the development of structuralism views. In the field of medicine, we studied the major areas of knowledge in the aspect of subject-specific terminology. There is a connection of specialized language research with medicine, at present, and this investment is considered terminological units in communicative contexts. These areas are offered to translation experts and medical doctors, as well as important ideas and proposals for communicative tasks in teaching and practice. Terminology forms fundamentals of written and oral professional communication in all areas of medicine. This also applies to the theory and practice, as well as for training and for fan-wide communication. Terminology requires knowledge of the professional 70 relationship in the working area. The voice and experience complement each other, so that in many cases an interdisciplinary cooperation between terminologists and specialists of the appropriate medicine is inevitable. The term as a way of thinking or knowledge units, is a center of learning terminology. Philosophy has been doing this since its inception in accordance with different conditions and explores the ways of describing .The close relationship between the two entities, among other things, is expressed in the doctrine of the terminology, the accepted symbols to indicate term relations of formal logic developed a set of symbols similar to this one. In close connection with logic is the theory of knowledge, which, among other things, tries to clarify the relationship between the sciences and to determine the position of the new science in context. Here the terminology is an indispensable tool. We studied the terminology in the aspect of learning information tasks. Here, the writing texts of various types play a central role. Especially important is the use of terminological principles in the development of classification systems and thesauri in the field of medicine. Finally, it should be noted that these tools are used in an intensive search of information on terminology and medical purposes.
CLINICAL AND LABORATORY CHARACTERISTICS AND AGE PECULIARITIES OF THE COURSE OF INFECTIOUS MONONUCLEOSIS CAUSED BY EBV IN CHILDREN ACCORDING TO THE STATISTICAL INPUTS FROM VOLGOGRAD REGION
Jaydeokar Pratik Suren, K.V. Baidova, V.E. Chebotar Volgograd State Medical University, Russia Department of Pediatric Infectious Diseases Scientific supervisor: Assistant of the Department of Pediatric Infectious Diseases B.A. Nevinsky
Introduction: The high grade of infection of the population confirms the importance of herpes virus infections in human pathology. Primary infection with viruses of the Herpes viridae family in 60%- 90% of the cases occurs in early childhood. Herpes viruses can persist in immunocytes throughout a lifetime, causing latent infection or 71 symptomatic form of the disease, which most commonly is called infectious mononucleosis (IM). In most cases, the etiology is associated with IM lymphotropic virus of herpes type IV Epstein-Barr (EBV). Objective: to explore and describe clinical and laboratory features of the course of infectious mononucleosis in children of different age groups on the basis of their comprehensive examination using clinical, instrumental and laboratory methods to improve the etiological diagnosis and therapy. Materials and methods: Complex clinical-laboratory examination was made in 138 patients in the age group of 1 to 9 years with syndrome complex of infectious mononucleosis who were treated in the Department of Respiratory Infections of Volgograd Regional Children’s Clinical Infectious Hospital No. 1. The first group consisted of 80 children (58%) aged 1 to 3 years; the 2nd group – of 45 children (32.6 per cent) from 4 to 6 years old; 3rd group – 13 children (9,4%) from 7 to 9 years old. The examination included: clinical analysis of blood; bacterial cultures for identification of the microflora of the nasopharynx and oropharynx; (LFT test) biochemical determination of hepatic aminotransferases (Alt, AST), total bilirubin, thymol; ultrasound examination of abdominal cavity. All patients consulted the otorhinolaryngologists. To confirm the etiological interpretation they used direct method – polymerase chain reaction (PCR). Results and discussion: In the age structure of the patients, the first were the children of three years old (56,7%). The most frequent clinical signs were lymphadenopathy – 52.9%, fever – 63.0%, tonsillitis with complications – 63,8%; acute adenoiditis – 58,7%; hepatomegaly – 47.2%, splenomegaly – 40,6%; and showed an increase in the proportion of children having them with exanthema syndrome, or 9.4%. Children of an early age were found to have developed more often a catarrhal syndrome – in 68,8% of cases of rhinitis. Laboratory data showed: white cell count was between 7.1 and 13.8 per/mm3 with an average of 10.5 leukocytes/mm3, and lymphocyte count was between 36,3 and 56.3/mm3 with an average of 43.8/mm3. The number of atypical mononuclear cells more than 10% was identified in 57,2% of cases. The most frequent hematologic complication was thrombocytopenia in 10.9% of patients. Conclusions: In the age structure of the patients, children of three years old (56,7%) were at the first place, thus, we conclude that they were younger. Infectious mononucleosis in most children occurs 72 with febrile fever, intoxication, acute adenoiditis, tonsillitis with complications, generalized lymphadenopathy, hepatosplenomegaly, lymphomonocytosis with the number of atypical mononuclear cells more than 10%. Keywords: herpes virus, Epstein-Barr virus, mononucleosis, pediatric infections
FATIGUE SYNDROME IN PREGNANT WOMEN WITH LONG-TERM CONSEQUENCES OF TRAUMATIC BRAIN INJURY
A.A. Volynkin Moscow State Medicine Dentistry University, Moscow Regional Scientific Research Institute of Obstetrics and Gynecology, Moscow, Russia Scientific supervisors: D.M.Sc., Professor P.N. Vlasov, D.M.Sc., Professor V.A. Petrukhin
Background: Traumatic brain injury (TBI) and its consequences is a significant problem in medicine. Fatigue after traumatic brain injury is common and it is one of the most important long-term symptoms following TBI. In various studies, the frequency of prolonged fatigue syndrome varies from 16% up to 73%. As a result of TBI in 50% of women various psychoaffective disorders, including fatigue syndrome may develop during pregnancy. These facts defined the relevance of our study. Objective: To study the signs and features of fatigue syndrome in pregnant women with long-term consequences of traumatic brain injury, who were hospitalized to “Obstetrics Physiological Department of MRSRIOG” during the period of 2013-2015. Materials and methods: All pregnant women (n=47) with consequences of TBI were examined using a subjective scale of fatigue (MFI-20). The MFI-20 consists of 20 statements including five subscales: general fatigue, physical fatigue, mental fatigue, decrease in motivation, decrease of the activity. In total, the points shouldn’t exceed 20-30 and more than 30 points are the bases for fatigue syndrome. Results and discussion: All patients were divided into 2 groups. 73 The 1st group – with consequences of mild TBI (44,7%; n=21), the 2nd group – with consequences of severe TBI (55,3%; n=26). The mean age of patients was: in the 1 group 31,4±6,3 years, and in the 2nd group 31,9±6,3 years. In 1 group – the fatigue was diagnosed in 4 (19,1%) pregnant women. The changes on a scale of MFI-20 have been recorded in subscales as the decrease of the activity (6,10±1,23 in 1 group and 5,12±0,89 in the 2nd group, p<0,05) and physical fatigue (7,4±1,42 in 1 group and 5,31±1,17 in the 2nd group, p<0,05). In the 2nd group – the fatigue was diagnosed in 7 pregnant women (26,7%). All changes were noted in subscales of a mental fatigue (7,23±1,95 in the 2nd group and 5,29±1,42 in 1 group, p<0,05) and decrease in motivation (6,88±1,78 in the 2nd group and 5,52±1,18 in 1 group, p<0,05). Conclusions: Thus, the fatigue syndrome as the result of TBI was diagnosed in pregnant women in 11 (23,4%) of cases. Among patients with consequences of mild TBI the fatigue syndrome belongs to a physical field of activity (n=4; 19,1%), and in group of pregnant women with consequences of severe TBI – to mental (n=7; 26,7%) Keywords: fatigue syndrome, traumatic brain injury, pregnant women.
74 SCIENTIFIC ABSTRACTS OF PATICIPANTS FROM THE UNIVERSITIES OF THE FOREIGN COUNTRIES
75 JOINT NATIONAL COMMISSION (JNC-7) GUIDELINES OF HYPERTENSION
Dr. M. Annamalai, MD.,DM., Prof. and Head, Dept. of Cardiology, Madurai Medical College, Madurai-625020. India
Hypertension [HTN] is a hereditary disease. It affects approximately one million people worldwide. Its incidence increases as age advances. Since it has not many manifestations, it is not detected unless looked for in the general population. When people come to know that they have hypertension they have already advanced into severe stage with target organ damage – a fatal stroke or myocardial infarction or irreversible renal failure. Unfortunately even in developed countries like United States 30% of hypertensives are unaware of its presence; only 59% of the known hypertensives are on treatment and only 34% have good control of their BP. Hence the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure (JNC-7), has been formed to review vast accumulation of HTN observation studies since JNC-6 report and to recommend new clear and concise guidelines that would be useful for the clinicians to maximize its benefits. The JNC-7 has simplified the classification: a new term “Prehypertension” has been added, as the chance of these people developing HTN doubles compared to those with normal BP. Stage 1 of JNC-6 has been retained and stage 2 & 3 has been combined together and classified as stage 2 in JNC-7. Risk Stratification and Cardiovascular Disease risk For persons over age 50, systolic BP (SBP) is more important than diastolic BP (DBP), as a cardiovascular disease (CVD) risk factor. Persons who are normotensive at age of 55, have 90% life time risk of developing HTN. Across the entire BP range from 115/75 to 185/115 mmHg, the CVD risk doubles with each increment of 20/10 mmHg. Hence even patients with pre-hypertension need to be informed about life style modification for the control of BP and prevention of CVD risk, because the relationship between BP and CVD events is continuous, consistent and independent of other risk factors. The higher the BP, the greater is the chance of heart failure, heart attack, stroke and kidney disease. 76 Benefits of lowering BP It has been shown clearly in the clinical trials, that good control of HTN by antihypertensive therapy has been associated with 35-40% reduction in the incidence of stroke, 20-25 % of myocardial infarction and more than 50% of heart failure. BP Control Rates and Goal of Therapy Good BP control is still far below the healthy people 2010 goal of 50% and the ultimate goal of hypertension therapy is the reduction in cardiovascular and renal mortality and morbidity. Systolic hypertension occurs much more commonly in older persons and controlling systolic HTN, which is a very important risk factor for CVD and stroke than DBP, is highlighted. The primary focus should be on achieving SBP goal, since most persons with HTN, especially those aged ≥50 years, will reach DBP goal, once SBP is at goal, which is <140/90 mmHg (and <130/80 in hypertensives with associated diabetes or renal disease). Treatment The principle aim of treatment of HTN is to achieve the goal BP (see above) and to reduce target organ damage (CVS, CNS & renal) and consists of life-style modification and pharmacological therapy, which includes compelling indications in specific situations. Life style modification to manage HTN Adoption of healthy life-style by all persons is beneficial for prevention of HBP and is an indispensable part of management of those with HTN, as this reduces the BP, enhances antihypertensives drug efficiency on cardiovascular disease risk. The major cardiovascular risk factors are: Hypertension Diabetes Cigarette smoking Microalbuminuria Obesity (BMI≥30kg/m2) Age (>55 for men, >65 for women) Physical inactivity Family h/o premature CVD Dyslipidemia These need correction / control by lifestyle modification and appropriate drug therapy. Drug therapy Thiazide type diuretics should be the initial drug therapy for most, either alone or combined with other drug classes. Most patients will require two or more antihypertensive drugs to achieve goal BP. 77 If BP is >20/10 mmHg above goal, initiate therapy with two agents, one of them usually should be a Thiazide type diuretic. Certain high risk conditions are compelling indications for other drug classes. (The other classes of drugs used in antihypertensive therapy include Beta Blockers (BB), Angiotension Converting Enzyme Inhibitors (ACEI), Angiotension Receptor Blockers (ARB), Calcium Channel Blockers (CCB), Aldosteronc Antogonists (ALDO- ANT), Alpha, Blockers, Central Alpha, agonists and direct vasodilators in addition to loop diuretics and potassium sparing diuretics). Special Consideration in Compelling Indications Hypertensive patients with comorbidities may have compelling indications that require certain specific combination of antihypertensive drug classes based on favourable outcome data from clinical trials. The compelling indication is to be managed in parallel with HTN. Conclusions The following are the key messages from JNC-7 ● In persons older than 50 years, systolic blood pressure greater than 140mmHg is a much more important cardiovascular disease risk factor than diatolic blood pressure. ● The risk of CVD beginning at 115/75 mmHg doubles with each increment of 20/10 mmHg. Individuals who are normotensive at age 55 have 90% lifetime risk for developing hypertension (HTN). ● Individuals with systolic blood pressure (SBP) of 120-139 mmHg or a diastolic blood pressure (DBP) of 80-89 mmHg should be considered as pre-hypertensive and require health promoting life style modifications to prevent CVD. ● Thiazide type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes. Certain high risk conditions are compelling indications for the initial use of other antihypertensive drug classes (ACEI, ARB, BB, CCB). ● Most patients with hypertension will require two or more antihypertensive medications to achieve GOAL blood pressure (< 140/90 mmHg or < 130/80 mmHg for patients with diabetes or chronic kidney disease). ● If blood pressure is >20/10 mmHg above goal blood pressure, consideration should be given to initiating therapy with two drugs, one of which usually should be a Thiazide type diuretic. 78 ● The most effective therapy prescribed by careful clinician will control hypertension only if patients are motivated. Motivation improves when patients have positive experiences with and trust in the clinician. Empathy builds trust and is a potent motivator. ● The responsible physician’s judgement remains paramount.
DIABETIC HYPERTENSION
Dr. Arthur Joseph Asirvatham Asirvatham Hospital, Sathamangalam, Madurai-625 020. India Scientific Supervisor: Dr.V.V. Muthusamy Retd. Prof. of Cardiology, Madurai Medical College, Madurai-625 020. India
Introduction Diabetes and hypertension are the two important diseases which are on the increase. They together have additive effect on the mortality and morbidity. Hypertension could be the effect of diabetes or its cause. This could also be a more coexistence. Antihypertensive drugs could also cause Diabetes. Some endocrine diseases cause both. Mechanisms The following mechanisms cause hypertension in a diabetic: 1. Hyperinsulinaemia and insulin resistance. 2. Renin Angiotensin mechanism. 3. Decreased free water clearance. 4. Kallikrein and kinin systems. 5. Decreased vascular compliance. 6. Altered factors of postural BP maintenance. 7. Atrial natriuretic peptide. 8. Endothelin. 1. Hyperinsulinaemia and insulin resistance Genetically mediated, environmentally triggered insulin resistance is the most common cause of hypertension. To overcome insulin resistance, there is increased insulin secretion resulting in hyperinsulinaemia. This begets insulin resistance and further hyperinsulinaemia. This is the crux of the metabolic syndrome, presenting with hypertension, 79 central obesity, dyslipidemia, glucose intolerance and other metabolic abnormalities. a. This high insulin levels increase Na+K+ ATPase activity and sodium retention. Increased sodium causes increase in Ca++ influx which in turn increases the contractility of vascular smooth muscles, increasing the peripheral vascular resistance resulting in hypertension. b. High insulin levels also cause hypertrophy of the vascular smooth muscles resulting in increased peripheral vascular resistance and hypertension. c. Hyperinsulinaemia also enhances catecholamine resulting in hypertension. 2. Renin angiotensin mechanism Lowered levels of PRA in diabetes, protects from malignant hypertension. Increased blood volume, hyalinization of macula densa and depleted catecholamines lead to decreased PRA. This ultimately results in a lowered angiotensin 1 level and increased sensitivity of Angiotensin 1. 3. Free water clearance Low free water clearance results in hypertension inspite of reduced renin, reduced aldosterone and reduced catecholamine. 4. Kallikrein and kinin system (KKS) Increased bradykinin enhances insulin sensitivity. In diabetes with hypertension, there is a defective exercise stimulated bradykinin and other KKS resulting in insulin resistance and hypertension. 5. Decreased vascular compliance Loss of elasticity in major vessels due to atherosclerosis, results in a decrease in the compliance and produces isolated systolic hypertension. 6. Altered factors in postural BP maintenance Postural BP Maintenance involves integrity of multiple mechanisms like baroreceptors reflexes, vasoactive hormones, cardiac output and blood volume. In diabetes, many mechanisms fail and result in orthostatic hypotension and supine hypertension. 7. Atrial Natriuretic Peptide (ANP) ANP interacts with hormones and controls salt and water balance and regulates BP. In diabetes the normal response of ANP secretion to sodium load is lost. That accentuates sodium retention and leads to hypertension. 80 8. Endothelin This is a potent vasoconstrictor of microcirculation. It modulates catecholamine, aldosterone and ANP. It also inhibits renin release. The exact role in diabetes is still uncertain. Choice of drugs The order of priority of drugs for diabetic hypertension is as follows: 1. Long acting ACE inhibitors (ACEI) 2. Angiotensin Receptor Blockers (ARBs) 3. Beta blockers (BB) 4. Selective alpha 1 adrenergic blockers 5. Long acting Ca channel blockers (CCB) 6. Diuretics ACE Inhibitors (ACEI) ACEI cause the reduction in the tone of efferent arterioles of the Bowman’s capsule, and reduce the intra glomerular pressure and thereby reduce micro proteinuria. Though many others also do so, ACEIs appear more logical and also proved by numerous studies. Hence ACEIs are useful in the prevention of progression of renal complications. The UKPDS proved that it is only the pressure reduction which is important and not the class of drug. Captopril, enalapril, lisionpril, ramipril, bisapril and fosinopril come under this group, each one having some special features than the other one. ACEIs do not interfere with glucose metabolism and so ACEIs are the first lint drugs in the management of diabetic hypertension. Ramipril is not only glucose metabolism friendly, but also prevents the onset of diabetes mellitus in hypertension group as evidenced by the HOPE trial. Angiotensin Receptor Blockers (ARBs) ARBs directly block the AT1 receptors and leave the AT2 to be open and active. They also block the non-ACE pathway thereby more effective. Losartan, valsartan, telmisartan are members of this group. lrbesartan has a special role in controlling systolic hypertension. LIFE study confirmed that the cardiovascular mortality is reduced with losartan compared to atenolol. Losartan also prevents the onset of diabetes mellitus. They are diabetes friendly as well as cardiovascular friendly. ARBs do not interfere with glucose metabolism as well as improve endothelial function regressing atherosclerosis and improving microcirculation. Studies also confirm that ARBs improve insulin sensitivity. 81 Beta Blockers (BBs) Beta Blockers like propranolol were ‘forbidden drugs’ in the past, for the fear of hypoglycemia unawareness. However it is only a relative contra indication and hypoglycemia could still be identified by sweating (mediated by acetylcholine). Newer adrenergic blockers like, carvedilol are both alpha and beta blockers with very minimal side effects on glucose tolerance. Calcium channel blockers Nondihydropyridine CCBs like diltiazem and verapamil are useful in controlling BP and preventing proteinuria in diabetic hypertensives. Diuretics Thiazide diuretics have been given a rebirth by JNC VII as an ideal anti-hypertensive; however its role in diabetic hypertension should be considered with a ‘pinch of salt’. It may be useful in a mild diabetic with no other problem, who has mild sodium retention. But as days go by these patients have a reduction in GFR and it is not safe to use thiazides. Moreover due to alteration in Na+K+ ATPase pump, interference with insulin secretory mechanism cannot be avoided while on diuretic therapy. Indapamide is the most suitable thiazide for its usage in diabetic population. Management The target BP aimed as per INC 7 recommendation is below 130/80 mmHg for diabetic hypertension. Lifestyle modification is given importance along with drugs. Though UKPDS did not find any statistical significance in the type of drug used, ramipril is advocated by HOPE study. Combination of ACEI and ARB has a mild risk of rebound effect once the drugs are skipped. Irbesartan will be effective in systolic hypertension. Nondihydropyridine CCBs like verapamil and diltiazem when used in combination with ACEIs have additive protective effect for kidneys in diabetic hypertension. Most often polydrug regimen is needed to achieve the target BP. Conclusion Diabetes mellitus and hypertension probably have many interlinks than what we know at present and they result in an exponential increase in the complications, each one contributing its might in aggravating it. Simple life style modifications, adequate, appropriate and effective drugs will successfully reduce the diabetic hypertension and its complications. 82 CHALLENGES IN DEVELOPMENT OF CLINICALLY USEFUL HERBAL ANTIMICROBIALS AND FUTURE PERSPECTIVES
Bhoj R Singh, Monika Bhardwaj, PrasannaVadhana Division of Epidemiology, Indian Veterinary Research Institute
Everyone knows about antimicrobial drugs sensing the sinking pulse of antibiotic era. Since long no new antibiotic could enter the market and old antibiotics have become ineffective in clinical practice due to high levels of multiple and total drug resistance. Due to short clinical life of antibiotics pharmaceutics are not putting much for development of new antibiotics. Leading organisations concerned with disease control are probiotics/ synbiotics (for competitive exclusive of pathogens) and herbal antimicrobials. Though we know about antimicrobial potential of several hundred herbs since dawn of the civilization, only few could reach norms set for antimicrobial chemotherapy. Vigorous efforts and systematic planning are required for evolving the system for development of herbal antimicrobials, a lot has been done, still more is underway but much more is required. The specific areas concerning urgent attention are: 1) Long term safety and toxicity studies on potential herbal antimicrobials using acceptable models; 2) Pharmacokinetic studies on assimilation, absorption, circulation, achievable and maintainable serum and tissue levels, deposition, catabolism, metabolism and excretion in experimental models and target species; 3) Nosological studies; 4) Determination of spectrum of activity using not only sensitive reference strains but clinically important microbes isolated from cases of diseases and death; 5) Development and establishment of uniform drug sensitivity testing methods to generate uniform international data similar to that of conventional antibiotics and other antimicrobials; 6) Development of methodology for economic isolation, characterization and evaluation of active gradients of herbs with antimicrobial potentials; 7) Systematic studies on interactions of herbal antimicrobials with other medicines, under different physiological and growth states specially with antibiotics, other herbal antimicrobials, vitamins, minerals, cytokines, hormones and other compounds in our body; 8) Herbal antimicrobial drug resistance, its emergence and spread (horizontal/ vertical), is it similar to antibiotic or different. The presentation may focus in synergism on antibiotics and herbal antimicrobials which lead to evolution of new era of herbobiotics. 83 NEW EUROPEAN GUIDELINES OF HYPERTENSION
Dr. P. Jeevaraj & Dr. S. Somasundaram Dept. of Medicine, Madurai Medical College, Madurai-625 020. India
The new guidelines were presented at the ESH (European Society of Hypertension) meeting-June 13-17, 2003 in Milan, Italy. The Chairman of the Guidelines Committee was Professor, Giuseppe Mancia, M.D., Ph.D., University of Milan, Italy. The purpose of the Guidelines The European Society of Hypertension and the European Society of Cardiology prepared the guidelines, to update the 1999 WHO/ISH guidelines which the ESH/ESC had previously endorsed, to establish regional guidelines and to develop educational rather than prescriptive guidelines. Definition of Hypertension The Europeans believe in Geoffrey Rose who 30 years back said: “Hypertension should be defined in terms of a blood pressure level above which investigation and treatment do more good than harm”. Classification of Blood Pressure
Category Systolic (mm Hg) Diastolic (mm Hg) Optimal <120 <80 Normal 120-129 80-84 High Normal 130-139 85-89 Grade 1 (mild) 140-159 90-99 Grade 2 (moderate) 160-179 100-109 Grade 3 (severe) >180 >110 Isolated systolic >140 <90 hypertension
WHO/ISH classification has been retained, with the reservation that the real threshold for hypertension must be considered as flexible, being higher or lower based on the total cardiovascular risk profile of each individual. 84 Total Cardiovascular Risk The following have to be considered for assessment risk factors: 1. Levels of systolic and diastolic BP 2. Men>55 years, Women>65 years 3. Smoking, Diabetes mellitus. 4. Dyslipidaemia – (total cholesterol>250 mg/dl or LDL cholesterol>155 mg/dl or HDL cholesterol M<40 & W<48 mg/dl.) 5. Family history of premature cardiovascular disease (at age 55 years M, 65 years F) 6. Abdominal obesity (abdominal circumference M>102 cm, W>88 cm) 7. C- reactive protein>1 mg/dl Target Organ Damage (TOD) 1. Left ventricular hypertrophy. 2. Ultrasound evidence of arterial wall thickening. 3. Slight increase in serum creatinine. 4. Microalbuminuria. Associated Clinical Condition (ACC) 1. Cerebrovascular disease 2. Heart disease 3. Renal disease 4. Peripheral vascular disease 5. Advanced retinopathy Global Cardiovascular Stratification
Risk High Normal Grade 1 Grade 2 Grade 3 factors Normal No risk Average Average Low added Moderate High added factors risk risk risk added risk risk
1 or 2 risk Low added Low added Moderate Moderate Very High factors risk risk added risk added risk added risk
2 or more risk factors Moderate High added High added High added Very High or TOD added risk risk risk risk added risk or DM
High added Very High Very High Very High Very High ACC risk added risk added risk added risk added risk
85 The terms “low”, “moderate”, “high” and “very high” and “added risk” are calibrated to indicate an approximate absolute 10-year risk of cardiovascular disease of 15%,15-20%, 20-30% and >30% respectively, according to Framingham criteria. Diagnostic Evaluation There are four stages: medical history, repeated blood pressure measurements, physical examination and laboratory investigations. Goals of Treatment 1. To achieve the maximum reduction in the long term total risk of cardio-vascular morbidity and mortality. 2. To lower blood pressure, both systolic and diastolic, at least below 140/90 mmHg and to definitely lower values if tolerated, in all hypertensive patients, and below 130 / 80 mmHg in diabetics and chronic kidney disease. Therapeutic Approach When to initiate antihypertensive treatment? The decision is taken considering, the total level of cardiovascular risk and the level of systolic and diastolic blood pressure. Lifestyle Changes Lifestyle measures should be instituted whenever appropriate in all patients, including subjects with high or normal blood pressure and patients who require drug treatment. The purpose is to lower blood pressure and to control other risk factors and clinical conditions present. It consists of smoking cessation, weight reduction, reduction of excessive alcohol intake, physical exercise, reduction of salt intake, increase in fruit and vegetable intake, decrease in saturated and total fat intake. Treatment of associated risk factors Lipid lowering agents: Long-standing type 2 diabetes with other ACC should receive a strain if their total cholesterol is >135 mg/dl, with the goal of reducing it by about 30% and recent-onset diabetes, with ‘high added’ risk, should also receive a strain if their total cholesterol is 135 mg/dl. Anti-platelet therapy: Patients with previous cardiovascular events and in patients older than 50 years with an even moderate increase in serum creatinine. Follow - up The frequency of follow-up visits is individualized based on risk profile and BP levels. Self-measurement of blood pressure at home should be encouraged to reduce follow-up visits. If the therapeutic 86 goals have not been reached within 6 months, the physician should consider referral to a hypertension specialist. Antihypertensive therapy is generally for life. Trial of cessation of therapy usually fails, among patients strictly observing lifestyle (non-drug) measures. Attempts to ‘step down’ treatment may succeed and should be accompanied by careful continued supervision of the blood pressure. The assets of European Guidelines The guidelines are more flexible and educational. Total CV risk quantification allows to modify BP threshold and BP targets for therapy, to modulate the treatment, to prognose more accurately.
PREGNANCY AND HYPERTENSION
Dr. Nalini Ganesh & Dr. M. Sooriyakumar Dept. of Medicine, Madurai Medical College, Madurai-625 020. India Scientific supervisor: Dr. V.V. Muthusamy Retd. Prof. of Cardiology, Madurai Medical College, Madurai-625 020. India
Background: Hypertension associated with pregnancy is the most common medical risk factor in 7%-10% of pregnancies. On many occasions, hypertension remains undetected in pregnant women until major complications supervene resulting in high maternal and foetal mortality. About 12% of maternal deaths are due to complications of hypertension in pregnancy every year. In normal pregnancy the blood pressure decreases during early pregnancy and thereafter increases gradually and reaches pre-partum values at term. Awareness of those physiological alterations is important for the following reasons: ● The normal increase in BP during late pregnancy may lead to erroneous diagnosis of gestational hypertension if made solely on the basis of increments in BP. ● Chronic hypertension may be masked by physiological decrement in BP if the patient is first seen in midgestation. The criteria to diagnose hypertension in pregnancy is BP = or >140/90 mmHg. Patients who have a rise of 30 mmHg systolic or 15 mmHg diastolic warrant close observation. 87 Classification I. Gestational hypertension II. Pre-Eclampsia III. Eclampsia IV. Superimposed pre-Eclampsia on chronic hypertension V. Chronic hypertension
I. Gestational Hypertension It is a diagnosis of exclusion. The diagnosis of gestational hypertension is made when the following criteria occur. ● Women with BP of 140/90 or higher without proteinuria observed for the first time during pregnancy after 20 weeks of gestation. ● Return to normal <12 weeks post-partum
II. Pre-Eclampsia It is a pregnancy specific syndrome of reduced organ perfusion secondary to vasospasm and endothelial activation. Glomerular filtration rate and renal perfusion are reduced. The degree of proteinuria may fluctuate widely within 24 hours. The diagnostic criteria are: Mild ● BP = or >140/90 mm Hg after 20 weeks of gestation ● Proteinuria ≥ 300 mg/24 hours or 1+ or more dipstick Severe ● BP = or >160/11 mm of Hg ● Epigastric pain ● Fundus may show retinal oedema and arteriolar spasm ● Proteinuria >2.0 gm/24 hrs or >1+dipstick ● Serum creatinine> 1.2 mg/dl unless known to be elevated previously ● Elevated ALT or AST ● Thrombocytopenia. Platelet count <100,000/mm3 ● Microangiopathic haemolysis (increased LDH) ● Persistent headache, visual disturbances ● Hyperbilirubinaemia, haemoglobinuria (haemolysis) ● Elevated uric acid The recurrence rate is 7.5% and the risk increases with severity of the disease.
III. Eclampsia Eclampsia is the occurrence of seizures in a woman with pre- 88 eclampsia not due to other causes. It appears before, during or after labour. In nulliparous seizures occurring 48 hours after postpartum may prolong up to 10 days. Recurrent eclampsia is rare. Seizures may be the first sign of pre-eclampsia.
IV. Pre-Eclampsia superimposed in chronic hypertension It is difficult to diagnose but in case of multiparity the hypertension is complicated by previous pregnancies and a family history of hypertension gives a clue to underlying chronic hypertension. Superimposed gestational hypertension is characterized by worsening hypertension with severe pre-eclamptic features. Worsening of pre-existing chronic hypertension after 24 weeks with proteinuria is diagnosticated. ● New onset of proteinuria 300mg or greater/24hrs in hypertensive women after 20 weeks of gestation. ● Sudden increase in BP or proteinuria or platelet count < 100,000/ mm3, abnormal liver function tests in women with hypertension and proteinuria before 20 weeks of gestation. These help to identify superimposed pre-eclampsia in chronic hypertension.
V. Chronic hypertension Chronic hypertension may be primary (95%) or secondary. Incidence Prevalence of chronic hypertension during pregnancy is 3%. About 20 to 25% of women with chronic hypertension develop preeclampsia during pregnancy. Pre-eclampsia complicates about 5% of all pregnancies, 10% of first pregnancies and 20% of pregnancies in women with a history of chronic hypertension. Risk factors Maternal 1. Race and ethnicity [Africans and Americans] 2. Family history/genetic predisposition 3. Diabetes 4. Extremes of age 5. Obesity 6. Changing paternity 7. Systemic lupus erythematosus 8. Nulliparity 89 Foetal and placental 1. Multiple gestations 2. Hydatidiform mole 3. Foetal hydrops 4. Triploidy Pathogenesis During normal pregnancy maternal cardiac output and blood volume increase by 40% to 50%; whereas total peripheral resistance and arterial blood pressure tend to decrease. Though renin and angiotensin II levels increase, the vascular responsiveness to angiotensin appears to be reduced, which results in fall of BP by 10 to 15 mm of Hg in the first half of pregnancy. The initiating event in hypertension in pregnancy is postulated to be reduced uteroplacental perfusion as a result of abnormal cytotrophoblast invasion of spiral arterioles. Placental ischaemia leads to widespread activation / dysfunction of maternal vascular endothelium that results in:
● Enhanced formation of endothelin I, thromboxane A2 and angiotensin. ● Increased vascular sensitivity to angiotensin II. ● Decreased formation of vasodilators like, prostacyclin, nitric oxide and prostaglandin E2 and I2. These endothelial abnormalities, in turn, cause hypertension by impairing renal pressure, natriuresis and increasing total peripheral resistance. This results in cardiovascular, haematological, endocrine and metabolic and regional blood flow changes with subsequent end-organ derangements. Cardiovascular changes – reduction in cardiac output and increase in peripheral resistance in pre-eclampsia, elevated cardiac output in gestational hypertension. Haematological changes – haemolysis, thrombocytopenia, decrease in clotting factors, intravascular coagulation and RBC destruction. Renal changes – acute tubular necrosis or cortical necrosis, glomerular capillary endotheliosis are common in eclampsia. Hepatic changes – periportal haemorrhagic necrosis with elevated serum ALT and AST in pre-eclampsia. CNS changes – retinal vessel spasm and cerebral oedema. The pathophysiology of chronic hypertension depends on etiology 90 and it does not share the renal, hepatic, coagulation and placental abnormalities of pre-eclampsia. Management Investigations Urine analysis ● Proteinuria >300mg/day in pre-eclampsia and renal hypertension ● Presence of casts suggest basic renal pathology ● Urine albumin and creatinine excretion rate Blood examination ● Peripheral smear picture: presence of RBC fragments and thrombocytopenia indicate haemolysis as in HELLP [Haemolysis, Elevated Liver enzymes, Low Platelet count] syndrome, haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura. ● Increased haematocrit in pre-eclampsia. ● Hb>13gm% suggests haemoconcentration as in pre-eclampsia. ● Platelet count<100,000/mm3 suggest pre-eclampsia, HELLP syndrome ● Serum creatinine<0.8mg% in normal pregnancy, any rise suspect pre-eclampsia or renal hypertension. ● Serum uric acid level >5mg% in pre-eclampsia. ● Elevated hepatic transaminases in pre-eclampsia. ● Decreased anti thrombin III in pre-eclampsia. ● Abnormal prothrombin time and activated partial thromboplastin time [as in severe eclampsia indicating disseminated intravascular coagulation and consumptive coagulopathy] should be done when liver enzymes are elevated and thrombocytopenia is present. ● Serum Na, K-and glucose levels. ● Serum lipids are deferred until post-partum as they are increased in pregnancy. ● ECG – Left ventricular hypertrophy in chronic hypertension ● Ultrasonogram – renal size, renal artery flow Prevention ● Identification of early markers like faulty placentation, activation of coagulation, reduced placental perfusion and endothelial dysfunction are of low significance. Life style modification is essential both to prevent and to treat hypertension in pregnancy. Antihypertensive therapy: ● It is indicated only if BP is > 160/100mm of Hg ● In mild chronic hypertension antihypertensives may be withheld under regular observation of BP as BP drops in pregnancy. 91 ● Methyl DOPA, betablockers and vasodilators are preferred medications for the safety of foetus. Angiotensin converting enzyme inhibitors, angiotensin receptor blockers should not be used in pregnancy because of the potential foetal defects and should be avoided in women who are likely to become pregnant. ● Antiplatelet therapy [low dose aspirin] as preventive measure should be started in women at high risk. ● Antioxidants like vitamin C, E, supplemental calcium and magnesium can be given. Treatment of pre-eclampsia is empirical. Delivery is the only choice of treatment. In some patients pre-eclampsia may develop into a hypertensive urgent case and may require hospitalization, intensive monitoring, early foetal delivery and parenteral antihypertensive and anticonvulsant therapy. Eclampsia ● Seizures if recurrent are to be treated with anticonvulsants. Most convulsions stop quickly and spontaneously. ● I.V diazepam is the drug of choice. Magnesium sulphate can be given I.V or IM with initial loading dose of 4 G and continuous infusion if necessary but with a note of caution of toxic effects. Prognosis Women who develop pre-eclampsia during pregnancy have an increased risk of recurrent pre-eclampsia during subsequent pregnancies. The overall risk is 18%. The risk is higher (50%) in women who develop severe early pre-eclampsia (before 27 weeks gestation). Gestational hypertension is associated with later development of chronic hypertension. Conclusion: Hypertension in pregnancy has a great influence on the maternal and foetal mortality. Perinatal risks of chronic hypertension in pregnancy result from superimposed pre-eclampsia. Extreme hypertension in pregnancy (>170/110 mm of Hg) demands urgent treatment. Mild hypertension does not warrant antihypertensive drugs. Methyldopa is the preferred drug in hypertension in pregnancy. Short- term use of blockers is preferred. Labetolol is the drug preferred next to methyldopa. ACE inhibitors and angiotensin receptor blockers are contraindicated. Diuretics are reserved for failure complicating pre- eclampsia. 92 THE ROLE OF NATURAL PRODUCTS IN DRUG DISCOVERY
Prof. Nanjan, M.J. TIFAC CORE HD, JSS College of Pharmacy, Ootacamund-643001, Nilgris, India
Despite the tremendous success of chemo- and antibiotic therapy, it is believed that only 30% of about 2000 existing diseases can be cured today. Others can be treated only symptomatically or insufficiently and some not at all. There is an urgent need, therefore, to discover efficient and causality acting drugs to treat several diseases. In this connection, Lipinski’s rule of 5 has created awareness among medicinal chemists, namely addressing pharmacokinetic properties early in the drug discovery process is of vital importance for discovering newer drugs. Natural products, however, are an exception to this rule. Unlike synthetics, they have more stereogenic centers and architectural complexity. In addition, they contain more C, H and O and less N and other elements compared to synthetics. Their molecular weight is generally higher than 500. They have higher polarities and greater water solubility. Rule of 5 is, therefore, not applicable to natural products. Combinatorial chemistry, a collection of methods whereby simultaneous chemical synthesis of a large number of compounds using a variety of starting materials can be produced quickly and high throughput screening, a process whereby the large number of compounds can be tested against biological targets to find active compounds, have been used as drug discovery source for the past more than 30 years. Since 1980 onwards a great number of screening programs have been initiated by industries, universities and research institutions, searching for new bio actives. But then, the number of new chemical entities using these techniques was only 25 in the year 2005 and it is declining since then. And what is more, to date we find only one new chemical entity, namely, Sorafenib from Bayer, approved as an anticancer drug, resulting from these techniques. In other words, the expected surge has not materialized. Natural products, however, have been closely linked through the use of traditional medicine for thousands years. Clinical, pharmacological and 93 chemical Studies of these traditional medicine derived predominantly from plants were the basis of early medicines like morphine, quinine. digitoxin, etc. After the discovery of penicillin by Fleming in 1928, reisolation and clinical studies by Chain and co-workers in early 940’s, commercialization of synthetic penicillin revolutionized drug discovery approaches. Today a significant number of natural products are also produced from microbes. The functional group diversity and architectural platforms built into natural products during biosynthesis, have been teaching us lessons about the chemical functionality that is Computable with the aqueous milieu of the biological environment. Chemomics, understanding the molecular logic of biosynthetic enzymes and pathways, has offered new approaches to reengineer newer natural products. Although natural products have played an important role in drug discovery, in the past few years big pharmaceutical companies have either terminated or considerably scaled down natural product operations. But then, when one analyzes the data on drugs and new chemical entities developed for all diseases and from different sources the world over for the past nearly 30 years, it shows that less than 30% of them are of synthetic origin. This clearly demonstrates the influence of natural products in drug discovery. Nature, in one form or another, seems to continue to serve as a source of novel active agents that will serve as leads and scaffolds for developing the drugs desperately needed for the multitude of diseases. The inventory of natural molecules remains incomplete. Discovery of new molecules and their functions are likely to continue as sources of natural products are more systematically evaluated. In this connection, a multidisciplinary approach for drug discovery, involving the generation of truly novel molecular diversity from natural product sources combined with total and etimhinatorial synthetic methodologies including the manipulation of biosynthetic pathways should provide the best solution to the current productivity crisis facing the scientific community engaged in the drug discovery and development. It is, there more necessary that we should expand and not decrease the exploration of nature as a source of novel active agents that may serve as scaffolds for elaboration into the desperately needed efficacious drugs for the multitude of disease indications.
94 CANCER CHEMOPREVENTIVE POTENTIAL OF NEW NATURAL PRODUCTS
Parimelazhagan Thangaraj & Rahul Chandran Bioprospecting Lab, Department of Botany, Bharathiyar University, Coimbatore-641046. India
Cancer is a leading cause of mortality worldwide. The World Health Organization has estimated that deaths from worldwide cancer are projected to continue rising, with an estimated 13.1 million deaths in 2030. Cancer is characterized by the deregulation of cell signalling pathways at multiple steps but existing anticancer therapies involve the modulation of a single target. Many plants based products accomplish multi targeting naturally and in addition they are inexpensive and safe compared to synthetic agents, one of the major limitations in the currently available treatment modalities for cancer is their side effects. Hence alternate treatment for cancer is being tested and plants and plant derived products are being tried for the purpose. Chemotherapy has been shown to produce severe neutropenia, which can lead to opportunistic infections, which may even lead to death. Hence alternate treatment for cancer is being tested and plants and plant derived products are being tried for the purpose. So, there is an urgent need to utilize medically important plant derived compounds for the prevention cancer. Botanicals have been used by human beings since ancient time. The widespread use of herbal remedies in many countries throughout the world and the presence of certain phytochemical constituents support the pharmacological and physiological efficacy of some plants. Extensive epidemiological and experimental evidence has accumulated indicating risk reduction for numerous cancers. The chemopreventive approach is highly attractive for a number of reasons. First, treatment of pre-neoplastic or early neoplastic, lesions would prevent the significant mobility and mortality associated with advanced neoplastic disorders. Secondly, it becomes practically and conceptually much easier to target disease processes which contain a smaller number of causative molecular targets. The promise of chemoprevention of neoplastic disorders has recently been brought into the realm of reality with clinical trials such as the breast cancer prevention trial and tamoxifen. Numerous phytochemicals derived from edible plants have been reported to interfere with a specific stage of the carcinogenic process. The success of several recent clinical 95 trials in preventing cancer in high-risk populations suggests that chemoprevention is a rational and appealing strategy. Chemoprevention by edible phytochemicals is now considered to be an inexpensive, readily applicable, acceptable and accessible approach to cancer control and management. The healthcare costs are being a key issue today. It would be cost-effective to promote the awareness and consumption of phytochemicals as a cancer-preventive strategy for the general public. The presentation will review the chemoprevention and address the intermediate biomarkers in cancer chemoprevention drug discovery.
ANTIMICROBIAL ACTIVITY OF SILICONE NIOSOMES MODIFIED WITH ATOMS OF SILVER
Philip I. Bazikov Charles University, Prague, Czech Republic Scientific supervisor:I.A. Bazikov, D.M.S., Professor, Head of the Microbiology Department of Stavropol State Medical University, Russia
Objective: It is known that the atoms of silver have antimicrobial properties. In this regard, the aim of this work was to study the antimicrobial activity of silicone niosomes modified with atoms of silver (Fig. 1). Material and methods: Microbiological studies of silver-plated niosomes were conducted by disk diffusion method (DDM) in the study of their sensitivity to microorganisms isolated from the skin surface. In advance, intact and silver-plated niosomes were applied on paper discs.
Fig. 1. An electron micrograph of silver-plated niosomes. 96 Results: As a result, it was shown that silver-plating of niosomes gives them a high antimicrobial activity. It was seen in the magnitude of zone of delay of the continuous growth of Staphylococcus isolated from the skin surface (Fig. 2).
a. b. Fig. 2. Zones of growth delay of the studied microorganisms around the disks impregnated with: a) intact niosomes; b) silver-plated niosomes.
The zone of growth delay of microorganisms around the disks with niosomes containing 50 mm/l of silver was 16.9 ± 0.5 mm. Conclusions: Thus, organosilicon niosomes with the modification of the surface with silver atoms can be used for targeted delivery of drugs. The use of niosomes with magnetic and bactericidal properties will contribute to the transdermal targeted delivery of pharmaceutical products. Keywords: niosomes, silver-plating, antimicrobial activity.
THE SIMPLE INTERVENTIONS AS A THERAPEUTIC OPTION IN THE TREATMENT OF SEVERE OBESITY – REPORT OF THREE CASES
Suncica Popovic, Dragana Zivkovic, Milos Markovic, Mugabe Herbert Medical Faculty University of Belgrade, Belgrade, Serbia Scientific supervisor: Assistant Dr. Milina Tancic Gajic, Internal medicine specialist-endocrinologist
Background: Obesity is one of the alarming health problems in modernized societies. The simple interventions, such as changes in 97 diet and exercise, should be considered as a therapeutic option in the treatment of severe obesity. Objective: To present, dietary effects on obstructive sleep apnea syndrome (OSAS), metabolic syndrome (MS) and hormonal status. Material and methods: Three male patients (A, B, C) were admitted to the Clinic for Endocrinology, Diabetes and Metabolic Diseases due to extreme obesity. The values of their anthropometric characteristics on admission were: body weight(BW): 156kg, 154kg, 126kg, body mass index (BMI): 44.1 kg/m2, 38.2 kg/m2, 45.1 kg/m2, respectively. Patients A and B had a severe and intermediate form of OSAS, apnea/ hypopnea index (AHI): 68.5/h, 27.4/h and total desaturation index (DSI) 68.6/h, 8.5/h. Patient A had four parameters of MS positive (HDL 1.02 mmol/l, arterial hypertension, fasting glucose 5.6 mmol/l, waist circumference>94 cm). The hormonal analyzes showedtestosterone (T) 9.9 nmol/l, 14.1 nmol/l,10.04 nmol/l; sex hormone-binding globulin (SHBG) 15.6 nmol/l,26.1 nmol/l, 11.9nmol/l and free testosterone (FT) 274 pmol/l, 345 pmol/l, 309 nmol/l. The patient C had insulin resistance (HOMA index 4.3) with the values of glycemia in OGTT test the diabetes type ( 4.8-11.7 mmol/l). After a three-week regime of very low calorie diet of 800 kcal in the hospital conditions and low calorie diet of 1500 kcal with dosed physical activity in outpatient conditions, the parameters were measured again. Results and discussion: The patient A has lost a total of 35.5 kg, he had no diagnostic criteria for diabetes (HbA1C=5.4%; OGTT: fasting plasma glucose (FPG) 5.8 mmol/l and 2-h plasma glucose 5.0 mmol/l) and MS (only 2 parameters were positive). AHI (31.7/h) and DSI (23.7/h) values were reduced. After aforementioned diet, the patient B has lost a total of 21 kg and OSAS was absent (AHI 3.4/h and DSI 3.5/h). The patient C lost a total of 27,5kg and HOMA was reduced from 4.3 to 2.8. Repeated hormonal analysis showed the increase of total and free testosterone (T:22.7nmol/l, 22.8 nmol/l, 18.7nmol/l; SHBG:23.6 nmol/l, 39.4 nmol/l, 19.9 nmol/l; FT:578 pmol/l, 427 pmol/l, 513 pmol/l). Conclusion: Reduction of BWimproves androgenic profile reduces the degree of severity of MS and OSAS in extremely obese men and decreases the cost of treatment. Keywords: obesity, diet, metabolic syndrome, OSAS, testosterone.
98 THE REVISED CARDIAC RISK INDEX OR THE VASCULAR STUDY GROUP OF NEW ENGLAND CARDIAC RISK INDEX IN PATIENTS UNDERGOING CAROTID ENDARTERECTOMY
Suncica Popovic1, Ksenija Stevanovic2, Igor Koncar1,2, Biljana Kukic2, Lazar Davidovic1,2 1 Medical Faculty University of Belgrade 2 Clinic for Vascular and Endovascular Surgery, Clinic Center of Serbia, Belgrade, Serbia Scientific supervisor: Professor Lazar Davidovic, General and Vascular Surgeon
Background: Currently, the most commonly used model to predict cardiac risk before non-cardiac or vascular surgery is the Revised Cardiac Risk Index (RCRI), but some studies have pointed out that The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) is a better predictor of cardiac complications. Objective: To assess which index indicates intraoperative hemodynamics instability (IHI) and a higher incidence of following comorbidities (FC). Materials and methods: The medical records of 101 patients, underwent carotid endarterectomy under cervical plexus block during a 3 month period at our institution, were retrospectively reviewed. RCRI and VSG-CRI were used to classify patients into 3 groups: low (I), medium (II) and high risk group (III). IHI was defined as an increase/ decrease in systolic and diastolic blood pressure or heart rate for ≥20% from basal value, for 2 minutes. The incidence of FC such as insulin- dependent diabetes mellitus (IDDM), chronic heart failure (CHF), coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), old age and smoking, were compared among groups. Results and discussion: According to RCRI, group I consisted of 26 patients (25.74%), group II of 68 (67.33%) and group III of 7 (6.93%). On the other hand, according to VSG-CRI, group I consisted of 52 patients (51.49%), group II of 35 (67.33%) and group III of 12 (11.88%). No statistically significant differences in blood pressure alterations (systolic and diastolic) and heart rate were noted among groups classified by the RCRI and VSG-CRI. The incidence of IDDM, 99 CHF and CAD were significantly higher in III group compared to the other two groups classified by RCRI (p=0.004, p=0.005, p=0.0001, respectively). In line with VSG-CRI, age and the incidence of CHF and CAD were significantly higher in group III compared to the other two groups (p<0,0001, p<0.0001). The incidence of COPD and smoking were statistically higher in the medium group compared to the other two groups, in accordance to VSG-CRI as well (p=0,008, p=0.03). Conclusion: VSG-CRI showed greater representation of the incidences of FC in high (3 FC) and medium risk group (2 FC), compared to RCRI which showed the presence of the only 3 FC in high risk group. Follow-up is necessary to confirm better predictive value of VSG-CRI. Keywords: carotid endarterectomy, cardiac risk index, comorbidities.
100 CONTENTS
SCIENTIFIC ABSTRACTS OF STUDENTS AND YOUNG RESEARCHERS OF STAVROPOL STATE MEDICAL UNIVERSITY, RUSSIA...... 6
MODERN ASPECT OF MISCARRIAGE Abhishek Singh, Nandini Kar, Praveen Roushan...... 7
MODERN SURGICAL TREATMENT METHODS OF EPILEPSY Abhishek Singh, Praveen Roushan...... 8
REPERFUSION INJURY IN ACUTE MYOCARDIAL INFARCTION DURING PERCUTANEOUS CORONARY INTERVENTIONS L.A. Adzhieva, A.A. Chotchaeva...... 10
EMBROGENESIS AND ABNORMAL DEVELOPMENT OF THE THYROID GLAND Anupam Kumar Mishra, Vikash Kumar...... 11
COMPLEX INTRA ARTERIAL TREATMENT IN FEMORAL ARTERY COMPLICATED FORM SYNDROME OF DIABETIC FOOT Attar Ruby Mohamed Nazir, RamizRaza...... 12
EFFECT OF NUTRITION ON FOREIGN STUDENTS IN RUSSIAN FEDERATION Chehaitli Ali...... 13
MORPHOMETRIC INVESTIGATION OF THYROID GLAND IN THE CASE OF AUTOIMMUNE THYROIDITIS Chehaitli Ali...... 14
EFFECTIVENESS OF AN INTEGRATED APPROACH IN REHABILITATION OF CHILDREN WITH I DEGREE SCOLIOSIS I. Ermakova...... 15
THE TREATMENT OF ACUTE HEMATOGENOUS OSTEOMYELITIS N. V. Filipieva...... 16
CONGENITAL DISLOCATION OF THE HIP JOINT Fayemi A. Florence...... 17 101 THE STUDY OF THE INFLUENCE OF MINERAL WATER “ESSENTUKI-17” ON CARBOHYDRATE EXCHANGE OF PATIENTS WITH INSULIN NON-DEPENDENT DIABETS MELLITUS A.S. Funtova, L.G. Voskanyan...... 19
THE SPECIAL FEATURES OF THYROID STATUS OF PATIENTS IN DIFFERENT STAGES OF CHRONIC KIDNEY DISEASES (CKD) Z. Grigoryan, K. Sheludko, A. Goncharova, K. Kalashnikova, L. Yakusheva...... 20
HPV AS A FACTOR IN THE DEVELOPMENT OF CERVICAL PRECANCERS A.S. Guseva...... 21
NUTRITIONAL COMPARISON OF INDIAN AND RUSSIAN STUDENTS AND THEIR ADAPTATION Habib Mohamed Ahamed Thahir, Arya R Kurup...... 23
FEATURES OF THE COURSE OF CORONARY HEART DISEASE AT THE BACKGROUND OF TYPE-2 DIABETES IN OLDER MEN Hussein Omar Sattar Hussein...... 24
HEALTH FINANCING SYSTEM IN NIGERIA Iyalomhe O.E...... 25
TREATMENT OF HEMANGIOMAS IN INFANTS A.A. Ivchenko...... 29
MODERN MORPHO-FUNCTIONAL PARAMETERS AND ARTERIAL FOUNDATION OF THE HEART (CASE STUDIES) Jitendra Sharma, Surabhi...... 30
PECULARITIES OF STRABISMUS TREATMENT IN ADULT PATIENTS S. Ladanova, E. Muradova...... 31
ADAPTION OF STUDENTS FROM GHANA TO NUTRITION IN RUSSIA Lois Nana Ofosua Okoree...... 33
THE STUDY OF THE PHYSICAL PROPERTIES OF NIOSOMAL FORM OF DOXORUBICIN FOR THE TREATMENT OF SKIN CANCER V.V. Lukinova...... 34 102 ANTIMICROBIAL ACTIVITY OF NIOSOMAL OPHTHALMIC GEL “REGENERIN” N. A. Malinin...... 36
EFFECT OF BREAST FEEDING ON THE FUNKTIONAL STATE OF GASTROINTESTINAL TRACT OF THE CHILD U. Mirzaeva, N. Kharitonova...... 37
METHODS OF PREECLAMSIA PREDICTION Mohamed Arsath, Nitin Thomas...... 38
IMPACT OF ALCOHOL ON FOETUS Muringasseril Mathew Jeffin...... 39
MOLECULAR BASE OF ALZHEIMER’S DISEASE (AD) Nameirakpam Malemnganba Meitei...... 41
PREVENTIVE MEASURE OF THE DEVELOPMENT OF CARIES D.M. Papshuova, L. R. Kossova...... 42
CARDIAC ARRHYTHMIAS AND PREGNANCY: THE STRUCTURE AND THE FREQUENCY OF OCCURRENCE A.V. Prutskova, А.Sh. Kuramshina...... 44
MALARIA RajannaBhartath...... 46
MUTIPLE SCLEROSIS IN INDIA Rashema Christopher...... 47
MODERN SURGICAL TREATMENT METHODS OF MULTIPLE SCLEROSIS Richa Verma, Alpha Sanal...... 49
PECULIARITIES OF PROTECTING OF THE OCULAR SURFACE IN PATIENTS WHO USE SPECTACLE CORRECTION AND CONTACT LENSES Saad Jabrane...... 50
PREGNANCY AND LIPID STATUS IN VIEW OF HEREDITY BURDENED BY EARLY CARDIOVASCULAR DISEASE Sadiki Jhagroo, Sasha-Gaye Graham...... 51
EPIDEMIOLOGY OF DIABETES MELLITUS (TYPE 2) IN INDIA Saleem Mohamed Arsath Buhari...... 53 103 THROMBOCYTOSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS Sarithala Vijaya Jawahar...... 54
CONCENTRATION OF OSTEOCALCIN IN THE BLOOD OF WOMEN WITH RHEUMATOID ARTHRITIS Sarithala Vijaya Jawahar...... 56
SURGICAL TREATMENTS OF ATHEROSCLEROSIS IN LOWER LIMB ARTERIES G.V. Sazanov, D.I. Zolotukhina, O. Bulda, N.V. Pisarenko...... 57
BREAST CANCER AWARENESS AMONG WOMEN IN INDIA P. Shiva Prasad, N. Mranalee...... 59
ASSESSMENT OF THE CHANGING IN NATURE OF NUTRITION IN STUDENTS AFTER ADMISSION TO THE UNIVERSITY A.V. Simonyan...... 60
ANTIMICROBIAL ACTIVITY OF FIBROBLASTS A. V. Simonyan...... 61
FEATURES OF VASCULAR AGE OF THE UNIVERSITY FEMALE STUDENTS Suren Vlasyants...... 63
ANXIETY-DEPRESSIVE DISORDERS AND ARTERIAL HYPERTENSION IN YOUNG MEN: ASPECTS OF CIRCADIAN BLOOD PRESSURE Yadav Desh Pal Singh, Mohit...... 64
THE FREQUENCY AND OUTCOMES OF ECTOPIC PREGNANCY AFTER IN VITRO FERTILIZATION D.I. Zolotukhina, G.V. Sazanov...... 65
SCIENTIFIC ABSTRACTS OF PATICIPANTS FROM OTHER MEDICAL UNIVERSITIES OF THE RUSSIAN FEDERATION...... 67
THE TREATMENT OF CONGENITALLY MISSING MAXILLARY LATERAL INCISORS: AN INTERDISCIPLINARY APPROACH A. Dolgalevа, T. Timoshenko...... 68 104 PSYCHOLOGICAL ADAPTATION OF THE 3RD-YEAR STUDENTS OF NORTH OSSETIAN STATE MEDICAL ACADEMY TO PROFESSION G. N. Enaldiev, Z. Panahov...... 69
PROFESSIONAL LANGUAGE OF MEDICINE AS AN INTERDISCIPLINARY SUBJECT LANDMARK S.A. Hugaev, G.M. Gabaraev, G. N. Enaldiev...... 70
CLINICAL AND LABORATORY CHARACTERISTICS AND AGE PECULIARITIES OF THE COURSE OF INFECTIOUS MONONUCLEOSIS CAUSED BY EBV IN CHILDREN ACCORDING TO THE STATISTICAL INPUTS FROM VOLGOGRAD REGION Jaydeokar Pratik Suren, K.V. Baidova, V.E. Chebotar...... 71
FATIGUE SYNDROME IN PREGNANT WOMEN WITH LONG- TERM CONSEQUENCES OF TRAUMATIC BRAIN INJURY A.A. Volynkin...... 73
SCIENTIFIC ABSTRACTS OF PATICIPANTS FROM THE UNIVERSITIES OF THE FOREIGN COUNTRIES...... 75
JOINT NATIONAL COMMISSION (JNC-7) GUIDELINES OF HYPERTENSION Dr. M. Annamalai...... 76
DIABETIC HYPERTENSION Dr. Arthur Joseph Asirvatham...... 79
CHALLENGES IN DEVELOPMENT OF CLINICALLY USEFUL HERBAL ANTIMICROBIALS AND FUTURE PERSPECTIVES Bhoj R Singh, Monika Bhardwaj, PrasannaVadhana...... 83
NEW EUROPEAN GUIDELINES OF HYPERTENSION Dr. P. Jeevaraj & Dr. S. Somasundaram...... 84
PREGNANCY AND HYPERTENSION Dr. Nalini Ganesh & Dr. M. Sooriyakumar...... 87
THE ROLE OF NATURAL PRODUCTS IN DRUG DISCOVERY Prof. Nanjan, M.J...... 93 105 CANCER CHEMOPREVENTIVE POTENTIAL OF NEW NATURAL PRODUCTS Parimelazhagan Thangaraj & Rahul Chandran...... 95
ANTIMICROBIAL ACTIVITY OF SILICONE NIOSOMES MODIFIED WITH ATOMS OF SILVER Philip I. Bazikov...... 96
THE SIMPLE INTERVENTIONS AS A THERAPEUTIC OPTION IN THE TREATMENT OF SEVERE OBESITY – REPORT OF THREE CASES Suncica Popovic, Dragana Zivkovic, Milos Markovic, Mugabe Herbert...... 97
THE REVISED CARDIAC RISK INDEX OR THE VASCULAR STUDY GROUP OF NEW ENGLAND CARDIAC RISK INDEX IN PATIENTS UNDERGOING CAROTID ENDARTERECTOMY Suncica Popovic, Ksenija Stevanovic, Igor Koncar, Biljana Kukic, Lazar Davidovic...... 99
106 ДЛЯ ЗАМЕТОК
107 THE INTERNATIONAL SCIENTIFIC CONFERENCE FOR STUDENTS AND YOUNG RESEARCHERS IN ENGLISH «TOPICAL ISSUES OF MEDICINE» (Abstracts)
АКТУАЛЬНЫЕ ВОПРОСЫ МЕДИЦИНЫ : МЕЖДУНАРОДНАЯ НАУЧНАЯ КОНФЕРЕНЦИЯ СТУДЕНТОВ И МОЛОДЫХ УЧЕНЫХ НА АНГЛИЙСКОМ ЯЗЫКЕ (Сборник материалов)
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