Молодежь и медицинская наука в XXI веке 30 марта 1 апреля 2011 года г. Киров
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ТЕЗИСЫ На ИНОСТРАННЫХ ЯЗЫКАХ
«АНГЛИЙСКИЙ ЯЗЫК»
Baturov MA, Vilkova KV
PECULIARITIES OF DIAGNOSTICS AND TREATMENT OF CONGENITAL
DIAPHRAGMATIC HERNIA IN CHILDREN AT THE PRESENT STAGE
Kirov State Medical Academy,
Department of Children’s Surgical Diseases
Head of the Department: professor M.P. Razin
Scientific supervisor: professor M.P. Razin
Aim: to study the state and characteristic features of the problem of congenital diaphragmatic hernia (CDH) in children in the modern period.
Material and methods of investigation: hospital medical records of 30 patients from 0 to 14 years old (14 boys and 16 girls) with CDH treated in our teaching hospital in 1987-2010 are retrospectively analyzed.
Results: We have noticed a two-time growth in occurrence of the pathology in the last two years (3 cases a year compared with 1.5 cases a year in the earlier years). Ten infants with cardiopulmonary decompensation (CPD) were operated on for life reasons. Ten patients with the clinical picture of subcompensated CPD were hospitalized in the first year of life. The same number of patients with compensated CPD were operated on when they were over a year (two of them - endoscopically). 11 patients showed true CDH, 19 patients showed false CDH (16 patients - Bogdalek’s hernia, one - parasternal (anterior diaphragmatic) hernia, two - paraesophageal hernia). It is interesting to notice that despite the considerable progress made in modern high-tech methods of diagnosis and treatment, postoperative recovery period has not changed much since 1980-1990s and lasts 17.3 days. Overall mortality in children with CDH was 21.4 % in the 1980-1990s and 12,5 % today. Sorry to say, mortality rate for CDH in newborns remains high (up to 50 %).
Resume: Diagnosis and treatment of CDH in children still remains an actual problem in pediatric surgery. At the present stage we can notice increase in frequency of occurrence of this pathology and certain progress in treatment of the disease in recent years.
Bondarenko A.L., Kontakova Ye.
PREDICTION CRITERIA OF SEVERE COURSES OF TICK-BORNE ENCEPHALITIS
Kirov State Medical Academy
Department of Infectious Diseases with a Course of Infectious Diseases of Institute of Postgaduate Professional Education Institute
Head of the Department: professor A.L. Bondarenko
In Kirov region, the morbidity of tick-borne encephalitis (TBE) was 18.47 per 100,000 population (2009 estimates). For the past decade severe encephalitic form of the disease have increased from 4.2±1.8% to 28.2±4.2%, р<0,001. That is why the problem of early prediction of TBE courses is becoming urgent.
The purpose of the current study was to reveal clinical-epidemiological and immunological criteria of prediction of severe courses of acute TBE.
174 patients with different forms of TBE were studied. Of them, 69 patients had a feverish form, 45 patients a meningitis encephalitis form, and 60 patients had a focal form. Diagnosis of TBE was made on the basis clinical epidemiological data and confirmed serologically. In 71 patients a cytokinin profile in the blood serum was studied in dynamics (IL-2, IL-6, IL-10, IL-18) within 1-3 and 18-20 days. The “Vector Best” test system was used. The average age of the patients was 47.8±1.2 years. There were twice as many male patients as female patients, р<0.001.
The following criteria of the development of severe TBE courses in comparison with feverish forms were determined: age over 60 years (р<0.05); absence of tick adherence by suction (р<0.05) or multiple bites (р<0.05); presence of accompanied chronic pathology (р<0.001); early evidence of psychopathological symptoms (р<0.001); changes of blood analyses within the first week of the disease in the forms of (р<0,001), lymphopenia (р<0.001). Neutrophil or mixed pleocytosis in liquor was registered twice as often as in patients with focal forms, as compared with meningitis form patients (р<0.05). The immunological risk factors of the development of focal forms of TBE are low IL-18 during the peak of the disease (р<0.05) and high level of IL-6 in dynamics (р<0.05) that reflects the deficit of effective cell immunity to viruses of cell immunity (the T-cell compartment of immune system).
To sum up, prediction criteria of TBE at early stages will help determine tactics of management of patients both during the acute period of the disease and during the period of reconvalescence.
Chuchkova M.R., Adarkin N.A., Shestopalov A.V., Polovnikova A.K., Gorchakov O.O., Mosunova Yu.V.
THE INFLUENCE OF SMOKING ON BIOCHEMICAL
PARAMETERS OF MIXED SALIVA OF STUDENTS
Kirov State Medical Academy,
Department of Biological Chemistry
Head of Department: professor P.I. Tsapok
Scientific supervisor: professor P.I. Tsapok
Introduction. Smoking causes activation of free radical oxidation in the body, contributes to depletion of antioxidant defenses and cause structural changes in cell membranes.
The purpose of: To study lipid peroxidation (LPO), the state of antioxidant protection (AOP), the activity of enzymes and metabolites in a slip in the saliva of smokers and non-students.
Materials and methods. Mixed saliva 15 smoking students aged 18 to 23 years and 10 non-smoking students of similar age. Evaluation of the LPO and AOD was carried out using induced by hydrogen peroxide and iron ions chemiluminescence (CL). Modern biochemical methods for studying the activity of enzymes and metabolites of protein, lipid and carbohydrate metabolism.
Results. Established significant decrease in the AOA background activation LPO in mixed saliva of smoking students (light sum of CL was 87.4 in 1948 photons / min, maximum flash CL - 87.6 7.8 photon) compared with the control group: (light sum of CL 1292.6 69.8 photons / min , maximum flash chemiluminescence -56.4 6.8, respectively). Identified breaches of oxidative balance correlated with quantitative changes of common proteins, glycosaminoglycans, urea, lactate, pyruvate, the activity of amylase, lactate dehydrogenase, aspartate aminotransferase and alanine aminotransferase.
Conclusion. Confirmed by the destructive effect of smoking on the molecular level.
Elsukova Olga S.
Cardiovascular system in females with type 2 diabetic
nephropathy and hypertension
Kirov State Medical Academy
Educational Department of Internal Medicine
Head of the Department: Professor Dr. Oleg V. Solovyov
Scientific supervisor: Associate Professor Sergey G. Onuchin
Purpose: To study the cardiovascular system in type 2 diabetic nephropathy associated with type 2 diabetes (T2D) and arterial hypertension (AH).
Materials and methods. After receiving consents, 182 females with T2D aged 62±8.5 years, were studied. Their parameters were: waist:>80 cm (104.7±13.2 cm), AH: systolic: 160.9±22.5 mm Hg; diastolic: 94.1±8.9 mm Mg. Duration of T2D was 7[4.14 years]; AH duration: 15 [10.20 years]. The above patients were divided into 4 groups. Group 1 included albuminuria patients with <30 mg/24 hr (16.5±4.2 mg/24 hr; n=87); Group 2: albuminuria patients with 30-300 mg/24 hr (115.1±46.9 mg/24 hr; n=59); Group 3: albuminuria patients >300 mg/24 hr (509±165.7 mg/24 hr) and plasma creatinine level <112 µm/L (n=21), Group 4: albumiuria patients: >300 mg/24 hr (621.1±192 mg/24 hr), plasma creatinine level: >112 µm/L (n=15). Excretion of urine albumin per 24 hr by means of immune turbidimetry, echocardiography parameters and remodeling of the left ventricle (LV); diastolic function; thickness of the inner and outer layers of the carotid arteries with ultrasound. Criteria for exclusion were impaired function of the thyroid, acute MI, VOPD, and liver cirrhosis. To compare the above groups dispersion analysis (or criteria of Kruscal-Wallise) followed by Student criterion with corrections for multiple comparison. To reveal differences between the groups according to quality peculiarities criterion ч2. Spireman analysis (rs) was used.
Results. As proteinuria increased and glomerular filtration decreased structural geometrical changes of LV developed. Rigidity of the myocardium increased at the background of normal systolic function of LV. In all the groups, concentric hypertrophy of the myocardium of LV. LF diastolic dysfunction was revealed in 2/3 of groups 1, 2. and in all patients of groups 3, 4. The more insulin resistance was, the more obvious was diastolic dysfunction (decreased E/A ration). Group 2: rs = -0.625, р=0.03); Group 3: rs =-0,300, р=0,04). Due to increased insulin resistance, LV myocardium mass increased in group (rs=0.505, р=0.04) and group 3 (rs=0.805, р=0.004).
Conclusion. Progression of diabetic nephropathy is accompanied by formation of concentric hypertrophy of LV and development of diastolic dysfunction, and progression of atherosclerosis of the carotid arteries. Insulin resistance worsens diastolic dysfunction and contributes to hypertrophy of myocardium.
Elsukova Olga S.
MULTIFACTOR THERAPY FOR FEMALES WITH DIABETIC NEPHROPATHY ASSOCIATED WITH TYPE 2 DIABETES AND ARTERIAL HYPERTENSION
Kirov State Medical Academy
Educational Department of Internal Medicine
Head of the Department: Professor Dr. Oleg V. Solovyov
Scientific supervisor: Associate Professor Sergey G. Onuchin
Purpose: To evaluate and estimate long-term multi-factor therapy of females with diabetic nephropathy associated with type 2 diabetes (T2D) and arterial hypertension (AH).
Methods and materials. After receiving consents, 182 females with T2D aged 62±8.5 years, were studied. Their parameters were: waist:>80 cm (104.7±13.2 cm), AH: systolic: 160.9±22.5 mm Hg; diastolic: 94.1±8.9 mm Mg. Duration of T2D was 7[4.14 years]; AH duration: 15 [10.20 years]. The above patients were divided into 4 groups. Group 1 included albuminuria patients with <30 mg/24 hr (16.5±4.2 mg/24 hr; n=87); Group 2: albuminuria patients with 30-300 mg/24 hr (115.1±46.9 mg/24 hr; n=59); Group 3: albuminuria patients >300 mg/24 hr (509±165.7 mg/24 hr) and plasma creatinine level <112 µm/L (n=21), Group 4: albumiuria patients: >300 mg/24 hr (621.1±192 mg/24 hr), plasma creatinine level: >112 µm/L (n=15). For 12 months, multi-factor therapy was used. It included metphormin (1.5 – 2 gr per 24 hr), either in monotherapy or in combination with glyclazid MR (30.0 – 90.0 gr per 24 hr) or with insulin, perindopril (4.0 – 8.0 mgr per 24 hr), atorvastatin (10.0 mg per 24 hr). Excretion of urine albumin per 24 hr by means of immune turbidimetry, echocardiography parameters and remodeling of the left ventricle (LV); diastolic function; thickness of the intima-media complex of the carotid arteries with ultrasound. The above investigations were carried out in dynamics. To compare the above groups dispersion analysis (or criteria of Kruscal-Wallise) followed by Student criterion with corrections for multiple comparison. To reveal differences between the groups according to quality peculiarities criterion ч2was used.
Rusults. After 12 months of the above therapy 18% of the patients with diabetic nephropathy (groups 2, 3, 4) and 40% with no kidney damage (group 1) had HBA1c (≤6.5-7.0%) (p=0.002); 44% of the patients with diabetic nephropathy and 90% of the patients with no kidney damage had cholesterol less than 4.5 mmol/L (р<0,0001); AH - 40% of the patients with diabetic nephropathy and 87% of the patients with no kidney damage had AH <130|80 (р<0,0001). Reduction of myocardium mass index of LV in groups 1,2,4 was revealed. Reduction of thickness of the inner and outer layers of the carotid arteries, improvement of diastolic function, reduction of albuminuria and reduction of insulin resistance (НОМА-IR-index) were noted. There were no deaths.
Conclusion. The above long-term multi-factor therapy reduced insulin resistance, risk factors for heart diseases (AH, dyslipidemia). The above treatment improves structural and functional parameters of the LV myocardium and kidney functions, reduces atherosclerosis of the carotid arteries and risks of acute cardiovascular events. Multi-factor therapy may prevent damage of the myocardium and development of diastolic dysfunction at early stages of diabetic nephropathy.
Fefelova M.A.
APPLICATION OF SYNTETIC BONE GRAFT AND RICH-PLATELETED PLASMA MIX WHILE DENTAL IMPLANTATION.
Kirov State Medical Academy
Department of Dentistry
Head of Department: DDS, MD, PhD V.Yu. Nikolsky
Scientific supervisor: professor: DDS, MD, PhD V.Yu. Nikolsky
Overwhelming majority of synthetic bone graft materials in practice do not have any or enough osteoinductive effect. At the same time in case we are going to make small osteoplasty we should not traumatize donor’s zone taking a bone from it. To have high degree of osteoinduction, we use bone graft material mixed with rich platelet plasma. The concentration of platelet-derived growth factor and transforming growth factor, which have expressed osteoinductive effects, is higher in rich platelet plasma than in blood.
Clinical case: Female patient with right side distal tooth defect. After installation of titan implants, we have seen vestibular defect of the bone near implants cervix and wise deficit of alveolar process of maxilla. Rich platelet plasma has been obtained after two time low speed centrifugation of patient’s blood first for 10 minutes (speed 2400 rot/min), than for 15 minutes(3600 rot/min). Major bone graft material was syntactic, calcium nano-sized hydroxiappothite modified by oxide silicone «Nanobone»®, Artoss, small pieces of autobone chips. In 2 month implants have been osteointegrated, alveolar process has esthetic vestibular shape. On X-ray images density of bone and level of osteointegration is enough for loading.
Result: application of synthetic osteoplastic material and rich platelet plasma mix is a convenient and easy way to have good result of bone grafty and implantation by giving it osteoinductive properties.
Gadzhiev R.G., Churkina K.G., Dolgusheva M.V., Kalinina A.G.
COMPARATIVE CLINICAL PROFILE OF INFLUENZA
IN THE EPIDEMIC SEASON 2009-2010
Kirov State Medical Academy
Department of Infectious Diseases
Head of the department: professor A.L. Bondarenko
Scientific supervisor: M.V. Savinykh,
The influenza and acute respiratory viral infections remain among the most actual problems of health protection: they account for about 90% of the whole infectious morbidity. In Russia there are registered yearly from 27.3 to 41.2 m cases of these infections. The urgency of this problem has been caused recently because of emergence of the new influenzavirus A, which had not been detected before.
The goal of research is to carry out a comparative analysis of the clinical features of high-pathogenic (А(H1N1/09)) and seasonal influenza course.
Materials and methods: we have analyzed 168 medical histories of the patients, aged 17 to 79 years, with the influenza, who underwent patient treatment in Kirov infectious clinical hospital in the epidemic season 2009-2010. There were 98 (58.3±3.8%) men among them. The average age of the diseased appeared 27.1±1.1 years. The diagnosis has been confirmed by separating the virus antigen using the polymerase chain reaction.
The diseased have been divided into 2 groups: the first (147 persons – 87.5±2.6%) has been made from the patients with the pandemic influenza (А(H1N1/09)), the second – from the patients with the seasonal influenza. There have not been detected any significant distinctions in age and sex structure.
Irrespective of etiology there prevailed the moderately severe influenza (87.1±2.8% and 95.2±4.8% respectively). The patients’ body temperature in both groups rose mainly up to 38-40°С (73.5±3.6% and 66.7±10.5% respectively) at the disease height. The fever remained significantly longer by the patients of the first group (9.0±0.4 as against 5.1±0.5 days, p<0.001). The significant distinctions have been stated also by comparing the occurrence frequency of the main symptoms of breathing passage involvement: rhinitis (59.9±4.0% and 33.3±10.5%, p<0.05), pharyngitis (92.5±2.2% and 47.6±11.2%, p<0.001), tracheitis (48.3±4.1% and 23.8±9.5%, p<0.05), and bronchitis (15.6±3.0% and 0% respectively, p<0.001). Complicated influenza course was present in both groups (20.4±3.3% and 23.8±9.5% respectively). There prevailed the pneumonias which frequency in the complication structure made 76.7±7.7% and 100% respectively. The fatal outcomes have been seen only among the pandemic influenza diseased and have been observed by 5 diseased (3.4±1.5%). In all instances the causes of fatal outcomes were bilateral pneumonias accompanied by the respiratory distress syndrome and acute respiratory failure.
By this means in the epidemic season 2009-2010 the pandemic influenza was detected more often. The influenza А(H1N1/09) compared to the seasonal flu was accompanied by a more lingering fever and a more often respiratory tract involvement. The fatal outcomes have been seen only by the patients with high-pathogenic inflienzavirus.
Gorshkov A.S., Polushin A.V.
Human chorionic gonadotropin SUPPRESSES throat carcinoma Hep-2
Kirov State Medical Academy
Department of Medical Biology and Genetics
Head of the Department: professor A.A. Kosykh
Scientific supervisor: professor A.A. Kosykh
Introduction. Oncogenesis is one of the most important problems of modern medical science. A lot of authors [Kopnin, 2000; Solopaev, 2000, Kosykh, 2009] paid attention to the importance of investigations on processes of differentiation and mechanisms of control of transmission of mitotic signal to tumor cells. In order to stimulate the processes of differentiation, it was suggested to use human chorionic gonadotropin (hCG). Human chorionic gonadotropin or human chorionic gonadotrophin (hCG) is a glycoprotein hormone produced in pregnancy that is made by the developing embryo after conception and later by the syncytiotrophoblast (part of the placenta). Later it turned out that hCG does not stimulate but suppresses a number of tumors that have specific receptors to hCG. Such receptors are located on the cells of gonads, epithelium of breasts, and hemopoietic cells. According to some investigations [Ch.V. Rao, X.Li, S.K. Manna et al., 2004], in some sensitive cells, p53 dependent apoptosis occurs due to checking of factors АР1 and NFkB. Effects of hCG on non-gonad tissues and tumors of non-gonad genesis have not been very well studied yet.
Purpose and targets of the current study are to evaluate effects of hCG on throat carcinoma Нер-2 that has no reliable evidence of receptors to gonadotropins.
Materials and methods. Evaluation of anti-tumor activity of hCG. Evaluation was performed by means of MTT assay.
Results and discussion. hCG is able to suppress throat carcinoma Нер-2 in MTT assay. Due to the effects of hCG in concentration of 1 and 2 IU/ml there is decrease of optic density of in the range of 20.38% - 22.95%. Increase of the concentration of hCG up to 4 IU/ml has a reverse effect and results in statistically insignificant increase of optic density (р=0.78). Thus, hCG has effects of different directions. It is quite possible that concentration of the hormone in 1 and 2 IU/ml may trigger apoptosis, and 4 IU/ml stimulate survival of cells.
Conclusions. hCG has effects of different directions on culture of throat carcinoma Нер-2. Concentrations of the hormone in 1 and 2 IU/ml reliably suppress growth of tumor cells. Increase of hCG concentrations up to 4 IU/ml does not increase the above effect.
Karpunicheva А.А., Musinskaya А.V., Petrygina E.А.
CHARACTERISTIC OF CLINICAL MANIFESTATIONS
OF ENTEROVIRUS INFECTION IN ADULTS
Kirov State Medical Academy,
Department of Infectious Diseases
Head of the Department: professor A.L. Bondarenko
Scientific supervisor: associate professor S.V. Abbasova
In recent years in the world there is a clear trend towards intensification of enterovirus infection, as noted in the Kirov region. So, in 2010 the registered incidence of enterovirus infection in 2.6 times compared with the year 2009 (9.14 and 3.47 in 100 000 inhabitants).
Purpose of our study was to examine the clinical features of enterovirus infection in 72 patients aged 15-64 years (average 28.9±1.4 years) who were treated at the Kirov Infectious Clinical Hospital in 2010. Men are 41 (56.9%) of them, women - 31 (43.1%). Diagnosis was based on the epidemiology, clinical picture of disease and detection of IgM-antibodies to enteroviruses in serological study of patients’ blood in IFA. The predominant clinical manifestations were singled out the following forms of enterovirus infection: inflammation of upper respiratory tract - 61.1%, enterovirus rash - 12.5%, hepatitis - 11.1%, gerptonsillitis - 5.5%, gastroenteritis - 4.2%, enterovirus fever - 2.8%, epidemic mialgia - 1.4%, serous meningitis - 1.4%. The severity of infection was moderate in 83.3% of patients, easy - in 9.7%, severe - in 7.0%.
Intoxication syndrome was observed in all patients from the first day of illness and lasted 5.7±0.6 days. Increase of temperature in average to 38.6±0,10С accompanied by weakness in 84.7% of patients, headache - in 30.6%, chill - in 27.8%, mialgia - in 13.9%. Pharyngitis was the most common manifestation of enterovirus infection: complaints of pain in the throat produced 79.2% patients, hyperemia mucosa of the pharynx was detected in 83.3% of cases, graininess of the rear side of the throat - in 29.2%, ulcers mucosa of the soft palate - in 5.5%, increase of submaxillary lymphatic nodes - in 9.7%. Maculae and papules on the skin were in 19.4% of patients. Rash was localized on the trunk and extremities and continued for 6.1±1.0 days. Hyperemia of the face and injection of scleras vascular were only in 5.6% of cases. Defeat of the gastrointestinal tract was characterized by abdominal pain in 6.9% of patients, nausea and vomiting - in 12.5%, fluid stool without pathological admixtures 3-5 times a day - in 9.7%. Involvement in the pathological process of liver was detected in 22.2% of cases. The level of ALT was increased to an average 183.5±60.2 u/l, AST - to 111.7±44.3 u/l, bilirubin - to 25.6±9.9 Umol/l. One patient (1.4%) had serous meningitis with lymphocytic pleocytosis 100 cells in 1 mkl. Epidemic mialgia with localization of pain in the lower divisions of thorax was found in 1 patient (1.4%). In general blood test lymphocytopenia in average of 10.4±0.8% was registered in 48.6% of cases, high ESR up to 29.9±4.9 mm/h - in 47.2%.
Thus, the clinical manifestations of enterovirus infection in adults characterizes by a marked polymorphism symptoms from easy forms type of acute respiratory disease to severe, with the development of meningitis. Most commonly registers enterovirus pharyngitis with intoxication syndrome and vesicular lesions mucosa of the pharynx.
Kolotov K.A., Kim A.V.
INFLUENCE OF HISTOLOGICAL FORM OF CEREBRAL GLIOMA
ON THE PATIENTS' SURVIVAL AFTER COMBINED TREATMENT
Kirov State Medical Academy
Department of Neurology, Neurosurgery and Medical genetics
Head of the Department: Professor B.N. Beyn
Scientific supervisor: Professor B.N. Beyn
Gliomas are the most frequent primary cerebral tumors of neuroectodermal origin. The purpose is to investigate how patients with astrocytal and ependymal brain tumors can survive after combined therapy. The registers of surgical and biopsy material, patients’ charts and afterhistory questionnaires of 74 patients with cerebral glioma, who were operated in the neurosurgical department of Kirov regional teaching hospital in 1999–2004, are analyzed.
The following histological forms of neoplasms are found out: ependymal tumors (8 cases), diffuse astrocytomas (21), anaplastic astrocytomas (13), glioblastomas (32). One-year and five-year survival rates are estimated. The results are the following: 1) one-year survival rate: ependymomas – 75,0 %, diffuse astrocytomas – 80,95 %, anaplastic astrocytomas – 76,92 %, glioblastomas – 40,63 %; 2) five-year survival rate: ependymomas – 62,50 %, diffuse astrocytomas – 61,90 %, anaplastic astrocytomas – 38,46 %, glioblastomas – 3,13 %. Analysis of the given results shows decrease of a number of survived patients with increasing malignancy of a tumor. Thus, while the one-year survival rate in patients with diffuse and anaplastic astrocytomas is almost the same, in 5 years it becomes significantly lower in patients with anaplastic forms. The lowest percent of survival is revealed in patients with glioblastomas. Ependymomas and diffuse astrocytomas have more favourable prognosis. The majority of fatal outcomes in these forms of neoplasms is noticed at the period of hospitalization to the neurosurgical department and during the first year after combined treatment.
Thus, histological verification of forms of cerebral gliomas must be an integral part of complex diagnosis and management of patients. It can help to improve the prognosis of the disease.
Kuligina N.A.
TREATMENT OF AGE RELATED MACULAR DEGENERATION
Kirov Teaching Ophthalmology Hospital
Age related macular degeneration is a medical condition which usually affects older adults that results in a loss of vision in the center of the visual field (the macula) because of damage to the retina. It is a major cause of visual impairment in older adults (>50 years). Macular degeneration can make it difficult or impossible to read or recognize faces, although enough peripheral vision remains to allow other activities of daily life.
Age related macular degeneration is one of the most common diseases of the elderly. Age related degeneration accounted for about 10 percent of blindness in Western Europe 25 years ago. Currently, it accounts for 50%. According to the current investigations, retina diseases are the second cause of primary disability. A lot of authors underline that about 70% of patients become practically blind in both eyes due to the disease. Age related macular degeneration occurs in “dry” and “wet” forms.
Neovascular or exudative AMD, the “wet” form of AMD is characterized by formation of submacular neovascular membrane. It accounts for 75 – 90% of all cases.
Appearance of submacular neovascular membrane requires laser coagulation, photodynamic as well as endovitral or retinal surgery. Currently, the efficacy of the above interventions leaves much to be desired. Recurrences of neovascular membrane account for 50% within 6-18 months. The growth factor of the vascular endothelium plays a big role in pathogenesis of submacular neovascular membrane. Avastin (buvuscibinab), lucentis (paninizumab) and macigen (Pegaptanib sodium/ Pfizer Inc) are medications that block the growth factor of the vascular endothelium in treatment for submacular neovascular membrane.
In our Kirov Opthalmology Teaching Hospital, Prospidium Chloridum (Prospidium chloride) was used for the first time as an effective medication that effects the morphology and pathogenesis of the neovascular membrane in case of age related macular degeneration.
The purpose of the current study was to follow the dynamics of the above medication within a year. The course of treatment included 5-7 injections. The course is repeated every 3-6 months
Materials and methods:
Prospidium directly effects DNA, Ribonucleic acid (RNA), has an anti-inflammatory, anti-modulator, anti-proliferative effects. This medication blocks messenger RNA and damages the synthesis vascular endothelial growth factor. Thus, it is indirectly a medication from group of anti-VEGF. In Kirov Teaching Ophthalmology Hospital, patients with wet form of age related macular degeneration were treated with Prospidium. The dose was 50 mg in peribulbar injections once every second week 90 patients, 96 eyes were studied. The age range was 44-82 years. Of them, there were 62 females and 34 males. The evaluation included: check-up of visual acuteness, examination of the eye fundus, photography of the eye fundus, fluorescent angiography of the retina. Due to the above evaluation, two groups of patients were formed:
1) Group I included patients who received one Prospidium course. The evaluation lasted 6 months from the moment of last injection.
2) Group II included patients who received two Prospidium courses. The evaluation lasted 12 months.
Results and discussion:
3 months later, stability of vision was noted in 56.2%. Visual functions improved in 21.6%. Worsening of visual functions was seen in 12.0%.
6 months later, stability of vision was noted in 36.0 %. Visual functions improved in 8%. Worsening of visual functions was seen in 56.0%.
6 months later, decrease of visual acuteness after a one time Prospidium course is associated with spread of age related macular degeneration and development of the pattern of exudative hemorrhagic stage.
Repeated decrease of visual acuteness after a one time infusion of Prospidium was noted in 56% of cases on an average 68 days. This fact explains the necessity of the next in-time course of injections.
Of 96 eyes, 38 eyes received a repeated Prospidium course.
The results and findings of the study are as follows:
Stability of vision was seen in 66.4%.
Visual functions improved in 23.8%.
Worsening of visual functions was noted in 12%.
Conclusions:
Treatment for the wet form of age related macular degeneration with Prospidium is effective.
After two treatment courses stability of visual acuteness is 10% more effective.
Kuligina N.A.
EVALUATING THE EFFECTIVENESS OF THERAPY WITH PROSPIDIN
IN PATIENS WITH AGE-RELATED MACULAR DEGENERATION
Kirov State Medical Academy,
Department of Ophthalmology
Head. Chair: Prof. Chuprov A.D.
Scientific supervisor: Prof. Chuprov A.D.
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Age related macular degeneration is a medical condition which usually affects older adults that results in a loss of vision in the center of the visual field (the macula) because of damage to the retina. In our Kirov Opthalmology Teaching Hospital, Prospidium Chloridum (Prospidium chloride) was used for the first time as an effective medication that effects the morphology and pathogenesis of the neovascular membrane in case of age related macular degeneration.
The purpose:
The current study was to follow the dynamics of the above medication within a year. The course of treatment included 5-7 injections. The course is repeated every 3-6 months.
Materials and methods:
Prospidium directly effects DNA, Ribonucleic acid (RNA), has an anti-inflammatory, anti-modulator, anti-proliferative effects. This medication blocks messenger RNA and damages the synthesis vascular endothelial growth factor. Thus, it is indirectly a medication from group of anti-VEGF.
In Kirov Teaching Ophthalmology Hospital, patients with wet form of age related macular degeneration were treated with Prospidium. The dose was 50 mg in peribulbar injections once every second week. 90 patients, 96 eyes were studied. The age range was 44-82 years. Of them, there were 62 females and 34 males.
The evaluation included: check-up of visual acuteness, examination of the eye fundus, photography of the eye fundus, fluorescent angiography of the retina.
Due to the above evaluation, two groups of patients were formed:
1) Group I included patients who received one Prospidium course. The evaluation lasted 6 months from the moment of last injection.
2) Group II included patients who received two Prospidium courses. The evaluation lasted 12 months.
Results and discussion:
3 months later, stability of vision was noted in 56.2%. Visual functions improved in 21.6%. Worsening of visual functions was seen in 12.0%.
6 months later, stability of vision was noted in 36.0 %. Visual functions improved in 8%. Worsening of visual functions was seen in 56.0%.
Repeated decrease of visual acuteness after a one time infusion of Prospidium was noted in 56% of cases on an average 68 days. This fact explains the necessity of the next in-time course of injections. The results and findings of the study are as follows:
Stability of vision was seen in 66.4%. Visual functions improved in 23.8%.
Worsening of visual functions was noted in 12%.
Conclusions:
Treatment for the wet form of age related macular degeneration with Prospidium is effective.
After two treatment courses stability of visual acuteness is 10% more effective.
Kushkova N.E.
Effects of respiratory interval on heart rate variability depends on individual autonomic modulation of heart rate
Kirov State Medical Academy
Department of Pathophysiology
Head of the Department: Professor A.P. Spitsin
Scientific supervisor: Professor A.P. Spitsin
Frequency-domain analyses of R-R intervals (or Heart rate variability) are used widely to estimate levels of autonomic neural traffic to the human heart. It’s known that respiration modulates autonomic activity. However, important influence of respiration on human R-R interval power spectra is largely ignored.
The present study investigated physiological responses to paced respiration of different frequencies in healthy people with different autonomic activity.
Twenty men and 30 women (mean age: 20.3 years) underwent 4 breathing conditions (paced with 0.1 Hz, 0.25 Hz, 0.30 Hz, and unpaced, without tidal volume control), each lasting 5 min. As dependent physiological measures heart period, and different heart rate variability (HRV) parameters were assessed. The target breathing sequence was displayed graphically in real time on a computer.
HRV (especially High frequency, or respiratory arrhythmia) decreased with higher breathing frequencies, under paced and unpaced conditions, whereas mood ratings did not change. The reduction of R-R interval spectral power that occurred at 0.3 Hz was more evident in people with cardiac parasympathetic innervation (HF power more then LF while spontaneous breathing condition measuring).
Сonclusion. We studied the effects of controlled breathing protocols on cardiovascular rhythms. We found that, during stepwise frequency breathing, total R-R interval spectral power at the breathing frequency tend to increase as breathing frequency decreases, and this depend on individual autonomic heart rate regulation. We suggest that, for short-term recordings, breathing protocols may allow for the most efficient assessment of autonomic cardiovascular rhythms.