REVIEWS
The presented literature review highlights the significance of the ischemia as a reason of reducing visual acuity in case of having such diseases as rhegmatogenous retinal detachment, primary open-angle glaucoma, AION and optic nerve atrophy. The expediency of prescribing “Cytoflavin” in the background of ischemia in case of neurodegenerative eye diseases is justified. The evidence of the effectiveness of this medicine in ophthalmological practice is provided.
The survey of the literature devoted to genetic epidemiology of keratoconus and also principles of genetic markers search showed predisposition to this disease suitable for screening test in the course of genetic certification of the population. It was revealed that hereditary predisposition to keratokonus was caused by gene mutations, encoding cellular cycle and metabolism of the keratocytes regulating the activity of tissue proteolytic enzymes, and also mechanisms of natural detoxification. Genes associated with keratoconus are characterized by allelic variation and multiple mutations taking different degrees of association with clinically apparent diseases. It was discovered that genotypes of people from different geographic regions can differ in terms of signs and markers showing predisposition to the disease.
The review of the literature on general issues concerning systematic and local (ophthalmological) beta-blockers (BB). Therapeutic effects, aspects of selectivity and the advantages of modern cardiotropic agents are highlighted. Special attention is paid to the frequency of side effects when taking systematic and ophthalmological BB and measures to decrease the frequency. Systematic additive effects in case of glaucoma caused by a range of chronic diseases were pointed out on the basis of its clinical experience. Recommendations to minimize the risk of BB side effects among patients having glaucoma and accompanying diseases of cardiovascular and respiratory systems were proposed.
The survey of the publications on cytoprotective antidiabetic, antimicrobial, antitumor and neuroprotective effects of the heterocyclic plant anthocyan glycosides, and also on their use to adjust metabolic processes in case of obesity. Having analyzed of publications it was concluded that wide spectrum of preventive and therapeutic effects of these glycosides mainly depends on their high antioxidant activity. It provides inactivation of the free radicals and also the ability to modulate intracellular energy systems of the mitochondria. Elimination of the manifestation and consequences of the oxidative stress using anthocyans is a forward-looking strategy to normalize metabolic disorders in case of cardiovascular pathology. High lability of anthocyans limits their usage in food and medical products. It is considered to be a complex and unsolved problem. The research in this field should primarily be aimed at increasing anthocyans’ resistance and preventing their degradation during processing and storage of the plant material.
Brief survey of the literature devoted to idiopathic non-granulomatous inflammation of the orbit which shows significant polymorphism of the clinical symptoms and absence of clear criteria of the diagnostics. Relevant publications are reviewed and latest data relating to epidemiology, classification and differential diagnosis of this disease is summarized.
ORIGINAL RESEARCHES
Objective: The evaluation of the frequency and level of the severity of post operational dislocation of the intraocular lens (IOL) among patients having complicated cataract.
Methods: Retrospective analysis of the reasons of IOL postoperative dislocation was conducted. 11251 phacoemulsifications (PE) dealing with complicated cataract were conducted in Khabarovsk branch of ISTC “Eye microsurgery” for the period from 2010 to 2020. Post operational dislocation of the lenses of non-traumatic genesis was registered in 33 cases – 0.29%.
Results: There were 19 men and 14 women aged from 50 to 89 years old among people having post operational dislocation. The period of patients appeals widely varies – from 4 months to 10 years, 4.7 years on average. Over time after PE, the frequency of such appeals increased progressively. IOL dislocations as a rule are based on a varying degree of the weakness of ligamentous apparatus of the lens as a consequence of accompanying ophtalmopathology that wasn’t detected before operation.
Conclusions: Patients having preoperative weakness of the zonular lens support are advised to have post operational dynamical monitoring of the IOL anatomical position for the period not less then 5 years.
Objective: The analysis of the antemortem changes of the microvasculature (MV) of the bulbar conjunctiva among older smokers.
Methods: 42 smokers middle age (45–59 years old, n=10), old age (60–74 years old, n=12) and senile age (75–86 years old, n=14) were examined. Smoking history is from 21 to 26 years, the number of smoked cigarettes – from 14 to 18 pieces a day. Control: 28 nonsmokers of both genders 45–59 years old (n=7), 60–74 years old (n=11) and 75–86 years old (n=9). MV was studied applying bio microscopy method using non-hydriatic retinal camera TOPCON TRC-NW8F (Japan), linked to the measuring complex of the automatic system of image analysis ImageScope (Leica, Germany).
Results: Arterioles spasm, unevenness of their caliber, the increase of the number of functioning anastomosis, disalignment of the microvessels and avascular fields were registered more frequently among older smokers, than among middle-aged smokers. Average arterioles diameter, arteriolar-venular coefficient (A/V) and specific density of capillaries were smaller, but the diameter of the venules was bigger among the older smokers than among nonsmokers of the corresponding age. The average arterioles diameter decreased by 22%, veins diameter increased by 15% among smokers aged 40–59. Both A/V coefficient and specific density of the capillaries reduced by 30 and 38% respectively. Among patients aged 60–74 the level of the relevant indicators declined by 5–8% on average. The differences of the examined parameters among smokers and non-smokers aged 75–86 were minimal and reached significant distinctions only on A/C coefficient and specific density of the capillaries.
Conclusions: Chronic tobacco smoking has negative influence on MV of the bulbar conjunctiva among older people: average arterioles size, A/V coefficient and specific density of the capillaries reduces, but the average size of venules increases.
Objective: The analysis of a chemical composition of fruits of far eastern species of plants of heather family (Ericaceae).
Methods: Fresh fruit and juice of Kamchatka bilberry (Vaccinium praestans) and crowberry (Empetrum nigrum) were used. The composition of the organic acids in fruits and juice was studied using high performance liquid chromatography, quantifying free organic acids – alkalimetry method using automatic titrator, quantifying phenolic acids – direct spectrophotometry method.
Results: Malic, citric and tartaric acids were identified in juice of Empetrum nigrum fruit. In addition to abovementioned acids, such acid as succinic was found in the juice of Vaccinium praestans fruit. The sum of free organic acids in terms of malic acid in Kamchatka bilberry juice was 4.98±0.04%, in crowberry juice – 1.01±0.01%. Gallic acid was also detected in the fruits of studied plants. The quantitative content of phenolic acids in alcohol extracts from Kamchatka bilberry and crowberry equaled 3.59±0.09% and 2.43±0.06%, respectively.
Conclusions: Vaccinium praestans and Empetrum nigrum fruits can be considered as a perspective source of malic, citric, tartaric and gallic acids.
Objective: The development of the way of diagnosing early damage of left ventricle (LV) of heart among smokers with early stages of the chronic obstructive pulmonary disease (COPD) and arterial hypertension (AH) by speckle-tracking of echocardiography using new indexes and possibility of its reproduction regardless the manufacturer of ultrasound scanner and its software.
Methods: 99 smokers 48.8 years old on average were observed. Patients were divided into four groups depending on the presence of COPD and AH. Strain-echocardiography with the estimate of the local and left ventricular global longitudinal strain was performed.
Results: Diastolic dysfunction of LV was defined during all observations, but it prevailed among patients having COPD and AH. Ventricular global and local longitudinal strains were within default values. The decrease in deformation of basal segments of LV among patients having COPD and AH was registered. Average value of the deformation in basal segments of LV turned out to be less among patients having AH regardless of existence of COPD.
Conclusions: Early signs of LV myocardial injuries among smokers are highly presented in case of COPD and AH. Both normal indexes of standard echocardiography and normal indexes of ventricular global and local longitudinal strains don’t exclude early myocardial damage. Relative indicators of ventricular longitudinal strains are more sensitive markers of myocardial damages among smokers in preclinical stage. Strain-echocardiography can be used as hardware-independent diagnostic method of the early signs of myocardial damage of LV.
Objective: Set functional peculiarities of the organization of cognitive activity of the high-school students caused by the type of interhemispheric asymmetry of the brains.
Methods: Comparative analysis of central nervous system was conducted among 250 students (9–11 grades) using variational chronoreflexometry, computer test “Landolt ring” and intelligence test.
Results: Teenagers having left hemisphere type of functional brain asymmetry prevailed (56%). The number of schoolchildren with the domination of right hemisphere didn’t exceed 40.4%. Equi-hemispheric students made 3.6%. Higher level of functional mobility of the nervous system was detected among children having left hemisphere type of functional brain asymmetry. It defined the optimal level of cognitive performance.
Conclusions: Low level of the development of cognitive functions’ dynamics among students having right hemisphere domination determines the necessity of training games usage for the purposes of the development and improvement of the cognitive abilities defining the level of academic performance of the students.
Objective: To estimate the effectiveness of preconception care using progesterone analog and acupuncture among women having primary oligomenorrhea in medical history.
Methods: 50 pregnant women having primary oligomenorrhea having got preconception care using folic acid and iodine. In 25 cases (main group) preconception care also included 3 months of applying dydrogesterone and acupuncture.
Results: The total number of side effects during the first trimester of pregnancy among women having taken dydrogesterone and acupuncture was sufficiently less (16%), then in control group (64%). The danger of spontaneous abortion was diagnosed 7 times more rarely (4%). Dydrogesterone and acupuncture usage during preconception care stage among women having primary oligomenorrhea didn’t have any influence on prenatal screening indexes.
Conclusions: 3 months of dydrogesterone usage and the course of acupuncture among women having primary oligomenorrhea on the stage of preconception care decreased the frequency of side effects by 4 times during the first trimester of the pregnancy, spontaneous abortion – by 7 times.
Objective: The analysis of the pharmacotherapeutic effectiveness of Empetrum nigrum juice in case of diabetes mellitus (DM) in the experiment.
Methods: DM chemical model applying single alloxan injection (100 mg/kg) was used for rats of Vistar line weighing 280–320 grams. Experimental animal groups got Empetrum nigrum juice and standard antidiabetic drug – rutin (quercetin biglycoside). The level of glucosemia and alanine aminotransferase in blood serum was measured. The state of lipids peroxidation (by malonic dialdehyde) and antiradical activity index off-load and applying glucose-tolerance test was estimated.
Results: Hypoglycemic, antioxidant and pancreas-protective effect of Empetrum nigrum juice was defined.
Conclusions: Received data allows recommending further antidiabetic potential of Empetrum nigrum with the perspective of using it in the therapy of diabetes mellitus of the second type.
METHODS
Objective: The estimation of the effectiveness of the treatment of primary open-angle glaucoma (POAG) using micro invasive non-penetrating deep sclerectomy along with the implantation of “Glautex drainage”.
Methods: The results of the treatment of 37 patients having POAG were analyzed before and after conducting micro invasive sclerectomy along with the implantation of “Glautex drainage”. Intraocular pressure level (IPL) before operation was 28.2 mm Hg on average.
Results: In all cases there were no complications during operations. POAG accounted 15.1 mm Hg the day after operation on average. Diffused filter pad of the moderate height was observed. Pathologic reaction of tissues to the implant was negative. In the period 1 to 3 months the intraocular pressure level was 16.8 mm Hg on average and most patients (92%) didn’t require hypotensive therapy. Descemetogoniopuncture was applied to all patients during this period. In 12 years the intraocular pressure level was 17.6% mm Hg on average. In 16 cases (43%) hypotensive mode was not implemented. According to ultrasound bio microscopy intrascleral cavity and intrascleral tunnels of the different intensity were still presented.
Conclusions: Micro invasive non-penetrating deep sclercetomy combined with implantation of the “Glautex drainage” can be considered as effective operation to normalize intraocular pressure level in patients having POAG.
Objective: The survey of the methods of surgical treatment of optic nerve atrophy (ONA) among children and the estimate of the effectiveness of the optic nerve revasculization using allomaterial “Alloplant”.
Methods: They survey of the surgical methods of ONA treatment was conducted. The effectiveness of practiced revasculization of the optic nerve among 30 children aged from 2 to 19 by the Children’s Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan.
Results: Methods of the surgical treatment of optic nerve atrophy are divided into 5 groups conditionally. Only extrascleral methods can be applied to children. The effectiveness of optic nerve revasculization is statistically proven. It is represented by increased visual acuity and the improvement of subjective feelings of patients after operation using proposed methodology.
Conclusions: ONA treatment among children and adults is a challenge of the modern ophthalmology which is still relevant. The operation on revasculization of the optic nerve using Alloplant has been put into practice in our clinic. It showed high clinical efficiency among patients under 19 years old.
PUBLIC HEALTH ORGANIZATION
Objective: The estimation of the level and structure of malignant neoplasms (MNP) mortality level in Republic of Buryatia for the period from 2009 to 2018.
Methods: Statistical data of forms No. 7 and No. 35 of federal statistical observation and materials by Republican Clinical Oncological Dispensary.
Results: Significant gender differences were defined in the level and structure of MNP mortality rate among population of the republic. The increase in mortality rate caused by tumor of the central nervous system, prostate, skin, lip, oral cavity, throat and kidneys was registered among men population. The increase in mortality rate among women was caused by skin melanoma, laryngeal cancer, lymphoma, hematopoietic tumor, ovarian and pancreatic cancer.
Conclusions: Despite the downward trend in the MNP death rate in Republic of Buryatia the oncological problem is still urgent because of the increase in death rate due to separate tumor localizations. The oncological service of the Republic has reserve to decrease death rate from general forms of MNP which can be supported by relevant activities.
594,631 children under 14 years old were registered in Russian Federation in 2019 to have eye muscles disease, friendly eye movement disorder, accommodation and refraction. There were 37,055 children in Far Eastern District and 8,537 children in Primorsky region having such diseases. 1,271 children received high-tech medical care in Children Ophthalmological Department (eye microsurgery) Regional Clinical Hospital No. 2 from the 1st of January to 25th of December 2019, including 210 children (112 boys and 98 girls) operated on strabismus. During a preventive examination of a babies under one year and diagnosing infant form of strabismus it is necessary to introduce a mandatory ultrasound eyes’ examination into a clinical practice of child ophthalmologists in Primorsky region. This additional examination is conducted in Children Ophthalmological Department of Regional Clinical Hospital No. 2 under compulsory health insurance as a consultation, including when planning a surgery.
Objective: The comparison of the quality of life indicators (QL) in patients having peptic ulcer disease of the duodenum (PUDD) during exacerbation period in in-patient and ambulatory care.
Methods: Main group consisted of 30 patients having exacerbation of PUDD receiving in-patient treatment. The age of studied patients varied from 20 to 55 years old. The estimation of the quality of life was conducted using short questionnaire on life quality MOS-SF 36.
Results: Before the beginning of treatment the reliable difference between two QL scales was detected. Compared with ambulatory patients the level of physical role functioning was significantly lower – 12.4%, social functioning – 12.9% lower. It indicated more critical condition of the hospitalized person. A reliable growth of the estimate of physical role functioning, life force and emotional role functioning was detected among in-patients in therapy dynamics. Out-patients QL indicators remained stagnant after two weeks of treatment.
Conclusion: The choice of treatment of PUDD patients relates to the quality of their life. In-patient treatment can be considered as the form of therapy maintaining psychological and physical well-being of the patient. The estimation and monitoring of PUDD patients’ quality of life can provide an opportunity to set priorities and make a targeted planning of healthcare program in order to take effective actions and as a result to improve the quality of life of medical services recipients.
Integration of the clinical protocol and practical experience in simulation center of the Irkutsk regional hospital allowed decreasing maternal mortality in the region. 583 obstetrician-gynecologist form all medical organizations in the region were trained in the simulation center. There was a direct correlation indicated between participation in simulation trainings and readiness of the personnel to do the teamwork with the better compliance of the medical care algorithms and treatment results improvement. Maternal mortality indexes were decreased by 31.3% by 2018 during the period of 5 years, in case of lack of deaths caused by postpartum hypotonic hemorrhage, strong preeclampsia and eclampsia. There were no registered maternal mortality cases in Irkutsk region for the period of 2019 and 9 months of the year 2020.
The observation of the glomus tumor of the middle ear of woman aged 62 years old is presented. The tumor of the size up to 15 mm was localized in middle-ear cleft. It caused mixed hearing loss of the second degree. Clinic managed to remove tumor as a single block and recover the wholeness of anatomical structures. The operation was conducted under total intravenous anesthesia and artificial pulmonary ventilation. In a year after surgical intervention audiological research showed sensorineural hearing loss of the minimal level.
PRACTICE OBSERVATIONS
Dural metastases from melanoma is a rare type of skin melanoma progression. Mainly such lesion is asymptomatic and is indicated in the later stages of tumor tissue downgrowth beyond the skull or cerebral compression. A radical excision is considered to be the main method of treatment if there is a clinically significant and surgically available single metastasis. The case of acute hemorrhage into a chronic subdural hematoma on the periphery of melanoma metastasis in the dura in patients aged 36 is presented. In spite of emergency surgery the patient passed away the next day.
Rare clinical form of larval toxocarous conjunctivitis with pseudotumor of the orbit and superior rectus muscle of eye lesion is demonstrated. It was caused by migrating toxocar larvaes. The patient was 46 years old.
SHORT REVIEWS
Objective: To enhance the effectiveness of prevention and treatment of the post-operative complications among patients having benign tumor of the salivary glands by applying drug treatment, reflexology and hirudotherapy.
Methods: 94 patients having post operational facial disorders and paresthesias appeared after subtotal parotid salivary gland resection due to pleomorphic adenoma. Patients were divided into two groups. Control group included 44 people. General drug treatment of such complications was conducted. Main group consisted of 50 patients who were prescribed reflexology and hirudotherapy.
Results: The length of facial muscles functional recovery on the side of disorder in main group was 31.2 on average, control group – 182 days.
Conclusions: Conducted research demonstrated undeniable advantages of the complex approach applying acupuncture and hirudotherapy as an addition to the basic drug treatment among patients operated on benign tumor of the salivary glands.
Retrospective analysis of the surgical activity in children and adult ophthalmological departments in Regional Clinical Hospital No. 2 was conducted on the basis of the treatment outcomes of 1,928 children and 11,922 adults for the period from 01.01.2018 to 25.12.2018. Major part of surgeries (51%) in a pediatric practice was directed at strabismus, among adult patients (56%) – aimed at cataract. Perioperative antibiotic prophylaxis allowed avoiding inflammatory complications completely.