MEDICO-BIOLOGICAL SCIENCES
ORIGINAL ARTICLES
SOME ISSUES OF THE RELATIONSHIP BETWEEN CORONAVIRUS AND BACTERIAL INFECTIONS ON THE EXAMPLE OF A FATAL CASE IN A CHILD
Dmitriev I.V., Ignatova N.B., Moiseenkova S.D., Abrosimov S.Yu.
Abstract: Objective. To study the features of the clinical course and morphological manifestations in a child who was treated on an outpatient basis and died in a hospital with a positive test for COVID-19 and sepsis. To identify the factors contributing to the development and progression of this disease. Methods. The data of the medical documentation of the fatal case of a child with a positive PCR test for COVID-19 and sepsis were analyzed. The published data from domestic and foreign sources on children with coronavirus infection, including those with bacterial infections, were studied. In the analysis, special attention is paid to the pediatric multisystem inflammatory syndrome associated with COVID-19. Results. A boy of 6 years and 8 months suffered from acute respiratory viral infection ("sore throat") a month before hospitalization. He was treated on an outpatient basis for 2 weeks, then attended kindergarten for 10 days. Two days before hospitalization, his eyes turned red, he sneezed, and his nose was "stuffy". 10 hours before hospitalization, there was repeated vomiting and weakness. After an examination at the reception department of the district hospital with recommendations for treatment, he was sent home. 4 hours before hospitalization, the temperature was 37.7 g C, and vomiting was noted. He was sent from the CRH to the OGBUZ "KB 1" in Smolensk, where he was admitted at 21:35. On examination: condition of moderate severity; conscious, in contact, oriented. Therapeutic and diagnostic measures were initiated. At 22:05 he lost consciousness. Resuscitation measures were started at 22:10. Death was registered at 22:40. A lifetime oropharyngeal smear on SARS/COVID-19 RNA was negative. The sectional material revealed inflammation in many organs and tissues; SARS/COVID-19 RNA and bacterial growth were detected. Conclusions. A feature of the presented clinical case should be considered a marked progression of the pathology in the last day of the child's life with a sharp decompensation. The absence of clearly expressed clinical symptoms due to damage to the respiratory, cardiovascular and a number of other systems, along with complaints of repeated vomiting, did not allow to unambiguously determine the diagnosis of the child. Even the macroscopic picture of organ changes at the autopsy did not immediately allow for a definite interpretation of the results obtained. The results of additional research methods (histological, bacteriological, PCR) significantly contributed to the verification of the diagnosis. The results presented above allow us to take a slightly different look at the pathological processes developing in children with coronavirus infection, including children's multisystem inflammatory syndrome associated with COVID-19. This kind of pathology, which is a "pathology in pathology", can probably occur atypically. The presented data can help in clinical practice to make timely and reasonable decisions on the correction of diagnosis and treatment of such patients. The remaining unresolved issues allow us to determine possible directions for further research.
Key words: COVID-19, pediatric multisystem inflammatory syndrome associated with COVID-19, sepsis, Kawasaki syndrome
AGE-ASSOCIATED CHANGES IN THE ACTIVITY OF GLUCOSE AND ADENOSINE METABOLISM ENZYMES
Mironova K.A., Bakurova E.M.
Abstract: Objective. To study the influence of the age factor on the activity of glucose metabolism dehydrogenases and adenosine deaminase in erythrocytes, lymphocytes and blood plasma of healthy donors. Methods. Erythrocytes, lymphocytes and blood plasma of 52 healthy donors (16 women and 36 men) aged 20 to 75 years were examined. The enzyme activity was determined spectrophotometrically using standard methods. For mathematical analysis of the obtained results, the licensed MedStat v. 5.2 program was used. To identify a statistically linear relationship between the features, the Pearson rank correlation indicator was calculated. To determine the significance of the identified relationship, a comparison of the calculated value with the corresponding critical value at a significance level of p = 0.05 was performed. Results. The activity of glucose metabolism enzymes in erythrocytes changed in the same direction and had age-related features. The results of the correlation analysis showed the existence of a moderate relationship between the activity of the glycolytic enzyme lactate dehydrogenase in erythrocytes and age: r=0.634 (p=0.0006). There was no such dependence for the activity of glucose-6-phosphate dehydrogenase: r=0.27 (p=0.18). The activity of adenosine deaminase inversely correlated with age (r=-0.932, p=0.009). The effect of age on the activity of the studied enzymes in lymphocytes was not confirmed by the results of the correlation analysis. However, the anaerobic reaction of glycolysis increased in the groups of mature and elderly age. The age-related dynamics of the activity of the adenosine metabolism enzyme reflected its decrease after 60 years. In blood plasma, the activity of all the studied enzymes increased with age. For young and mature individuals, the activity of carbohydrate metabolism enzymes in blood plasma inversely correlates with the activity in erythrocytes. Age dependence was confirmed for the studied enzymes of blood plasma: for lactate dehydrogenase (r=0.404, p= 0.002), for glucose-6-phosphate dehydrogenase (r=-0.47, p= 0.001) and for adenosine deaminase (r=0.303, p=0.004). Conclusion. Changes in enzyme activity in erythrocytes, lymphocytes and blood plasma are age-related. The most pronounced enzymatic shifts in carbohydrate and nucleoside metabolism in blood cells are manifested in the elderly group.
Key words: lactate dehydrogenase, glucose-6-phosphate dehydrogenase, adenosine deaminase, ageing
ANTIHYPOXIC EFFECTS OF 2-ETHYLTHIOBENZIMIDAZOLE AND A COMPLEX OF SUCCINCIC ACID SALTS IN RATS PRE-TRAINED TO HYPOXIA WITH ACUTE OXYGEN STARVATION
Shabanov P.D., Kozhurin M.V., Zarubina I.V.
Abstract: Objective. Experimental study of the adaptogenic effect of metaprot, a complex of succinic acid salts (amosuccinate) and their combinations to increase individual brain resistance to hypoxia during interval hypoxic hypobaric training. Methods. Acute hypoxic hypobaric hypoxia was induced in a flow pressure chamber. Rats were divided according to their resistance to acute hypoxia, raising them in a pressure chamber to a height of 11,000 m at a speed of 50 m/s and exposing them to the height until agonal breathing occurred. Rats that were exposed to hypoxia for 5-10 minutes were considered low-resistant (LR), and those exposed to hypoxia for more than 10 minutes were considered highly resistant (HR). The interval hypoxic training regimen was 3 days. The one-day training cycle consisted of raising rats 6 times at a speed of 15 m/s to an altitude of 5000 m and exposing them to the height for 30 min. The interval between lifts was 20 minutes. In the study we used the synthetic adaptogen 2-ethylthiobenzimidazole hydrobromide (metaprot) 25 mg/kg and a complex of succinic acid salts (amosuccinate) 50 mg/kg, which were administered intraperitoneally for 3 days immediately after the end of the one-day training cycle. The control group consisted of trained and untrained rats that received an equivalent volume of saline. Creatine phosphate and free adenine nucleotides (ATP, ADP and AMP) were determined in the brain, and the energy charge of the adenyl system was calculated. Results. Acute hypoxia caused a decrease in the content of high-energy phosphates in the brain of rats of both groups by 44-73%. Metaprot and, to a lesser extent, amosuccinate increased the survival rate of LR and HR to hypoxia in rats at an altitude of 11,000 m with an exposure of 30 min. The combination of interval hypoxic training with metaprot and, to a lesser extent, amosuccinate enhanced the antihypoxic effect of training. Synthetic adaptogens (metaprot and amosuccinate) against the background of interval training of rats to hypoxia prevented the depletion of high-energy phosphates observed in untrained animals. Conclusion. It was concluded that the combination of high-altitude training with the use of synthetic alaptogens (metaprote and amosuccinate) potentiates adaptive metabolic changes in the brain of rats exposed to pulsed high-altitude training. Against the background of the action of the drugs, the pool of basic high-energy phosphates and the energy charge of the adenyl system are preserved in the brain tissue.
Key words: metaprot, complex of succinic acid salts, high-altitude hypoxia, adaptation, rats
POTENTIAL MARKER OF CHRONIC PAIN STRESS
Lyubimov A.V., Efimov A.V., Tarakhteev A.S., Bykova D.D., Trandina A.E., Pogozhaya E.A.
Abstract: Objective. Study of adaptation mechanisms based on hypoxia-inducible factor 1 alpha (HIF1α) in the context of chronic pain stress.Methods. The “Formalin” test technique was used on male Wistar rats as a model of stress-induced mechanisms of adaptation to painful stimulation. А 2,5% formalin solution was injected into the dorsal surface of the foot of the rat hind limb in a dose of 50 μl. with the assessment of the dynamics of indicators 1 hour, 24 hours and 72 hours after administration of the solution.Results. Comparison of HIF1α levels in the blood, amygdala and cerebral cortex before formalin administration, 1 hour after administration, 24 hours, and 72 hours using two-factor rank analysis of variance showed a statistically significant increase in the level of HIF1α 72 hours after formalin administration in comparison with the level of HIF1α in the control group and 1 hour after administration. When examining the level of HIF1α in the blood, no statistically significant differences were revealed.Conclusion. The discovered association between HIF1α and chronic pain stress makes it a potentially important diagnostic marker and an important therapeutic target for pain pathologies. Further research will open up new directions for therapeutic strategies to detect and correct chronic pain stress.
Key words: pain stress, hypoxia-inducible factor 1 alpha, adaptation
EFFECT OF DALARGIN ON PHAGOCYTIC ACTIVITY OF NEUTROPHILS IN THE EXPERIMENTAL ULCERATIVE COLITIS IN MICE
Liashev A.Yu., Mal G.S.
Abstract: Objective. To study the dalargin effects on the phagocytic activity of peripheral blood neutrophils in mice with experimental ulcerative colitis.Methods. Ulcerative colitis was simulated by replacing drinking water with a 5% solution of dextran sodium sulfate in boiled water for 5 days. Animals were removed from the experiment on the 5th, 7th and 28th days. Dalargin was administered subcutaneously at a dose of 100 mcg/kg body weight once a day for 7 days from the start of ulcerative colitis simulation. Sulfasalazine was administered intragastrically to mice at a dose of 200 mg/kg body weight in a volume of 0.3 ml for 7 days. The phagocytic activity of peripheral blood neutrophils was assessed by the following indicators: phagocytic index, phagocytic number, opson-phagocytic index.Results. It has been established that ulcerative colitis simulation is accompanied by an increase in the neutrophils phagocytic activity, which is manifested by an increase in the phagocytic number, phagocytic and opson-phagocytic indices on the 5th and 7th days of the experiment. There were no changes in the phagocytic activity of neutrophils in the animals with ulcerative colitis compared to naïve mice on the 28th day. Dalargin administration had a corrective effect on the phagocytes function. A statistically significant decrease in the phagocytic number, phagocytic index and opson-phagocytic index was shown in mice with ulcerative colitis. The administration of the reference drug sulfasalazine also led to a decrease in the studied parameters on the 5th and 7th days of the experiment. There were no statistically significant differences in the effects of dalargin and sulfasalazine on the phagocytic activity of neutrophils in mice with experimental ulcerative colitis.Conclusion. The corrective effect of dalargin on the neutrophils activity is apparently associated with a decrease in the production of pro-inflammatory cytokines, an increase in the production of anti-inflammatory interleukins, as well as a direct modulating drug effect on phagocytic cells.
Key words: ulcerative colitis, dalargin, phagocytic activity, neutrophils
REVIEWS
PHARMACOLOGICAL NEUROPROTECTION IN ISCHEMIC BRAIN LESIONS (PART 3. JUSTIFICATION OF THE CHOICE AND PHARMACODYNAMICS OF DRUGS FOR BLOCKADE OF ISCHEMIC CASCADES)
Novikov V.E., Pozhilova E.V.
Abstract: Objective. Evaluation of the effectiveness of pharmacological neuroprotection and the prospects for its clinical use in ischemic brain lesions. Methods. Collection, systematization and analysis of literature data and the results of our own research on the experimental and clinical study of pharmacological neuroprotection in ischemic brain lesions. Results. The third part of the work presents a scientifically reasoned justification for the choice and pharmacodynamics of drugs for primary and secondary pharmacological neuroprotection, implemented by blocking the pathogenetic links of the ischemic cascade. The results of experimental and clinical studies of the neuroprotective activity of various pharmacological agents are discussed. A comparative assessment of the effectiveness and safety of the use of drugs of various pharmacotherapeutic groups and potential medicinal compounds in model conditions of ischemia/hypoxia and the prospects for their clinical use in cerebrovascular insufficiency is carried out. Conclusion. The choice of the means for blocking ischemic cascades for the purpose of pharmacological neuroprotection in cerebral ischemia depends on the period of neuroprotection and ways of its implementation, taking into account pathogenetic targets for pharmacological effects. To increase the effectiveness of anti-ischemic pharmacotherapy, it is advisable to carry out combined neuroprotection using drugs to block the main pathological reactions of the ischemic cascade (glutamate excitotoxicity, hypoxia and oxidative stress, mitochondrial dysfunction, etc.), and to carry it out sequentially (primary and secondary neuroprotection).
Key words: pharmacological neuroprotection, cerebral ischemia, glutamate excitotoxicity, oxidant stress, mitochondrial dysfunction
CLINICAL MEDICINE
ORIGINAL ARTICLES
REAL PRACTICE OF DIAGNOSING GASTROESOPHAGEAL REFLUX DISEASE IN PATIENTS WITH BRONCHIAL ASTHMA ON AN OUTPATIENT BASIS
Shadrina N.E., Akimova A.A., Karyakina V.S., Khazova T.V., Ilyushina I.V., Volskaya O.S., Tuchkov I.A., Gorbacheva E.M., Slonchakova D.M., Chestnyh V.A., Galkina I.P., Dehnich N.N., Punin A.A.
Abstract: Objective. To evaluate the actual practice of diagnosing gastroesophageal reflux disease (GERD) in patients with bronchial asthma (BA) on an outpatient basis. Methods. The analysis of 148 medical records of patients with asthma receiving outpatient medical care who were treated by a pulmonologist at the polyclinic №6 in Smolensk was carried out. Information was collected using a specially designed individual registration card (IRC). Results. Reliable signs of GERD were detected in 1.3% of patients with BA. Among the identified reasons for the low frequency of GERD diagnosis in patients with AD are in-depth questioning of patients and inattention to complaints from other organs and systems, difficulties in diagnosing GERD - the unavailability of modern GERD diagnostics - daily pH impedance. Conclusion. General practitioners and pulmonologists should be more wary of detecting GERD in patients with asthma. All patients with asthma should be offered the GERD-Q questionnaire. Complaints of heartburn and regurgitation should be actively identified. In the absence of an exacerbation of asthma and in the absence of proper control over asthma, it is advisable to perform esophagogastroduodenoscopy and daily pH impedancometry to exclude GERD.
Key words: gastroesophageal reflux disease, bronchial asthma, daily pH impedancometry of the esophagus
FEATURES OF THE COURSE OF NEW CORONAVIRUS INFECTION IN ACUTE AND RECOVERY PERIOD IN MEDICAL WORKERS
Maryin G.G., Medvedeva E.A., Ploskireva A.A.
Abstract: Objective. To study the features of the clinical course of COVID-19 in medical workers who have suffered a new coronavirus infection. Methods. A cross-sectional study was carried out between September and November 2023. The questionnaire was posted on the ancetolog.ru platform, with the inclusion of respondents from various regions of Russia: Moscow, Moscow region, Samara and Samara region. The study involved persons over 18 years of age with a history of laboratory-confirmed new coronavirus infection. The analysis was carried out based on data from 385 questionnaires (77.9% - women, 22.1% - men). Group 1 (main) (n=274) included persons carrying out medical activities in a public health care institution. Group 2 (n=111) (control) included people from other professions. The average age in the main group was 36.5±14.1 years, in the control group 38.7±21.1 years. Results. The severity of the acute period of the new coronavirus infection was comparable in two groups. In healthcare workers, compared with the control group, COVID-19 more often occurred in the clinical form of acute respiratory viral infection (ARVI) (84.3% versus 72.9%, p = 0.036) and less often in the form of pneumonia without respiratory failure (RF)) (9.5% vs. 21.6%, p=0.002). The clinical picture of COVID-19 was dominated by general infectious symptoms identified in 247 (90.1%) medical workers and 92 (82.8%) people from other professions and symptoms characteristic of acute respiratory infections (66.1% versus 43.2% respectively, p<0.001). Lack of vaccination significantly increased the risk of the most common clinical manifestations of the infection. The incidence of long Covid among medical employees was statistically significantly higher (77.3% versus 66.7%, p = 0.031) than among people in other professions, and the incidence of post-Covid did not differ between professional groups. Conclusions. The analysis made it possible to identify the features of the clinical course of the acute and recovery periods of a new coronavirus infection among medical staff. The characteristics of acute infection depending on the vaccination status, and the frequency of protracted and chronic course of COVID-19 depending on the clinical variant of acute infection have been established.
Key words: coronavirus, vaccination, long-Covid, post-Covid syndrome, medical workers
ASSESSMENT OF NEUROPSYCHIATRIC STATUS IN PATIENTS WITH COVID-19 AT THE TIME OF DISCHARGE FROM HOSPITAL, 3 AND 6 MONTHS AFTER DISCHARGE
Delmaeva Kh.S., Mukhina N.V., Komarova I.S., Rachina S.A., Tarykina E.V., Belova I.V., Keligova A.A., Yandieva R.A., Sagova A.A.
Abstract: Objective. To study the presence and degree of severity of neuropsychiatric manifestations at the time of discharge, 3 and 6 months after inpatient treatment for COVID-19. Methods. Fifty-nine patients with COVID-19 and CT lung lesions of 2-4 severity were included in a cohort prospective observational study. Neuropsychiatric status was assessed at all stages of the study using: MFI-20 international asthenia test, Spielberger-Hanin situational anxiety scale, Beck depression scale, MMSE brief cognitive function evaluation scale, lung and heart ultrasound, mMRC dyspnea score, 6-minute walk test (6-MT). Results. Eleven patients dropped out within 6 months, 48 patients were examined, 21 (43.7%) males and 27 (56.3%) females, median age was 64.0 (60.0-70.0) years. Depression: after 6 months, a statistically significant positive association of depression with age (r=0.525; p=0.02) and a negative association with distance travelled during 6-MT and saturation were found. Anxiety during hospitalization, after 3 and 6 months was observed in 33 (68.8%), 30 (62.5%) and 33 (68.8%) patients, respectively. Correlation analysis revealed a significant negative association between anxiety, distance travelled during 6-MT and saturation during hospitalization and 6 months after discharge. Asthenia: was observed in 100% of patients at all stages of follow-up. At 6 months after discharge, a significant negative correlation was found between asthenia, distance travelled during 6-MT and saturation. No patients with dementia-related disorders were identified. Conclusion. At 3 and 6 months after hospital discharge, depression persisted in about one third of all patients, and anxiety was noted in more than 2/3 of cases. All patients had asthenia with a significant decrease in severity in dynamics. In women asthenia, anxiety and depression were observed more often than in men.
Key words: COVID-19, post-covid syndrome, psychoemotional status, depression, anxiety, asthenia
FIRST EXPERIENCE IN THE SMOLENSK REGIONAL CLINICAL HOSPITAL OF USING THE DRUG REFRALON
Zhelvetro K.S., Tsareva V.M., Korzhakov I.I.
Abstract: Оbjective. To consider the first clinical cases of successful use of the drug refralon in the Smolensk Regional Clinical Hospital for the restoration of sinus rhythm in the persistent form of atrial fibrillation and flutter. Methods. Survey, physical, clinical and laboratory, instrumental examination and treatment according to the standards of medical care according to the profile of the disease. Results. Two clinical examples are presented that demonstrate the successful use of the drug refralon to restore sinus rhythm in patients with persistent atrial fibrillation and flutter. The presented clinical cases are the first experience of using the drug refralon in the Smolensk Regional Clinical Hospital. Conclusions. Refralon is a highly effective and safe antiarrhythmic drug for drug-induced cardioversion in patients with persistent atrial fibrillation and flutter.
Key words: atrial fibrillation, persistent form, atrial flutter, refralon, medical cardioversion
CLINICAL CASE OF INTERACTION OF WARFARIN WITH LEVOFLOXACIN IN A PATIENT WITH COMORBID PATHOLOGY
Suleymanova S.V., Baigishieva A.A., Karimova A.M., Mamaev S.N.
Abstract: Objective. To demonstrate a case of interaction between warfarin and levofloxacin in a comorbid patient.Methods. Patient Ch., 70 years old, was admitted to the cardiology department of the SBI of the Republic of Dagestan "Republican Clinical Hospital named after A.V. Vishnevsky". A survey, physical examination, and laboratory and instrumental studies were conducted.Results. A clinical case of the interaction of warfarin with levofloxacin in a 70-year-old patient with comorbid pathology is presented. Clinical diagnosis: coronary heart disease; angina pectoris of tension III FC; sinus node weakness syndrome; paroxysmal form of atrial fibrillation; hypertension of the III stage; arterial hypertension of the 2nd degree; risk of cardiovascular complications IV; chronic heart failure I st, II FC according to NYHA; condition after mitral valve replacement with mechanical prosthesis Medinj No.29; suturing of the auricle of the left atrium from 11/20/2018 Implantation of a two-chamber pacemaker Medtronic Adapta, stimulation mode DDD = AAI; Videothoracoscopic (VATS) atypical resection of the lower lobe of the right lung; biopsy of the diaphragm and mediastinum from 08/22.23; community-acquired right-sided lower lobe pneumonia of moderate severity, respiratory failure 1st.; cancer of the upper lobe of the right lung with atelectasis of the upper lobe; MTS into the right pleural cavity with tumorous pleurisy of the 4th degree of the 2nd clinical group; T3N2M1; mild iron deficiency anemia. Prescriptions: warfarin 3.75 mg p/day, omeprazole 20 mg 2 p/day, amiodarone 200 mg 1 p/day, bisoprolol 2.5 mg 1 p/day, azilsartan 20 mg 1 p/day, veroshpiron 25 mg p/day, furosemide 20 mg for three days, then transferred to torasemide 10 mg p/day, diacarb 250 mg 1 p/day 1 day, ACC long 600 mg 1 p/day, sorbifer 100 mg 2 p/day, bificin 1 capsule 1 p/day, freshly frozen plasma, levofloxacin 500 mg 2 times intravenous drip p/day. On the 2nd day of therapy, it was canceled due to an increase in INR levels to 8.4. From 09/15/2023, levofloxacin was replaced with meropenem 1g 3 r/d intravenously, with positive dynamics.Conclusion. This clinical case demonstrates the possibility of drug interaction between vitamin K antagonist warfarin and fluoroquinolone levofloxacin and the need for careful monitoring of INR in patients with comorbid pathology.
Key words: warfarin, comorbidity, levofloxacin, drug interactions, INR, clinical case
EFFECT OF SARS-COV-2 ON THE COURSE OF STREPTOCOCCAL INFECTION IN CHILDREN OF THE SMOLENSK REGION. DEMONSTRATION OF A CLINICAL CASE
Sokolovskaya V.V., Litvinova A.A., Zhilina E.A., Krikova A.V., Kozlov R.S.
Abstract: Objective. Analysis of the dynamics of the incidence of streptococcal infection in children of the Smolensk region in the pre- and pandemic period, demonstration of a clinical case of severe scarlet fever in a child. Methods. The analysis of the dynamics of the incidence of streptococcal infection in children of the Smolensk region for the period from 2018 to 2022 was carried out. When considering the clinical case, an analysis of the medical documentation of the OGBUZ "Clinical Hospital No. 1" was performed. Results. During the pandemic of the new coronavirus infection caused by SARS-CoV-2, there was a significant decrease in the incidence of streptococcal infection in children of all age groups compared with the pre-pandemic period. A clinical case of severe scarlet fever in a child who suffered from COVID-19 with the development of complications and concomitant pathologies is presented. The arguments about the literacy of choosing the starting empirical antibacterial therapy are presented. Conclusions. The pandemic of the new coronavirus infection led to the displacement of all known pathogens of infectious diseases and the creation of a "genetically bottleneck", which, in turn, contributed to the growth of bacterial infections with a high probability of non-smooth course and complicated forms. Scarlet fever is traditionally considered a benign infectious disease, however, adjustments made by the COVID-19 pandemic to the laws of the epidemiological process have led to certain clusters of outbreaks and invasive forms of this infection.
Key words: streptococcal infection, COVID-19, children
PATHOLOGY OF VISION IN CHILDREN WITH OBESITY: PROBLEM OR SYMPTOM?
Otto N.Yu., Bezrukova D.A., Dzhumagaziev A.A., Bezrukov T.D.
Abstract: Objective. To study the structure of the pathology of the visual organs in children with constitutional exogenous obesity in comparison with the control group according to the life history and the results of an examination by a hospital ophthalmologist. Methods. A retrospective analysis was carried out using a random sampling method (extracts from the developmental history, hospital records) of the documentation of 372 children: 186 children with constitutional exogenous obesity (CEC) and 186 children from the control group. All children were examined at the Regional Children's Clinical Hospital in Astrakhan from 1994 to 2020. The median age of obese children is 13 years [min 3.9; max 17.0], control group - 14 years [1.5; 17.0]. The median SDS body mass index in obese children was +2.6 [min +1.1; max +4.5], in the control group, respectively, -0.5 [min -3.0; max +1.0]. Statistical processing of the results was carried out using the Statistica 10 software package. Differences were considered significant at p<0.05. Results. In children with constitutional exogenous obesity, pathology of the visual organs significantly prevails (39.8%) compared to the group of children without obesity (6.9%), χ2 = 6.04, p = 0.0134. The first place among diseases of the visual organs in the group of obese children is occupied by myopia (7.0%), the second place is retinal angiopathy (5.4%), the third is accommodation spasm (3.3%), the fourth is hypermetropia (2. 1%). Retinal angiopathy is registered 5 times more often in the group of obese children (5.4%) compared to the control group (1.1%), χ2=4.22, p=0.040. Conclusion. In obese children, pathology of the visual organs (p = 0.0134) and retinal angiopathy (p = 0.040) are more common in comparison with conventionally healthy children. Obese children were diagnosed with retinal angiopathy almost 5 times more often (5,4%) than in children from the comparison group (1,1%). The detection of changes in the fundus indicates not only regional ill-being, but also possibly reflects the systemic nature of damage to the microvasculature, similar to what occurs in diabetes mellitus.
Key words: children, overweight, obesity, organ of vision, retinal angiopathy
LUNG CANCER METASTASIS TO THE SCIATIC NERVE
Kurshin A.A., Torpanov B.R., Sitnikov A.R.
Abstract: Objective . Presentation of a clinical case of intraneural sciatic nerve lesion by lung cancer metastasis. Methods. Description of the clinical case, surgical treatment, development of tactics for managing such patients. Results. The presented clinical case demonstrates the possibility of intraneural metastatic lesion of the peripheral nervous system and emphasizes the need for specialists to be alert to this pathology in a group of patients with neuropathic pain, peripheral nerve dysfunction and a history of cancer. Conclusion. The main clinical signs of metastatic lesion of the peripheral nerves may be painful space-occupying lesions in the projection of the nerve trunks with the presence of concomitant neurological disorders (weakness in the muscles innervated by this nerve, sensory disturbances, neuropathic pain). To develop optimal tactics for managing such patients, clinical studies are required, which is difficult due to the rarity of this pathology.
Key words: peripheral nerves, metastasis, neuropathic pain, intraneural metastases
CEREBROVASCULAR CONSEQUENCES OF EXPOSURE TO EXTERNAL RADIATION AS A RESULT OF LOCAL AND TOTAL BODY IRRADIATION
Meshkov N.A., Kulikova T.A., Solodkiy V.A., Valtseva E.A.
Abstract: Objective. The purpose was to assess the incidence of cerebrovascular disorders occurring as a result of local and total body irradiation long after the exposure. Methods. Publications about patients and data from the archives of the Russian Scientific Center of Roentgenoradiology. Human subjects: patients with head and neck cancers who received radiotherapy (local irradiation) and “liquidators” consequences of the Chernobyl accident (total body irradiation). The study used Microsoft Excel 2016 for statistical processing and quantitative data that follows a normal distribution with mean score (M) and standard deviation (SD). The probability of cerebrovascular diseases (CVD) was measured using relative risk and 95% confidence intervals; the significance of difference was assessed using the c² criterion. We looked for correlations between variables using the correlation and regression analysis. The difference was considered statistically significant at p<0.05. Results. The incidence of CVD in the liquidators and patients was 41.0% (8.8) and 17.9% (12.9). The radiation dose received by the liquidators and patients was 0.13 Gy (0.09; 0.17) and 53.55 Gy (47.45; 59.64), respectively. The average incidence of CVD in liquidators was 41.0% (8.8), which is two times (р<0.001) higher than in the patients (17,9% (12.9)). We have found a correlation between the incidence of CVD and radiation dose both for the patients (R = 0.693; R² = 0.480) and the liquidators of the Chernobyl accident (R = 0.639; R² = 0.408). Conclusion. The long-term consequences of exposure to radiation largely depend on the type and duration of exposure: short-term local irradiation at high doses results in 2.3 times lower incidence of CVD than long-term continuous total body irradiation at low doses.
Key words: cerebrovascular disease, local irradiation, total body irradiation, radiation dose
VERIFICATION OF THE SURGICAL REVASCULARIZATION QUALITY DURING CORONARY BYPASS SURGERY IN PATIENTS WITH CORONARY ARTERY DISEASE BY DIRECT ASSESSMENT OF MYOCARDIAL BLOOD MICROCIRCULATION
Mamadaliev D.M., Sidorov V.V.
Abstract: Objective. To improve the results of coronary bypass surgery in patients with coronary heart disease by upgrade in verification of surgical revascularization quality via direct assessment of myocardial blood perfusion. Methods. The wearable analyzer “LASMA PF” with laser Doppler flowmetry was used to assess dynamics of myocardial perfusion indicators before and after coronary bypass surgery. In the pilot prospective study main diagnostic parameters were evaluated in relative units, such as average blood perfusion in microcirculation system, average value of nutritive blood flow or fraction of blood flow through capillaries and part of blood flow through arteriovenular anastomoses. Definitive verification of revascularization quality was performed by ultrasound Doppler flowmetry of blood flow in created conduits using the MiraQ Cardiac device. To assess blood flow were evaluated average volume velocity, pulsation index and percentage of diastolic volume filling. Results. Beneficial increase of perfusion after coronary bypass surgery confirmed by acceptable values after ultrasound Doppler flowmetry was recorded in 70% of observations. In most cases its average value was 21%. After preliminary correlation analysis of methods for main parameters it was noted that beneficial increase of the average blood perfusion in microcirculation system was observed if values of the mean graft flow were ≥ 25 ml/min. The data obtained are consistent with criteria of the guidelines for myocardial revascularization ESC/EACTS. Conclusions. Implementation of the laser Doppler flowmetry method in wearable form of "LASMA PF" analyzer is devoid of most disadvantages and can become the leading method of rapid intraoperative analysis of myocardial revascularization quality.
Key words: coronary heart disease, coronary bypass surgery, revascularization, perfusion, blood flow, microcirculation, laser doppler flowmetry
NEURO-MICROCIRCULATORY INTERRELATIONSHIPS IN PATIENTS WITH KYPHOSCOLIOSIS ASSOCIATED WITH NEUROLOGICAL DEFICITS
Nazarenko A.G., Krupatkin A.I., Kuleshov A.A., Militsa I.M., Vetrile M.S., Lisyansky I.N., Makarov S.N.
Abstract: Objective. To study the features of neuro-microcirculatory relationships in patients with kyphoscoliosis associated with spinal cord compression before and after surgical treatment. Methods. At the N.N. Priorov NMIC, 20 patients with spinal deformities associated with neurological deficits of varying severity were examined using laser Doppler flowmetry (LDF) followed by wavelet analysis and operated on. Decompression of the spinal canal and correction of deformity were performed. LDF was performed before surgery, 1-2 weeks after surgery, as well as at a follow-up examination 3-6 and 6-12 months later; and more than 1 year after surgery. A statistical analysis of microcirculation parameters was carried out. Results. After surgery, the activity of trophotropic sensory peptidergic nerve fibers and the amount of perfusion of the microcirculatory bed increased and was maintained, starting from the early postoperative period. Ergotropic sympathetic adrenergic activity significantly decreased in the period 6-12 months after surgery. The maximum mobilization of trophotropic neurogenic mechanisms of sanogenesis was observed in the period 6-12 months after surgery. Conclusion. The use of laser Doppler flowmetry with spectral wavelet analysis of blood flow fluctuations makes it possible to assess the functional state of thin unmyelinated nerve fibers and objectify the dynamics of recovery processes in patients with kyphoscoliotic spinal deformities associated with spinal cord compression.
Key words: kyphosis, scoliosis, neurological deficit, laser Doppler flowmetry, microcirculation, wavelet analysis
POSSIBILITIES OF APPLYING ROBOT-ASSISTED METHODS IN PRIMARY HIP ENDOPROSTHETICS
Dgebuadze G., Shumsky A.A., Krylov S.V., Matsakyan A.M.
Abstract: Objective. To evaluate the effectiveness of using robot-assisted technologies in hip replacement. To characterize the possibilities of using robot-assisted technologies by comparing the results of surgical treatment with the patient’s initial condition, as well as the patient’s condition at the time of discharge from the hospital. Methods. An analysis of a clinical case was performed - total robot-assisted endoprosthetics of the left hip joint. The patient is a woman aged 50 years. Diagnosis of the underlying disease (M16.3): Left-sided dysplastic coxarthrosis, grade 3. Shortening of the left limb 2 cm. Components of the Stryker endoprosthesis: acetabular component Trident 54mm\E, femoral component Accolade 3, liner 32/E, head COBALT CHROME 32/+4). Results. The patient was mobilized the next day after the operation. The length of the limb has been restored. Upon discharge, the patient’s condition was satisfactory, she moved with the help of crutches, and was referred for outpatient rehabilitation at the place of residence. Conclusions. The use of robot-assisted methods is considered as a promising direction in hip replacement. At the same time, additional research is currently required into the specifics of using robot-assisted technologies, in particular, in hip replacement. The article presents a case of hip replacement using robot-assisted methods. The promise of using robot-assisted methods in the surgical treatment of deforming arthrosis of the hip joint is shown.
Key words: robot-assisted endoprosthetics, hip joint, clinical case
РROLE OF DIFFUSION-WEIGHTED IMAGES IN PERFORMING MR-ENTEROGRAPHY
Otochkin V.V., Rosengauz E.V., Isabekova A.E., Kim A.N.
Abstract: Objective. To study the possibilities of diffusion-weighted images during MR-enterography and determine the need for its use in a standard protocol. Methods. MR-enterography was performed in 374 patients with suspected Crohn's disease, in 20 patients with enteropathy, and in 14 patients with suspected neoplasm of the small intestine. The evaluation of the signal characteristics of diffusion-weighted images (DWI) and apparent diffusion coefficient (ADC) values for the affected and unchanged walls of the small intestine was performed in patients with various pathologies. The patients were examined on magnetic resonance imaging machines with 1.5 Tesla magnetic field induction. Results. When assessing the unchanged wall of the small intestine (n=152), there was no MR signal increase at the measurement point on the DWI and there was по MR signal reduction on ADC maps. The ADC values of the examined patients ranged from 1.43 to 2.87×10-3 mm2/s in different parts of the same segment of the intestine. The criteria for an active inflammatory process (n=52) were: a mandatory MR signal increasing on DWI and MR signal decrease on ADC maps. The ADC values in these cases were < 1 and ranged from 0.6-0.8×10-3mm2/s. Minimal inflammation (n=27) in the form of erosions and hyperemia was difficult to visualize on T2 FS WI. The ADC values of small intestine tumors ranged from 0.2-0.8×0-3 mm2/s and overlapped with the ADC values of patients with Crohn's disease (p>0.05). Conclusion. The use of diffusion-weighted images during MR enterography makes it possible to carry out differential diagnosis of various intestinal diseases, to assess the activity of Crohn's disease and identify lymphadenopathy.
Key words: MR-enterography, Hydro-MRI, Crohn's disease, DWI
REVIEWS
GENETIC PREDICTORS AND GENOTYPE-BASED THERAPY FOR ATRIAL FIBRILLATION
Iskenderov B.G., Lokhina T.V., Mozhzhukhina I.N.
Abstract: Objective. To study and analyze current data on genetic nature atrial fibrillation (AF) and to assess the importance of genetic risk in the diagnosis and determination of prognosis, as well as to become familiar with the issues of genotype-based pharmacotherapy for familial AF. Methods. Collection, analysis, and systematization of data on the genetic nature of AF. Results. This review article presents current concepts about genetic predictors of AF, including genes involved in the regulation of cardiac ion channels, transcription factors, and secondary risk factors for AF. Modern therapeutic technologies are described in detail, in particular the choice of treatment tactics and assessment of the effectiveness of interventions and genotype-based antiarrhythmic pharmacotherapy for AF. Conclusions. It has been shown that the familial form of AF is quite common in the general population, makes a serious contribution to mortality and thereby diverts enormous economic resources to solve medical and social problems associated with the provision of specialized medical care. In this context, verification of patients with familial AF will contribute to early diagnosis and prevention of cardiovascular complications associated with AF, as well as the introduction of effective pharmacotherapy and interventional procedures.
Key words: atrial fibrillation, genetic risk, antiarrhythmic therapy, catheter ablation
PRIMARY HIP REPLACEMENT IN PATIENTS WITH HIV INFECTION
Babkov B.D., Airapetov G.A., Serdobintsev M.S.
Abstract: Objective. To study the effect of HIV infection on the incidence of complications in the postoperative period after total hip replacement on a basis of modern literature analysis. Methods. A review of modern domestic and foreign literature, including original articles containing information on the results of total hip replacement in HIV-infected patients in the bibliographic databases eLibrary, PubMed, MEDLINE, Google Scholar by keywords: "hip replacement", "HIV", "HIV", "hip arthroplasty. Results. According to the available modern literature it is not possible to obtain a consensus on the direct effect of HIV infection on the results and development of complications in the postoperative period after total hip replacement due to a small number of publications and limited research parameters. At the same time, current studies are mainly representations of clinical cases, a retrospective analysis of the perioperative stage in this category of the population. These studies are limited to small cohorts, they lack a clear algorithm for perioperative examination. Not all studies take into account such significant factors as concomitant diseases (in particular, hemophilia), indicators of immune status (CD4 cell level, viral load), the use of ART, the use of intravenous narcotic drugs. Conclusion. The issue of hip replacement in HIV-infected patients in general, and the prediction of the frequency of infectious complications in particular, is currently very relevant due to the growing population of such patients. Attention is also drawn to the younger age of HIV-infected patients requiring arthroplasty in comparison with the general population. Understanding the key aspects of pathology development will allow predicting outcomes and minimizing the number of complications and, as a result, reduce the cost of future revision interventions.
Key words: HIV, AVN, endoprosthetics, hip joint, CD4 lymphocytes
ASSESSMENT OF HEMOSTASIS IN NEWBORN CHILDREN: OLD METHOD - NEW FEATURES
Pasechnik L.V., Volkova E.N., Kubyshkina A.V.
Abstract: Objective. To analyze modern scientific information about the features of hemostasis in newborn children and methods of its assessment. Methods. The review includes research by foreign and domestic scientists related to this topic. Results. The hemostatic balance between bleeding and clotting in the fetus and newborn is unique. This uniqueness is manifested in the enhancement of the coagulation function in combination with a shortage of individual components of the coagulation system. Currently, there are two basic methods for studying the state of hemostasis in newborn children - "global" and "local" tests. The most reliable are the "global" tests, since they record not only the moment of clot formation, but also its subsequent transformation. Timely assessment of the main components of hemostasis, the use of modern methods for their diagnosis will significantly reduce the number of thrombotic and hemorrhagic complications, as well as the time spent by newborns in intensive care units and nursing. Conclusions. The literature review examines the features of hemostasis in full-term and premature newborns. The authors compare "local" and "global" methods of hemostasis research, and cite the main advantages of thromboelastography over "local" tests. The analysis of modern research data is presented.
Key words: thromboelastorgaphy, newborns, hemostasis
PHARMACEUTICAL SCIENCES
ORIGINAL ARTICLES
DEVELOPMENT OF SEXTAPHAG® PYOBACTERIOPHAGE POLYVALENT FILMS COMPOSITION BASED ON MULTICRITERIA OPTIMIZATION METHOD
Kovyazina N.A., Nikolaeva A.M.
Abstract: Objective. Development of Sextaphag® Piobacteriophage polyvalent films composition by mathematical method of multicriteria sampling planning. Methods. The object of the study was model films with combined bacteriophage Sextaphag® Piobacteriophage polyvalent based on biodegradable polymers. The specific activity of the combined bacteriophage was evaluated by Appelman's method. Bacteriophage release from the films was determined by the method of diffusion into agar on dense nutrient medium. Pharmacokinetics of bacteriophages was determined by equilibrium dialysis through semipermeable membrane by Kruvchinsky method. Adhesion properties of films - by the force of detachment from the surface. Optimization of Sextafag® Piobacteriophage polyvalent films composition was carried out by methods of mathematical planning - multicriteria sampling by additive optimality criterion and Pareto principle. Results. Multicriteria sampling according to the additive criterion of optimality of values for specific activity of sextaphage in the film, release, dialysis and adhesion showed that polymeric matrices based on food gelatin have optimal indicators. The selection of the ratio of components of the polymeric biomatrix formulation was carried out according to the Pareto principle by analyzing the stability criteria of the combined bacteriophage during air drying and the adhesion of model films. The dominant biopharmaceutical characteristics according to optimization criteria were found in model films of the following composition: gelatin - 5.0; glycerin - 2.0; Sextaphag® Pyobacteriophage polyvalent - 40.0; purified water - 53.0. Conclusion. The optimal composition of antibacterial modified films Sextaphag® Piobacteriophage polyvalent has been developed as a result of complex research with the use of mathematical planning methods.
Key words: adhesion, bacteriophage, optimization, films, release, specific activity, Sextaphag®
STUDY OF ANTIBACTERIAL AND WOUND HEALING EFFECTS OF NEW EXTERNAL PRODUCT (POWDER)
Pozdnyakov D.I., Sergeeva E.O., Yurtaeva E.A., Airapetova A.Yu., Kompantsev D.V., Petrova A.L.
Abstract: Objective. Experimental confirmation of the antimicrobial and wound-healing activity of a new drug (powder). Methods. The study of antimicrobial and reparative activity was studied on five samples of a powder containing dexapanthenol 5 g, glucosamine sulfate 10 g, pectin 15 g, starch from 70 g. (Sample 1) and 50, 40, 30 and 20 g, respectively (samples 2-5) and streptocide 10, 20, 30 and 50 g (samples 2-5). The antimicrobial activity of powder samples was studied in vitro by diffusion into agar, using the “well” method to establish the sensitivity of microorganisms to drugs, with statistical processing of the results obtained. A rat planar wound model was obtained by depilating the skin on the back surface of animals after narcotic treatment with chloral hydrate (350 mg/kg, intraperitoneal). The scalpel was dissected with an area of 1,5×1,5 cm2, after which the skin flap was completely removed. During the study, a change in the linear dimensions of the wound was recorded with an accuracy of 0.01 cm. The dimensions were determined using a caliper on the 4th; 8th; 12th; Day 16 and 20 of the experiment. The dimensions (area) of the wound were expressed in cm2, with statistical processing of the results obtained. Results. All test samples containing streptocide showed high antibacterial activity of varying degrees of intensity. Samples - the leaders of the microbiological study were samples No. 3 and No. 4 with streptocide content of 20%, 30%, respectively. An increase in streptocide content up to 50% in the sample does not lead to statistically significant changes. The use of the analyzed compositions 1-5 contributes to an increase in the rate of skin regeneration and accelerated healing of the planar wound in rats of varying severity. At the same time, the test samples demonstrate a comparable level of efficacy with the reference preparation - Baneocin powder during the observation period from the 8th to the 16th days and exceed it on the 20th day of the experiment. It was noted that there were no significant differences between the analyzed formulations 1-5. Conclusions. It has been proven that the new formulation in the form of a powder is not inferior to the product Baneocin, convenient in dosing and application to the wound, effective in use. The efficacy of sample 1is comparable to samples containing streptocide. However, to prevent complications of wounds due to possible infection, a sample containing (g) streptocide, dexapanthenol, glucosamine, pectin, starch (10:5:10:15:60) was chosen as the subject of the study. The established wound healing effect and antimicrobial activity of the powder can serve as the basis for scientific research on the development of a new reparative drug.
Key words: glucosamine sulfate, dexapanthenol, streptocide, pectin, powder, antimicrobial activity, regenerating, effect
STUDY OF TRACRADE TRANSITION ALONG THE CHAIN "SOIL - HERBAL MEDICINAL RAW MATERIALS - WATER EXTRACTION" OF ESSENTIAL TRACE ELEMENTS
Dyakova N.A.
Abstract: Objective. An experimental study of the features of the trans-red transition of essential elements along the chain "soil - medicinal plant raw materials - infusions and decoctions". Methods. Pharmacopoeial types of medicinal plant raw materials were used as study objects: dioecious nettle leaves, big plantain leaves, common fir flowers, heart-shaped linden flowers, five-lobed motherwort grass, bitter wormwood grass, common yarrow grass, avian mountain grass, common burdock roots, medicinal dandelion roots. The microelement composition of the samples was studied by mass spectroscopic method after acid-microwave decomposition. Results. The studied raw materials contain essential trace elements in an amount from 763 μg/g to 9795 μg/g. The infusion of dioecious nettle leaves (more than 120 μg/mL) is released by the sharply emitting content of essential trace elements; in the remaining aqueous extracts, the indicator varied from 9.37 μg/mL to 25.16 μg/mL. In all the studied aqueous extracts, a high (relative to other elements) content of silicon, as well as manganese, iron and zinc was noted. The degree of transition of various elements along the chain "soil - medicinal plant raw materials - aqueous extracts" varies greatly. The elements strongly accumulated by medicinal plant raw materials are transferred from soils to water extracts most efficiently. Conclusion. The results of the study showed a rich macroelement composition of the studied LMS, which can be used in medical and pharmaceutical practice to correct the physiological norms of the content of elements in the human body.
Key words: soil, medicinal plant raw materials, infusions, decoctions, essential trace elements
STUDY OF THE MINERAL AND AMINO ACID COMPOSITION OF THE LEAVES OF THE EUROPEAN DEWBERRY (RUBUS CAESIUS L.)
Ilina M.B., Sergunova E.V.
Abstract: Objective. To conduct a qualitative and quantitative analysis of the amino acid and elemental composition of the leaves of the European dewberry. Methods. The objects of the study were the leaves of the European dewberry (Rubus caesius L.) collected on the territory of the Moscow region. The detection of amino acids was carried out by thin-layer chromatography and capillary electrophoresis. Atomic adsorption spectroscopy was used to study the mineral composition after mineralization of raw materials. Results. As a result of the study, 16 amino acids have been identified in the leaves of the European dewberry, including essential arginine, valine, histidine, isoleucine, leucine, lysine, methionine, threonine, phenylalanine and nonessensial alanine, glycine, proline, serine, tyrosine, glutamine. The predominant amino acids in the leaves are proline (1.31%), arginine (1.05%) and leucine (1.03%). The total content of amino acids in the raw material was 6.03%. 8 elements were found in the leaves of the European dewberry, among which there are trace elements (Fe, Mn, Zn, Cu, Cr) that regulate the work of organs and systems of the human body. The content of heavy metals and arsenic did not exceed the permissible values. Conclusion. The leaves of the European dewberry are promising for use as medicinal plant raw materials - a source of amino acids and minerals.
Key words: European dewberry, Rubus caesius, amino acids, elemental composition, capillary electrophoresis, atomic adsorption spectroscopy, leaves
PHARMACOGNOSTIC ANALYSIS OF PEGANUM HARMALA RAW MATERIALS COLLECTED IN THE LOWER VOLGA REGION POPULATION
Makarova A.R., Vlasenko M.Yu., Zemlyanskaya I.V., Yanitskaya A.V.
Abstract: Objective. Study of raw materials of Garmala herb harvested in populations growing in the Lower Volga region to assess the possibility of import substitution of this type of raw material. Methods. The paper presents the results of analysis of macroscopic and microscopic features of raw materials of Peganum Harmala herb (Peganum Harmala herbae), harvested in Akhtubinsk district of Astrakhan region, quantitative determination of the content of the main active substances. The alkaloid content determined by alkalimetric titration and direct spectrophotometric method. The content of tannins by permangonatometric titration method. Flavonoid content by differential spectrophotometric method. Results. The content of alkaloids in terms of peganine by the method of alkalimetric titration was 2.4%. By direct spectrophotometric method, peganine is 1.6%, garmine is 0.15%. The content of tannins in terms of catechin by permanganatometric titration was 2.02%. The content of flavonoids in terms of hyperoside by differential spectrophotometric method was 0.25%. Conclusions. Raw material Peganum harmala herb (Peganum harmala herbae) harvested in populations growing in the Astrakhan region is not inferior to foreign ones. It can be an alternative to import.
Key words: medicinal plant material, alkaloids, flavonoids, Peganum harmala, spectrophotometry, garmin, peganin
DEVELOPMENT AND VALIDATION OF A METHODOLOGY FOR THE DETERMINATION OF FLAVONOIDS IN HORSE CHESTNUT FLOWERS OF VARIOUS GROWING REGIONS
Dunilin A.D., Trineva O.V., Kovaleva T.Yu.
Abstract: Objective. Development and validation of a methodology for the determination of flavonoids in horse chestnut flowers of various growing regions. Methods. The amount of flavonoids in medicinal plant raw materials harvested in the Leningrad, Moscow, Voronezh, Volgograd regions and Stavropol territory during flowering in 2023 was determined using a technique for this type of raw material developed earlier, based on the method of quantitative determination of flavonoids in the flowers of black elderberry (Sambucus nigra L.) GF RF XIV FS.2.5.0008.15. The choice of regions for harvesting raw materials was determined, firstly, by the traditional natural area of cultivation of this plant (Fig. 1), secondly, the need to assess the influence of a combination of natural environmental factors on the accumulation of flavonoids in flowers. Results. The content of flavonoids varied from 3.30 to 4.55% depending on the region. The highest content of flavonoids in terms of rutin was shown by flowers harvested in the Stavropol Territory (4.55%), which may be due to the most favorable combination of climatic conditions in the region. Validation, as the final stage of the developed methodology, was carried out using the example of raw materials harvested in the Voronezh region. Such indicators as specificity of the technique, linearity and limit of detection, correctness of the technique, precision of the technique at the convergence stage were determined. Conclusion. As a result of the study, the validity of the developed methodology for quantifying the amount of flavonoids in terms of rutin in horse chestnut flowers was established. The obtained validation results allow us to recommend a technique for the quantitative determination of flavonoids in horse chestnut flowers. The variability of accumulation of this group of BAS in raw materials (from 3.30 to 4.55%) was determined depending on the combination of ecological and geographical factors of the growing region. A unified criterion for evaluating the quality of this raw material is recommended for the future FS project "Horse chestnut flowers" according to the indicator "Quantitative determination" of the amount of flavonoids in terms of rutin of at least 2%.
Key words: horse chestnut flowers, quantitative determination of flavonoids, validation of the technique
CREATION OF A MODEL OF LEGAL COMPETENCE OF A PHARMACY ORGANIZATION
Kashina E.V., Mezentseva E.S.
Abstract: Objective. The aim of the study was to review the concept of legal competence for the development of a model of legal competence of a pharmacy organization. Methods. Scientific publications of the Russian information and analytical portal eLibrary.ru, the electronic fund of dissertations of the Federal State Budgetary Institution "Russian State Library". The review of literary sources and normative legal acts was carried out using methods of content analysis, systematization, generalization and grouping of data. Results. Based on the current regulatory legal acts, the authors formulate the importance for a pharmaceutical specialist of legal knowledge, skills and abilities in his professional activity. The analysis of literary sources of the definition of "legal competence" in various branches of scientific knowledge is carried out, and a definition of the legal competence of a pharmacy organization is proposed. The models of legal competence of specialists in various professional fields have been studied. Conclusion. The authors have developed and proposed a model of legal competence of a pharmacy organization, which contains a three-component structure.
Key words: legal competence, components, pharmacist, pharmacy
ANNIVERSARIES
DEPARTMENT OF OBSTETRICS AND GYNECOLOGY WITH A COURSE OF PRENATAL DIAGNOSTICS - FORWARD MOVEMENT ALONG A GIVEN VECTOR
Pokusaeva V.N.
Abstract: The article presents the history of the creation and the main stages of development of the Department of Obstetrics and Gynecology of the Smolensk State Medical Institute (now university) from 1923 to 2023. The article is based on information obtained from archival sources and memoirs of the department staff.