Contents 2021-3 The issue is dedicated to 10th Anniversary of North-Western University named after I.I.Mechnikov
MEDICAL SCIENCE
Study of arterial elasticity parameters in combination with general accepted cardiovascular risk factors in middle-aged men. Сlinical observation
V.V. Gomonova, S.A. Saiganov, V.E. Gumerova 4
Training the preventive medicine specialists within development and strengthening of the federal state sanitary and epidemiological supervision system: separate aspects
Enteral therapy and nutritional support during the perioperative period for of colon cancer complication in elderly patients
N.I. Glushkov, T.L. Gorshenin, C.K. Dulaeva28
The first Russian case of reconstruction of the central face area by a vascularized composite allograft M.A. Volokh, N.E. Manturova, G.G. Khubulava, N.V. Kalakutskiy 34
The effectiveness of antioxidant - based toothpastes and mouthwashes for the prevention of dental diseases in patients with non-removable orthodontic appliances
STUDY OF ARTERIAL ELASTICITY PARAMETERS IN COMBINATION WITH GENERAL ACCEPTED CARDIOVASCULAR RISK FACTORS IN MIDDLE-AGED MEN. CLINICAL OBSERVATION
V.V. Gomonova, S.A. Saiganov, V.E. Gumerova North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint- Petersburg, Kirochnaya Street, 41 Abstract Introduction. The development of the unified preventive environment within the primary outpatient dispensary contributes to the formation of skills and the study of healthy lifestyle principles among population. Prevention of non-communicable diseases, such as arterial hypertension and diabetes mellitus and etc. are of a high importance. In modern studies, arterial elasticity parameters are considered as risk markers the of cardiovascular diseases. The article presents the analysis of arterial hypertension among middle-aged men considering themselves healthy. The information on the examination results of 73 men aged from 35 to 60 years is presented and a program for the early diagnosis and prevention of arterial hypertension for these very patients is proposed. The aim of the study was to analyze the elasticity of arteries in healthy individuals to determine the possible markers of the rapid development of cardiovascular diseases, and to present an idea for the early diagnosis and prevention of arterial hypertension for these categories of patients. Materials and methods. The study included 73 almost healthy male individuals aged from 35 to 60 years; mean age was 46 years (σ=7 years). Results. The main parameters characterizing the arteries elasticity are the propagation speed of the pulse wave, the augmentation index, pulse pressure, and central (aortic) systolic blood pressure. The study showed that the normal blood pressure range, measured by a routine method, may not correspond to the parameters of arterial elasticity. Changes in the parameters of arterial elasticity in normotensive middle-aged men are associated with the presence of risk factors for cardiovascular diseases. The association with smoking and a sedentary lifestyle is especially pronounced. Key words: arterial elasticity, central aortic pressure, propagation speed of the pulse wave, augmentation index, risk factors for arterial hypertension, non-drug prevention of arterial hypertension.
TRAINING THE PREVENTIVE MEDICINE SPECIALISTS WITHIN DEVELOPMENT AND STRENGTHENING OF THE FEDERAL STATE SANITARY AND EPIDEMIOLOGICAL SUPERVISION SYSTEM: SEPARATE ASPECTS
A.V. Meltser1, А.А. Pronina2, O.G. Khurtsilava1, N.V. Erastova 1, Т.I. Aristova 2, Т.V. Kolomenskaya1, N.T. Gonchar1 1 North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint- Petersburg, Kirochnaya street, 41 2 Personnel division of prevention of corruption and other types of offences and administrative work of Rospotrebnadzor,Russia,127944, Moscow, Vadkovsky lane, 18, building 5 and 7 Abstract Introduction. The development of personnel capacity is one of the tasks of the action plan ("road map") approved by the Government of the Russian Federation for the development and strengthening of the Federal State Sanitary and Epidemiological surveillance system for 2021 - 2028. In 2015 on the basis of the North-West State Medical University named after I.I. Mechnikov was formed the Federal educational and methodological association in the system of higher education for enlarged group of specialties and areas of training 32.00.00 "Health Sciences and Preventive Medicine", where were developed educational standards for higher education in the field of "preventive medicine"; formed and supported by the experts community professional competencies necessary for graduates to carry out professional activities. This determines the necessity to implement a unified strategy for organizing the educational process in higher education institutions. The aim of the studywas to analyze the separate aspects of training the preventive medicine students of higher education institutions within the development and strengthening of the Federal state sanitary and epidemiological supervision system for 2021-2028. Materials and Methods.It was presented the dynamics analysis of control figures foradmission to training in the specialty "preventive medicine" at the expense of federal budget allocations and the number of graduates in the specialty " preventive medicine " in educational institutions of higher education; analysis of the results of the primary accreditation of graduates in the specialty "preventive medicine", the structure of faculties and departments of educational organizations training preventive medicine specialists. An analysis of employer satisfaction with the quality of graduate education in 2020 was carried out. Results and discussion. A decrease in the number of graduates and the admission control figures for training in the specialty "preventive medicine" was determined. The absence of specialized faculties and departments in some educational organizations was observed. The survey results of Rospotrebnadzor employees on satisfaction with the quality of graduates' education revealed that the graduates competencies mostly (67.84%) or completely (17.54%) correspond to the professional standard. Satisfaction with the level of practical training of graduates is significantly lower. Conclusion. The creation of unified training strategy, strengthen the requirements for the quality of training of preventive medicine specialists is necessary for the implementation of the action plan ("road map") for the development and strengthening of the Federal State Sanitary and Epidemiological surveillance system for 2021 - 2028 Key words: preventive medicine, preventive medicine specialists, training, primary accreditation, professional competencies, federal state sanitary and epidemiological supervision
NECESSITY OF ORGANIZATIONAL MODEL IMPROVEMENT OF SKIN NEOPLASMS SCREENING WITHIN COVID-19 PANDEMIC RESTRICTIONS
A.N. Barinova, M.V. Gusarov, B.M. Tayts, S.L. Plavinskii North-Western State Medical University named after I.I. Mechnikov, Russia,191015, Saint-Petersburg, Kirochnaya street, 41 Abstract Introduction. The COVID-19 pandemic has imposed restrictions on the provision of routine medical care in many areas. However, for the organization of medical care, primarily for screenings, it is important to understand whether there are still demand for them or there is the necessity to use other organizational models. Material and methods. It was analyzed the data on patients’ visits to the Clinical Dermatovenerologic Dispensary № 1 with various skin neoplasms during 2018-2020. The data was obtained from medical information system with aggregation by month and by diagnosis. Before the pandemic the prognostic model to predict the number of visits was designed and the expected values were compared with the values observed both monthly and for 10 months in 2020. Results. It was found that in March, April, May and June 2020, there is a significant decrease in the number of patients visits with ICD-10-CM Code D23 and Code L82. In April, October and November 2020, there is a significant decrease in the number of patients visits with ICD-10-CM Code C44. There is also a significant decrease in the total number of visits during March - December 2020 with ICD-10-CM Code D23, L82, C44.
Conclusions. The accessibility analysis revealed that the restriction in the visit of medical organizations due to the complicated sanitary and epidemiological situation resulted in uncompensated decrease in outpatient visits and, accordingly, in a decrease in the number of detected diseases, which may subsequently affect the early detection of malignant diseases with a lower levels of survival rates and possible deterioration in the quality of life due to the late detection of neoplasms and other skin diseases. This indicates that during the restrictions period, it is necessary to maintain the possibility of contacts between patients and dermatovenerologists, as well as contactless access to medical organizations. Key words: impact of a pandemic on medical care provision, time series, screening organization, skin neoplasms, telemedicine.
ENTERAL THERAPY AND NUTRITIONAL SUPPORT DURING THE PERIOPERATIVE PERIOD FOR OF COLON CANCER COMPLICATION IN ELDERLY PATIENTS
N.I. Glushkov1,2 , T.L. Gorshenin1,2 , C.K. Dulaeva1,2 1North-Western State Medical University named after I.I. Mechnikov, Russia,191015, Saint-Petersburg, Kirochnaya Street, 41 2Hospital for War Veterans, Russia,193079, Saint-Peterburg, Narodnaya Street, 21 Abstract Introduction. The issues of providing medical care to patients with complicated forms of colon cancer remain relevant. One of the main reasons of unsatisfactory outcomes is the malnutrition. The aim of the study was to compare the treatment results of elderly patients with colon cancer complications and without correction of trophological changes. Materials and methods. The study included 132 elderly and senile patients with complicated colon cancer. The patients were divided into two groups. In the control group, the treatment was carried out according to the standard scheme, in the main group it was corrected the revealed trophological disorders. Results. In 87 (65.9%) patients, protein-energy deficiency was observed. The inclusion of enteral therapy and nutritional support according to the developed scheme in the treatment of patients with complicated colon cancer contributed to an early recovery of trophological parameters. Postoperative complications more often developed in the control group - 30 (46.9%), in comparison with the main group - 19 (27.9%). Postoperative mortality in the control group was 9.4%, in the main group - 5.9%. Conclusion. The inclusion of nutritional therapy in the treatment of elderly and senile patients with complicated colon cancer could improve the treatment results. Keywords: colon cancer, enteral therapy, nutritional support, old and senile age.
THE FIRST RUSSIAN CASE OF RECONSTRUCTION OF THE CENTRAL FACE AREA BY A VASCULARIZED COMPOSITE ALLOGRAFT
M.A. Volokh1, N.E. Manturova1,2, G.G. Khubulava1,3, N.V. Kalakutskiy1 1 North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint Petersburg, Kirochnaya Street, 41 2 Pirogov Russian National Research Medical University, Russia, 119435, Moscow, BolshayaPirogovskaya street, 9A, building 2st.BolshayaPirogovskaya, 9A, building 2 3 S.M. Kirov Military Medical Academy, Russia, 194044, Saint-Petersburg, Akademika Lebedeva Street, 6 Abstract Introduction. The article presents the first Russian experience in performing allotransplantation of a complex of facial tissues for the serviceman who has suffered from an electrical burn. The main points of preparation and carrying out of the surgery, followed by rehabilitation and immunosuppressive therapy, are presented. Materials and methods. Patient E, a 19-year-old man, was admitted to hospital for treatment
of third- to fourth-degree electrical burns to 17% of the surface of the head, neck, and right upper and lower limbs injured on 09.08.2012, after a multistage preparation, he underwent allotransplantation of a complex of tissues of the upper and middle faces areas. In the perioperative period, the appropriate immunosuppressive therapy was carried out according to the scheme. Also, in the postoperative period, corrective rhinoplasty, additional immunosuppressive therapy and psychosocial rehabilitation of the patient were performed. Results and discussion. From our point of view, the allograft removal should be performed according to the “full-face” model, regardless of the variant of the transplanted allotissue complex, since this approach allows maximally adapting the obtained tissue complex to the recipient, save the vascular system of the graft for performing adequate perfusion at the all stages, and also provides reserve of plastic material.
The general and target indications for the partial face allotransplantation were: motivation, stabilization of the long-term outcome of trauma, full awareness of the consequences of trauma, preservation of the emotional-volitional and intellectual-mental characteristics of the patients personality, age, the limitation of autoplasty. Conclusion. After completing the preparation algorithm according to the world pre-transplantation protocol for facial allotransplantation, using the results of hemifacial allografting in the experiment, as well as with the help of other preparatory measures, it became possible to introduce this complex technique into the practice of plastic surgery and transplantology in the Russian Federation. Key words: face transplant in Russia, face transplant, reconstructive surgery, face reconstruction, face transplant, vascularized composite allograft, allograft of composite flaps, electric burn of the face.
THE EFFECTIVENESS OF ANTIOXIDANT - BASED TOOTHPASTES AND MOUTHWASHES FOR THE PREVENTION OF DENTAL DISEASES IN PATIENTS WITH NON-REMOVABLE ORTHODONTIC APPLIANCES
E.A. Satygo, A.V. Silin, O.V. Shalak, R. A. Fadeev, V.A. Gordeeva North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint Petersburg, Kirochnaya Street, 41 Abstract Introduction.The prevention of dental diseases is extremely important in maintaining population health. Patients undergoing long-term orthodontic treatment with fixed appliances, have the increased risk of dental caries and periodontal disease. However, the efficiency of various hygiene products and professional dental medications for prevention is different. Many researchers observe a decrease in microcirculation in the periodontium during orthodontic treatment. Thus, it is necessary to select oral hygiene products that could influence the microcirculation. Aim of the study was to analyze of efficiency of using toothpastes and mouthwash with antioxidants as the prevention of dental diseases of patients with fixed orthodontic appliances. Materials and methods. The study included 75 patients undergoing orthodontic treatment, dividing into 4 groups: Group 1 – patients used the antioxidant toothpaste, mouthwash for daily care; Group 2 - patients used the toothpaste with herbal extracts, mouthwash for daily care; Group 3 - patients used the toothpaste with antioxidants, mouthwash for daily care, applications with paste with herbal extracts and group 4 - control group.
During the control dental examinations, the state of hygiene of the oral cavity, periodontal tissues was determined according to the following criteria: hygiene efficiency index, PMA index,
gingival bleeding index, Doppler ultrasonography of the vessels of the gingival papilla and attached gums. Results. The most significant improvement in the hygiene index was observed in the second group, the same high rates of improvement in the hygiene index were demonstrated in the first and third groups. A significant decrease in gingival inflammation according to the PMA index was observed in the first, second and third groups. A decrease in the bleeding index was observed to a greater extent in patients of the second group. The linear velocity of blood flow in the periodontium significantly increased in patients of the third group. The pulsation index increased in patients of the first, second and third groups. The resistance index significantly increased in patients of the third group. The activity of the carious process according to PD data significantly decreased in patients of the first and third groups. Conclusion. The results of a clinical study of the use of toothpastes and mouthwash with antioxidants have shown a high efficiency in improving the hygienic state of the oral cavity and in reducing the activity of the carious process and bleeding. Keywords: prevention of dental diseases fixed orthodontic equipment, toothpaste, rinse aid, hygiene index, periodontium, Doppler ultrasonography of the vessels of the papilla and attached gums, laser fluorescence diagnostics.
SUBTOTAL ADRENALECTOMY AS AN ALTERNATIVE TO TOTAL ADRENALECTOMY IN PATIENTS WITH BILATERAL PHEOCHROMOCYTOMA
A.A. Lisitcyn, V.P. Zemlyanoi, M.M. Nakhumo North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint Petersburg, Kirochnaya Street, 41 Abstract Introduction: Adrenalectomy is the main treatment for patients with adrenal neoplasms. However, in situations requiring intervention on two or adrenal gland only requires a personalized approach to such patients in order to maintain unchanged part of the adrenal cortex and therefore avoid a lifetime of hormone. The choice of organ-preserving surgery on the adrenal gland is always a compromise between endogenous euccorticism and the risk of recurrence of the disease, which requires a balanced approach to considering the indications for such an intervention. Today, the possibility of performing subtotal adrenalectomy in patients with bilateral pheochromocytoma is very often discussed. However, there are still questions about the size of the limit size of the formation posing a risk of malignancy, the amount of residual tissue of the gland sufficient to maintain the physiological needs of the body, the possibility of crossing the central vein of the adrenal gland and distant changes in the resected adrenal tissue. Aim: Determination of the size of the residual tissue of the gland, sufficient to maintain endogenous eucorticism after subtotal resection of the adrenal gland in patients with bilateral pheochromocytoma. Materials and methods: The study included 5 patients with bilateral pheochromocytoma who underwent subtotal adrenalectomy. To assess the possibility of performing corticosteroids and to determine the permissible volume of resected adrenal tissue patient’s hormonal status was performed in the early and late postoperative period. Results and Discussions: The analysis showed the possibility of considering and performing subtotal adrenalectomy in patients with bilateral pheochromocytoma with a permissible preservation of adrenal tissue up to 20% in combination with crossing of the central vein of the gland. Long-term observations indicate the development of hyperplasia of the residual tissue of the adrenal cortex, which requires constant hormonal and intrascopic monitoring of this group of patients. Conclusion: Subtotal adrenalectomy is the operation of choice in patients with bilateral pheochromocytoma, which avoids the development of adrenal insufficiency. This operation can be considered as an alternative to bilateral adrenalectomy for the treatment of patients with bilateral lesions of the adrenal medulla. Key words: bilateral pheochromocytoma, adrenalectomy, adrenal gland resection, subtotal adrenalectomy, eucorticism
CLINICAL CASE OF THE EFFICIENT APPLICATION OF BACTERIOPHAGE IN THE TREATMENT OF STERNO-MEDIASTINITIS AFTER CORONARY ARTERY BYPASS GRAFTING
V.K. Noginov1, D.G. Gramatikov1, B.I. Aslanov2 1Leningrad Regional Clinical Hospital, Russia, 194291, Saint Petersburg, 45 Lunacharsky avenue, building 2, letter a 2North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint Petersburg, Kirochnaya st., 41 Abstract Introduction. Sterno-mediastinitis is a threatening infectious complication after median sternotomy. Despite advances in the prevention of sternal infection, the incidence of sterno-mediastinitis remains high. Due to the increasing microbial antibiotic resistance, there is a need to search for new effective antimicrobial agents. Currently, one of the safe and effective means is the bacteriophage. The aim of the study was to assess of effectiveness of bacteriophage in the treatment of purulent mediastinitis caused by the association of multiresistant microorganisms. Materials and methods. The study included the patient aged 60 years old after coronary bypass surgery. In the early postoperative period, developed sterno-mediastinitis associated with antibiotic-resistant microorganisms. Long-term antibiotic therapy and negative pressure vacuum therapy were unsuccessful. Wound sampling was performed every 5-7 days with constantly positive results. Due to the lack of positive dynamics, after two months of sternal infection treatment, complex pyobacteriophage was used for seven days in the form of the wound irrigation during dressings, use of turunda moistened with bacteriophage. From the third day after beginning of phage therapy, there was a positive dynamic in changing of the nature of the discharge from purulent to serous, followed by the disappearance of the wound discharge. The double control samples from the wound were negative. Results. The total period of elimination of infection from the wound was 64 days. From the beginning of the phage therapy, the elimination of infection was 14 days (until the negative wound samples). Complete healing and scarring of the wound occurred in six months after the sterno-mediastinitis treatment. To date, no relapse of sternal infection has been observed. Conclusion. Due to the increase of antimicrobial resistance, the use of bacteriophages in the complex treatment of sterno-mediastinitis are promising and safe and could reduce hospitalization duration and the cost of treatment of sternal infection. Key words: sterno-mediastinitis, bacteriophage, phage therapy, mediastinitis, antibiotic resistance.
RISK FACTORS FOR LYMPHOCELES FORMATION AFTER HYSTERECTOMY WITH PELVIC LYMPHODENECTOMY FOR UTERINE CANCER PATIENTS
T.T. Rogovskaya1, I.V. Berlev1,2, A.A. Sidoruk1,2, M.G. Yakovleva1, I.E. Meshkova1, N.A. Mikaya1, A.F. Urmancheeva1,2, 1National Medical Research Center of Oncology named after N.N. Petrov, Russia, 197758, Saint-Petersburg, Leningradskaya street, 68 2North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya street, 41 Abstract Introduction.The most common complication of pelvic lymphadenectomy in gynecologic cancer patients are lymphoceles. Modern approach to surgical treatment with the use of minimally invasive surgery causes a search for new optimal methods for preventing the formation of lymphocysts. Aim of the study wasto identify the incidence of asymptomatic and symptomatic lymphoceles, as well as risk factors for their development after hysterectomies with pelvic lymphatic nodes dissection for uterine cancer patients. Materials and Methods. The study included 773 female patients withendometrial cancer, who underwent hysterectomy and bilateral pelvic lymphadenectomy with laparoscopic and open surgery from 2010 to 2018. A total of 430 patients, who underwent laparoscopic surgery, were compared to 343 patients from open surgery group. According to the type of drainage and peritonization, patients were divided into four subgroups of comparison. Ultrasound examination of the pelvis for all patients was performed on 3-14 day after surgery. Results.The overall incidence of lymphoceles was 43.6% with frequency of 33.5% after laparoscopy and 56.3% after open surgery (р=0,001).88.7% of all lymphoceles were asymptomatic and regressed spontaneously within 6 months. Body mass index <30 and laparotomic approach as well as peritanization and drainage following lymphadenectomy were found to be risk factors for lymphocysts formation. Conclusions. Laparoscopic approach and change in perioperative management of patients without peritonization and drainage is effective prevention methods of occurrence lymphoceles in endometrial cancer surgery. Keywords: lymphocysts,lymphoceles, pelvic lymphadenectomy, endometrial cancer, drainage, lapariscopy.
1 Saint-Petersburg Research Institute of Phthisiopulmonology, Russia, 191036, Saint-Petersburg, Ligovsky avenue,2-4 2 N.N. Petrov National Medicine Research Center of oncology,Russia, 197758,Saint-Petersburg, Leningradskaya street, 68 3 North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, , Saint-Petersburg, Kirochnaya street, 41. Abstract
Lung cancer remains the leading cause of cancer death worldwide, comprising nearly 20 % of all cancer deaths, mostly due to tobacco use, whereas primary and secondary prevention could significantly reduce this mortality rate. The first studies focused on lung cancer screening were performed in the middle of the 20th century, while the first low-dose computed tomography screening trials were conducted about 30 years ago. In this review it was analyzed the data on the use of low-dose computed tomography as a screening method for the diagnosis of lung cancer. Conclusions about the effectiveness of using low-dose computed tomography as a screening method in the lung cancer diagnostics were based on data from a wide range of studies and a justified reduction in lung cancer mortality. Keywords: lung cancer, cancer screening, low-dose computed tomography, mortality.
LABORATORY ALGORITHM APPLICATION FOR THE DIAGNOSIS OF HEREDITARY SPHEROCYTOSIS ( CASE REVIEW)
T.T. Asatryan, L.B. Gaikovaya, M.N. Zenina North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint Petersburg, Kirochnaya Street, 41 Abstract Introduction. Hematologists often face with clinical situations where patients with signs of hemolysis and splenomegaly were diagnosed with hereditary spherocytosis due to the insufficient laboratory support for the diagnostic process. This leads to an unjustified splenectomy and the development of serious complications. In this regard, in 2019, the authors proposed a laboratory algorithm for diagnosing hereditary spherocytosis. The aim of the study was to use the proposed algorithm to identify latent forms of hereditary spherocytosis and conduct a differential diagnosis with hemolytic anemia occurring with the appearance of microspherocytes in the blood on a specific clinical example. Materials and methods. Analysis of the clinical case of patient A, aged 8 years 9 months with suspected hereditary spherocytosis. At the first stage, blood was analyzed according to erythrocyte and 2nd calculated indices, the presence of microspherocytes in the blood was determined, at the second stage, erythrocyte morphometry was performed using a hardware and software complex and the rate of erythrocyte lysis was determined in a glycerin test, and at the third stage the hereditary nature of the disease was confirmed using the eosin – 5-maleimide dye binding test by flow cytometry. Results. Study results analysis allow to diagnose A hereditary spherocytosis (Minkowski-Shoffar disease) with a latent course of the disease. Conclusion. The use of the presented algorithm made it possible to diagnose hereditary spherocytosis. Keywords: hemolysis, hereditary spherocytosis, diagnostic algorithm, laboratory tests
FEATURES OF STEROID METABOLOMICS IN PATIENTS WITH UNILATERAL AND BILATERAL ADRENAL CORTEX MASSES WITH AUTONOMOUS CORTISOL SECRETION
L.I. Velikanova, N.V. Vorokhobina, Z.R. Shafigullina, Zh.V. Paltsman, S.B. Shustov, E.V. Malevanaya, E.G. Strelnikova, K.A. Balandina North-Western State Medical University named after I.I. Mechnikov. Russia, 191015, Saint Petersburg, Kirochnaya Street, 41 Abstract Introduction. Autonomous cortisol secretion is a disease with subclinical manifestations, which is extremely difficult diagnosed by traditional methods of examination. The study of steroid hormone metabolism by chromatography methods in patients with suspicion of autonomous cortisol secretion allows confirming the diagnosis and preventing the development of complications. Aim of the study wasto analyze the metabolism of corticosteroids in biological fluids by chromatographic methods in patients with autonomous secretion of cortisol with solitary, bilateral neoplasms and bilateral macronodular adrenal hyperplasia to improve the differential diagnosis of the diseases. Materials and methods. The study included43 patients with autonomous cortisol secretion, who were examined by high performance liquid chromatography and gas chromatography-mass spectrometry, among them: 11 patients with bilateral macronodular adrenalhyperplasia, 14 patients with bilateral adrenocortical adenomas, and 19 patients with solitary adrenocortical adenomas. To assess the functional state of the pituitary-adrenal system, it was used traditional tests of immunoassay with the determination of free salivary cortisol at 11 p.m., free urine cortisol, plasma adrenocorticotropic hormone, serum dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, renin, cortisol at 9 a.m., 21 p.m. and after the suppression dexamethasone test with 1 mg and 2 mg. Results. An increase in glucocorticoid function of the adrenal cortex and signs of a decrease in 11β-hydroxysteroid dehydrogenase type 2activity (which contributes to the accumulation of active glucocorticoids) were revealed in patients with autonomous cortisol secretion with bilateral macronodular adrenal hyperplasia and in patients with bilateral adenomas. These patients were more likely to have disorders of carbohydrate metabolism. An increase in the mineralocorticoid function of the adrenal cortex according to the data of chromatographic methods was noted in patients with solitary adenomas in comparison with other examined patients. Key words: autonomous cortisol secretion, bilateral macronodular adrenal hyperplasia, bilateral adrenocortical adenomas, solitary adrenocortical adenoma, high performance liquid chromatography, gas chromatography-mass spectrometry, steroid metabolism.
PROPHYLACTIC ANTIBIOTICS USE FOR CESAREAN SECTION: MISTAKES AND THEIR IMPACT ON THE LEVEL OF RESISTANCE OF HOSPITAL MICROFLORA
N.A. Korobkov, E.I. Kakhiani, T.A. Dudnichenko, O.S. Arnt, K.V. Nikitenko, Zh.G. Pukhavskaya North-Western State Medical University named after I.I. Mechnikov, Russia, 191015, Saint-Petersburg, Kirochnaya street, 41 Abstract Introduction.There is still no consensus on an issue concerning the most rational schedule of prophylactic antibiotics use in obstetrics. The aim of the study is to determine the typical violations (mistakes) of the prophylactic antibiotics use for сcesarean section affecting the resistance level of hospital strains in the maternity hospital. Materials and methods.The study included 168obstetric patients suffering endometritis following cesarean section. Results and discussion.The major mistakes in prescribing antibiotics that negatively affect the resistance level of hospital strains are the following: the routine use of a prolonged course of antimicrobial prophylaxis; using the same antibiotic both for etiotropic therapy and to prevent a postpartum infection; using an antibiotic of the category of "limited access” for preoperative prophylaxis; a wrongly chosen dose exceeding an average daily dose. Conclusion.The irrational choice of antibiotics for preventive purposes leads to the active selection of resistant hospital strains. The study results could be used to develop local protocols for prophylactic antibiotics in maternity hospitals. Keywords: antibiotic prophylaxis; postpartum infection; multi-resistant microflora; endometritis after cesarean section; infectious complications.
(с) 2020 North-Western State Medical University named after I.I.Mechnikov
