Extreme Medicine

ISSN Print 2713-2757 ISSN Online 2713-2765

Extreme Medicine

SCIENTIFIC AND PRACTICAL REVIEWED JOURNAL OF FMBA OF RUSSIA

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Misharin VM, Kochubey AV

Shortcomings of the categorization system include weakness of the normative regulation oriented towards the outdated ideas about the qualification and formal features of professional development. It is often proposed to objectify measuring the professional competence of the subjects evaluated in order to improve the categorization system. The study was aimed to test the qualification requirements of physicians for the relationship with their qualification and the possibility of accurate full-fledged measurement of those in the evaluated subjects. We performed expert assessment of 22 requirements for grades approved by the Order of the Ministry of Health of the Russian Federation dated 31 August 2023 No. 458n relative to four items: their relationship with the physician’s qualification, feasibility of measurement (usability), relationship with the competence of the evaluation commission member (objectivity), possibility of determining the extent of the knowledge, abilities, skills required for each professional grade. Assessment involving the use of the Stapel rating scale (“–5” to “+5”) was performed by seven experts. The sums of scores by items were as follows: relationship with qualification — 477, usability — 316, objectivity — ‒662, grade — –699. There are significant differences between the scores reported for all the requirements and pairs of all items (р ≤ 0.0001), except the objectivity–grade pair (р = 0.103). The total of the scores reported for the majority of requirements is negative due to the lowest possible scores of objectivity and grade. The experts believe that none of the qualification requirements approved by the Order enables accurate full-fledged determination of physician’s qualification during evaluation.

Received: 2024-02-24

Published online: 2024-03-30

DOI: 10.47183/mes.2024.014

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VIEWS 280

Eichler OV, Miroliubov AA, Nechaev DN, Titova AG, Trusov GA, Garbuz VV, Lomov AN, Yudin VS, Keskinov AA, Kraevoy SA

The paper provides the summary of foreign literature data on the organizational and methodological aspects of functioning of the bone marrow and hematopoietic stem cell donor registries, the issues of HLA typing, the technical algorithms for compatibility degree ranking. The changes in the citizens’ motivations in response to the bone marrow donating program popularization are described, along with the features of arranging recruitment, approaches to determining the requirements for the registry population considering the multinationality and heterogeneity of ethnic composition, and the statistical approximation algorithms. Furthermore, attention is paid to the so-called specific aspects of the functioning of bone marrow and hematopoietic stem cell registries and biobanks. The latter is important in terms of ensuring national security, adaptation of the population to the effects of the disasters, emergencies, and terrorist attacks associated with the development of bone marrow syndrome in a large number of victims.

Received: 2023-12-18

Published online: 2024-03-28

DOI: 10.47183/mes.2024.011

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VIEWS 291

Kostyushok NYa, Gornov SV, Sizov AV

Introduction of point genetic associations into clinical and laboratory diagnosis will allow the physician to determine the risk of severe diabetes mellitus and its complications with a focus on detection of the genetically determined disorder. The study was aimed to identify the molecular genetic markers of severe diabetic nephropathy in patients with type 1 and 2 diabetes mellitus (DM) based on the GSTP1 (I105V) gene assessment. Genotyping of the GSTP1 gene I105V locus was performed in patients with type 1 and 2 DM. Then we identified the features of oxidative status, free radical oxidation, and renal function in patients with various polymorphic variants of the studied gene. Patients with type 1 DM, who were carriers of the GSTP1 heterozygous polymorphic variant (Ile/Val), showed higher activity of the oxidative stress enzymes (glutathione-S-transferase, catalase) and malondialdehyde compared to homozygous carriers (р < 0.001, р < 0.001, р < 0.05). They also showed a significant increase in the levels of triglycerides (1.6-fold) and the glycated hemoglobin levels (1.1-fold) (p < 0.05). Patients with type 2 DM, who were carriers of the GSTP1 polymorphism homozygous for allele 2 (Val\Val), had a higher level of malondialdehyde (100.5 µmol/L, (р < 0.001)), which was associated with the more severe diabetic nephropathy (average glomerular filtration rate — 48 mL/min/1.73 m2, 24-h urinary albumin excretion — 0.9 g/L; р < 0.01). It has been proposed to assess the GSTP1 (I105V) gene in individuals with type 1 and 2 DM. This polymorphism that is heterozygous in individuals with type 1 DM and homozygous for allele 2 in individuals with type 2 DM is unfavorable in terms of the DM course and complications.

Received: 2024-01-25

Published online: 2024-03-28

DOI: 10.47183/mes.2024.012

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VIEWS 268

Semigolovskii NYu, Balluzek MF, Guslev AB, Mazurenko SO, Kozaev AV, Semenova IG, Nikolskaya EM, Scheglov AN

The main causes of postoperative mortality associated with percutaneous coronary interventions involving the coronary artery stent insertion are perioperative myocardial infarction and acute heart failure due to inadequate protection of the myocardium against ischemia/reperfusion. The standard therapy includes beta blockers, anticoagulants, antiplatelet drugs. Two clinical cases of successful use of intravenous levocarnitine for cardioprotection in senile patients with acute forms of coronary heart disease with multivessel lesions are reported. The postoperative period went well, smooth dynamics of biomarker levels (troponin I, creatine phosphokinase, MB fraction of creatine phosphokinase) was observed, and ischemic ECG changes were relatively small. The expected results of the technique application include reduction of intraoperative and postoperative complications of ischemia/reperfusion and the increase in effectiveness of the stent insertion clinical outcomes in high-risk patients.

Received: 2024-01-29

Published online: 2024-03-25

DOI: 10.47183/mes.2024.010

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VIEWS 312

Achilov AA, Baranov AV, Gornov SV, Usmonzoda DU, Achilova SA, Pulatova MD, Achilov AlA, Mamedyarova IA, Lazechko MI

Based on clinical practice, some patients with lipid metabolism disorders (LMD) are resistant to lipid-lowering therapy (LLT) — in such patients, taking optimal doses of LLT drugs does not reduce levels of cholesterol and its fractions to target levels and using LLT at higher doses is associated with increased odds of adverse events. To optimize the treatment, 58 patients with ischemic heart disease with LMD resistant to LLT were examined. The patients were divided into two groups: in the main group, 29 patients received laser therapy and unloading therapeutic gymnastics; in the control group, 29 patients continued to take their usual medications. The obtained results showed a significant lipid-lowering effect of the treatment in the main group: we observed a significant decrease in total cholesterol (by 27.7%, p < 0.01) as well as low-density lipoprotein cholesterol (by 34.7%, p < 0.01), a significant increase in high-density lipoprotein cholesterol (28.1%, p < 0.01), a significant decrease of atherogenic coefficient (by 50.2%, p < 0.01) and in the levels of triglycerides (by 49.6%, p < 0.01). At the same time, no significant positive changes in lipid profile were observed in the control group. In patients of the main group, tolerance to physical activity increased significantly, with statistically insignificant changes in the control group accordingly.

Received: 2023-12-19

Published online: 2024-03-25

DOI: 10.47183/mes.2024.009

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VIEWS 267

Daykhes NA, Diab KhM, Nazaryan DN, Vinogradov VV, Reshulskiy SS, Machalov AS, Karshieva SSh, Zhirnov SV, Osidak EO, Kovalev AV, Hesuani YuD

Microtia is a combined congenital malformation with the prevalence of one case per 10,000–15,000 newborns, which accounts for 50% of all congenital malformations. Treatment of microtia is a challenging task. Numerous solutions have been proposed, however, none of these options guarantee good functional and aesthetic outcome. High hopes for solving the problem are placed on advances in reconstructive surgery. The study was aimed to determine the possibility of using advanced biocompatible endoprostheses manufactured using the tissue engineering technologies. Two closely related male 2-year-old minipigs of the Sus salvanius breed underwent implantation of bioengineered implants manufactured by combined 3D bioprinting with application of the collagen solution containing autologous cartilage tissue cells under the temporal fascia. The samples were collected 3 months later. Histological examination and immunohistochemistry showed that the implanted endoprosthesis initiated the development of regenerated connective tissue and its own vasculature in 100% of cases, thereby ensuring cell viability and integrity of biological structures; furthermore, no facts of the endoprosthesis rejection or resorption were reported. We have concluded that the developed implant manufacturing method is promising and can provide the basis for creation of domestic porous ear implants based on biocompatible polymeric materials, hydrogels, and autologous cellular material. It is necessary to further test the auricular implant using biological models.

Received: 2023-12-20

Published online: 2024-03-25

DOI: 10.47183/mes.2024.007

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VIEWS 365

Filimonov DA, Eresko AB, Raksha EV, Trubnikova NN, Ischenko RV, Tereschenko DA, Kisilenko IA, Nosova IN

The oxidative stress associated with ischemic stroke is a major factor damaging the nervous tissue. Thyroid hormones have a significant effect on the body’s redox status, however, the impact of their derivatives, thyronamines, considered as potential neuroprotectors, on the characteristics of lipid peroxidation (LP) is not clearly understood. The study was aimed to assess the impact of the Т0АМ thyronamine synthetic analogue on the main LP indicators in the model of acute cerebral ischemia. Permanent ligation of the right common carotid artery was performed to simulate acute cerebral ischemia in white rats. The animals were divided into two groups: the control group receiving no treatment and the experimental group, to which the Т0АМ thyronamine synthetic analogue was intraperitoneally administrated (75 mg/kg of the rat’s body weight). After 24 h the rat was decapitated, and the cerebral cortex tissue was extracted for biochemical analysis. The following LP indicators were determined by spectrophotometry: malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx). When administering the Т0АМ thyronamine synthetic analogue, a significant (2-fold) decrease in MDA levels was observed in the ischemic hemisphere (р = 0.022), along with the 2.49-fold increase in the GPx activity in the brain tissue (р = 0.004) of the intact hemisphere and the 2.65-fold increase in its activity (р = 0.021) in the ischemic hemisphere, as well as the 1.23-fold increase in SOD activity in the ischemic hemisphere (р = 0.042). The Т0АМ thyronamine synthetic analogue has a great potential in terms of activation of the antioxidant protection mechanisms in the cerebral cortex of white laboratory rats under conditions of acute hemispheric ischemia.

Received: 2024-01-04

Published online: 2024-03-22

DOI: 10.47183/mes.2024.003

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VIEWS 284

Gonchar NV, Kopersak AK, Skripchenko NV, Razdyakonova IV, Podlipnaya YuA

The development of complex criteria for the diagnosis, differential diagnosis, and optimization of treatment of infectious diarrhea associated with opportunistic Enterobacteriaceae is a pressing issue of pediatric research and practice. The paper reports a clinical case of protracted intestinal infection associated with Klebsiella pneumoniae in the form of moderate hemorrhagic enterocolitis in an infant, which is explained by the decrease in specific resistance due to unfavorable maternal obstetric and gynecological history, perinatal CNS injury, iron deficiency anemia, protein-energy malnutrition. The disease relapse associated with secondary norovirus infection was reported after the first hospitalization. Three courses of intestinal antiseptics and probiotics were required to achieve a beneficial treatment outcome, although usually in such a situation one course of such drugs is enough. The recovery process was accompanied by the nutritional status improvement, hemorrhagic colitis relief, normalization of gut microbiota.

Received: 2023-11-29

Published online: 2024-03-20

DOI: 10.47183/mes.2024.006

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VIEWS 311