[V. N. Vinogradov Faculty Therapy Clinic of Sechenov University: the flagship of the therapeutic service of the Russian Federation. A review].

The history of the Faculty Therapy Clinic of Sechenov University is presented. The stages of the formation of its therapeutic school are discussed. Diagnostic and therapeutic methods first developed and implemented in the clinic are described in detail.

Morphological changes in salivary glands of neonatal rats after intra-abdominal hypertension.

OBJECTIVE: Given the overall prevalence of elevated Intra-abdominal pressure (IAP), along with earlier detection and appropriate therapy of Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS), a significant reduction in patient morbidity and mortality is currently achieved by modern medicine. This article assesses the long-term degree of salivary gland damage in rats depending on the severity of experimental IAH during the neonatal period. MATERIALS AND METHODS: To simulate IAH, newborn rats, under the control of intravesical manometry, were injected into the abdominal cavity with bulking collagen filler in the amount necessary to create a given level of IAP. RESULTS: As shown by the results obtained, rats exposed to intra-abdominal hypertension for ten days had pathological changes in their salivary glands within 120 days. The severity of sialadenitis revealed a correlation with the severity of IAH. Some rats had individual reactions expressed in relative resistance to their organs' abnormalities under hypoxia. CONCLUSIONS: It was concluded that children with severe IAH history might need the disease prevention of the CNS, kidneys, digestive, and respiratory systems and oral diseases, particularly diseases involving the salivary glands. Future research is supposed to investigate further the IAH effect on various organs and tissues, including the dentofacial system.

[Сardiac myxoma: challenge in diagnostics. Case report].

Cardiac myxoma is the most common primary benign cardiac tumor (up to 50% of all primary cardiac neoplasms). The implementation of the modern imaging techniques into the clinical practice, particularly, 2D echocardiography, computed tomography and magnetic resonance tomography (MRI) results to the prompt diagnosis of the myxoma. However, the absence of specific clinical features, insufficient awareness of this condition among the physicians along with a rare prevalence, may lead to a misdiagnosis. This case report is notable for the relatively late diagnosis of a giant left atrial myxoma due to a number of circumstances but with successful surgical treatment.

[VACCINE-ASSOCIATED PARALYTIC POLIOMYELITIS IN RUSSIAN FEDERATION DURING THE PERIOD OF CHANGES IN VACCINATION SCHEDULE (2006-2013 yy.)].

The results of virologic testing of clinical materials and epidemiological analysis of vaccine-associated paralytic poliomyelitis (VAPP) cases obtained in 2006-2013 during AFP surveillance are presented. Among the 2976 cases of AFP 30 cases were VAPP. 15 cases were observed in OPV recipients, whereas 15 cases were observed in non-vaccinated contacts. The age of the patients varied from 4 months to 5.5 years (13.6 ± 12.4 months old). Children younger than 1 year constituted 63.3% of the group; boys were dominant (73.3%); 53.3% of children were vaccinated with OPV; the time period between receipt of OPV and onset of palsy was from 2 to 32 days (18.7 ± 8.2). Lower paraparesis was documented in 48.3% of patients; lower monoparesis in 37.9%; upper monoparesis, in 6.9%; tetraparesis with bulbar syndrome, in 6%. The majority of the patients (85.7%) had an unfavorable premorbid status. The violations of the humoral immunity were found in 73.9% cases: CVID (52.9%), hypogammaglobulinemia (41.2%); selective lgA deflciency (5.9%). In 70.6% cases damage to humoral immunity was combined with poor premorbid status. The most frequently observed (76%, p < 0.05) represented the single type of poliovirus--type 2 (44%) and type 3 (32%). All strains were of the vaccine origin, the divergence from the homotypic Sabin strains fell within the region of the gene encoding VPI protein, which did not exceed 0.5% of nucleotide substitutions except vaccine derived poliovirus type 2--multiple recombinant (type 2/type 3/ type 2/type 1) with the degree of the divergence of 1.44% isolated from 6-month old unvaccinated child (RUS08063034001). The frequency of the VAPP cases was a total of 1 case per 3.4 million doses of distributed OPV in 2006-2013; 2.2 cases per 1 million of newborns were observed. This frequency decreased after the introduction of the sequential scheme of vaccination (IPV, OPV) in 2008-2013 as compared with the period of exclusive use of OPV in 2006-2007: 1 case per 4.9 million doses, 1.4 cases per million newborns and 1 case per 1.9 million doses, 4.9 cases per 1 million newborns, respectively. The study has been financed from Russian Federation budget within the framework of the Program for eradication of poliomyelitis in the Russian Federation, WHO Polio eradication initiative, WHO's European Regional Bureau, Russian Foundation for Basic Research (project No. 15-15-00147).

[Markers of Fas-mediated apoptosis in primary open-angle glaucoma and opportunities of their pharmacological correction].

In order to assess the role of apoptosis in pathogenesis of primary open-angle glaucoma (POAG) apoptosis markers were studied in blood serum and tear fluid of patients with or suspected to have different stages glaucoma. To date the study of POAC pathogenesis goes along with search of possible ways of pharmacotherapy, neuroprotection is considered to be a promising option. Dynamics of sFas/Apo-1 and sFasL as the markers of Fas-mediated apoptosis was studied during treatment. We used nootropic citicoline as a neuroprotector. The markers were studied using enzyme immunoassay. The results show association of POAG onset and progression with interruption of Fas-mediated apoptosis, indicated by the level and proportion of sFas/Apo-1 and sFasL in tear fluid and in a less degree in blood serum. Characteristic features are detected in Fas/FasL system associated with glaucoma stage and correlating with some clinical and functional parameters (perimetry) that is important for understanding of POAG pathogenesis and for prognosis of disease course.

[Arrhythmogenic right ventricular dysplasia: polymorphism of clinical manifestations].

We observed 15 patients with arrhythmogenic right ventricular dysplasia (ARVD): 9 with definite and 5 with probable ARVD (modified European Criteria, 2010). Eight patients had typical ARVD (frequent right ventricular extrasystoles, nonsustained right ventricular tachycardia without heart failure with or without myocarditis). Five patients had ARVD with progressive heart failure (right- or biventricular with or without myocarditis). Two patients had full scale arrhythmic form (sustained right ventricular tachycardia without or with right ventricular dilation, with or without myocarditis). In 3 cases diagnosis was confirmed morphologically or with DNA-diagnostics. This material allowed us to highlight the following specific points related to diagnostics of ARVD. Detection of fat at MRT is not obligatory for diagnosis, fat can be detected by MSCT; ventricular arrhythmias can move backwards in the picture of the disease; leading clinical manifestation can be unexplained right ventricular insufficiency; ARVD can be combined with other genetic cardiomyopathies as well as with infectious immune myocarditis (up to 50% of patients); elevated titer of anticardiac antibodies is not characteristic for isolated ARVD; myocardial biopsy allows to verify both ARVD and concomitant myocarditis. The paper also contains discussion of the role of myocarditis in various forms of ARVD and possibilities of its diagnosis and treatments.

[The effect of parenteral citicoline on visual functions and life quality of patients with primary open-angle glaucoma].

The effect of nootropic drug citicoline on visual functions, perimetric indexes of static automated perimetry, morphometric characteristics of retinal tomography and life quality of patients with primary open-angle glaucoma (POAG) stage I-III and normalized intraocular pressure (IOP) was studied. 40 patients aged 46-78 years old with POAG stage I-III and normalized IOP were treated with citicoline. Among them there were 24 female and 16 male. The patients were divided into 2 equal groups--experimental and control. Patients of both groups were treated with intravenous citicoline for 10 days. The dose of citicoline in experimental group was 1000 mg/day, in control--500 mg/day. After treatment in both groups visual functions, perimetric indexes of static automated perimetry, morphometric characteristics of retinal tomography and life quality showed improvement. Citicoline has significant neuroprotective effect preventing apoptosis.

Role of lipid components in formation and reactivation of Mycobacterium smegmatis "nonculturable" cells.

We have found that transition of actively dividing Mycobacterium smegmatis cells into the dormant "nonculturable" state is accompanied by increase in the protein/lipid ratio and disappearance of one of the main lipid components of the mycobacterial cells, trehalose monomycolate. In this case, oleic acid is accumulated in the culture medium due to its secretion by the mycobacterial cells. Addition of lipids of different classes to "nonculturable" M. smegmatis cells induces their resuscitation. The lipid reactivating effect is evidently caused by the presence of fatty acids in their composition, because free fatty acids also exhibited reactivation effect. Oleic acid in concentration of 0.05-3 µg/ml exhibited maximal effect, and that allows us to draw a conclusion concerning its signal role in the transition of dormant cells into active state.

[Changes of the first electrocardiographic derivative in patients with ischemic heart disease].

Timely recognition of ischemic heart disease (IHD) is one of the main tasks of cardiology. As a result the search for ways of early recognition of pathologic changes of the myocardium is continuing. Analysis of the first electrocardiographic derivative allows making more detailed assessment of repolarization processes in ventricles. Aim of this study was to assess possibility of the use of analysis of the first electrocardiographic derivative in diagnosis of ischemic changes of myocardium. We examined 61 patients (mean age 63.9+/-9.4 years) with proven ischemic heart disease (IHD). Control group included 92 subjects (mean age 33.1+/-15.4 years) without cardiovascular diseases. Basing on obtained results a conclusion was made that temporal and velocity parameters of the first electrocardiographic derivative changed dramatically during myocardial ischemia: all intervals became lengthened and velocity parameters decreased. Thus analysis of the first electrocardiographic derivative can be useful in differential diagnosis of myocardial ischemic changes.

[State of autonomic regulation in patients with mitral valve prolapse and dysfunction of sinus node]. / Sostoianie vegetativnoi reguliatsii u bol'nykh s prolapsom mitral'nogo klapana i disfunktsiei sinusovogo uzla.

This study was made of 62 patients with idiopathic mitral prolapse, 17 patients with vagus sinus dysfunction and 8 patients with combination of the above disorders. Clinical, psychological and electrophysiological examinations revealed in all the patients psychovegetative syndrome with paroxysmal and permanent vegetative disorders, anxious-hypochondriacal and anxious-depressive conditions. Vegetative disorders were characterized by definite discoordination of vegetative regulation manifesting as hyperactivity of suprasegmental vegetative structures and insufficiency of both sympathetic and parasympathetic vegetative regulation.

[Characteristics of rate and time parameters in secondary changes in the ventricular repolarization period]. / Osobennosti skorostnykh i vremennýkh parametrov pri vtorichnykh izmeneniiakh perioda repoliarizatsii zheludochkov.

An analysis of the first electrocardiographic derivative in 48 patients with left-ventricular hypertrophy and complete block of the left limb of His bundle demonstrated a prolongation of myocardial excitation spread and increased rate of change in the difference of potentials during repolarization, the changes being more marked in patients with left-ventricular hypertrophy. In cases where left-ventricular hypertrophy was combined with coronary disease, the rate of change in the difference of potentials was reduced dramatically during repolarization.

[Sensitivity to chlorine-containing disinfectants of Salmonella typhi strains with transmissible drug resistance]. / Chuvstvitel'nost' k khlorsoderzhashchim dezsredstvam shtammov Salmonella typhi s transmissivnoi lekarstvennoi ustoichivost'iu.

Sensitivity of 201 S. typhi strains to antibiotics and chlorine containing disinfectants was studied. The strains were isolated in the regions of the Left Bank Ukraine. Among the typhoid cultures the proportion of R+ strains was on the whole equal to 29.3 per cent. Chloramine resistant strains amounted to 21.8 per cent. Among chloramine resistant strains the number of the cultures carrying R plasmids was 3 times higher than that of the strains sensitive to disinfectant. Simultaneous transfer of the R plasmid and chloramine resistance to the recipient strain suggested that resistance of the S. typhi strains to chloramine was of plasmid nature.

[R plasmid distribution in S. typhi isolated on the territory of the left coast of the Ukraine in 1970-1982]. / Raporstraenenie R-plazmid u S. typhi, vydelennykh na territorii Levoberezhnoi Ukrainy v 1970-1982 gg.

A total of 373 strains of S. typhi isolated in 1970-1982 were tested with respect to their sensitivity to 9 antibiotics active against gram-negative bacteria. It was shown that about 1/3 of the isolates were resistant to 1-3 antibiotics. Among the resistant isolates the number of strains resistant to 4-5 and more antibiotics amounted to 12.5 per cent. The plasmid nature of the antibiotic resistance in the isolated strains of S. typhi was shown. Transmissive R plasmids were detected in 13 per cent of the strains studied. Within the last 5 years there was an increase in the proportion of strains with transmissive R plasmids in patients with sporadic typhoid fever or especially in groups of patients with the disease.

[Level and nature of the drug resistance of Shigella flexneri]. / Uroven' i priroda lekarstvennoi ustoichivosti shigell Fleksnera.

Characteristics of antibiotic resistance of 300 strains of Shigella flexner 2a isolated from patients within 1976--1977 in the regions where these bacteria were very rare for a long period of time were studied. It was shown that most of the isolates were resistant to chloramphenicol (88.1 per cent), tetracycline (94.8 per cent), streptomycin (89.1 per cent), polymyxin M (82.4 per cent) and others. 46.5--61.6 per cent of the isolates were resistant to neomycin antibiotics. A high level of the resistance was also noted: the bactericidal effect was registered in 52.0-74.0 per cent of the cultures at a dose of 500--1000 microgram/ml. 91.4 per cent of the strains possessed multiple dug resistance, 78.8 per cent of them being simultaneously resistant to 4--7 drugs. Transmissive R-plasmids were found in 68.8 per cent of the isolates. After exposure to acridine dyes the plasmid nature of the resistance was confirmed in 72.3 per cent of the cultures. Variability of the r-determinant sets in r-plasmids was noted. Strains (64.9 per cent) carrying r-determinants Tc, Cm, Sm and Tc, Cm were more frequent. Strains with one transmissive r-determinant were usually solitary.

[Antibiotic sensitivity of S. typhi cultures that have reverted from L forms isolated from the blood of patients]. / Chuvstvitel'nost' k antibiotikam kul'tur S. typhi, reversirovavshikh iz L-form, vydelennykh iz krovi bol'nykh

L-forms of bacteria were isolated in 18 out of 300 fever patients with diagnoses of typhoid-paratyphoid fever, grippe, virus respiration disease and others in the Diagnostic Department of an Infection Hospital during bacteriological tests of the blood. Among the cultures tested 13 were instable and reversed to the bacterial form. The type identification showed that only 9 revertants possessed properties characteristic of the typhoid fever microbes and belonged to S. typhi. Sensitivity of the typhoid fever revertants to levomycetin, sintomycin, streptomycin, pencillin and tetracycline was studied. The studies showed that the typhoid fever revertants from the L-forms isolated from the patients were sufficiently sensitive to levomycetin, sintomycin, penicillin and tetracycline. The minimum bactericidal concentrations of the above antibiotics ranged within 12.5--100 gamma/ml.