Journal «MEDICINA» 4/2023

The article analyses morbidity and mortality caused by chronic obstructive pulmonary diseases among the population of the Russian Federation in the period from 2011 to 2019. Two indicators were analyzed in the entire population: the absolute incidence numbers of newly established chronic and unspecified bronchitis, emphysema (J42-J43), and other chronic obstructive pulmonary disease (J44); as well as mortality caused by these diseases, also measured in absolute numbers. To analyze the impact of the prevalence of tobacco smoking among the population on morbidity and mortality, the observation period was split into two time periods: 2011-2014 – before the adoption of Federal Law No. 15-FZ «On protecting the health of citizens from the effects of second-hand tobacco smoke, the consequences of tobacco consumption or the consequences of the consumption of nicotine-containing products», 2014-2019 – after the adoption of the law. Linear approximation was used to assess the dynamics of changes in the indicators, the dynamic trends of the indicators were built for the selected time periods. The results of the study showed that morbidity and mortality from chronic obstructive pulmonary diseases after the adoption of Federal Law No. 15-FZ, resulting in the constant annual decrease in the prevalence of smoking in the Russian Federation, reversed from a steady increase to a steady decrease. However, the beginning of the decrease in mortality was observed later (2015) than the decrease of incidence (2014), and the rate of decrease in mortality was 2 times lower than the rate of decrease in incidence.

Key words: tobacco smoking prevalence, chronic obstructive pulmonary diseases, COPD incidence, COPD mortality, chronic bronchitis incidence, anti-tobacco law

The study of the role of chemical addictions in the emergence of self-harming dangerous behavior in adolescence has been the subject of research by psychiatrists for more than a decade. Various types of destruction and the use of psychoactive substances are in the sphere of close attention of the medical and psychological communities, given the significant impact of the abovementioned behavioral disorders not only on the life of a particular family, but also their tangible negative impact on social functioning. Minors, as one of the most vulnerable categories, are actively involved in various forms of risky illegal behavior. The article presents the results of studying the information resources of the electronic scientific library elibrary.ru, electronic catalog of Russian dissertations (http://diss.rsl.ru /), the Scientific Center for Mental Health of the Russian Academy of Medical Sciences, the PubMed database of the National Center for Biotechnological Information. About 300 literary sources and scientific publications were identified, and over 200 materials, mostly containing duplicater information, were excluded from the study. The literature review examines the opinions of domestic and foreign researchers regarding the formation of chemical addictive and self-destructive behavior in minors.

Key words: addictive behavior, psychoactive substances, adolescents, self-destruction, minors

A clinical case of a foreign body in the respiratory tract in a young child in the clinical practice of a district pediatrician is considered. The paper presents the authors' thoughts on the possible causes of the development of this pathology in a child, proposals for accelerating the diagnostic search, as well as for reducing the risk of such conditions and their complications.

Key words: foreign body, fibrotracheobronchoscopy, airway obstruction, aspiration

Introduction. Klebsiella pneumoniae, one of the leading causative agents of nosocomial infections, is included in the group of so-called «ESKAPE» pathogens – microorganisms associated with increased antibiotic resistance, representing a serious problem for public health. K. pneumoniae is widespread and has a pronounced ability to acquire resistance to antimicrobial drugs. Inadequate antibacterial therapy in patients with nosocomial infections worsens the prognosis of the disease and increases hospital mortality, therefore, the prescribing of medications should be based on knowledge of the current profile of antibiotic resistance of the pathogen in a particular hospital. The study of the genetic diversity of K. pneumoniae will reveal the main mechanisms of resistance of this pathogen and formulate recommendations for rational antibiotic therapy. Objective. Genome-wide analysis of resistant K. pneumoniae isolates in the context of epidemiological surveillance of healthcare associated infections (HAI) in a multidisciplinary hospital. Materials and methods of research. 41 isolates of bacteria of the genus Klebsiella isolated in a multidisciplinary hospital in Barnaul from clinical samples were studied. Genome-wide sequencing was performed using NextSeq 2000 (Illumina). Research results and their discussion. A comparative analysis of the microbiological background in a multidisciplinary hospital and hospitals in Russia demonstrated the predominance of K. pneumonia in the overall structure: 39.2% and 27.86%. In the course of genome-wide analysis of resistant strains of K. pneumoniae, combinations of beta-lactamase genes and genes encoding mechanisms of resistance to disinfectants were identified. Genes associated with the resistance of Klebsiella pneumoniae to hydrogen peroxide were found, genes of carbapenemases of the OXA-48 group, genes of extended-spectrum beta-lactamases of the CTX-M group, as well as metallo-b-lactamases of the NDM group were identified among the studied cultures. Conclusion. The use of genome-wide sequencing of isolates of HAI pathogens in clinical practice (using the example of Klebsiella pneumoniae) determines the choice of antibacterial therapy, the use of disinfectants and antiseptics in the organization of preventive and antiepidemic measures.

Key words: Klebsiella pneumoniae, antibiotic resistance, genome-wide sequencing

Over the past decades, in the EU countries, educational and rehabilitation interventions for drivers who have committed gross violations of the traffic rules, including driving under influence of alcohol, have become a common addition to traditional administrative and criminal measures. Initially, intervention programs in European countries were differentiated depending on the type of traffic violation. Thus, the intervention programs for drunk drivers differed significantly from the programs for drivers who exceeded the speed limit. Later the results of scientific research proved the feasibility of using a different methodological approach when creating intervention programs for offending drivers, which was based on the study of their behaviour patterns, socio-demographic characteristics and psychological profiles. The practical implementation of this approach made it possible to conclude that complex intervention programs that include all types of gross violations of traffic rules and are differentiated in accordance with violators’ profiles, are highly effective. The recommendations under consideration also concern such a gross violation of traffic rules as driving while intoxicated which is characterized by high latency of its commission in road traffic. Despite the universality of such intervention programs for certain profiles of violating drivers, in relation to drunk drivers the authors suggest the initial differentiation of the latter, taking into account the presence or absence of alcohol addiction, since this information is significant in determining the profile of the driver. Accordingly, the presence or absence of addiction among drunk drivers is one of the main criteria for choosing an intervention program based on the profile of the offending driver. The review presents scientific interest, given the existing negative trends in road traffic injuries associated with driving under influence in the Russian Federation.

Key words: driver, driver intoxication, alcohol intoxication, drunk driving prevention, vehicle, traffic rules, violating drivers, educational program, rehabilitation program, driver rehabilitation, intervention

In the article we present the results of a study of the effectiveness and safety of nutritional support for patients with alcohol withdrawal with a specialized food product «Glutamine-plus». An intergroup comparison of patients who received and did not receive «Glutamine-plus» was carried out according to the following parameters: clinical characteristics and metabolic features, including its dynamics during observation. Analysis of the data obtained showed that the addition of «Glutamine-plus» to a standard diet significantly improved metabolic processes, affected tissue respiration and more effectively restored the acid-base state in patients with alcohol withdrawal. Intake of «Glutamine-plus» also had a positive effect on the reduction of clinical manifestations of alcohol withdrawal and craving.

Key words: alcohol withdrawal syndrome, glutamine, metabolism, energy metabolism

In the Republic of Tatarstan, in the period 2012 to 2021 we observed a twofold decrease in the incidence of tuberculosis: from 48 cases per 100 thousand population to 23.4 cases per 100 thousand population. However, there is an increase in the proportion of patients with respiratory tuberculosis in the decay and contamination phase, as well as fibrotic-cavernous and multiple drug-resistant forms of tuberculosis. It is important to analyze the epidemiological situation over a ten-year period, that will allow to develop or adjust measures for the prevention of tuberculosis in the Republic of Tatarstan. Objective: To establish patterns of manifestations of the epidemic process based on the indicators of the general incidence of tuberculosis in the Republic of Tatarstan for the period 2012-2021. Materials and methods: The study design is a descriptive epidemiological study. A retrospective epidemiological analysis of the incidence of general tuberculosis in the Republic of Tatarstan for 2012-2021 was carried out. The analysis of the long-term dynamics of the tuberculosis incidence in the population of the Republic of Tatarstan was carried out. Intensive indicators of morbidity in general, by contingents and ages were calculated. The structure of tuberculosis incidence in the Republic of Tatarstan was assessed, extensive morbidity rates in percentages (%) were calculated. Results: The long-term dynamics of annual morbidity rates of newly diagnosed tuberculosis in the Republic of Tatarstan in 2012-2021 is characterized by a statistically significant downward trend (р = -0,973 р < 0,001) at a rate of 7.8% per year. The indicated speed of the trend has reduced the incidence of newly diagnosed tuberculosis in 10 years from 48 cases per 100 thousand of population to 23.4 per 100 thousand of population, or twofold. Conclusion: Despite a significant decrease in the overall incidence of tuberculosis over a ten-year period, both in newly diagnosed patients and registered patients, in the Republic of Tatarstan the clinical structure of tuberculosis becomes more severe, namely, we experience an increase in the proportion of patients with respiratory tuberculosis in the phase of decay and contamination among newly diagnosed patients, with fibrous-cavernous tuberculosis among registered patients with multidrug-resistant tuberculosis.

Key words: morbidity, tuberculosis, fibrous-cavernous tuberculosis, multiple drug-resistant forms of tuberculosis

The purpose of this review was to summarize the history of the discovery and study of bacteria of the genus Borrelia, causing ixode tick-borreliosis (IBC). The material is presented in chronological order, starting from the first mention of the disease in 1883 and ending with the developments of the last decade. Much attention is paid to the fact of discovery of the causative agent of the disease – Borrelia burgdorferi, personal contribution to the case of foreign and domestic scientists. The data on the discovery of species diversity of Borrelia genospecies and determination of the role of ticks of the genus Ixodes in the circulation of pathogens of IBD are presented. The review is of interest to a wide range of specialists involved in the study of IBD and can be used as a lecture material in the educational process.

Key words: ixodes tick-borreliosis, Lyme disease, borrelia

The introduction of new types of medicinal plant raw materials into medical practice is an urgent task. Pine cones are harvested in huge quantities by forestry and are one of the by-products of logging. The rich chemical composition of this raw material is the basis for its possible medical applications. The aim. To determine the optimal timing of pine cones harvesting for obtaining a dry aqueous extract with antiradical activity. Materials and methods. For the study, cones of the Scots pine of the second year of life were harvested on the territory of the Ilyinsky district of the Perm Territory. Harvesting was carried out in the period from July to March. Dry water extract was prepared by extraction of cones with hot water. The content of procyanidins in extracts was determined by acid cleavage of procyanidins to anthocyanidins using the Porter method. The content of tannins in the extracts was determined according to the methodology of the State Pharmacopoeia. To determine the antioxidant activity of the extracts, a reaction with a stable free radical 2,2-diphenyl-1-picrylhydrazyl was used. Results and discussion. As a result of the study, it was found that the highest content of tannins is observed in extracts obtained from cones harvested in October, and the minimum is from cones harvested in March. The highest content of procyanidins in extracts obtained from cones collected in February and March. The lowest content of procyanidins in extracts obtained from cones harvested in August and October. The level of antiradical activity was highest in extracts from cones harvested in October with a sharp decrease in activity in November. From November to March, antiradical activity increases. Conclusion. All the studied extracts have a high level of antiradical activity, which makes it possible to harvest pine cones for extracts in the period from July to March.

Key words: Scots pine, cones, tannins, procyanidins, antiradical activity