[Sexual dysfunction on the background of antidepressant therapy]

The review is devoted to the problem of sexual dysfunction caused by taking antidepressants. Sexual dysfunction is widespread, but it is not reported, and its impact on the quality of life and compliance of patients is underestimated. Partly because of its bidirectional association with depression, sexual dysfunction is difficult to diagnose. Possible mechanisms and risk factors associated with sexual dysfunction in patients with depression are considered. The data on the frequency of sexual dysfunction with the use of various antidepressants are given. Therapeutic strategies for sexual dysfunction associated with taking antidepressants are described. The advantages of agomelatin as an antidepressant associated with a low risk of sexual side effects are emphasized.

[Prescription of psychotropic drugs off label]

The review was written based on the analysis of available publications (Pubmed, other Internet resources) on the problem of off-label use of drugs. It reveals the concept of off-label prescribing and discusses modern approaches to the use of off-label drugs in domestic psychiatric and addiction practice. The problems of normative substantiation of prescribing off-label drugs are discussed. It has been established that, despite some progress in this matter, for patients in adult psychiatric practice, the use of off-label therapy is carried out only by decision of the medical commission. The issue of substantiating the prescription of off-label drugs on the basis of scientific and clinical studies and experience in the use of drugs at the legislative level remains relevant.

Prevalence, Structure, and Risk Factors for Mental Disorders in Older People

This review focuses on assessing the prevalence and risk factors of mental disorders in older people in the modern era, including the COVID-19 pandemic. A systematic review of the literature was conducted in PubMed, Elsevier, and Google using keywords over the past 10 years. Substantial discrepancy of data on the prevalence of psychiatric disorders has been shown in the elderly population. The significant incidence of mental disorders among nursing home residents is highlighted. The relevance of nonpsychotic depressive and anxiety disorders is demonstrated for the elderly, along with the difficulty of diagnosing mental disorders associated with physical pathology and cognitive impairments. The risk factors for mental disorders in older adults are socio-demographic but also economic, psychological, and physical. The problem of mental health of the elderly is characterized for the conditions of the COVID-19 pandemic associated with specific risk factors for psychiatric disorders. The shortage of evidence-based research in the treatment of mental disorders in the elderly and the urgency to improve the organization of psychiatric care for such patients are noted. Understanding the structure and prevalence of mental disorders among the elderly will allow optimizing the functioning of healthcare systems.

[Depression in the structure of schizophrenia: clinical and biochemical characteristics]

THE AIM OF THE STUDY

Was to investigate clinical and biochemical correlates of depression in the structure of schizophrenia to improve its diagnosis and differential diagnosis and to deepen understanding of mechanisms of schizophrenia development. Material and Methods. Forty-two inpatients at the stabilization stage of paranoid schizophrenia, aged 29.5±5.9 years, of whom 64.3% were women, were examined. The duration of the disease was 5.6±6.3 years. We used clinical and psychopathological methods, clinical scales (PANSS, SANS, BACS, Calgary Scale), catamnestic and clinic-laboratory methods (determination of brain-derived neurotrophic factor BDNF, proinflammatory cytokine interleukin-6, C-reactive protein). Results. At the stabilization stage, depression in patients with paranoid schizophrenia occurred in 19% of cases, more frequently in women. Female patients were more severely depressed, which was associated with an increased concentration of C-reactive protein, while negative symptoms predominated in male patients as compared to females. The presence of depression correlates with a lower severity of psychopathological, primarily positive symptoms and with a greater severity of neurocognitive deficit in schizophrenic patients. BDNF level directly correlates with the severity of positive and negative symptoms, and the level of interleukin 6 at the stage of remission formation does not differ from that in healthy individuals. C-reactive protein levels are associated with the characteristics of the course of schizophrenia.

[Prevention of impulsive suicide with antidepressants in outpatients]

Self-poisoning is a common method of suicide, for which various medications are used, including antidepressants. A non-systematic review of Russian-language and English-language publications, by keywords, in the databases: ELibrary.ru, PubMed, Cochrane Database of Systematic Reviews. The purpose of the review was to analyze the literature on new risk factors and methods of their reduction in suicides with self-poisoning with antidepressants. Every fifth (20%) self-poisoning performed with antidepressants. In self-poisoning attempts, one drug used in 55% of cases, and more than one drug was used in 45% of cases. Impulsive suicides account for up to half of all suicide cases. Risk factors for impulsive suicides include the presence of impulsive character traits, female gender, young age, and the use of psychostimulants. The WHO Regional Office for Europe's mhGAP-IG guidelines recommend limiting access to a patient at risk of suicide to a weekly dose of an antidepressant. Preferably, the use of antidepressants from the group of SSRIs in small forms of release.

[Comorbidity of depression and anxiety in clinical practice]

OBJECTIVE

The study was the comparative characterization of depressed patients depending on the presence of comorbid anxiety.

MATERIAL AND METHODS

Thirty patients of the Clinic of neuroses named after acad. I.P. Pavlov Clinic of Neuroses. Comparison groups included 15 patients with comorbid anxiety and depressive disorders and 15 patients with depressive disorder without comorbid anxiety. The groups were comparable by sex and age. Clinical-catamnestic, clinical-therapeutic, and clinical-scale methods, including the Hamilton Depression and Anxiety Scales, were used during the study.

RESULTS

The structure of clinically diagnosed comorbid anxiety and depressive disorders was shown to be characterized by high representation of somato-vegetative symptoms and higher level of depression in comparison to depressive disorder without comorbid anxiety. According to psychometric assessment results, the level of anxiety did not differ in comparison groups, while clinically, according to ICD-10 criteria, anxiety was not diagnosed, indicating a discrepancy between clinical and scale assessments of anxiety and depressive disorders and greater accuracy of clinical and scale assessment of the condition. The effectiveness of combined treatment, including psychotropic therapy and psychotherapy, was lower in patients with comorbidity of anxiety and depression according to parameters of the degree of reduction of psychopathological symptoms, duration of treatment, and quality of remission. The structure of incomplete remission was similar in patients with comorbid anxiety and depressive disorders and depression.

CONCLUSION

The obtained data suggest the expediency of continuous systematization of affective disorders and the need to improve the diagnostic criteria of comorbid anxiety and depressive disorders on the basis of combined clinical and scale assessment.

[Cognitive impairment in remitted patients with bipolar disorder]

OBJECTIVE

To assess the frequency and severity of cognitive impairment as well as its correlations with clinical characteristics in remitted patients with bipolar disorder (BD).

MATERIAL AND METHODS

Eighty-five patients with BD type I (64 patients) and BD type II (21 patients) in remission were examined (average age 36.6±5.7). Affective symptoms were assessed using the Hamilton Depression Rating Scale (HDRS) and Young's Mania Rating Scale (YMRS). Cognitive impairment was assessed using the Brief Neuropsychological Cognitive Examination (BNCE).

RESULTS

Cognitive impairment was revealed in 43.5% of the patients. The frequency and structure of cognitive impairment in patients with BD type I and type II did not differ. The patients with cognitive impairment were characterized by decreased speed of mental processes, decreased working memory and attention deficit. The correlation of the total BNCE score with the age of the patients, duration of the disease, total HDRS and YMRS scores was revealed.

CONCLUSION

The results demonstrate the affective nature of cognitive deficit in the patients. Cognitive impairment in remitted patients with BD is a significant therapeutic target.

[Prevalence, structure, and risk factors for mental disorders in older adults.]

This review focuses on assessing the prevalence and risk factors of mental disorders in older adults in the current era, including the COVID-19 pandemic. A systematic review of the literature in PubMed, Elsevier, Google, using keywords over the past 10 years was conducted. It is shown that data on the prevalence of psychiatric disorders in the elderly population, including in comparison with young adults, diverge significantly. The significant incidence of mental disorders among nursing home residents is highlighted. The relevance of non-psychotic disorders of the depressive and anxiety spectrum in older adults is demonstrated. The difficulty of diagnosing mental disorders associated with somatic pathology as well as cognitive disorders in elderly patients is demonstrated. Risk factors for mental disorders in older adults are socio-demographic as well as economic, psychological and somatic factors. The problem of mental health of the elderly under the COVID-19 pandemic associated with specific risk factors for mental disorders is characterized. The shortage of evidence-based research in the treatment of mental disorders in old age and the urgency to improve the organization of psychiatric care for such patients are noted. Understanding the structure and prevalence of mental disorders among the elderly will allow to optimize the work of the healthcare system.

[Apathy syndrome in depressed patients previously treated with selective serotonin reuptake inhibitors]

This review of literature considers apathy syndrome induced by selective serotonin reuptake inhibitors (SSRI). Epidemiology and etiology of this phenomenon are not clear. Clinical features, diagnosis of apathy, differentiating and correlations between apathy and depression are presented. The possible mechanisms of onset and strategies of therapy of SSRI-induced apathy are discussed. It has been concluded that, despite the clinical evidence of the relationship between apathy and SSRI treatment, evidence-based research is needed.

[The effectiveness and feasibility of preventive interventions for psychoses]

In recent years, prevention of psychosis in people, who have early signs of its development, but do not fully meet the diagnostic criteria of mental disorder, has been an important issue of research in psychiatry. The article considers the approaches to the intervention in high-risk states of psychosis. At present, it can be considered obvious that early intervention in ultra-high-risk (UHR) individuals, most often consisting of cognitive-behavioral therapy and second generation antipsychotics, is safe, effective and cost-effective even in cases, in which psychosis develops because of the increase in the time before it occurs, reduction of the intensity of stress and improvement of outcomes by reducing the duration of untreated psychosis and lowering probability of hospitalization. Comparative studies of the first generation antipsychotics would be appreciated in UHR. The available data make it possible to state that not only the psychosis prevention should be the goal of interventions, but also trying to maintain personal and social functioning of people with UHR. The main purpose of interventions should be considered not to prevent psychosis, but to achieve more favorable outcomes.

[Morphofunctional status of inner ear's cells in case of experimental hearing loss]

AIM

To study ultrastructural changes in stria's vascularis cells of inner ear and determine possible ways of correction.

MATERIAL AND METHODS

The work was carried out on male guinea pigs. After completion of the experiment, stria vascularis of inner ear was subjected to electron microscopic examination.

RESULTS AND DISCUSSION

In the control group (receiving gentamycin sulfate in an ototoxic dose), signs of blood flow disturbance were revealed, as well as ultrastructural changes in stria's vascularis cells (expansion of intercellular space, deformation of organelles, thinning of glycocalyx, blebbing). Also, fragmented cells were found. These changes are characteristics for apoptosis. In experimental group (receiving gentamycin sulfate and melaxen), degenerative changes were less pronounced. An increase of cell's secretory activity was observed.

CONCLUSION

Changes in stria's vascularis cells by using melaxen are less pronounced. Increase of cell's secretory activity in stria vascularis is a compensatory reaction and saves auditory function.

[The role of fraction analysis of ferritin in diagnostic of secondary hemophagocyte syndrome]

The secondary hemophagocytic syndrome is a life-threatening condition characterized by non-specifc manifestations: systemic inflammatory reaction, cytopenia, liver affection, high content of ferritin in blood serum. One of manifestations of secondary hemophagocytic syndrome is decreasing of level of glycated ferritin in blood serum expressed in percentage of total level. The detection of glycated ferritin can be applied for a differentiated diagnosis with cli9nically similar conditions, including septic process. The purpose of study was to determine clinical value of easurement of glycated ferritin for diagnostic and differentiated diagnostic of secondary hemophagocytic syndrome. The analysis was applied to samples of blood serum and clinical data of patients with diagnoses of secondary hemophagocytic syndrome (n=40), severe sepsis (n=24), cytolitic syndrome (n=36) and healthy donors (n=40). The total content of ferritin is established using rbidimetric technique ("BioSystems", Spain). The glycated ferritin was calculated. To determine level of of glycated ferritin the glycated fraction of ferritin was precipitated using concanavalin A, polymerized with sepharose 4B ("GE Healthcare", USA). The normal values of glycated ferritin made up to 78.3%-87.1%. Under secondary hemophagocytic syndrome decreasing of content of glycated ferritin made up to 25.0 ± 18.7% and was signifcantly lower than under sepsis (47.0 ±17.7%, p<0.001) and cytolytic syndrome(63.5% ±18.7%, p<0.001). According the results of ROC-analysis, the area under curve was maximal as compared with other markers of secondary hemophagocytic syndrome, including total ferritin, triglycerides, fbrinogen. At decreasing of level of glycated ferritin lower than 30.4% the applied technique provides clinical sensitivity 69%, specifcity 94.3%, accuracy 86.9% in applying differentiating diagnosis of secondary hemophagocytic syndrome. At calculation of absolute content of non-glycated ferritin it was discovered that its values correlate with concentration of triglycerides, international normalized ratio, aspartataminotransferase, alaninaminotransferase and total bilirubin in patients with secondary hemophagocytic syndrome (p<0.05). Therefore, decreasing of level of glycated ferritin permits to diagnose secondary hemophagocytic syndrome with higher accuracy.

MENTAL DISORDERS AND THEIR INFLUENCE ON THE COMMITMENT TO OBSERVATION IN THE INFECTIONIST IN HIVINFECTED PATIENTS WITH EARLY SYPHILIS

HIV and syphilis have similar epidemiological characteristics which causes a high level of combined infection. Both STDs affect the central nervous system early after infection. Mental disorders occur with a high incidence in HIV-infected patients and patients with syphilis, but data on the effect of combined HIV and syphilis infection on mental disorders are found only in single articles. Objectives. The goal is to study mental disorders and their effect on the commitment to observation in the infectionist in HIV-infected patients with early syphilis. Materials and methods. A comparative study of 148 patients (65 HIV-infected patients with syphilis, 50 patients with syphilis monoinfection, 33 HIV-infected patients, seronegative for syphilis) was carried out. We used clinical, psychopathological, follow-up, psychometric, laboratory and statistical methods of investigation. Results. It was found that mental disorders occur in the majority (83%) of HIV-infected patients with syphilis with the predominance of affective (54%) and addictive (48%) disorders. In HIV-infected patients with early neurosyphilis, psychogenic reactions developed statistically significantly more often than in HIV-infected patients with early syphilis. In contrast, there were no statistically significant differences in the incidence of addictive, affective, personality disorders and mental disorders due to organic brain damage in patients with early neurosyphilis and early syphilis in the case of co-infection with HIV infection. Mental disorders due to organic brain damage had a mixed genesis (including infectious) in all cases and were associated and caused by the already existing HIV infection. HIV-infected patients with syphilis, in general, were characterized by the low commitment to observation in the infectionist which were influenced by the following factors: social maladjustment, drug abuse and criminal activity. Discussion. The frequency of detected mental disorders in the examined HIV-infected patients with syphilis (83,1%) corresponded to the literature on the incidence of mental illness in HIVinfected patients inSt. Petersburg(85,6%), but was higher than the prevalence of mental disorders in patients with syphilis (68%). Given the established influence of neurosyphilis mono-infection on the development of mental disorders due to organic brain damage, it can be concluded that the disease with early neurosyphilis is important in the development of mental disorders of organic genesis. But the weight of this factor is insufficient in case of co-infection with HIV and early neurosyphilis and can only have additional significance in the development of mental disorders and the key factor is HIV-infection action. Mental disorders (addictive disorders and cognitive impairment) adversely affect the commitment to observation in the infectionist of HIV-infected patients with syphilis, therefore timely correction of mental disorders may be one of the factors improving compliance of patients. Conclusions. The study found a minor role of early neurosyphilis (as opposed to HIV infection) on the formation of mental disorders in the case of a combination of these infections. At the same time, it was found that addictive and cognitive symptomatic complexes have a negative impact on the probability of reference to an infectious disease specialist for initiating therapy in HIV-infected patients with syphilis.

[Multi-centre clinical assessment of the Russian language version of the Diagnostic Interview for Psychoses]

OBJECTIVES

The Diagnostic Interview for Psychoses (DIP) was developed to enhance the quality of diagnostic assessment of psychotic disorders. The aim of the study was the adaptation of the Russian language version and evaluation of its validity and reliability.

MATERIAL AND METHODS

Ninety-eight patients with psychotic disorders (89 video recordings) were assessed by 12 interviewers using the Russian version of DIP at 7 clinical sites (in 6 cities of the Russian Federation). DIP ratings on 32 cases of a randomized case sample were made by 9 interviewers and the inter-rater reliability was compared with the researchers' DIP ratings. Overall pairwise agreement and Cohen's kappa were calculated. Diagnostic validity was evaluated on the basis of comparing the researchers' ratings using the Russian version of DIP with the 'gold standard' ratings of the same 62 clinical cases from the Western Australia Family Study Schizophrenia (WAFSS).

RESULTS

The mean duration of the interview was 47±21 minutes. The Kappa statistic demonstrated a significant or almost perfect level of agreement on the majority of DIP items (84.54%) and a significant agreement for the ICD-10 diagnoses generated by the DIP computer diagnostic algorithm (κ=0.68; 95% CI 0.53,0.93). The level of agreement on the researchers' diagnoses was considerably lower (κ=0.31; 95% CI 0.06,0.56). The agreement on affective and positive psychotic symptoms was significantly higher than agreement on negative symptoms (F(2,44)=20.72, p<0.001, η2=0.485). The diagnostic validity of the Russian language version of DIP was confirmed by 73% (45/62) of the Russian DIP diagnoses matching the original WAFSS diagnoses. Among the mismatched diagnoses were 80 cases with a diagnosis of F20 Schizophrenia in the medical documentation compared to the researchers' F20 diagnoses in only 68 patients and in 62 of the DIP computerized diagnostic outputs. The reported level of subjective difficulties experienced when using the DIP was low to moderate.

CONCLUSION

The results of the study confirm the validity and reliability of the Russian version of the DIP for evaluating psychotic disorders. DIP can be recommended for use in education and training, clinical practice and research as an important diagnostic resource.

Analytical and numerical study of travelling waves using the Maxwell-Cattaneo relaxation model extended to reaction-advection-diffusion systems

Within the framework of the Maxwell-Cattaneo relaxation model extended to reaction-diffusion systems with nonlinear advection, travelling wave (TW) solutions are analytically investigated by studying a normalized reaction-telegraph equation in the case of the reaction and advection terms described by quadratic functions. The problem involves two governing parameters: (i) a ratio φ^{2} of the relaxation time in the Maxwell-Cattaneo model to the characteristic time scale of the reaction term, and (ii) the normalized magnitude N of the advection term. By linearizing the equation at the leading edge of the TW, (i) necessary conditions for the existence of TW solutions that are smooth in the entire interval of -∞<ζ<∞ are obtained, (ii) the smooth TW speed is shown to be less than the maximal speed φ^{-1} of the propagation of a substance, (iii) the lowest TW speed as a function of φ and N is determined. If the necessary condition of N>φ-φ^{-1} does not hold, e.g., if the magnitude N of the nonlinear advection is insufficiently high in the case of φ^{2}>1, then, the studied equation admits piecewise smooth TW solutions with sharp leading fronts that propagate at the maximal speed φ^{-1}, with the substance concentration or its spatial derivative jumping at the front. An increase in N can make the solution smooth in the entire spatial domain. Moreover, an explicit TW solution to the considered equation is found provided that N>φ. Subsequently, by invoking a principle of the maximal decay rate of TW solution at its leading edge, relevant TW solutions are selected in a domain of (φ,N) that admits the smooth TWs. Application of this principle to the studied problem yields transition from pulled (propagation speed is controlled by the TW leading edge) to pushed (propagation speed is controlled by the entire TW structure) TW solutions at N=N_{cr}=sqrt[1+φ^{2}], with the pulled (pushed) TW being relevant at smaller (larger) N. An increase in the normalized relaxation time φ^{2} results in increasing N_{cr}, thus promoting the pulled TW solutions. The domains of (φ,N) that admit either the smooth or piecewise smooth TWs are not overlapped and, therefore, the selection problem does not arise for these two types of solutions. All the aforementioned results and, in particular, the maximal-decay-rate principle or appearance of the piecewise smooth TW solutions, are validated by numerically solving the initial boundary value problem for the reaction-telegraph equation with natural initial conditions localized to a bounded spatial region.

[Mechanisms of neurocognitive deficit development in schizophrenia and current treatment approaches]

This article reviews accumulating knowledge on the signs and pathogenesis of cognitive impairment in schizophrenia. The existing data indicate that cognitive disorders, along with positive and negative symptoms, are key symptoms of schizophrenia. Several neurotransmitter systems, including prefrontal dopaminergic transmission, are involved in the pathological process that causes cognitive disorders. GABAergic and glutamatergic pathophysiological models of schizophrenia are discussed. The main subtype of glutamate receptor NMDA receptor hypofunction is one of the causes of cognitive impairment in schizophrenia. Recent studies revealed alterations in gene expression and activity of kynurenine pathway enzymes in patients with schizophrenia. Concentration of kynurenic acid (KYNA) is increased in the prefrontal cortex of schizophrenca patients and correlated with glutamate, dopamine and acetylcholine levels that reflects the pathophysiological mechanism and degree of cognitive impairment. An overview of animal models of schizophrenia, in particular pharmacological models, is presented. Treatment approaches that promote the recovery of cognitive function are described.

[Clinical features of depression in the remission phase of paranoid schizophrenia]

Phenomenological and pathogenetic features of depression developed in the remission phase of paranoid schizophrenia were studied in 75 patients (mean age 44.9±1.22 years). Depression was diagnosed in 58.7% patients. It has been shown that the psychopathological structure of depression was not homogenous and 63.6% cases were atypical. In 25% patients, depressive disorders were psychogenic. Depression concomitant with anxiety disorders was most common. Depression in the phase of remission developed most often in female patients older than 39 years and in male patients younger than 39 years. Cognitive function was not impaired in patients with depression in the remission phase of paranoid schizophrenia.

[Treatment side effects and compliance in patients with depression]

The impact of treatment side-effects on the compliance was studied in 85 depressive patients with different mental disorders - recurrent depressive disorder, postschizophrenic depression and organic affective disorder. The comparison of objective and subjective evaluations of compliance and a comparative analysis of the level of compliance, with its dependence on the treatment specifics, in different diseases were done. A significant role of efficacy and treatment side-effects was identified. The levels of "mental" and "autonomous" side-effects were highest in the treatment of depression: patients with postschizophrenic depression had the highest risk in respect of maintenance treatment; patients with recurrent depressive disorder and organic (affective) disorder were more tolerant to the treatment side-effects and their treatment, including the maintenance therapy, was rather effective. The compliance of all patients with depression was negatively correlated with the severity of side-effects of pharmacotherapy. The greatest side-effects and the lowest level of compliance were observed in the complex treatment with antidepressants and atypical neuroleptics. The effect of side-effects on the compliance was dependent on their severity and subjective tolerability and, to a lesser extent, on the amount of drugs.

[Mental disorders in neurological patients]

Thirty-five patients, 24 men (mean age 50.5 +/- 7.1 years) and 11 women (mean age 54.9 +/- 6.4 years) with chronic vascular insufficiency have been studied using a complex approach which included clinical, psychometric and experimental psychological methods. 25.7% of patients had no symptoms of mental disturbances. Depressive and anxiety disorders were most frequent among mental disorders. The data obtained suggest that pronounced alexithymia and higher intensity of psychological defense may play a role in their genesis.

[Personal and psychological peculiarities of patients with complicated forms of duodenal ulcer, and their influence on the progress of the disease]

In spite of achievements of modern pharmacology, duodenal ulcer (DU) incidence and, what is more, the frequency of complications, are still high. The presented study was carried out in order to evaluate somatic, personal, and psychological peculiarities of patients receiving different types of treatment for duodenal ulcers complicated by hemorrhage or perforation. The patients whose treatment for perforation or hemorrhage was not radical, demonstrated high relapse rate within 4 to 7 years after hospitalization (76% and 50%, respectively). Study of coping revealed high rate of "optimization " mechanism in the emotional sphere of the patients in both groups (56% in the group with perforation, 48%--in the group with hemorrhage). The dominance of this coping mechanism was associated with frequent refusals to receive repeated courses of antiulcer therapy. The study found significant difference in the cognitive and behavioral spheres of coping between the groups. So, "active avoidance" and "retreat" mechanisms predominated in the behavior of hemorrhage patients, which was accompanied by significant reduction in a range of life quality parameters. The obtained data correspond to the results of study of "internal picture" of the disease. Anosognostic attitude to the disease was predominant in perforation group (43.5%), while ergopathic attitude was typical of hemorrhage patients (28.6%). The results suggest that in order to increase the life quality and compliance of patients with DU, medical and rehabilitation measures should be individualized and optimized in accordance with personal and psychological peculiarities of these patients.

[Psychological characteristics and quality of life of patients with chronic kidney diseases]

AIM

To study quality of life of patients with progressive renal pathology at the stage of conservative treatment.

MATERIAL AND METHODS

Quality of life and psychological features were examined in 40 patients with renal diseases (40% males, mean age 48.6 +/- 1.3 years). 77.5% examinees suffered from glomerulonephritis, the rest had diabetic nephropathy.

RESULTS

Personality, behavioral features of the patients were characterized as well as relationships between psychological and somatic factors in development of the disease. Factors influencing quality of life of the above patients are described.

CONCLUSION

Correction of the variables influencing, primarily, the psychological component of the quality of life and, by this component, satisfaction of the patients with their state as a whole may have a good effect on their rehabilitation.

[Combined use of an antihypoxic agent and a B-cell stimulator]

Evaluation of the effect of poviargol on the B cells of mice showed that the drug activity is retained for 21 h upon single injection. An analysis of the refractory period between the B-cell stimulant introduction and the administration of various antihypoxants showed that the most effective treatment is provided by poviargol injection 14 days before and antihypoxant (IEM-1875 preparation) 30 min before the hypoxia model induction. This regime, ensuring the best protection of experimental animals from hypoxia, can be of great importance and value in the prophylaxis of hypoxia in various pathological conditions.

[Psychopathological aspects of pain syndrome in somatoform disorders]

Basing on the data on patients in situation of somatogenic vital threat, essential psychogenic grounds of chronic pain syndrome are shown which negatively affects psychogenic adaptation and rehabilitation, deteriorates quality of life. Addition of antidepressants in routine therapy of somatic patients improves psychic status of patients, reduces pain syndrome, raises effectiveness of rehabilitation.

[The use of atomic emission spectral method for metal detection in environment and biologic materials]

Registering spectrum simultaneously by two devices enables to use atomic emission spectral method for various metals detection in environmental objects and biologic materials.

[Effect of mildronate on life quality of patients with chronic heart failure]

AIM

To study quality of life (QL) of patients with chronic heart failure (CHF) and QL changes resultant from mildronate therapy.

MATERIALS AND METHODS

QL was studied in 30 IHD patients with CHF of NYHA class II-IV, ejection fraction > 45%; 40 IHD patients without CHF and 30 healthy subjects. CHF patients were treated for 30 days with oral mildronate (250 mg 4 times a day). QL was assessed according to the method SF-36 Health Status Survey.

RESULTS

QL in CHF patients is much lower than that of the controls. Objective severity of the disease and subjective satisfaction with life do not always coincide. Mildronate in a dose 1 g/day per os may be beneficial for LQ of CHF patients.

CONCLUSION

It is thought desirable to include QL in analysis of efficiency of managing patients with CHF. SF-36 is a tool able to follow up changes in QL of CHF patients within a short-term treatment period.

[Colonic microenvironment in familial helicobacter infection]

To elucidate the significance of the familial microenvironment in the genesis of Helicobacter infection, a clinical and instrumental investigation was made of 13 families selected by the probands who had digestive diseases associated with H. pylori: gastroduodenitis and duodenal ulcer disease. The occurrence of Helicobacter infection and gastritis in the family members was ascertained to be largely determined by their concurrent residence in the limited area, i.e. by the way of life. The contribution of the "family" factor in antral gastritis, fundal gastritis, and H. pylori infection was 60.0, 40.0, and about 90.0%, respectively. The patients with gastroenterological abnormalities associated with H. pylori were found to show changes in the species-specific and quantitative composition of the colonic microbiocenosis, which were symptomatic and revealed by bacteriological studies in 47.5% of cases and severe in 32.5%. When antihelicobacter therapy is planned, a through treatment of all family members and, if possible, pets should be made. Colonic microbiocenosis should be monitored while treating Helicobacter infection.

[Spectrophotometry of thiols in the blood serum]

The technique of spectrophotometry of thioldisulfide (TDS) ratio in the plasma by methods making use of Ellman's reagent is described. TDS test is regarded as an indicator of the nonspecific resistance of the organism.

[The effect of Recormon therapy on the quality of life of patients on hemodialysis treatment]

Recormon was given to 34 patients on hemodialysis. The drug's effects on quality of life were judged by the results of clinical, laboratory, experimental and psychological dynamic investigations. The highest effect occurred on the therapy month 6-12. Recormon contributed to relief of asthenic and depressive syndromes, to an increase of activity and improvement of well-being, quality of life by Karnofsky scale within the first year of treatment. The dynamics of life quality changes depended on initial psycho-physical condition of the patients, the age, blood pressure, hematocrit. Recormon treatment is associated with the risk of euphoria.

[Pulmonary sling in a patient with anomalous intrathoracic heart displacement (diagnosis and surgical treatment)]

The pulmonary sling is the origin of the left pulmonary artery from the right one, this is a rare abnormality giving a marked clinical picture. The paper presents a case of solely rare combination of the pulmonary of the pulmonary sling with abnormal cardiac placement--dextroversion. A three-year-old child underwent explorative thoracotomy for erroneously diagnosed mediastinal cyst. The thoracotomy revealed a suspected pulmonary sling. To make an accurate diagnosis, a comprehensive study (chest X-ray with esophageal contrasting, tracheobronchography, echocardiography, digital subtraction angiography) was performed. Echocardiography clearly showed the absence of bifurcation of the pulmonary trunk and the origin of the left pulmonary artery from the right one proved to be most informative, as evidenced by colour Doppler mapping. The paper deals with the specific features of surgical treatment of this pathology (the patient was successfully operated on through lateral sternotomy by using extracorporeal circulation). The good functional result of the operation was confirmed by echocardiography and angiography.

[Right aortic arch with a retro-esophageal diverticulum (embryology, anatomy, classification, clinical picture, diagnosis and surgical treatment)]

Five clinical cases (adult patients) are discussed in illustration of the problems of embryology, anatomy, clinical picture, and X-ray and angiographic diagnosis of a rare anomaly, right arch of the aorta (RAA) with retro-esophageal diverticulum of the aorta. According to I. J. Garti's classification, type C RAA was determined in 4 patients and type B RAA in one patient. The vascular ring around the esophagus and trachea was manifested clinically by mild respiratory disorders in 2 and marked dysphagia in all 5 patients, which required surgical correction. Four patients were operated on through a left posterolateral thoracotomy in the fourth-fifth intercostal space, one patient through a bilateral approach with division of the sternum on the level of the third intercostal space. The clinical effect of the operation was good in all patients. The indications for and the tactics of surgical treatment are discussed.

[Vascular ring: classification, clinical aspects, diagnosis and principles of surgical treatment]

In the period between 1978 and 1989 operations were conducted on 56 patients with symptoms of the vascular ring (VR). The diagnosis of the disease was established on grounds of the clinical picture and the results of esophagography and angiocardiography. Double arch of the aorta (DAA) was recognized in 28 patients, anomalies of the right arch of the aorta (RAA) with VR formation in 25, and anomalies of the left arch of the aorta (LAA) in 3 patients. In 29 patients VR was combined with another congenital heart disease (CHD): with Fallot's tetralogy (FT) in 9 patients, with ventricular septal defect (VSD) in 4, and with coarctation of aorta (CA) in one patient. RAA anomalies were combined with FT in 6, with VSD in 4, and with CA in one patient. LAA anomalies were combined with VSD in 3 and with CA in one patient. VR separation was carried out through left anterior posterolateral thoracotomy in 91% of cases and through right thoracotomy in the remaining cases. In combination of VR with CHD the VR was corrected in one stage and then the CHD was corrected under extracorporeal circulation. Combination of RAA with FT allowed anastomosis with the use of a divided proximal stump of the left arch of the aorta to be established in 6 cases. In the group of 56 patients one died from hemorrhage during the operation. The late-term results are good.

[Accumulation of metals in animal body after their administration with drinking water]

It has been stated that separate and simultaneous administration into the animal organism of low doses of copper, lead and nickel with drinking water is accompanied by dose-dependent change in the level of not only administered but also endogenic elements in animals' organs. A supposition has been made that the character of changes in the content of the administered and endogenic metals is associated in the organism of animals with the depth of disturbances in metabolic processes.

[Clinical aspects, diagnosis and indications for surgery in anastomotic aneurysms occurring after reconstructive operations of the thoracic aorta]

Twenty-three patients who had had thoracic aorta surgeries for its coarctation (15 patients), arch kinking (4), traumatic aneurysm (2), non-specific aortoarteritis (1), and Type III dissecting aneurysm (1) were examined and operated on. In addition to conventional examination tools, the authors applied Doppler ultrasonography, volume sphygmography, electrocardiography, esophageal contrast X-ray in three projections, radiopaque angiography. All the surgeries for anastomotic aneurysms required thoracic aorta prosthesis. Eighteen patients had benefits from the surgery.

[Chronic pancreatitis and alcoholism (the need for continuous treatment)]

It was shown that the absence of the alcoholic treatment was responsible for the deterioration of the patient's condition after the operation for chronic pancreatitis of the alcoholic nature and resumption of taking alcohol. Labour rehabilitation of the patients made up as little as 50%. Psychotherapy and psychopharmacotherapy of alcoholism if performed before and after operation under conditions of specialized hospitals resulted in a considerable improvement of the patients' condition, in better labour and social rehabilitation of patients with chronic alcoholic pancreatitis. Labour rehabilitation in such patients made up 80%.