International Journal of Mechanical Engineering and Technology (IJMET)
Volume 10, Issue 03, March 2019, pp. 636-643. Article ID: IJMET_10_03_066
Available online at http://www.iaeme.com/ijmet/issues.asp?JType=IJMET&VType=10&IType=3
ISSN Print: 0976-6340 and ISSN Online: 0976-6359
© IAEME Publication
Scopus Indexed
ENGINEERING SOLUTIONS TO REDUCE
VULNERABILITIES IN BIOTECHNICAL
SYSTEMS
Lyudmila Khasanova
Department of Infectious Diseases, Ryazan State Medical University
Ryazan. Russia.
Kira Ageeva
Department of Infectious Diseases, Ryazan State Medical University
Ryazan. Russia.
Maria Chernobavskaya
Department of Eye and ENT Diseases, Ryazan State Medical University
Ryazan. Russia.
Alexander Kolesnikov
Department of Eye and ENT Diseases, Ryazan State Medical University
Ryazan. Russia.
Vladimir Martynov
Department of Infectious Diseases, Ryazan State Medical University
Ryazan. Russia.
ABSTRACT
To assess the clinical significance of electrophysiological, functional, and
morphometric studies of the optic nerve in patients with serous meningitis during the
recovery period. Congestive fundus changes during the follow-up observation period in
patients with serous meningitis were diagnosed more often 19.4% (6) compared with
changes in the fundus in the acute period 13% (4)). Analysis of perimetric indices
revealed a significant decrease in photosensitivity in 80% (8) patients with serous
meningitis during the recovery period compared with the control group. According to
optical coherence tomography in patients with serous meningitis, significant changes
were detected in 90% (9) patients. According to the data of visual evoked potentials and
electroretinography in patients with serous meningitis, a deterioration in visual
afferentation was detected.
Key words: Serous meningitis, optic nerve damage.
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Lyudmila Khasanova, Kira Ageeva, Maria Chernobavskaya, Alexander Kolesnikov and Vladimir
Martynov
Cite this Article Lyudmila Khasanova, Kira Ageeva, Maria Chernobavskaya,
Alexander Kolesnikov and Vladimir Martynov, Engineering Solutions to Reduce
Vulnerabilities in Biotechnical Systems, International Journal of Mechanical
Engineering and Technology, 10(3), 2019, pp. 636-643.
http://www.iaeme.com/IJMET/issues.asp?JType=IJMET&VType=10&IType=3
1. INTRODUCTION
Currently, more and more researchers are concerned about the course of the infectious process
of complications of such neuroinfections as serous meningitis and meningoencephalitis [1]. The
authors state that it is necessary to apply modern research methods for the topical diagnosis and
control of the functional activity of both the cortical regions of the brain and the cranial nerves
[2]. Of the cranial nerves, the auditory and optic nerves are more often affected [3]. To date,
standard protocols for examining patients with meningitis include a consultation with an oculist
with a mandatory examination of the fundus. Ophthalmoscopy in patients with serous
meningitis in the acute period can be diagnosed with congestive optic nerve discs [4].
Researchers associate these phenomena with an increase in intracranial pressure in the acute
period of serous meningitis [5]. However, dispensary observation of patients with serous
meningitis usually does not include dynamic observation of changes in visual functions.
To date, there are many highly sensitive non-invasive methods for the study of sensory
systems allowing to identify erased and subacute forms of ophthalmic pathology [6]. Such
methods as visual evoked potentials (VEP), Electroretinography (ERG), static, dynamic
perimetry, optical coherence tomography allow to evaluate the electrophysiological, functional
and morphometric state of the optic nerve [7]. The question of reflecting the effects of the
neuroinfectious process (serous meningitis) on the state of the optic nerve prompted us to
conduct the present study. To date, medical organizations have become full-fledged economic
entities [9] - and this fully applies to both commercial clinics [10] and municipal [11] or
departmental [12]. Thus, [13], making a decision on the use of information technologies [14]
in its institution [15] (development [16], delivery [17], implementation [18], maintenance of
software products used [19]), the manager (or person responsible for the informatization of the
MoD [20] one way or another should determine [21] how much money he is willing to spend
and how to justify this amount - justify for himself [22], for the higher management [23], for
the public [24], for the controlling bodies [25], for their employees - for all [26].
The problem of justifying the cost of informatization of MO is also facing IT service
providers [27]. They have to justify the cost of certain types of services provided at negotiations
with potential customers and at the conclusion of contracts [28]. And although contracts are
usually concluded on the basis of tenders held in accordance with 44-FZ — for example, the
price is formed as a result of an auction — this is often not sufficient, and in practice a detailed
justification is required from the service provider [29].
In determining the price of the goods, various methods can be applied, we divide them into
two groups, the first of which is conventionally called comparative, and the second - costly
[30]. With comparative methods on the basis of certain data (comparison with similar ones), a
direct assessment of the price of the planned contract is made (and here we should pay attention
to the need to take into account the dynamics of price changes). At cost - the price is determined
based on the planned costs of the service provider (product) / executor of works.
2. EXPERIMENTAL SETUP
A total of 41 patients were examined, of which 31 patients with serous meningitis of the
moderate course, aged 18 to 60 years old, were treated in the hospital. ON. Semashko "(Head
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Doctor Sorokina L.Yu.) in 2015 -2017 The average age of patients was 31 ± 12.4 years. The
etiology was represented by herpetic (1), enteroviral (7) and unspecified (23).
A traditional ophthalmologic examination of patients (n = 31) was carried out twice: in the
acute period and in the recovery period from 1 to 110 days after discharge from the hospital.
Ophthalmologic examination of patients included the determination of visual acuity in standard
illumination conditions using the Roth apparatus, Sivtsev-Golovin tables without correction
and with correction according to the generally accepted method during the recovery period.
Direct and reverse ophthalmoscopy using a direct ophthalmoscope in conditions of medical
mydriasis.
Evaluation of the state of the visual field was carried out using computed static and kinetic
perimetry (OCTOPUS, Switzerland) in patients with serous meningitis (n = 10) during
convalescence and the following indicators were taken into account: average retinal sensitivity
in decibels (dB) in general and by sector , mean deviation or mean defect (MD) - the total
difference between normal photosensitivity (taking into account age) and retinal
photosensitivity in a given patient in dB, square root of loss depression (variability of defects,
sLV) , being a measure of the difference in the patient's field of view from the normative age
field of view, taking into account the possible variation in the visibility indicators of the tag
from refraction, media transparency, age and other factors and reflecting the severity of focal
perimetric lesions.
Morphometric study of the optic nerve head in patients with serous meningitis during the
recovery period (n = 10) was carried out using an optical coherent tomograph (OCT Stratus,
Germany), the following indicators were evaluated:
1. Vert. Integrated Rim Area (Vol.) - integral volume of the neuroretinal belt (mm³);
2. Horiz. Intergated Rim Width (Area) - integral area of the neuroretinal belt (mm²);
3. Disc Area is the area of the optic nerve disc (mm²);
4. Cup Area - the excavation area (mm²);
5. Rim Area - the area of the neuroretinal belt (mm²);
6. Cup / Disc Area Ratio - the ratio of the area of the optic nerve to the area of excavation
(the proportion of the diameter of the optic nerve is expressed as a decimal fraction, normally
does not exceed 0.46, with age from 30 to 70 years increases by 0.1);
7. Cup / Disc Horiz. Ratio - the ratio of the horizontal diameter of the excavation to the
diameter of the optic nerve head;
8. Cup / Disc Vert. Ratio - the ratio of the vertical diameter of the excavation to the diameter
of the optic nerve head.
9. The conclusion of the doctor on the results of the survey.
Evaluation of the electrophysiological state was carried out using ERG and SGP using the
Neurosoft computer diagnostic complex (Ivanovo, RF). The amplitude and latency parameters
of the ɑ- and β- waves of the electroretinogram were taken into account. As well as the
parameters of visual evoked potentials on the reversible chess pattern with an estimate of
latency N75 (projection of the generation of the convexital area - Brodyman 17th field), P100
(generation in the striatum core - 17-18 fields) and N145 (generation of the projection of the
visual analyzer area, field 18 and 19), and an estimate of the amplitude of the N75-P100 and
P100-N145. ERG and SGP on a reversible chess pattern was performed on 11 patients with
serous meningitis during the observed cult-period.
The comparison was carried out with a control group of patients without neuroinfectious
and ophthalmologic pathology (n = 10), the average age was 24 ± 2.6 years.
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Lyudmila Khasanova, Kira Ageeva, Maria Chernobavskaya, Alexander Kolesnikov and Vladimir
Martynov
3. THEORETICAL ANALYSIS
3.1. Dynamics of fundus fundus changes
Analysis of visual acuity in patients with serous meningitis during convalescence revealed an
average visual acuity of 0.94. In the control group, the average visual acuity is 1.
Analysis of the fundus ophthalmoscopy in patients with serous meningitis during the acute
period revealed signs of stagnation in the fundus in 13% of patients (4) and retinal angiopathy
in 10% (1) of patients. Ophthalmoscopy of the fundus during the recovery period revealed signs
of stagnation in the fundus of 19.4% (6) patients and retinal angiopathy in the same patient as
in the acute period (Figure 1).
Figure 1 Dynamics of fundus fundus changes (direct and reverse ophthalmoscopy) in patients with
serous meningitis (n = 31) in the acute period and the recovery period
Analysis of perimetry indicators in patients with serous meningitis during the recovery
period, in comparison with the control group, showed a decrease in the average sensitivity of
the retina (MS) in 80% (8) patients (Student coefficient p≤0.05) and an increase in the average
deviation (MD) in 70 % (7) patients (Student Ratio p≤0.05) compared with the control group
(Figure 2).
Figure 2 Dynamics of perimetry indicators in patients with serous meningitis during the
recovery period
Analysis of the dynamics of changes in perimetry indicators in patients with serous
meningitis depending on the time of examination of patients (from the 1st day to 110 days after
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discharge from the hospital) revealed a direct correlation between the recovery of the average
photosensitivity index and the duration of the recovery period (Spearman coefficient p≤0.01) .
Analysis of morphometric parameters revealed in patients with serous meningitis during the
recovery period a significant decrease in the area of the neuroretinal girdle (Rim Area) in both
eyes (p≤0.05), an increase in the ratio of the area of the optic nerve disk to the area of excavation
(Cup / Disc Area Ratio) (from the right eyes p≤0.05), an increase in the ratio of the vertical
diameter of the excavation to the diameter of the optic nerve head (Cup / Disc Vert. Ratio)
(from the right eye p≤0.05) and an increase in the area of the optic nerve disk (Disc Area) (from
the left eye p≤0.05) (Figure 3).
Figure 3 Distribution of average morphometric parameters of optical coherence tomography in
patients with serous meningitis in comparison with the control group
3.2. Analysis of the correlation of indicators
Analysis of statistics for different implementations of noise with different Analysis of the
correlation dependence of OCT in patients with serous meningitis on the visual acuity of
patients, and the time of the survey (from 1 to 110 days after discharge from the hospital) did
not reveal any significant correlation dependence (optic nerve excavation was diagnosed in
patients from 1 to 110 days from discharge) from the hospital).
An analysis of the relationship between OCT indicators in the period of convalescence and
examination of the fundus in the acute period in patients with serous meningitis (congestion of
the fundus in the acute period was diagnosed in 4 patients (40%)) revealed a direct correlation
dependence (Spearman test p≤0.05). An analysis of the relationship between OCT indicators in
the period of convalescence and examination of the fundus in the period of recovery in patients
with serous meningitis did not reveal a correlation dependence (none of the patients at the time
of the examination in the period of recovery of congestion in the fundus found in the fundus).
Analysis of the parameters of visual evoked potentials revealed a decrease in the amplitude
of P100-N145 (generation in the striatum cortex and fields 18 and 19) in patients with serous
meningitis compared with the control group. The latency of VEP in patients with serous
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meningitis did not differ from the control group. The dependence of the normalization of
parameters of VEP in patients with serous meningitis on the time of recovery period (from the
moment of discharge from the hospital) was revealed. The dependence of the change in the
parameters of VEP in patients with serous meningitis on the detection of flattening of the
excavation of the optic nerve in OCT was not detected. The dependence of the N75 amplitude
parameters in patients with serous meningitis on stagnation in the fundus during the acute period
of the disease (Spearman coefficient 0.54 p <0.01) and the latency parameters of P100 on
stagnation in the fundus during recovery period (Spearman coefficient 0.3 p <0.05).
Analysis of the parameters of electroretinography in patients with serous meningitis during
the recovery period revealed a significant increase (Student coefficient p≤0.01) of the latent
period of ɑ- and β- waves and decrease in the amplitude of β-wave (Student coefficient p≤0.01)
compared with the control group . The connection of the β-wave latency parameters in patients
with serous meningitis with congestive fundus of the fundus in the acute period (Spearman
coefficient 0.42 p≤0.05) and the latency of the β- and β-waves with congestive fundus of the
eye in the convalescence period. However, a correlation with changes in the morphometric
parameters (OCT) of the optic nerve was not found when studying the parameters of the VEP
and ERG.
Thus, analysis of the traditional ophthalmologic examination of patients with serous
meningitis during the recovery period revealed a lag in stagnation in the fundus (13.4% were
diagnosed more often during the catamnestic period (6) compared with the changes in the
fundus in the acute period 13% (4)) .
Analysis of perimetric indices revealed a significant decrease in photosensitivity in 80% (8)
patients with serous meningitis during the recovery period compared with the control group.
Analysis of OCT indicators in patients with serous meningitis revealed significant changes
in 90% (9) of patients who are not dependent on visual acuity and the duration of the observed
catamnestic period (110 days after discharge from the hospital). The revealed direct correlation
between flattening the excavation of the optic nerve and diagnosed congestion of the fundus in
the acute period in patients with serous meningitis may indicate pathogenesis of changes in the
optic nerve in patients with serous meningitis during convalescence and requires further study
of this issue.
4. RESULTS AND DISCUSSIONS
Analysis of the parameters of visual potentials (generation in the cortex of the striatum and
fields 18 and 19) and electroretinography (potentials from the retina) in patients with serous
meningitis revealed a deterioration in visual afferentation compared with the control group. The
improvement in the parameters of the SGP, ERG and perimetry in the dynamics of the
infectious process indicate that the resulting disturbances (electrophysiological and functional)
are transient in nature and are likely due to cerebral edema [2].
5. CONCLUSION
Modern methods of electrophysiological, functional, and morphometric studies of the optic
nerve are sensitive objective methods for diagnosing lesions of the visual pathways in patients
with serous meningitis during the recovery period. 2. It is necessary to closely monitor the state
of the optic nerve in patients with serous meningitis during the recovery period even in the
absence of subjective complaints of visual impairment in order to early diagnose the effects of
the acute process and timely medical correction.
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