IMPROVEMENT OF METHODS OF TREATMENT OF POISONING WITH PHOSPHORORGANIC COMPOUNDS BY METABOLIC PROTECTORS OF METAPROT AND ETOMERSOL
Vorobieva V.V., Zarubina I.V., Shabanov P.D.
UDC: 615.015:546.18.099
Abstract: Objective.To study the protective effect of metaprot and etomerzol in FOS (carbophos) poisoning. Methods. Carbophos at the dose of 256.4±8.7mg/kg (LD50) was once administered intra-gastrically to white male rats. Blood samples were taken from the abdominal aorta or inferior vena cava of the hexenal-anesthetized animals (125mg/kg) to study the activity of aspartate aminotransferase, alanine aminotransferase, total protein, creatinine, urea nitrogen, potassium and sodium serum, malonic dialdehyde and reduced glutathione 1, 3 and 7 days following poisoning. An integrative assessment of endogenous intoxication was conducted by calculating the leukocyte intoxication index (LII) by the method of Ostrovsky O.V. and Kalf-Kalif Ya.Ya. To ensure pharmacological protection metaprot (25mg/kg) and etomerzol (50mg/kg) were taken orally. Results. Some mechanisms of the protective action of thiobenzimidazole derivatives of metaprot and etomerzol were studied experimentally in the model of acute intoxication with carbophos. Both drugs restored physical exercise tolerance, normalized the activity of aspartate aminotransferase and alanine aminotransferase, and decreased the levels of bilirubin, creatinine and urea nitrogen. The effect on the processes of lipid peroxidation resulted in a decrease of the concentration of malonic dialdehyde and an increase of the levels of reduced glutathione. An elimination of endogenous intoxication was revealed. Conclusion. The antihypoxic, antioxidant, actoprotective, energotropic activities of metaprot and etomerzol were confirmed, providing organo(histo)protective effects. The drugs can be beneficially used by occupational therapists and military doctors in the treatment and rehabilitation of people affected in occupational accidents and other emergency conditions.
Key words: отравления ФОС, карбофос, метапрот, этомерзол, метаболические протекторы, эндогенная интоксикация, FOS poisoning, carbophos, metaprot, etomerzol, metabolic protectors, endogenous intoxication
FEATURES OF MORPHOMETRIC INDICES OF THE PROSTATE GLAND OF THE IMMATURE RATS AFTER IMMUNOSUPPRESSOR ADMINISTRATION
Zakharov A.A.
UDC: 611.6+59.084:615.37
Abstract: The influence of the immunosuppressive state on the structure and functioning of the male reproductive system was established by clinical studies; however, morphological changes in organs under such conditions were not studied, especially in childhood. Objective. To determine experimentally the morphological changes in the prostate gland after systemic immunosuppression. Methods. The experiment was carried out on 60 immature white male rats. Immunosuppression was modeled by administration of cyclophosphamide at a dosage of 1.5 mg/kg body weight intramuscularly for 10 days. Animals that received equivalent volumes of 0.9% sodium chloride solution according to the same scheme were included in the control group. Animals were taken out from experiment under ether anesthesia on 1, 7, 15, 30 and 60 days after discontinuation of the drug administration. Results. Volume-linear parameters of the prostate gland, as well as micromorphometric indices (height, width and volume of epithelial cells, larger and smaller diameters and volume of epithelial cells), were studied. Conclusion. Statistically significant decrease of the organometric and micromorphometric parameters of the gland in comparison with the parameters of the control groups of animals was observed at the early stages of the experiment (1, 7and 15 days), which is caused by the direct inhibitory effect of cyclophosphamide on the biosynthetic apparatus of the cell, as well as the disruption of endocrine regulation of organ morphogenesis and the response to systemic immunosuppression.
Key words: предстательная железа, крысы, циклофосфамид, иммуносупрессия, prostate gland, rats, cyclophosphamide, immunosuppression
INFLUENCE OF NEW SELENIUM CONTAINING METAL COMPLEX COMPOUNDS ON MICE LIFE SPAN IN HYPOXIC HYPOXIA DEVELOPMENT
Yevseyev A.V., Surmenev D.V., Parfenov E.A., Yevseyeva M.A., Sosin D.V.
UDC: 616-001.8:615.355
Abstract: Objective. To test the new selenium containing metal complex (Zn) compounds with the acute hypoxia-hypercapnia method for their antihypoxic effect in experiments on mice. Methods. The screening of antihypoxants in 11 new metal complex selenium containing compounds in experiments on mice placed in acute hypoxia-hypercapnia condition (AH+H) was performed. The condition of AH+H in the animals was developed by placing them in hermetic glass boxes with 0.25 L free volume. Each substance was once introduced intraperitoneally 60 min. before placing the mice in AH+H area at the doses of 10, 25, and 50 mg/kg. The “life span” parameter was used as a criterion of antihypoxic activity. At different steps of the study all animals underwent rectal temperature measuring. Results. The antihypoxic effect was shown in four compounds among 11 (πQ2719, πQ2720, πQ2721 πQ2882). The greatest result in life span was found in substance πQ2721. In this case a direct positive interaction between the doses of substances and the results was revealed - the doses of 10, 25 and 50 mg/kg provide a life span increase by 25.1, 81.7 (р<0.05), and 186.1% (p<0.005) in comparison with the control groups correspondently. The efficiency of etalon substance πQ1983 corresponded to that of πQ2721 but at the dose of 50 mg/kg, it provided a weaker action than the new compound. Conclusion. The result of the test of 11 new metal complex (Zn) substances with selenium in the structure of ligand with the use of acute hypoxia-hypercapnia method revealed πQ2721 antihypoxant activity that was confirmed by a significant mice life span increase when taking 25 and 50 mg/kg and dose-dependent rectal temperature decrease.
Key words: мыши, острая гипоксия, селенсодержащие металлокомплексные соединения, антигипоксанты, mice, acute hypoxia-hypercapnia, selenium containing metal complex compounds, antihypoxants
LEADING MARKERS OF FUNCTIONAL PREPAREDNESS AND HEALTH STATUS OF MULTIATHLONISTS WITH DIFFERENT SKILLS LEVELS
Bruk T.M., Litvin F.B., Osipova N.V., Terekhov P.A., Evseeva M.A.
UDC: 612.1/.8
Abstract: Objective. To identify the most important markers of the functional state of the multiathlonists of different sexes and skills levels. Methods. The study was conducted with the participation of 37 multiathlonists of various qualifications. To evaluate the fitness and health of the athletes, the following methods were used: a variation analysis of the heart rhythm to evaluate the vegetative homeostasis, cardiorespiratory exercise testing, reflecting aerobic capabilities, veloergometric testing, determining aerobic capabilities, assessing the energy activity of various brain structures, and methods of psychodiagnostics. Results. The study identified the leading markers, which reflect the condition of the athlete and closely correlate with each other. In particular, it was shown that highly functional multiathlonists have high functional capabilities due to an increase in the activity of the autonomous circuit of heart rate regulation on the background of improving the work of local regulatory mechanisms in the microcirculation system. As a result, the value of the BMD increases and the level of acidification of the cerebral fluid decreases. In a state of relative rest, the organism of highly skilled multiathlonists economically consumes blood oxygen, as evidenced by high oxygen saturation and low values of tissue oxygen consumption. In athletes of mass ranks, aerobic capacity is limited by low MIC, YHEL and FEV1. Sex differences according to the studied indicators are determined irrespective of the skill level. Conclusion. According to the data received, women involved in all-around athletics have low, compared to men, indicators that reach a statistically significant level of difference. The application of the complex method allows to assess the current state of the athlete, to reveal their functional reserve and the boundaries of the adaptive potential of all-rounders, both in the annual training cycle, and in the competitive periodd.
Key words: легкоатлетическое многоборье, микроциркуляция, вариабельность, аэробная физическая нагрузка, энергообеспечение, athletic all-around, microcirculation, variability, aerobic exercise, energy supply
FIRST EXPERIENCE OF KIDNEY RESECTION IN CYST CANCER IN THE UROLOGY DEPARTMENT OF SMOLENSK STATE MEDICAL UNIVERSITY
Griniov A.V., Safonov D.V., Nikolaev S.I.
UDC: 616.61-006.6-089
Abstract: Objective. To study the expediency of removal of kidney cyst neoplasm of type 3 by Bosniak on the example of the clinical observation we considered. Methods. Patients with kidney cyst neoplasm are subject to treatment which depends on the type and size of the neoplasm. Various variants of intervention are performed: puncture sclerotherapy, open resection of the kidney, laparoscopic resection of the kidney, nephrectomy. In recent years open resections of kidney cyst neoplasm of type 3 by Bosniak, with the size no more 4 sm are widespread. To clarify the diagnosis we performed ultrasound examination and multislice computer tomography of the abdominal cavity and retroperitoneal space. A cystic formation with clear contours with the size of 30×30 mm was revealed in low pole of the left kidney. Results. When lumbothomy was performed, a cyst neoplasm of the low pole of the kidney with a smooth surface and the size of 30 mm was revealed. Resection of the lower pole of the left kidney in thermal ischemia was carried out. Microscopic examination revealed nephrocellular cancer. Conclusion. The method of choice for the treatment of kidney cyst neoplasm of type 3 by Bosniak is kidney resection or nephrectomy.
Key words: киста почки, нефрэктомия, резекция почки, renal cyst, nephrectomy, kidney resection
SOCIOLOGICAL SURVEY OF SURGICAL PROFILE PATIENTS AS A TOOL TO STUDY THE SATISFACTION WIH MEDICAL CARE PROVIDED
Kasapov K.I., Nekrasov A.Yu., Velichko E.A.
UDC: 614.2+617-089
Abstract: Objective. To study the satisfaction with provided medical care in hospital patients of the surgical profile. Methods. The article summarizes the results of the treatment of 432 patients with acute surgical pathology treated in the surgical department from 2014 to 2016. To explore the opinions of patients about their satisfaction with their organization and quality of medical care we developed a questionnaire. The developed "Questionaire of patients undergoing inpatient treatment", contains 40 details that characterize gender, age, time of onset of the disease, medical facility referring the patient, diagnosis, timeliness of appointments, diagnostic, therapeutic procedures, satisfaction with the drug supply of the hospital, work of the hospital in general, etc. Results. According to our research in most cases (87.3%) the patients were satisfied with the work of the hospital as a whole, 11.3% were not satisfied, 1.4% - not quite satisfied. We analyzed the reasons of dissatisfaction of the work of the hospital: 70.5% of cases - lack of essential drugs, 16.4% - inattention of the nurses, 8.2% - lack of methods of examination, 4.9% - careless attitude of the doctors. Conclusion. Integral index of satisfaction with medical care of the population, despite the presence of a component of subjectivity, is highly informative and should be used in assessing the quality of the provision of inpatient surgical care.
Key words: пациенты, социологический опрос, хирургическая помощь, стационар, удовлетворённость, patients, a survey, surgical care, hospital, satisfaction
LATENT (PRE-CLINICAL) STAGE OF THE PERIPHERAL DIABETIC NEUROPATHY: CLINICAL AND ELECTRONEUROMYOGRAPHYC ANALYSIS
Sergeev V.V., Majorova N.G.
UDC: 616.379-008.64-073.7
Abstract: Objective. To examine the functions of the motor, sensory and sympathetic fibers of the peripheral nerves in patients who suffer from type 2 diabetes mellitus without clinical symptoms of the peripheral diabetic neuropathy wth clinical methods and using ENMG-investigation and infomativeness analysis of a number of ENMG-parameters. Methods. 35 patients (18 females and 17 males aged 25 - 60) with type 2 diabetes mellitus without clinical manifestations of the peripheral neuropathy were examined clinically including the diagnosis of the pain and tactile threshold, sense of vibration and using ENMG including the analysis of the parameters of M- wave, S- responses, F-wave and evoked skin sympathetic potential. 140 nervous trunks were examined. Results. It was revealed that in 71,4% of the examined patients ENMG signs of the disorders of sensory and sympathetic fibers of the peripheral nerves in extremities and dysfunction of the terminal motor fibers mainly in lower extremities were presented. It was presented by a decrease of the level of the amplitude of M- and S- responses, increase of their latency, residual latency, and reduction of the speed of conduction into fibers with different functional modality. The question of the expediency of ENMG-investigation as one of the pathways of early diagnostics of the peripheral diabetic neuropathy was discussed. Changes which were established had different character and can be described both as axonopathy and myelinopathy. Conclusion. High frequency of the involvement of the peripheral nervous structures in patients with type 2 diabetes mellitus without neurological manifestations was revealed. Different pathogenetical types of damage were established. It is supposed that ENMG complex investigation is recommended to diagnose the early phase of damage of the PNS structures in the examined group of patients, especially informative are the parameters of the sensory evoked potentials, sympathetic response, residual latency and speed of sensory conduction.
Key words: периферическая диабетическая нейропатия, доклиническая диагностика, электронейромиография, peripheral diabetic neuropathy, pre-clinical diagnosis, electroneuromyographia
COMPARATIVE ANALYSIS OF THE ELEMENTAL STRUCTURE OF THE PLACENTA AT TERM AND PRETERM PREGNANCY
Deev L.A., Solovyeva E.S., Dorosevich A.E., Moiseenkova S.D., Lopashinov P.M., Nevinitsyn E.L., Novikov I.A., Pakhomova N.A.
UDC: 618.36
Abstract: Objective. To conduct a comparative analysis of the content of chemical elements in placenta in the case of term and preterm pregnancies. Methods. The content of some chemical elements was established: carbon (C), nitrogen (N), oxygen (O), calcium (Ca), chlorine (Cl), potassium (K), sodium (Na), phosphorus (P) in 280 biopsies. Tissue extraction was carried out at five points of placenta: chorionic and basal plates in the parenchyma of the placenta, the navel-string part of the placenta and membranes of every tested woman. All mothers’ placenta material was divided into two groups according to the gestational age. The main group consisted of women (n=42) with 24-35 weeks gestational age. The women (n=14) with 39-40 weeks of the gestational age entered the control group. The study of pecularities of the accumulation of the content of certain chemical elements in the placenta biopsy was carried out with the help of a scanning electron microscope SEM EVOLS10 (Zeiss, Germany) with EDS Oxford-X-Max-50 (Oxford, UK) in a low vacuum mode with an accelerating voltage of 20 kV and a current on the sample of 470 pA. The test of Mann-Whitney and the Kruskal-Wallis criterion were used for statistic analysis. Results. It was stated that the structure of general content of some chemical elements: carbon, nitrogen, calcium, chlorine, potassium, sodium, phosphorus in the placenta at term and preterm pregnancies is the same. It was noted that general content of oxygen in the main group was considerably smaller than that in the control group (p=0,006). The content of the studied chemical elements was different in the groups of study and depended on the point of material intake. At preterm pregnancy the content of chemical elements in the navel-string part of placenta statistically differed from other points of material intake. Conclusion. The stated regularities in accumulation of some chemical elements in the placenta at a preterm pregnancy can serve as an orientation for the comparison with the mothers’ placenta of preterm babies with retinopathy of prematurity.
Key words: биоптат, плацента, химические элементы, biopsy, placenta, some of the chemical elements
ADRENAL GLAND MYELOLIPOMA: PATHOLOGICAL ANATOMY OF RARE TUMORS
Kozlov D.V., Molchanov V.V.
UDC: 611.451-616-006
Abstract: Objective. To describe the observation of myelolipoma (ML) of the adrenal gland in a woman aged 69 with the results of histopathological examination of the surgical material, which was a rounded, homogeneous soft-elastic growth of 104×108×105 mm in size, of light yellow color, covered with a thin transparent capsule. Methods. Fragments removed during the surgery of the tumor were fixed in 10% aqueous neutral formalin solution for a day and were subjected to paraffin transaction. Dewaxed histological sections were stained with hematoxylin and eosin, fat - with Sudan III and picrofuxin by van Gieson. Results. In histological specimens we revealed a combination of mature adipose tissue with few variable in size lipocytes, and foci of hematopoietic tissue, which corresponds to benign tumors of the adrenal gland without hormonal activity. Conclusions. It is concluded that the investigated tumor is incidentaloma, that account for 0.2% of all hormonally inactive tumors of the adrenal gland.
Key words: миелолипома, надпочечник, myelolipoma, adrenal
CLINICAL AND PSYCHOLOGICAL OPPORTUNITIES FOR EARLY RECOGNITION OF BIPOLAR AFFECTIVE DISORDER TYPE II
Osipova N.N., Gaponova V.N., Turanskij M.M., Bardenshtein L.M.
UDC: 616.89-008.44-07
Abstract: Objective. To clear up the risk factors and opportunities for early diagnosis of bipolar affective disorder type II. Methods. For the study of 100 students aged 18 to 20 years, psychodiagnostic and screening tests were used: Bipolar Spectrum Diagnostic Scale, R. Pies; Mood Disorder Questionnaire (MDQ); Hypomania Checklist (HCL-32); Reduced Multiphasic Personality Inventory (Mini-Mult), Kincannon J.C, Zaitsev V.P., Kozulya V.N.; Zung Self-Rating Depression Scale. Results. Moderate correlation dependencies between personality traits ("Pa" scales - paranoia, "D" -depression, "Ma" - hypomania) and a tendency to develop an affective pathology of the bipolar spectrum were revealed. Conclusions. Diagnostics of premorbid personality characteristics in combination with the use of screening methods allowed to reveal moderate correlation dependencies between the paranoia personality traits and a tendency to affective pathology of the bipolar spectrum, which in our opinion is associated with a tendency to "stuck" affect, rigidity of the emotional sphere, long fixation on negative experiences. The increased indices on the scale of hypomania, which are in moderate dependence with values on the scales MDQ and HCL-32, require additional attention for the purpose of differential diagnosis with hypomaniacal phases of bipolar affective disorder.
Key words: биполярное аффективное расстройство, преморбидные особенности личности, персонализированная психиатрия, bipolar affective disorder, premorbid features of personality, personalized psychiatry
DIAGNOSIS OF AND CHOICE OF ERADICATION THERAPY: RESULTS OF QUESTIONNAIRE OF DOCTORS IN SMOLENSK
Dehnich N.N., Molotkova S.A.
UDC: 616.33-002.44(470.332)+615.015
Abstract: Objective. To assess the knowledge of medical specialists on the diagnosis and choice of eradication therapy of H. pylori . Methods. 79 physicians from Smolensk were anonymously interviewed in 2016-2017. Results. Among interviewed respondents, 91.2% and 88.6% indicated that they performed the diagnostic test for H. pylori in peptic ulcer disease and chronic gastritis; in patients with GERD it was 63%, MALT-lymphoma - 39%, gastric cancer - 29%, NSAID-gastropathy - 26.5%, autoimmune thrombocytopenia - 16.5% of the respondents, respectively. For the primary diagnosis of infection, doctors mainly used invasive methods: histological method (77.2%), rapid urease test (18.9%). Serological method, stool antigen test and C-urea breath test was preferred by 36.7%, 25.3% and 24% of the respondents. Of the 77 prescriptions of anti- Helicobacter pylori therapy of the first line, 45.5% of the respondents indicated fully adequate therapy, consistent with the recommendations of the Russian Gastroenterological Association (RGA). Among these schemes, the respondents mainly referred to standard triple therapy based on clarithromycin, including a combination with bismuth. 10.4% and 9% of the respondents, respectively, used adequate non-invasive methods to control the effectiveness of eradication of H. pylori, such as the determination of antigen in the feces and breath test. Inadequate control using the serological method and rapid urease test was recommended by 16.9% and 5.2% of the interviewed doctors, respectively. When selecting the components of anti- Helicobacter therapy of the second-line, 26.2% of the schemes corresponded to the recommendations of the RGA. 21.4% doctors recommended bismuth quadruple therapy, triple therapy based on levofloxacin - 4.8%. Conclusion. In general, doctors of Smolensk are informed of the indications, methods of primary diagnosis of H. pylori and the composition of first-line therapy. However, additional educational measures are required to inform doctors about the need for and methods of monitoring the effectiveness of H. pylori eradication, the composition and dosage of second-line therapy.
Key words: Helicobacter pylori, антигеликобактерная терапия, диагностика, Helicobacter pylori, eradication therapy, diagnostics
PREMORBID TRAUMATIC FACTORS AND POSSIBLE SOCIO-PSYCHOLOGICAL SCENARIOS OF PUPILS OF SOCIAL PROTECTION INSTITUTIONS
Ulasen T.V.
UDC: 615.851:616-053.2
Abstract: Objective. To study the features of the "premorbid" psychotraumatic factors and their factor connection with the experienced subjective emotional deficit among pupils of the socioprotective institutions, that will allow to form a differentiated approach to the development of mental traumas in the conditions of deprivational experience, making it possible to construct an individual psychotherapeutic program in each specific case. Methods. Clinico-psychological manifestations of traumatic experiences and features of premorbid psychotraumatic factors were identified using the following tests: a semi-structured interview (PIVPPSD) developed by A.I. Shchepina and A.V.Makarchuk (2004), the improved Toronto Alexithymia Scale (Toronto Alexithymia Scale or TAS-20) to determine the quantitative evaluation of particular manifestations of alexithymia, a questionnaire on the aggressiveness of Bassa-Darka and the study of cases of deviant behavior based on the analysis of individual cards of pupils of a socioprotective institution with the identification of three types of deviations: mercenary, aggressive and socially-passive. Results. In connection with the socio-psychological functioning determined by pupils of socio-protective institutions, an attempt was made to study the factor linkage of the "aggressiveness index" and the "hostility index" with previously isolated traumatic events. In the group of orphans, there is one significant link between the factor of sexual harassment and the "aggressiveness index," which can be interpreted as meaningful and moderate according to the Cheddock scale. In Group II statistically significant links between the "aggressiveness index" / "hostility index" and premorbid traumatic factors were not defined. At the same time, in the course of the previous statistical analysis, a significant difference was found between the group of orphans (group I) and adolescents raised in the blood family (group II) in determining the criterion of "subjective emotional deficiency" (p <0.002). In this regard, attention is focused on studying the links of this factor with traumatic events - physical and psychological violence, sexual harassment, difficult financial situation, death of the parent / parents, dependent behavior of parents (alcoholism, drug addiction). In orphans (social and true), this analysis was not carried out between the symptoms because the symptom of "subjective emotional deficiency" in the first group does not vary. The adolescents of group II, on the contrary, revealed significant statistical links between the factors of "subjective emotional deficiency" and the following traumatic events: the factor "physical violence" (Cheddock's connection classified as moderate); factor "neglect" (communication on the Cheddock scale classified as notable); factor "dependent behavior of parents" (communication on the Cheddock scale classified as notable). Conclusion. The conclusion is made that the study of the features of the "premorbid" psychotraumatic factors in orphans and teenagers raised in families, along with other data obtained, will make it possible to develop a differentiated approach to providing clinical and psychological assistance to pupils of socio-protective institutions, taking into account belonging to the group and developing a model assessing the effectiveness of ongoing activities. Attention is focused on the fact that the study of situations of violence and related traumatic experiences against the background of explicit deprivation can be useful in studying the consequences and predicting the development of the phenomenon of "hidden deprivation" widely represented in our time.
Key words: преморбидные травматические ситуации, факторы насилия, воспитанники социозащитного учреждения, «жизненные сценарии», premorbid traumatic situations, factors of violence, pupils of a socioprotective institution, "life scenarios"
SELF-TREATMENT OF PERIODONTAL AND ORAL MUCOSA DISEASES
Tsepov L.M., Nikolaev A.I., Galanova T.A., Levchenkova N.S., Petrova E.V., Turgeneva L.B., Nesterova M.M., Tcherbakova T.E., Antonova A.N.
UDC: 316.48(075.8)
Abstract: Objective. To investigate the prevalence of self-use of drugs with the diseases of gums, oral mucosa, lips, tongue of adults in the city of Smolensk and the region, and assessment of consumer attitudes to self-treatment. Methods. Research was conducted with the involvement of people over the age of 18. In the survey each respondent was issued a unique registration card which was filled in either directly by the interviewee (for example, in a survey of 3-5 years students) or the coordinators of the study (co-authors), according to the study participant. Results. The reason of self-treatment were in 55% of cases periodontal disease (gingivitis, periodontitis) and oral mucosa diseases, tongue, and lips (40%) and only in 5% of the respondents - injury of these organs and tissues. More than half of the respondents obtained information about medicines from the dentists; a considerable part of the respondents got it from the Internet and the mass media. Every fifth respondent received it from relatives and friends. The most frequent reasons for self-treatment were problems with the periodontium, oral mucosa, lips and tongue. Conclusion. The research shows that the situation with self-treatment can be complicated in connection with reduction of disease prevention at the population and increase of the probability of complications.
Key words: самолечение, распространенность, причины, выбор препаратов, оценка эффективности, болезни десен, заболевания слизистой оболочки рта, губ, языка, self-treatment, prevalence, causes, choice of medicine, assessment of efficiency, periodontal diseases, oral mucosa diseases, lips and tongue diseases
SATISFACTION WITH DENTAL CARE OF PATIENTS WITH TEETH, PERIODONTAL AND ORAL MUCOSA DISEASES
Tsepov L.M., Nikolaev A.I., Petrova E.V., Scherbakova T.Ye., Nesterova M.M., Antonova A.N., Dmitrieva O.N., Antsupova O.A., Starostenkova A.A.
UDC: 614.2:616-06
Abstract: Objective. To analyze satisfaction with dental care of patients with the diseases of teeth, periodontal and oral mucosa diseases. Methods. The research group consisted of 104 patients of Smolensk dental clinic (aged 18-55 years). The questionnaire and analysis of impersonal data were used. The study included clarification of the satisfaction of patients with medical care received in the hospital. Results. 100% of patients were satisfied with the dentist (kindness, politeness). 99/1% were also satisfied with the competence of a dentist. The surveyed patients submitted a number of proposals that may help solve not only medico-social problems of the criteria of quality, but also lawful, logistical, ethical and economic challenges, balancing patient satisfaction with dental care. Conclusions. Satisfaction with medical care of patients with dental diseases depends on a number of factors: the duration of dentist admission, effectiveness of treatment, patient participation in decision-making, opportunities for learning self-control and self-help, relationship with the doctor. All of these factors can be taken into account in the work of the dental department of the hospital, which is able to ensure the coordination and integration of various types of dental care, as well as uninterrupted treatment of patients by prosthodontist, dental surgeon and dental therapist.
Key words: характеристика качества медицинской помощи, критерии качества, своевременность, стоматологические заболевания, удовлетворенность пациентов, quality of medical care, criteria of quality, timeliness, dental disease, patient satisfaction
ASSESSMENT AND CORRECTION OF SPEECH FUNCTION OF A PATIENT DURING THE COURSE OF ADAPTATION TO THE FULL REMOVABLE DENTURES
Pozhilova E.V., Ratnikova S.P., Abolmasov N.N., Azarova N.A., Kovalkova E.A.
UDC: 616.314-089.28:612.789
Abstract: Objective. Assessment of speech function of patients with total loss of teeth at stages of adaptation to full removable dentures. Methods. 20 patients, at the age of 55-82 years, from them 12 women and 8 men which has for the first time made full removable dentures participated in a research. Assessment of speech function was carried out by the Magnera method before orthopedic treatment, with full removable dentures in day of imposing, in a week, in 1 month with the imposed dentures and in 1 month without dentures. Along with conducting speech tests correction of basis of an removable dentures, by his grinding in the places corresponding to zones of formation of the main sound phonemes was carried out. Results. The lowest indicators of phonetic adaptation have been noted at a stage of imposing of full removable dentures. Correction of basis of dentures with simultaneous conducting speech tests has allowed to achieve improvement of speech function of patients with each subsequent stage of adaptation to full removable artificial limbs. But, at the same time, any excellent result of assessment of speech function hasn't been received that, perhaps, speaks about insufficient amount of time for completion of process of phonetic adaptation to removable dentures. Conclusion. Control and correction of speech function of the patient at different stages of adaptation allows to increase quality of orthopedic treatment by full removable dentures. This method of assessment of speech function of the patient with total absence of teeth can be recommended to practical doctors of dental policlinics of any level.
Key words: полные съемные протезы, адаптация, речевая функция, full removable dentures, adaptation, speech function
SURGICAL APPROACHES TO THE MEDIОBASAL REGION OF THE TEMPORAL LOBE
Timoshenkov A.V., Sitnikov A.R., Grigoryan Yu.A., Maslova N.N.
UDC: 616.831-089
Abstract: Objective. To highlight the modern surgical approaches to mediobasal temporal region. Methods. For this research, various domestic and foreign literature on the relevant topic was collected and analyzed. Results. The article represents the literature review devoted to the anatomy and pathology of this region, as well as the advantages and disadvantages of various surgical approaches. Conclusion. The deep and hidden location of the mediobasal temporal region surrounded by basal cisterns, vascular and neural structures, determines the complexity of the choice of surgical approach to this area. Recent publications highlighting the anatomy and surgical approaches to the mediobasal temporal region, nevertheless, contain many controversies regarding the choice of surgical approach to the medial structures of the temporal lobe.
Key words: медио-базальный отдел височной доли, хирургический доступ, эпилепсия, mediobasal temporal region, surgical approach, epilepsy
AUTISM SPECTRUM DISORDER COMORBIDITY WITH EPILEPSY
Skorobogatova V.A., Maslova N.N.
UDC: 616.896-036.22.312(045)
Abstract: Objective. To analyze the main theoretical concepts of autism spectrum disorder (ASD) comorbidity with epilepsy. To identify the main external and internal factors influencing the possible links between autism and epilepsy, to analyze the mutual influence of two diseases on the disruption of cognitive development and the clinical outcomes. Methodology. For this research, various foreign and domestic literature on relevant topic was observed and analyzed. Results. The study revealed the common development paths of both diseases. The genetic preconditions of either ASD or epilepsy were discussed as well. The effectiveness of treatment with antiepileptic drugs (AEDs) was evaluated. The common regularities influencing the clinical course of both diseases and their common EEG-features were identified. Conclusion. The conclusion of all genetic studies is that there is a great diversity and heterogeneity of genetic loci which may be responsible for development of similar phenotypes. Considering the acknowledged connection between the lower IQ level and the severity of de novo mutation, we can suggest that the disruption of cortical neuron circuits will be more profound in the presence of epilepsy and ASD in one patient. From the point of treatment perspective, the fact that the different genetic mutations are associated with certain neuron functions and cortical interneurons dysfunction can be useful for determination of future treatment strategy. The modern studies do not answer the question whether the treatment of epilepsy might improve the cognitive and behavioral outcomes for the patients with comorbid ASD as the EEG-normalization and the absence of pathological patterns are not always associated with the good clinical dynamics.
Key words: расстройства аутистического спектра, эпилепсия, генетические заболевания, ЭЭГ, туберозный склероз, нейрофиброматоз, эпилептическая энцефалопатия, autism spectrum disorders, epilepsy, genetic disorders, EEG, tuberous sclerosis, neurofibromatosis, epileptic encephalopathy
PROGRAM OF IMPORT SUBSTITUTION IN THE FIELD OF DRUG SUPPLY OF THE POPULATION IN THE RUSSIAN FEDERATION
Danilov A.I., Asriev S.A., Lavrova E.V.
UDC: 614.27 (470)
Abstract: Objective. To study the import substitution program in the field of provision of medicines to the population of the Russian Federation and development of recommendations about its improvement. Methods. During the study the annual report on the results of the pharmaceutical market for 2016 prepared by DSM group was analyzed and opinions of leading experts in the field of provision of medicines were studied. Results. The volume of the pharmaceutical market in the Russian Federation in the prices of the end consumer in 2016 taking into account a segment of parapharmaceutics was 1344 billion rubles that is 7% higher than in 2015. The commercial segment of medicines is the driver of the development of the pharmaceutical market. The majority of new medicines is produced by foreign manufacturers. Nevertheless, the Russian companies in 2016 brought more than 120 new brands to the market and 10 of them entered the TOP-20 new trade names in value terms. Two domestic manufacturers - Otisifarm and Pharmstandard were included in the TOP-20. Conclusions. During the study of the pharmaceutical market of the Russian Federation the conclusion was drawn that now the domestic pharmaceutical industry is "catching up" in relation to the world branch and has a series of challenges: disability to satisfy the requirements of the Russian pharmaceutical LS market on the main pharmacotherapeutical groups; high dependence of domestic manufacturers on import substances; presence in the portfolio of domestic manufacturers of a large number of outdated, and also low-profitable medicines; disadvantage of investments into scientific research of the program and small quantity of innovative medicines; wear of production resources and difficulty of transition of domestic manufacturers to the GMP standards; high share of the forged medicines in the Russian pharmaceutical market, undermining trust to domestic manufacturers; deficiency of highly qualified personnel in domestic pharmaceutical branch. For the purpose of ensuring medicinal independence of the Russian Federation, is is recommended to form the strategic list of medicines, providing a full cycle of their production in the territory of the Russian Federation and to improve the mechanism of government purchase within this list, including the system of preliminary purchases.
Key words: импортозамещение, лекарственные средства, фармацевтический рынок, лекарственное страхование, import substitution, medicines, pharmaceutical market, prescription drug insurance
ANALYSIS OF MEDICINAL MAINTENANCE OF PREFERENTIAL CATEGORIES OF CITIZENS ON THE EXAMPLE OF THE SMOLENSK REGION
Kisilyova A.N., Lopashinov P.M., Narkevich I.A., Nevinitsyn E.L., Evseev A.V.
UDC: 615.11
Abstract: Objective. To study the peculiarities of preferential drug supply at the regional level (on the example of the Smolensk region), as well as to offer ways of its optimization. Methods. In the experiment, we used analytical, logical and theoretical methods as well as content analysis of reference literature. The analysis of the items of drugs of different pharmacological groups, registered and allowed for circulation in the Russian Federation was performed. Results. The findings allow to study in detail the situation in individual parameters of preferential drug supply during in the reported period. Analyzing the data of COMIAC, as an example, the system of personified registration shows the index for the maximum subsidy 25 148 and its cost of 12494564 RUB. The indicator "the average cost of a preferential prescription" is monitored by the Department of health and Roszdravnadzor, both at the regional level and at the level of the Russian Federation, as a factor characterizing the level of provision with drugs of a certain price range. Conclusion. Department of the Smolensk region on public health regularly carries out monitoring of the situation on provision to citizens with the right to receive state social assistance, medicines and medical products. The conducted research gives the opportunity to make a planned economic calculation on the cost of treatment for each patient.
Key words: льготное лекарственное обеспечение, средняя стоимость рецепта, заболеваемость, preferential provision of medicines, the average cost of a prescription, the incidence
THE ROLE OF D.N. ZBANKOV IN THE ORGANIZATION OF SANITARY INSPECTION OF THE INDUSTRIAL ENTERPRISES OF THE SMOLENSK PROVINCE
Rogutskiy S.V., Avchinnikov A.V., Sidorenkova L.M., Avchinnikova S.O., Kostukov A.A.
UDC: 614.255.3
Abstract: Objective. To study the activities of a country doctor D. N. Zbankov in sanitary investigation of factories and plants in the Smolensk province. Methods. The object of research was the paper "Sanitary investigation of factories and plants of the Smolensk province", prepared by D. N. Zhbankov in the late XIX century. Results. It was established that in the course of inspection of factories and plants in the Smolensk province, doctor D.N. Zhbankov showed the real sanitary condition of industrial enterprises and proved the influence of harmful production factors on the health of workers. A large part of the publication is devoted to the presentation of the results of the survey of selected industries, occupational hazards of working professions, health and living conditions of workers. The paper describes the professional composition of workers; including working children, their age and sex composition, marital status, characteristics of work experience, indicates the caste composition of workers. The papers also contains the list of diseases identified during a visual examination of the workers. Conclusion. The results of the study allow to conclude that in fact, in the work of D. N. Zbankov fundamentals of the system of socio-hygienic monitoring are presented. For modern specialists of sanitary service of our country this work is a model of large-scale implementation of the study, an integrated approach to addressing sanitary and epidemiological problems.
Key words: санитарное обследование, фабрики и заводы, Смоленская губерния, sanitary survey, factories and plants, Smolensk province
THE GOLDEN FUND OF PHARMACOLOGY (TO THE 120TH ANNIVERSARY OF THE DISCOVERY OF ACETYLSALICYLIC ACID)
Danilov A.I., Litvinov A.V.
UDC: 615.2
Abstract: Objective. To provide information on opening and use in clinical practice of acetylsalicylic acid. Methods. An analysis of domestic and foreign sources of information was carried out. History of the discovery and application of acetylsalicylic acid, the conclusions about the role of history and significance in modern medicine are highlighted. Results. Acetylsalicylic acid opens the era of chemotherapy drugs as the first products manufactured at first in the laboratory and then in the factory. It was first derived from two plants: white willow and meadowsweet. Its chemical formula is almost identical to the original compound - salicylal and needed only a little work. Acetylsalicylic acid irreversibly acetilizes the hydroxyl group in the molecule cyclooxygenase, which catalyzes the biosynthesis of prostaglandins and other eicosanoids. Currently, it is widely used as a drug with a pronounced anti-inflammatory, antipyretic and analgesic effects as well as antiplatelet agent in a complex therapy of cardiovascular pathology. Conclusions. Acetylsalicylic acid currently continues to be among the drugs most often prescribed by physicians all over the world. In Russia, there are more than 100 different drugs, including acetylsalicylic acid. Acetylsalicylic acid is usually well tolerated, but sometimes its application is accompanied by the development of adverse drug reactions, frequency and severity of which are primarily associated with the dose of the drug. The greatest danger is cerebral (hemorrhagic stroke or intracranial hemorrhage) complications and gastrointestinal bleeding. To reduce the risk of development of gastrotoxicity enteric-coated and buffered forms of aspirin are used. Sales of acetylsalicylic acid in the world increased significantly in the last decade of the twentieth century and retain today a strong position with regard to its wide use as a component of a prophylactic and therapeutic agent in cardiovascular pathology as the gold standard of the antithrombotic therapy. Its efficacy and safety are confirmed by numerous controlled studies at the global level.
Key words: история открытия, клиническая эффективность, ацетилсалициловая кислота, istory of discovery, clinical efficacy, acetylsalicylic acid
TECHNICAL DIFFICULTIES AND PERIOPERATIVE COMPLICATIONS OF MINIMALLY INVASIVE SURGERY IN ELDERLY PATIENTS WITH THORACO-LUMBAR VERTEBRAL COMPRESSION FRACTURES
Abakirov M.D., Abdrakhmanov R.R., Borisov Ja.A., Mader A.E., Svetlov D.V.
UDC: 617-089.844
Abstract: Objective. To investigate complications and technical difficulties that are associated with minimally invasive surgery in elderly patients with vertebral compression fractures. Methods. 88 patient above 60 years of age sustaining thoraco-lumbar compression fractures were treated surgically and examined. 56 patients underwent percutaneous vertebroplasty or ballon kyphoplasty, 10 patients - minimally invasive pedicle screw fixation, 22 - combined technique. Surgical technique, short-term and mid-term results and complications were evaluated. Results. Vertebroplasty and kyphoplasty were associated with preliminary cement polymerization in 3.6% of cases (2/56), cement leakage in 26.8% (15/56), which was asymptomatic in majority of cases except 1 miocardial infarction. In minimally invasive pedicle screw fixation 2 cases of anterior displacement of guide wire occurred without any visceral injury. 1 pedicle screw was malpositioned causing radiculopathy. Comorbidity exacerbation in elderly patients occurred in 3.4% cases; 5.4% of patients sustained adjacent level fractures. Overall, 90.4% of positive results were achieved. Conclusions. To avoid complications meticulous preoperative planning, clinical evaluation and accurate performance of surgical technique is recommended.
Key words: минимально инвазивная транспедикулярная фиксация, вертебропластика, кифопластика, компрессионный перелом, остеопороз, vertebroplasty, kyphoplasty, minimally invasive pedicle screw fixation, vertebral compression fractures
SUBSTITUTION OF POSTRESECTION BONE DEFECTS WITH NANOSTRUCTURED CARBON IMPLANTS IN TUMORAL OR TUMOR-LIKE DIEASES OF THE SKELETON
Snetkov A.I., Batrakov S.Yu., Frantov A.R., Balametov S.G.
UDC: 617-089:616-7
Abstract: Objective. To evaluate the results of the application of nanostructured carbon implants (NCI) to replace postresection bone defects at tumoral and tumor-like diseases of the skeleton in clinical practice with its isolated use and in combination with allobone. Methods. 46 patient aged 12 to 18 were operated in the department of "Pediatric bone pathology and teenage orthopedics" of FSBI «Central research institute of traumatology and orthopaedics of N.N. Priorov». Carbon nanostructured implants were used isolatedly and in the combination with allobone. Results. The results were evaluated both by the clinical picture and by the radiation methods of diagnosis: X-ray, computed tomography. In any case, fresh accretions in the area of the implant-maternal bone zone were not revealed, which indicated the absence of a peristaltic reaction in the implantation zone of the NCI. Analyzing the results of the application of UNI in clinical practice, the absence of implant rejection and local inflammatory reactions in the early postoperative period were found. Conclusion. The use of NCI in combination with allobone made the process of osseointegration increase in comparison with the isolated application. During the late observation periods, we observed a significant increase in osseointegration in the NCI.
Key words: углеродный наноструктурный имплантат, пострезекционный дефект, аллотрансплантаты, carbon nanostructured implant, postresection defect, alloimplants
HETEROTOPIC OSSIFICATION OF LARGE JOINTS, AS A COMPLICATION OF INJURIES AND DISEASES OF THE CENTRAL NERVOUS SYSTEM (REVIEW)
Kesyan G.A., Urazgildeev R.Z., Dan I.M., Arsenyev I.G., Karapetyan G.S.
UDC: 617.51-001.4-06
Abstract: The article represents a short review of modern and fundamental literature sources representing the issue of heterotopic ossification of patients with the pathology of the central nervous system. It also describes the current problematic issues of etiology, diagnosis, prophylaxis and therapy of this pathology orthopedic consequences.
Key words: гетеротопическая оссификация, патология суставов, травмы и заболевания нервной системы, heterotopic ossification, pathology of joints, neurological injuries and diseases
DIFFERENTIATED APPROACH TO SURGICAL TREATMENT OF THE CONSEQUENCES OF SEVERE INJURY OF THE ELBOW JOINT
Kesyan G.A., Arsenyev I.G., Urazgildeev R.Z., Karapetyan G.S.
UDC: 616.727.3-001-08
Abstract: Objective. To improve results of treatment of patients with consequences of injuries of the elbow joint by a differentiated approach to the choice of tactics and method of surgical intervention. Metods. From 2008 to 2017 the study included 108 patients with consequences of injuries of the elbow. In 70 cases arthrolysis of the elbow was carried out: with an open method - in 52 patients, with arthroscopic techniques - in 18 cases. In 24 cases for the development of movements and prevention of instability, the hinged-distraction Oganesyan apparatus was used while 45 patients were operated without the use of the apparatus. 38 patients underwent arthroplasty of the elbow joint. According to the method of surgical intervention the patients were divided into 5 gropus: 1st group (36 patients) - open arthrolysis without the imposition of the hinged-distraction Oganesyan apparatus; 2-nd group - (16 patients) open arthrolysis with the imposition of the hinged-distraction Oganesyan apparatus; 3rd group (10 observations) - arthroscopic arthrolysis without the imposition of the hinged-distraction Oganesyan apparatus; 4th group (8 patients) - arthroscopic arthrolysis with the imposition of the hinged-distraction Oganesyan apparatus; 5th group (38 patients) - arthroplasty of the elbow joint. Results. The analysis (up to 9 years following surgery) showed that, in most cases a good result was achieved. The highest percentage of complications (29%) was in the 5th group of patients. The most frequently developed complications were suppurative-inflammatory complications (13%) and aseptic instability of the endoprosthesis components (10.5%). Conclusion. The choice of the method of surgical treatment of the consequences of severe injuries of the elbow joint depends on the degree of destruction of the bone, joint and soft-tissue structures, and lack of range of motion in the joint. Strict indications for arthroplasty are required in these patients due to a large number of inflammatory complications and instability.
Key words: локтевой сустав, артролиз, эндопротезирование локтевого сустава, elbow joint, arthrolysis, arthroplasty of the elbow
OPERATIONS ON THE TENDON OF THE POSTERIOR TIBIAL MUSCLE IN THE TREATMENT OF A STATIC FLAT-VALGUS DEFORMATION
Matsakyan A.M., Shirmazanyan A. G., Gorochovodatsky A.V.
UDC: 617.51-001.4-06
Abstract: Objective. To conduct a comparative analysis of surgical procedures in the treatment of flat-valgus deformities of the feet at different stages. To development a noninvasive method of transposition of the posterior tibial muscle tendon for the talon-navicular joint stabilization. Metods. 16 patients were operated with the author's technique. Postoperative assessment of the results according to clinical parameters, X-ray indices and implantation parameters was performed. Results. Using the above methods of assessing the results, of sixteen patients - twelve achieved good results, three patients - satisfactory results and one patient - unsatisfactory result. Conclusion. Due to this technique, an artificial "talon-navicular ligament" is created, providing a static stabilization, more stable to the load, a stable fixation of the tendon of the posterior tibial muscle in the bone channel, due to the screw into the channel. Reduction of the complications risk due to the low invasiveness of the operation, and reduction of the duration of rehabilitation are demonstrated.
Key words: flat-valgus deformation, tendoscopy, tendon plastic
EARLY RESULTS OF TREATMENT OF CHILDREN WITH CEREBRAL PALSY BY SINGLE-EVENT MULTILEVEL SURGERY
Mikhovich M.S., Hlazkin L.S.
UDC: 617-089.844
Abstract: Objective. To evaluate the early results of Single-Event Multilevel Surgery (SEMLS), performed in orthopedic department of the Mogilev regional children's hospital. Methods. The early results of SEMLS were studied on 31 children who underwent surgery in 2014-2017. The group according to the level of the lesion of the central nervous system was determined before the surgery. The active and passive ROM in the hip, knee and ankle joints was determined. The degree of spasticity of separate muscle groups was measured by using specific tests. The gait of the patient was recorded on video in the normal mode and in the slow motion mode. All measurements were recorded in the Gate Observation Scale. Each patient was classified by Gross Motor Function Control System, patients were divided into 3 groups. 31 children underwent 212 procedures. Results. GMFCS II-III group (7 patients): average improvement by Gate Observation Scale - 7.2 points. Two patients improved GMFCS II to III. GMFCS IV group (17 patients) - average improvement - 7 points. 4 patients improved GMFCS IV to III, one patient IV to II. The parents of 7 patients with GMFCS V reported an improvement in care after surgery. During follow up deterioration was not observed. Conclusion. SEMLS changes the whole pathological stereotype of the musculoskeletal balance of extremities. It can improve the child's motor activity, eliminate the severe contractures of joints and provide adequate care for the patient in a relatively short period of time.
Key words: одномоментная многоуровневая коррекция, детский церебральный паралич, деформации нижних конечностей, функциональный класс GMFCS, шкала оценки наблюдения ходьбы, костно-мышечный баланс, ближайшие результаты, Single-Event Multilevel Surgery, cerebral palsy, lower extremities deformities, Gross Motor Function Classification System, Gate Observation Scale, musculoskeletal balance, early results
MINIINVAZIV ARTHROSCOPIC STABILIZATION OF OLD ANKLE JOINT LIGAMENT INJURIES
Ochkurenko A.A., Matsakyan A.M., Shirmazanyan A. G., Gorochovodatsky A.V.
UDC: 617.51-001.4-06
Abstract: Objective. Comparative analysis of the results of anatomic restoration of capsular-ligamentous system in chronic lateral ankle instability using low invasive arthroscopic techniques was performed. Methods. 48 patients (17-60 years old) with chronic lateral ankle instability were operated. In 25 patients a standard “Arthrobrostrum” technique with a use of 2-3 biocomposite fixatives and in 23 patients - the modified arthroscopic intervention with use of 1 titanium anchor - was performd. Treatment efficacy was evaluated by AOFAS score. Results. One year after surgery treatment, results were followed up in 38 patient: excellent result were achieved in 7(38.89%) , good - in 6(30.0%), satisfactory - in 3(16.67%) and poor - in 2 patients after standard technique and in 9 (45.00%), 7 (35.09%), 3 (15%) and 1 (5.0%) after modified method, respectively. Conclusion. Thus modified arthroscopic technique is in no way inferior to a standard “ArthroBrostrum” intervention having certain advantages (use of 1 versus 3 fixatives, possibility of inter operative X-ray control, and shortening of the operation duration). So it could be recommended for the treatment of patient with lateral ankle instability.
Key words: капсульно-связочный аппарат, нестабильность голеностопного сустава, артроскопия голеностопного сустава, пяточно-малоберцовая связка, capsule-ligament system instability of the ankle joint, ankle joint arthroscopy, heel fibular ligament