Vol 93, No 2 (2012)

Aim. To study the features of time characteristics of heart rate variability during isolated chronic obstructive pulmonary disease, as well as in association with arterial hypertension and ischemic heart disease. Methods. The characteristics of heart rate variability using Holter electrocardiography monitoring, echocardiography and duplex scanning of carotid arteries were studied. The results of investigations of 298 individuals of both sexes aged 37-78 years were included into the analysis, including 79 patients with chronic obstructive pulmonary disease who were divided into three groups. The first group included 19 patients with isolated chronic obstructive pulmonary disease, the second group consisted of 25 patients with chronic obstructive pulmonary disease and arterial hypertension, the third group included 35 patients with chronic obstructive pulmonary disease and ischemic heart disease, who were divided into two subgroups: patients with (n=9) and without (n=26) a prior history of myocardial infarction. For comparison, examined were 48 patients with isolated hypertension, 132 patients with ischemic heart disease and 39 practically healthy individuals. Results. In patients with isolated chronic obstructive pulmonary disease an autonomic imbalance occurs in the form of a uniform decrease in the activity of the parasympathetic nervous system during the day and an increase of the night time heart rate, identifiable are the signs of subclinical cardiac pathology in the form of thickening of the «intima-media» complex and the formation of atherosclerotic plaques in the carotid arteries, hypertrophy of the myocardium and left ventricular diastolic dysfunction, reduced systolic velocity of the mitral valve fibrous annulus. If chronic obstructive pulmonary disease is combined with aerterial hypertension and ischemic heart disease, as opposed to isolated cardiac pathology, a monotonic tachycardia develops during the day. In cases of concomitant chronic obstructive pulmonary disease and arterial hypertension during a simultaneous decrease in all time characteristics of heart rate variability, in most patients hypertrophy of both ventricles can be visualized. Conclusion. In patients with chronic obstructive pulmonary disease the time characteristics of heart rate variability depend on the presence or absence of concomitant diseases of the cardiovascular system.

Aim. To study the content of autoantibodies to activated blood coagulation factors IIa, VIIa and IXa during ischemic heart disease. Methods. The investigation of autoantibodies was performed in 31 patients (mean age 57.6±7.8 years, male to female ratio 4:1). The patients were divided into three groups: the first - patients with myocardial infarction in the acute stage (9 people), the second - patients with myocardial infarction in the subacute stage (9 people), the third - patients with stable angina (13 people). The control group included 18 practically healthy subjects comparable by age and sex. The study of the content of autoantibodies to blood coagulation factors was performed by an original immunoassay method of Tsybikova N.N. et al. Results. Established was a decrease in the content of the following autoantibodies: class M immunoglobulins to fac-tor VIIa, class G immunoglobulins - to factor VIIa, classes M and G immunoglobulins - to factor IXa in the acute phase of myocardial infarction compared with the controls, as well as a decrease in the content of class G immunoglobulins to the factor IXa in the acute stage of myocardial infarction compared with the subacute stage and stable angina. Conclusion. During ischemic heart disease a decrease in the content of autoantibodies to the activated blood coagulation factors IIa, VIIa and IXa occurs, which is presumably due to their binding with excessively formed activated coagulations factors.

Aim. To assess the correlation of the indices of the «intima-media» complex thickness of brachiocephalic vessels by ultrasound investigation and the degree of coronary stenosis by angiography. Methods. 239 patients with ischemic heart disease and a history of myocardial infarction participated in the study. An ultrasound investigation of brachiocephalic vessels and angiography of the coronary arteries was performed in all patients in the in-patient setting. Results. Among patients with a thickness of the «intima-media» in the range of 0.8-1.1 mm not a single case of coronary stenosis was registered. When the thickness of the «intima-media» complex was 1.3 mm or more the prevalence and extent of atherosclerotic lesions of coronary vessels increased proportionally. Conclusion. The evaluation of the «intima-media» complex thickness of the brachiocephalic vessels makes it possible to predict with high accuracy the prevalence of coronary atherosclerosis, as well as to monitor the effectiveness of the treatment of atherosclerosis.

Aim. To identify the clinical and genetic associations of polymorphisms of the detoxification of xenobiotics genes during liver cirrhosis that developed as a result of viral hepatitis B. Methods. The study randomly included 38 patients with liver cirrhosis at the age of 25 to 54 years. The control group consisted of 147 healthy individuals. Conducted was an analysis of mutations in the deletion polymorphism of gene CYP1A1, leading to the replacement of the amino acid isoleucine with valine (Ile462Val) in position 462 of the cytochrome P-450 CYP1A1 and polymorphism of the gene GSTM1, which codes an enzyme antioxidant enzyme from the family of glutathione-S-transferase in patients with liver cirrhosis, which developed as a result of hepatitis B with the aim to identify possible associations with an increased risk and severity of the disease. Results. Revealed was a statistically significant increase in the proportion of patients with genotype Ile-Val/(+) compared to genotype Ile-Ile/(+), established was an association between the genotype S65C/N with polymorphism S65C of the gene HFE and liver cirrhosis of combined genesis (viral B + toxic). Conclusion. Ile462Val genotype of the CYP1A1 gene of the cytochrome P450, as well as the presence of a deletion of the glutathione-S-transferase M1 gene are risk factors for the development of liver cirrhosis secondary to hepatitis B.

Aim. To study of the effectiveness of the drug mesodiethylethylendibenzosulfonate (Sagenit) in women with urination disorders in the climacteric period. Methods. During the years 2009-2010 at the Department of Urology and Nephrology of Altai State Medical University were examined, treated and followed-up 40 women of the climacteric period (aged 43 to 64 years) with urination disorders. All patients were prescribed Sagenit, 1 tablet a day for 1-6 months. Results. Sagenit was well tolerated by female patients for a long period of time, had no significant side effects, which would require discontinuation of the drug. After the conducted treatment the time of urination lengthened, the volume of urination increased and the maximal urinary flow rate decreased. The positive effect of therapy (improvement of the quality of life) was reported by 75% of the surveyed women. Conclusion. Sagenit was shown to be effective in treating women with urination disorders in climacteric period.

Aim. To study the effectiveness of a universal antiseptic Betadine (international nonproprietary name - povidone-iodine) in the treatment of pustular skin diseases. Methods. The study had the form of an open, non-comparative one, which involved 25 patients aged from 2.5 to 40 years (mean age 16.1±1.2 years) with disease duration from 1 to 7 days (mean 4.2±0.8) with various forms of pyoderma: 21 patients with streptococcal impetigo and 4 patients with folliculitis. Assessment of safety of the study was carried out on the basis of clinical and laboratory data, patient tolerability of the substance, the expert-opinion of the physician-researcher. Changes in the quality of life as a result of treatment of patients with pyoderma using Betadine solution was evaluated by a questionnaire SKINDEKS-29. Results. All patients willing used the proposed betadine solution. No reasons for discontinuation of treatment during the study (including side effects, allergic reactions or exacerbation of the cutaneous process) were identified. Deterioration of the quality of life on the «Emotions» scale of SKINDEKS-29 questionnaire at the beginning of treatment was 49.8±1.3 points («sometimes»), during the second visit - 26.8±0.9 points («rarely»), by the end of treatment (third visit) - 10.2±0.3 points («no»); on a scale of «Function» at the beginning of treatment - 77.8±1.8 («often»), during the second visit - 53.2±1.6 («sometimes»), by the end of treatment - 16.2±0.8 points («no»); on a scale of «Symptoms» at the beginning of treatment - 51.2±1.3 («sometimes»), during the second visit - 27.6±2.8 («rarely»), by the end of treatment - 12.3±0.3 points («no»). Conclusion. Betadine is characterized by high clinical efficacy in pustular skin diseases, good tolerance, absence of adverse reactions, a positive impact on the quality of life and can be recommended as a therapeutic and prophylactic agent.

Aim. To determine the diagnostic significance of antibodies to Hantavirus in patients with hemorrhagic fever with renal syndrome, depending on the period and the severity of the course of disease. Methods. Studied was the content of specific antibodies (immunoglobulins G) to hantaviruses in blood serum in the rapidly precipitating and slowly precipitating circulating immune complexes by enzyme immunoassay using a test system «Hantagnost» in modification. Studied were 226 patients with hemorrhagic fever with renal syndrome (24 patients with mild form, 105 with moderate and 97 patients with severe form of the disease) in the febrile, oliguric and polyuric periods. Results. Specific antibodies (immunoglobulins G) were present already in the febrile period of the disease in all (100%) patients in the serum and in the rapidly precipitating circulating immune complexes. Antibodies in the slowly precipitating complexes in the febrile period were found only in patients with severe and moderate forms of hemorrhagic fever with renal syndrome, in subsequent periods they were found significantly more frequently in patients with a severe course of disease. Severe forms of hemorrhagic fever with renal syndrome caused the most pronounced serologic response with a maximal content of immunoglobulins G to Hantaviruses in the oliguric period. During the period of polyuria the severe forms of hemorrhagic fever with renal syndrome were accompanied by significantly lower levels of free circulating antibodies and a high level of bound antibodies compared with moderate and mild forms of the disease. Conclusion. In patients with hemorrhagic fever with renal syndrome anti-Hantavirus antibodies (immunoglobulins G) in serum and in the rapidly precipitating immune complexes are detected already at the early stages of the disease in 100% of the cases; the frequency of detection of antibodies in the slowly precipitating circulating immune complexes in the early stages depends on the severity of disease: they are present in 100% of patients with a severe form of the disease, in 50% - with the moderate form, and with the mild form - can not be detected.

Aim. To pathogenetically substantiate the effectiveness of performing prosthetic appliances of the dentition defects and predicting the results of occlusal rehabilitation of patients with pathology of the dental system based on the analysis of immune homeostasis of the oral mucosa. Methods. Examined were 39 people with secondary partial (I and II class according to Kennedy) and complete lack of teeth aged from 25 to 85 years, for whom removable acrylic dentures were manufactured. The control group included 18 people aged 20-85 years with abnormal dentition, requiring preliminary surgical preparation for prosthetics. Three age groups were identified: 20-40 years (first group), 40-60 years (second group), aged 60 and above (third group). Conducted was a morphological study of prosthetic bed biopsies obtained after 3, 6 and 12 months after returning the prostheses with immunohistochemical determination of markers for CD68, CD204, and CD163, with high specificity for dendritic cells, mast cells and macrophages, respectively, providing the immune homeostasis of the oral mucosa. For identification of intraepithelial lymphocytes determined was the expression of CD4 and CD8. In order to evaluate the intensity of regeneration of epithelial cells determined was the expression of the Ki-67 marker. Results. In the individuals of the first and second age groups noted was the predominance of dendritic, mast cells, CD4+ and CD8+. In patients of the third group the dynamics of the content of CD68+ and CD163+ cells in the mucosa of the prosthetic bed was less pronounced. A direct strong correlation relationship between the proliferation index and the number of CD68+, CD204+, CD4+, CD8+ cells, which provide the immune homeostasis of the oral mucosa in these patients, was established. A direct strong correlation relationship between the clinical changes in the oral cavity in the process of usage of the removable dentures and the absolute number of lymphocytes and dendritic cells in the inflammatory infiltrate was established. Revealed were the dynamics of changes in mitotic activity of keratinocytes in the process of usage of the removable dentures and the correlation of these parameters with the terms of use of the prostheses. Conclusion. The changes of the immune homeostasis parameters of the oral mucosa with this type of prosthesis can be considered a basis for pathogenetic substantiation of treatment and predicting the outcomes of occlusal rehabilitation of dental patients.

Aim. To evaluate the effectiveness of rehabilitation measures for dental caries. Methods. Studied were 246 patients aged 18-50 years (146 women and 100 men) who received dental treatment for dental caries and its complications, the duration of follow-up was 18 months. Conducted was an expert evaluation of 246 medical records of dental patients and patients’ management. The hygienic status of the oral cavity was assessed by the criteria of OHI-S (Oral Hygiene Index Simplified) and PHP (Patient Hygiene Performance), for values of OHI-S (PHP) 0.6±0.1 (0.4±0.03) the status was considered good, for values 1.3±0.1 (0.7±0.02) - satisfactory, for values 2.6±0.1 (1.8±0.04) - unsatisfactory. Results. Good oral hygiene status was noted in 64 patients (first group), satisfactory - in 88 (second group), unsatisfactory - in 94 patients (third group). In the third group, the share of fully intact restorations and fillings during middle and deep caries after 6 months was 89 and 81%, at 12 months - 80 and 78.2%, after 18 months - 79.7 and 71.8%, respectively; in the second group after 6 months - 94 and 92.8%, after 12 months - 89 and 85.3%, after 18 months - 87.5 and 81.2%, respectively; in the first group at 6 months - 96 and 96%, after 12 months - 96 and 91.3%, after 18 months - 94.5 and 90.5%, respectively. Only 152 of the 246 patients fulfilled all the recommendations and prescriptions, 34 (13.8%) did not complete the rehabilitation of the oral cavity. Prevention and rehabilitation activities were performed in 30% of cases: in 15% - in full, in the remaining 15% primarily professional oral cleaning and remineralization therapy was conducted. Conclusion. The program of rehabilitation of dental patients should include regular inspections, monitoring of the oral hygiene, professional cleaning of the oral cavity, grinding and polishing of the restorations and fillings, pathogenetic therapy.

Aim. To optimize medical care for patients with metastatic tumors of the central nervous system in the Republic of Tatarstan. Methods. The database of the Cancer Registry of the Republican Clinical Oncology Dispensary of the Ministry of Health Care of the Republic of Tatarstan and the case histories of patients treated in the neurosurgical departments for the period from 1998 to 2007 served as the material for this study. Results. Lung cancer, breast cancer, kidney cancer and melanoma were the most frequent types of cancers to metastasize to the central nervous system. There was a significant discrepancy between the predicted and the detected number of patients with metastatic lesions of the central nervous system. Studied was the quality of medical care provision to this category of patients. In the Republic of Tatarstan established is a modern instrumental base for the timely diagnosis of metastatic lesions of the central nervous system and their complex treatment in accordance with the current guidelines. However, the effectiveness of diagnostic and therapeutic measures still remains unsatisfactory. Conclusion. A set of measures for optimizing medical care for patients with metastatic tumors of the central nervous system has been developed in the Republic of Tatarstan.

Aim. To improve the outcomes of treatment in patients with lateral abdominal hernias by combining autoplastic methods with autodermoplasty. Methods. 42 case histories of patients with lateral abdominal wall hernias, operated in the first surgical department of the State Institution «Republican Clinical Hospital», Tiraspol city, from 2001 to 2011 were subjected to retrospective analysis. In all of the cases surgical treatment was performed. Combined methods of hernioplasty, which combine autoplasty with autodermoplasty, were applied. The authors’ personal patented method of hernioplasty was also used among others. Results. According to the classification of Chevrel-Rath (2000) 23 (54.7%) of the patients had inferolateral hernias, 5 (11.9%) patients - supra-lateral hernias, 8 (19%) patients - lumbar hernias, there were also 2 (4.8%) patients each with transrectal, pararectal and paracolostomy hernias. Despite their small number in the total amount of postoperative hernias (17.5%), 26 (65%) patients had large and giant lateral hernias, while recurrences were present in 7 (16.7%) cases. Treatment results were satisfactory. Complications and recurrence occurred in 1 (2.9%) patient each. Conclusion. The combination of autoplasty with autodermoplasty is an effective method of treatment for inferolateral, supra-lateral, pararectal, transrectal, paracolostomy and lateral hernias; during lumbar hernias autodermoplasty even with two autodermal grafts was not as effective, and therefore justified is the search for new methods of hernioplasty.

Aim. To evaluate the effectiveness of dismembered flap pyeloplasty for extensive obstruction of the pyeloureteral segment in children. Methods. Dismembered flap pyeloplasty throughout the period 2001-2010 was performed in 9 children (first group), mean age 69 months, 7 (77.8%) boys and 2 (22.2%) girls. Left-sided hydronephrosis was diagnosed in 8 (88.9%) cases, right-sided hydronephrosis - in 1 (11.1%) case. Dismembered flap pyeloplasty was performed in those cases, when after the resection of the ureter and during an attempt to form a direct uretero-pyelo-anastomosis excessive tension of the tissues occurred. In order to replace the resected part of the ureter used was a tubularized U-shaped flap of the renal pelvis, which was anastomosed in an «end to end» fashion with the proximal section of the ureter. The comparison group (second group, 58 patients) included patients who had undergone dismembered pyeloplasty with the formation of uretero-pyelo-anastomosis in the horizontal plane after standard resection of the dysplastic area of the proximal ureter. Results. In the early postoperative period, clinical manifestations of urinary tract infections were recorded in 1 (11.1%) of 9 patients, treated medically. The degree and rate of reduction of the increased anteroposterior size of the renal pelvis after dismembered flap pyeloplasty significantly lagged behind the comparable parameters of patients undergoing standard dismembered pyeloplasty, and at the same time, one year after the operation noted was a marked decrease in the anteroposterior size of the renal pelvis by almost 3 times as compared to the preoperative values. Conclusion. Implementation of dismembered flap pyeloplasty for extensive ureter obstruction makes it possible to achieve good short- and long-term results in the treatment of hydronephrosis in children.

Aim. To evaluate the results of treatment of patients with varicose disease of the lower extremities using endovenous laser obliteration. Methods. Endovenous laser obliteration of the saphenous and perforating veins was used in the treatment of 72 patients with varicose disease of the lower extremities by applying a laser with a wavelength of 1.56 µm. The intervention technique included puncturing and catheterizing of the great saphenous vein or small saphenous vein under ultrasound angioscanning control followed by an introduction of the laser fiber-optic light guide and advancing it to the level of the saphenofemoral or saphenopopliteal junction. After paravasal introduction of the anesthetic solution the laser obliteration was performed under ultrasound control. Results. Postoperatively noted was the low intensity of pain, low severity of ecchymosis and no tenderness along the obliterated veins. No complications were recorded. 40 patients were examined in follow-up during the period from 2 to 4 months after the endovenous laser obliteration. The degree of obliteration of 39 great saphenous veins, 2 small saphenous veins and 8 perforating veins was evaluated. In all cases complete obliteration of veins subjected to laser exposure was noted, no abnormal refluxes or areas of preserved blood flow were revealed. Conclusion. The endovenous laser obliteration is a mini-invasive effective method of providing a complete occlusion of the blood vessel, which eliminates the vertical and horizontal pathological reflux in varicose disease of the lower extremities; this technique can be used in an outpatient setting.

Aim. To conduct an analysis of the refraction of the vision organ of school children living and studying in an area with high intensity of automobile traffic, and in children living in a more environmentally clean area. Methods. The investigation of eye refraction in 62 children (124 eyes) of school age, living and studying in an area with high intensity of automobile traffic. Hygienic assessment of the environment in the study areas. Results. In the majority of the school children living and studying in an area with high intensity of automobile traffic a myopic refraction was revealed in contrast to the control area, where the frequency of myopia was less. The obtained data on the frequency of myopic refractive disorders in the children’s population were above the average statistics for the Russian Federation. A significant relationship between the nature and intensity of air pollution and the occurrence of myopia in children was established. We assume that one of the risk factors for myopia development is air pollution emissions by a complex of hazardous substances. Conclusion. Prophylaxis of eye diseases of children living in ecologically unfavorable areas of large cities is much needed; therapeutic measures for vision organ dysfunctions of this cohort should be implemented taking into account the influence of adverse environmental factors.

Aim. To assess the significance of changes in the content of ethanolamine in biological fluids in the diagnosis of nephropathies. Methods. Examined were 246 patients (56% men, 44% women) aged 17 to 68 (41.1±13.1) years and 75 healthy subjects (49% men, 51% women) aged between 16 and 72 (31. 4±12.4) years. The first group consisted of 55 patients with essential hypertension, the second - 47 patients with insulin-dependent diabetes mellitus in the compensation stage, the third - 65 patients suffering from gout. The fourth group included patients with secondary (due to systemic lupus erythematosus - 29 people) and primary chronic glomerulonephritis. We used non-parametric statistical methods: analysis of the differences between the two groups was performed using U-criteria of Mann-Whitney, among three or more groups - the Kruskal-Wallis test; to identify the dependencies - Spearman correlation analysis was used. Results. The content of ethanolamine in the blood correlated poorly with the age, but only in patients with gout (r=-0.3, p=0.03). The concentration of ethanolamine in the blood was significantly lower in the first three groups, in urine was not significantly different from controls only in patients with gout (p=0.05). It is in the first, second and third groups that the majority of patients had a higher body mass index, arterial hypertension and metabolic disorders. There was an inverse relationship between the content of ethanolamine in the blood and the body mass index (r=-0.35, p=0.0001), the concentration of cholesterol in the blood (r=-0.27, p=0.02), weak positive - with creatinine levels (r=0.14, p=0.04). The ANOVA analysis revealed a negative relationship between the concentration of ethanolamine in the blood and body mass index (at f=20.3; p <0.001). Established were significant differences in terms of ethanolamine level in blood and urine when compared to patients with arterial hypertension and without it (p=0.01), as well as when comparing patients with and without dyslipidemia (p=0.02). Conclusion. The decrease in the concentration of ethanolamine in the blood may be a predictor of hemodynamic disturbances in the glomeruli of the kidneys; the content of ethanolamine in the blood is closely related with hypertension and obesity, and in the urine - is not associated with diseases of the diseases of the kidney glomerular apparatus, but correlates with the severity of tubular disorders in gout.

This review article presents the current views on genotyping during administration of clopidogrel - an antiplatelet drug from the class of thienopyridines, for patients with acute coronary syndrome. Highlighted were the data on genetic disorders affecting the absorption and metabolism of clopidogrel. The gene ABCB1 (MDR1) encodes the intestinal transporter P-glycoprotein. The variability of this gene may affect the bioavailability of clopidogrel. However, data on the relationship between C3435T polymorphism of ABCB1 gene and the expression of P-glycoprotein still remain controversial. Differences in the effects of C3435T may reflect the differences in the frequency of ABCB1 polymorphism among ethnic groups and the complex of effects of different polymorphisms in the same gene within a haplotype, or confounding factors of the environment. The most important role in the metabolism of clopidogrel is played by cytochrome P-450 (iso-enzyme CYP2C19). Several large studies have confirmed the prognostic significance of CYP2C19 polymorphism in patients receiving clopidogrel. In a recent meta-analysis of nine pharmacogenetic studies of clopidogrel, which included 9685 patients with acute coronary syndrome, revealed was a significant association between the homozygous and heterozygous alleles with reduced CYP2C19 function and an increased risk of death due to cardiovascular disease, myocardial infarction or stroke. Two large randomized studies of CYP2C19 genotyping did not reveal any relationship between its variants and the occurrence of cardiovascular events in patients with acute coronary syndrome or atrial fibrillation. Thus, in genetic studies of the antiplatelet effectiveness of clopidogrel, there are many uncertainties; domestic data on this subject is extremely scarce.

The analysis of publications devoted to modern methods of treatment of pyo-necrotic complications of diabetic foot syndrome has been presented. Identified were the most important principles of therapeutic tactics for this type of pathology. In order to create optimal conditions for wound healing after surgical sanitation local drug treatment is carried out - a thorough wound detersion with application of the isotonic sodium chloride solution or a neutral bathing solution, periodic (as needed) necrectomies, application of bandages, in accordance with the phase of wound healing process. The choice of medication for local treatment depends on the one hand on the type of lesion of the lower limbs, on the other - on the diabetes related morbidity and phase of wound healing. In the first phase of wound healing antiseptics are used: iodophors, polyhexanide (lavasept), hydroxymethyl quinoxaline dioxide (dioxidine), and in the absence of ischemia - compositions based on gelevine, water-soluble base ointments. In the second phase used were various wound covers based on collagen, as well as oil and hydrogel dressings. Ready-to-use bandages are also used, which are multi-layered system, comprised of a cellulose substrate, collagen, fibroblasts, growth factor, coated with plates of silicon to control humidity. The disadvantage of the ready-to-use dressings is the impossibility of controlling the wound on a daily basis. One of the trends in the treatment of chronic diabetic wounds is the use of living skin cells that serve as a source of growth factors, cytokines and other proteins that stimulate the healing process. The use of local immunomodulators is seen as promising. Treatment should be individualized and systemic antibiotic therapy is required. The main principle of local treatment is the creation of optimal conditions for accelerating the healing process.

Presented was a review of the literature devoted to allergy to the components of latex among health care workers. Described were three types of reactions to natural rubber latex: (1), contact dermatitis, (2) type I allergic reactions associated with immunoglobulin E, and (3) type IV allergic reactions. Clinical symptoms of latex allergy can manifest as local [contact dermatitis (dermatitis from irritation), allergic contact dermatitis, contact urticaria] and/or systemic (rhinitis, conjunctivitis, difficulty in breathing attacks, widespread urticaria, Quincke’s edema to the extent of an anaphylactic shock) reactions. For the diagnosis of latex sensitization the applicational («glove») test is of particular importance, which consists of controlled wearing of latex gloves for 1 hour or more before the onset of symptoms of skin irritation, local and systemic allergic reactions become evident. Prick test - the most unified, technological and highly sensitive (up to 97% in the diagnosis of latex sensitization) method out of all the skin tests, virtually eliminates the occurrence of nonspecific reactions due to skin irritation or the reactions of its vessels. In the Russian Federation the prick test for the diagnosis of allergy to latex is not yet available, as the latex allergen has not yet been registered. There are publications, indicating the high sensitivity of the nasal provocation test in the diagnosis of latex allergy. The latex-specific immunoglobulin E is mainly detected by the radioallergosorbent test and enzyme immunoassay, sometimes by immunoblotting. The elimination of contact with latex products is the basis of the etiological treatment. The issue of the rational employment of health workers is very relevant. With latex allergy elimination diet is recommended to eliminate the products with cross-allergenic properties with latex: bananas, avocado, kiwi, chestnuts, peaches, tomatoes, shrimp, walnuts, etc. The usage of powder-free gloves with low allergenic potential led to a sharp reduction in the incidence of allergic reactions to latex among health care workers.

Aim. To study the characteristics of composition of the new sorbent tseloform by the method of electron paramagnetic resonance and to evaluate its impact on the content of free radicals in the gum tissue during experimental periodontitis. Methods. Using the method of electron paramagnetic resonance studied were the characteristics of the composition of the sorbent tseloform, as well as its influence on the content of free radicals in the experimental model of periodontitis. Results. The method of electron paramagnetic resonance made it possible to determined that the sorbent tseloform initially contains a large amount of free radicals (up to 4.6±0.3×1020 for 1 cm3 of a sample), and that is 4.6-4.8 times (p <0.01) greater than in the samples of raw materials and the antiallergenic preparation from cotton cellulose nazaval (England). On the model of acute periodontitis in rats shown was a dramatic increase in the content of nitrogen oxide (II) in the pathologically altered gingival tissue: up to 7.5±0.61×10-7 M (р <0.05). During local treatment with the sorbent tseloform the level of nitric oxide significantly decreased in the gum: up to 3.12±1.85×10-7 M (р <0.05). Conclusion. The sorbent tseloform contains significantly more free radicals than the original raw material, and during local use has a positive effect on the course of the pathological process in an experimental model of periodontitis.

Aim. To create a united informational space for members of the health care system and to optimize the pharmaceutical and medical services by improving the use of digital technologies. Methods. Theoretical and empirical modelling. Results. Proposed was the project entitled «Personal mobile medical and pharmaceutical electronic patient card» that makes it possible to combine all the aspects of pharmaceutical patient’s history and some medical information into a united informational database with the aim of rational organization of the personalized choice of drugs for each individual patients at any stage of delivering medical or pharmaceutical care. On the example of patients with diabetes, especially those in need of constant medical and pharmaceutical supervision, it was shown that the proposed project is an important component of optimizing the pharmaceutical activity, which makes it possible to enhance the quality, speed and efficiency of medical and/or pharmaceutical care. Conclusion. Practical application of the proposed project will make it possible to unify the system of delivering pharmaceutical care, provide access to patient information, and improve the quality of individual health care services for people affected by socially significant diseases.

Aim. To optimize the training of medical personnel for providing emergency medical care to the general public. Methods. Socio-hygienic, statistical and experimental. A questionnaire-based survey was conducted among 450 medical doctors and 136 members of the nursing personnel in order to determine the subjective level of knowledge in the field of organizing medical evacuation procedures in the centers of mass sanitary losses. Conducted was an initial testing of 108 doctors and 106 members of the nursing personnel in order to objectively assess their level of knowledge followed by a final post-training test. A new technology for training health professionals has been developed and recommended for inclusion into the program of medical postgraduate education. Results. If the doctors prior to training had the level of preparedness to provide first medical care in centers of sanitary losses of 49.71%, then after training, this figure increased to 75.38% (p <0.001). Among the nursing staff the level of preparedness prior to training did not exceed 51.88% of the cases, while after the training it reached 74.28% (p <0.001). Thus, after training according to the proposed methodology the level of knowledge in organizing medical care to the affected casualties in centers of sanitary losses at the pre-hospital stage increased by 47.89% (p <0.001 for t=12.19). The survey of health professionals showed that 97.2% of health workers gave a positive evaluation of our proposed method of training. Conclusion. The proposed technology makes it possible to increase the level of training of medical personnel in organizing and delivering health care.

In this article presented was the substantiation of the methodology of studying the work environment factors among parents, particularly the mothers, and their influence on the development of allergic diseases in children taking into account the specifics of the working conditions in the agricultural sector. The proposed study algorithm includes investigation of sanitary conditions of labor and adverse industrial factors in women of the reproductive age, employed in the agricultural sector, as well as investigation of the incidence of disease, including allergic disease, among their children. Analysis of variance allows us to quantitatively determine the significance and share impact of the industrial environment factors and of the working process of parents, as well as the of the social and hygienic conditions on the incidence of allergic disease of their children. Complex studies make it possible to determine the clinical and immunological features of allergic diseases in children of agricultural industry workers, to develop and validate the criteria for long-term effects of the factors of professional activity of parents of the agricultural industry on the formation of allergic diseases in children, as well as to determine the proportion of the effect of individual risk factors on the parameters and structure of allergic diseases of preschool children with their isolated and combined effects. The study of the relationship «professional female hazards - allergic diseases of the child» is based on the usage of a united methodological approach, which includes hygienic, sociological, allergological, immunological methods of investigation and makes it possible to determine the significance of occupational exposures of parents in the implementation of mechanisms of allergic diseases development in children and to develop a model of priority measures for improving prevention of allergic diseases in children of agricultural workers.

In the article based on the analysis of literature data and on authors’ personal experience presented were the main principles of conducting intensive medical therapy in patients with severe forms of pancreonecrosis.

Aim. To propose a pathogenetically substantiated infusion therapy based on the results of a comprehensive evaluation of lower limb ischemia in diabetic foot syndrome. Methods. Energetic Doppler sonography of the blood vessels of the lower extremities in its distal part and electrothermometry in 32 patients with diabetic foot syndrome and critical limb ischemia was conducted in addition to the general clinical imaging studies (radiography, ultrasonography in the «gray scale» mode). Considering the obtained data the treatment strategy in these patients (conservative or surgical) was determined together with a physician-endocrinologist. Results. Presented is an example of tactics formation for conservative infusion therapy of a patient with diabetes mellitus, which is complicated by the diabetic foot syndrome with critical limb ischemia. Compiled was an individual treatment algorithm. At the initial stage crystalloid solutions (slow drip, followed by urination stimulation) were administered. Next prescribed were vitamins from group B (cyanocobalamin 0.25 mg and pyridoxine 50 mg) in order to regulate the metabolism of key neuromediators and amino acids. The complex of treatment included the nonsteroidal anti-inflammatory drug diclofenac (25 mg). This was followed by administration of dextran solutions (reopolyglukine), in combination with an antiplatelet solution (pentoxifylline). At the final stage of therapy administered was prostaglandin E1 (alprostadil, 3-4 infusions per course). Local treatment: osmotic agents were applied to the right foot as semi-alcohol compresses to relieve swelling, improve microcirculation and promote closure of the fistulas. After the conducted treatment noted was an improvement in general condition, pain symptoms subsided, the fistula closed, the soft tissue on the foot had no signs of inflammation. Recovery of the parameters of microcirculation signify the relief of arterial and venous stasis. Conclusion. This treatment scheme will make it possible to improve the course of the disease, reduce the time of treatment and disability of patients, will also improve their quality of life.

Medical personnel of health care institutions are a group of occupational risk for infectious diseases. The aim of the present study was to draw attention of the medical personnel to the relevance of preventing nosocomial infection by bloodborne pathogens while performing professional duties. According to the blood service of the Central Military District among the donor-servicemen for the past 5 years the proportion of carriers of hepatitis B viral markers reached 7.9%, of hepatitis C - 8.0%, HIV - 1.7%. Presented in detail were the precautions while conducting invasive procedures and other manipulations with medical products, which are contaminated with biological fluids, discussed were the requirements of the sanitary legislation on this issue. The basic principle of prevention of occupational infection is compliance with the rules of sanitation and anti-epidemic regimen while providing service to any patient.

Aim. To evaluate the effectiveness of blood salvaging technologies in cardiosurgical patients operated under cardiopulmonary circulation. Methods. Analysis of perfusion protocols and transfusion cards of cardiosurgical patients operated using cardiopulmonary bypass during the period 2010-2011. Two groups of patients were identified: the first group - with the application of blood salvaging technologies (906 patients), the second group - without the application of this technique (122 patients). Blood from the operative wound was collected during the operation, processed, filtered through the «Cell-saver» machine from «Fresenius» company and was then re-introduced into the patient’s bloodstream. After completion of cardiopulmonary bypass the blood remaining in the circuit of the cell-saver machine and blood that was discharged through the drainage tubes was returned to the patient after being processed. Results. In the first group at the end of the operation 314.6±28.6 ml of washed red blood cells were returned to the patient from the heart-lung machine, while during the first postoperative day, the amount of the returned autologous erythrocytes from the drainage tubes was 72.8±12.5 ml. In this group, only 45 (4.9%) patients required donor erythrocyte mass transfusion, its volume per patient amounted to 172.3±31.8 ml. In the first group 182 (20.1%) patients required transfusion of fresh frozen plasma with the aim of achieving hemostasis, its volume amounted to 425±51.3 ml. In the second group 51 (41.8%) patients received erythrocyte mass transfusion in the volume of 346.7±31.1 ml, and 86 (70.5%) - received fresh frozen plasma in the amount of 568.7±41.2 ml. Hemoglobin content and hematocrit at the end of the operation and on the first postoperative day were significantly higher in the first group compared to the second group (p <0.01). These changes were associated with both intraoperative bleeding and with the loss of blood through the drainage tubes on the first postoperative day in the second group of patients. Compensation for these losses required transfusion of blood components significantly more frequently (p <0.001) and in larger volumes (p <0.01) than in the first group. Conclusion. Blood salvaging technologies using the «Cell-saver» machine during cardiac surgery under cardiopulmonary bypass significantly reduce blood loss, reduce the number of postoperative hospital days and complications, and are less expensive.

Aim. To assess the dynamics of wound healing process based on the biochemical parameters of blood serum in patients with phlegmons of the lower extremities treated with various methods of ozone therapy. Methods. Conducted was dynamic monitoring of the biochemical parameters in patients with pyo-inflammatory diseases of the lower extremities. Depending on the method of treatment the patients were divided into three study groups and a control group, 29 people in each. The first group consisted of patients in whon in combination with traditional treatment local ozone therapy was performed. The second group consisted of patients who received intravenous and local ozone therapy in combination with traditional treatment. The third group consisted of patients who received traditional treatment with intraarterial and local ozone therapy. The control group consisted of patients who received traditional treatment. Results. The results showed that during treatment with ozone therapy a relief of endogenous intoxication and a significant improvement in albumin concentration takes place compared with the control group. Conclusion. A more rapid decrease in endogenous intoxication, relief of inflammation at the local and systemic levels occurs secondary to ozone therapy; most effective are intraarterial and local applications of ozone.

Disseminated intravascular blood coagulation syndrome is a rather complex pathology, accompanied by multi-directional shifts in the overall haemostasis. This article presents the diagnostic algorithm and treatment strategy, depending on the stage of disseminated intravascular blood coagulation syndrome.

The article presents the experience of using infusion thrombolytic agents in the complex therapy of patients with complicated diabetic foot syndrome. Presented was a vivid clinical case. This method made it possible to optimize the treatment of this group of patient.

In order to assess the correctness of choice of medicinal treatment of a disease, safety of intravenous transfusions, the effectiveness of treatment Chosen was a method for the analysis of heart rate variability using a complex of diagnostic functional changes in the cardiac rhythm, «Kardioanalizator “Expert 01”» (СJSC «NPO “Markiz”», Saint-Petersburg). In patients with hypersympathicotonia marked was a tendency for rigidity of cariac rhythm, overstress condition, depletion and collapse of the adaptive systems. Treatment of such patients, including infusion therapy, should be done in a hospital setting. Among patients with hypervagotonia such phenomena are not registered, although the rigidity of the cardiac rhythm is possible in them as well. For this reason, the planning of rehabilitation programs requires an individual approach. Based on heart rate variability indices, formed were groups of patients for outpatient infusion therapy at the ambulatory hospital. Patients with risk factors for development of acute vascular disease should be referred for inpatient treatment.

With the aim of ensuring safety of transfusion of plasma and its products conducted is a deposit of the plasma with the prohibition of use for a certain period of time - plasma quarantine. The needs of medical institutions in the quarantined and inactivated plasma are met to the full extent.

The hydraulic model of the human circulatory system was discussed, presented from the position of classification and systematization of the major blood vessels, identified were the main consumers of the circulatory system, considered in detail was the area of regulation associated with the processes of blood pressure and heart rate measurement.

There is an urgent necessity to work on optimizing the network of blood services institutions and to address the problem of staffing with highly qualified personnel - physicians-transfusiologists, nurses and technical staff. The authors propose a number of measures that contribute to solving this severe problem.

Aim. To determine the criteria for conservative infusion therapy with the assessment of its effectiveness using the electrothermometry method. Methods. One of the major complications of diabetes is the diabetic foot syndrome. This diagnosis is established on the basis of clinical data and imaging studies. The resulting parameters are objective, but the specificity, selectivity, and the multiplicity of diagnostic procedures negate the effectiveness of these methods, making it difficult to consequently form treatment strategy. Registration of temperature parameters during different degrees of ischemic disturbances of the lower limbs by electrothermometry was performed with the subsequent formation of the algorithm of conservative therapy. Results. In patients with diabetic foot syndrome determined was the direct correlation between the degree of tissue ischemia of the lower extremities and the variation of temperature parameters. The formation of the course of conservative therapy was performed after evaluating the obtained parameters; its formation was based on the main pathogenetic links. Clinical data and the parameters of electrothermometry served as the method of dynamic control. Conclusion. Despite the achieved successes in the modern diagnosis of the diabetic foot syndrome, there still remains a number of inaccuracies, the key ones among then are the difficulties associated with determining the level of trophic disorders; electrothermometry makes it possible to expand the diagnostic horizons, and the obtained result can serve as a prognostic guide for the formation of the tactics of therapy and as a method of dynamic control.

Aim. To assess the ability of immobilized autologous bone marrow stromal cells to provide an effective repair with the formation of a robust bone block in the area of the interbody defect of the spinal motor segment after total removal of the intervertebral disc. Methods. Studied were the effects of autotransplantation of different cell fractions isolated from the bone marrow (mononuclear, stromal cells and stromal stem cells) on the formation of the anterior bone block during interbody spondylosyndesis in an experiment on 24 mongrel dogs of different sexes (mean weight 18.3 kg, the mean diameter of the lumbar vertebral bodies according to radiographic study 18.6 mm). All animals underwent the crest puncture the right wing of the ilium, with aspiration of 10 ml of bone marrow, conducted was a total diskectomy at the level of the bodies of the VII and VIII lumbar vertebras with replacement of the interbody defect with a porous metal cylinder of the Nickel titanium of an appropriate shape and size. All animals were randomly divided into four groups, 6 in each. In the first group the interbody defect was filled with a porous metal cylinder only, in the second group - with the fraction of bone marrow mononuclear cells, in the third - with the fraction of stromal cells, in the fourth - with the fraction of culture-grown stromal cells. Results. In the first (control) group established were the signs of delayed formation of the anterior bone block, formation of the hypertrophic interbody pseudarthrosis. Noted was the formation of coarse fibrous capsule in the zone of «implant-bone» contact, an excess of cartilage tissue, the small size and low proliferative activity of osteoblasts, hypoplasia of the blood vessels. In the second group determined was the forming artificial bone block with paravertebral hyperostosis, radiologically - microdislocation of the implant with protrusion into the body of the adjacent vertebra and partial osteointegration with the porous structure of the fixer in the contact «implant-bone» zone. Bone formation occurred by the type of secondary osteogenesis with an excess of cartilage tissue. In the third and fourth groups formed was a robust artificial bone block, no signs of implant dislocation were observed. Determined was the full osteointegration of the porous structure of the fixer in the contact «implant-bone» zone. The newly formed bone tissue surrounded the implant in a muft-like fashion and grew into its porous structure, grew into the periosteal zone of adjacent vertebral bodies, well adhering with their surface. Conclusion. The proposed method of correction of osteoreparation disorders can be considered as an alternative to osteoplastic operations with the transplantation of massive bone grafts, as well as in conditions of systemic disorders of the ostepoetic function with a critical shortage of endogenous progenitors of bone cells.

The outcome of the work of Nurelgayan Nuriakhmedovich Bayteryakov is thousands of saved lives, the fact that always maintained his high morale, energy and high surgical activity. The article discusses the difficult and worthy life path of this amazing man.