卷 31, 编号 4 (2020)

Objective: to demonstrate the relevance of the nutritional problem in gynecological cancer patients in the rehabilitation period; to formulate the goals and objectives of anticancer diet; and to highlight the most important principles of nutrition support for patients with the early stages of the disease. Basic provisions. The authors consider the scientific basis of rational nutrition in women with malignant neoplasms of the reproductive system in the rehabilitation period. Based on their significant clinical experience, the authors propose their view of the problem. The importance of nutrition support is much great that it is the latter that governs the prognosis of the disease and the risk of recurrence. Eating disorders substantially worsen the results of antitumor therapy and quality of life in gynecological cancer patients. Anticancer diet implies a multidisciplinary approach to providing good nutrition due to the diet that is optimally balanced in chemical composition and energy value, which contributes to the effective recovery of patients, to the improvement of their general condition, and to the increase in relapse-free survival. An individual selection of foods and their cooking methods, dietary pattern and water load are recommended, by taking into account calories and adequate provision of the body with micro- and macronutrients. It is important to remember the possible synergistic effects of biologically active substances and to correctly combine them. Dishes can vary in composition; however, food should provide the body's energy needs, eliminate toxins, stimulate the immune system, promote physical performance, improve mood, and therefore increase quality of life in a woman. Conclusion. The development of an individual rational nutrition program and its compliance should be considered an important component of treatment and rehabilitation measures aimed at achieving the maximum quality of life in gynecological cancer patients.

The paper presents principles for forming groups at risk for tuberculosis in adults and a procedure for its screening in the work of a primary care physician.

The present-day treatment of cardiac arrhythmias is performed using drug and non-drug options. Their role substantially varies in the treatment of individual types of cardiac arrhythmias. Based on the clinical recommendations published in 2019-2020, the author discusses the choice of medical tactics in typical clinical situations. The paper considers the results of the most important randomized trials (CASTLE-AF, CABANA, etc.) devoted to the impact of drug treatment and catheter ablation on clinical outcomes in patients with the most common persistent cardiac arrhythmia - atrial fibrillation (AF). It also presents the possibilities of an integrated patient-oriented approach to antiarrhythmic therapy for AF.

Part 2 of the review considers the mechanisms for the elevated cardiac isoforms of troponins and their diagnostic value during physical exercise, tachyarrhythmias, intake of cardiotoxic drugs (chemotherapy), cerebrovascular diseases, sepsis, skeletal myopathies, dissecting aortic aneurysm, and renal failure. In addition, it discusses the main factors causing a false-positive increase in the level of cardiac troponins: heterophile antibodies, rheumatoid factor, and alkaline phosphatase.

An accident investigation commission set up by the employer is authorized to qualify the accident as related or unrelated to production. Moreover, no examination to establish the severity of an accident is made; it is determined by the physicians of the healthcare facility to which the victim has been delivered. It can only be about the quality and safety of assistance provided at a healthcare facility: such as internal and departmental control; examination of healthcare quality in accordance with the criteria. However, the mechanisms are still far from perfect. There are conflicts in the normative legal regulation of determining the degree of human health harm as a result of an accident at work. The article considers ways to eliminate shortcomings in the legal regulation on determining the severity of harm to a victim’s health as a result of an accident at work and on examining the quality of medical care rendered to him/her.

The importance of reducing perinatal risks has currently increased; this is well-founded by the marked deterioration of reproductive and demographic processes. Objective: to assess the capabilities of the automated information system: monitoring of obstetric/gynecological services (AIS:MOGS) for the information support of a physician in preventing maternal and perinatal morbidity and mortality. Results. The scientific rationale for the need for information support of a physician’s functions in ensuring the prevention principle in monitoring pregnant women is the established large volume of risk factors for perinatal and maternal morbidity and mortality (about 200), including combined risks (4.6 per woman), as well as a large number of measures to prevent perinatal and maternal risks (about 400). An analysis of the work of an obstetric/gynecological service in one of the subjects of the Russian Federation on the prevention of perinatal risk and the use of automated monitoring of the health of pregnant women and women who have completed their pregnancy creates real opportunities for the development of a system to support decision-making in classifying pregnant women from risk groups into obstetric and perinatal diseases, and for the monitoring of maternal and perinatal mortality for the physicians and heads of institutions and services to manage perinatal and maternal risks. Conclusion. The leading condition for effectively using the information system is to increase the activity of physicians and health managers in applying the innovative organizational system, as well as the participation of women themselves in collecting data for reasoned organizational decision-making.

Objective. A prospective, randomized, single-center study was conducted involving 160 patients comprising four groups each with 40 people operated on. The patients underwent primary total knee replacement (TKR) under spinal anesthesia. Group 1 underwent periarticular local infiltration anesthesia (LIA); Group 2 had femoral nerve block; Group 3 had popliteal arterial area block; in Group 4 (a control one), multimodal analgesia was used to relieve postoperative pain. Results. The study showed the same level of pain with LIA (Group 1), femoral nerve block (Group 2), and periarterial blockade of the popliteal artery (Group 3); however, the dynamics of quadriceps muscle strength recovery (straight leg lifts) during the first 7 postoperative days were best in Group 1. The Oxford Knee Score (OKS) demonstrated that lower limb function improved significantly in the groups, without a statistically significant difference before and 6 and 12 months after surgery. Conclusion. LIA ensures adequate pain relief in the early postoperative period, which makes it possible to commence early active rehabilitation and to achieve good functional results during primary TKR.

Objective: to determine population patterns by the prevalence and clusters of metabolic syndrome (MS) in able-bodied men from an open urban population. Subjects and methods. A one-stage epidemiological study was conducted among Tyumen able-bodied men. A representative sample (n = 1000) was formed from the electoral rolls of 25-64-year-old men, (250 people aged 25-34, 35-44, 45-54, and 55-64 years each), by using the random number method; the response rate was 85.0%. The 2004 National Cholesterol Education Program Adult Treatment Panel III (NCEPATPIII) classification criteria were used to evaluate MS. Results. According to the 2004 NCEPATP III classification, the prevalence of MS was 9.5% in the Tyumen male population aged 25-64 years. In the latter, the most common forms of MS by the 2004 NCEPATP III criteria were when its 3 components were combined (a cluster of hypertension, abdominal obesity (AO), and hyperglycemia (5.6%); when 4 components of MS were combined (a cluster of the same components and hypertriglyceridemia (HTG) (1.5%). Conclusion. The Tyumen population’s pattern of a common cluster of MS components, such as hypertension, AO, and hyperglycemia, and, moreover, a cluster of the prevalence of the same components and HTG is extremely unfavorable, which is explained by both the high prevalence of somatic and behavioral risk factors for cardiovascular diseases and the conjugation of the components of MS with the psychosocial characteristics of able-bodied men.