Vol 31, No 10 (2020)

The purpose of the article is to identify the features of the application of General medical ethics in surgical practice and to identify special moral and ethical problems of surgical activity, as well as to find ways to overcome particular ethical problems, both to improve communication with patients and within the medical team, where the surgeon remains the Central and responsible person. A special ethic of surgery is formed by non-trivial relationships between those who receive surgical care and those who conduct it. Understanding the nature of these features and the depth of these relationships allows us to understand the causes of vulnerability and vulnerability of our patients and, perhaps, to understand their own problems.

The paper considers the problem of an association between myocardial ischemia and the reflection of this pathological process on the electrocardiogram (ECG). It analyzes the difference and relationship between the transmembrane potential of myocardial cells and the ECG signal. It is theoretically substantiated that the change in the location of the ECG ST segment is determined by the flux ratio of potassium and calcium ions through the membranes of myocardial cells. Impaired coronary blood flow results in an insufficient supply of calcium ions to the myocardial cells, which leads to any displacement of the ST segment from the zero potential line.

High-performance sports often requires athletes to train almost to the limit of their functional capabilities, forcing them to balance between the desired sporting fitness and the danger of overstrain of the body systems. In this connection, of paramount importance is active influence on recovery processes after physical exercises through their natural stimulation. Our study considers whether Osteomed Forte can be used to correct adverse changes in the musculoskeletal system of athletes after a long (> 6 years) period of doing sports, to optimize their functional state, and to decrease recovery time in athletes when chronic fatigue and overfatigue develop at the stages of training and competition cycles.

With the available variety of prognostic factors that influence long-term adverse outcomes in patients with myocardial infarction (MI), their role in death in a cohort of able-bodied patients remains controversial. Objective: to determine the predictors of poor long-term prognosis of non-ST segment elevation MI (NSTEMI) in able-bodied patients and, on the basis of the findings, to propose a mortality prediction model for this patient category. Subjects and methods. The investigation enrolled 155 patients (139 men and 16 women; mean age, 51 [44; 55] years) with an established diagnosis of NSTEMI. Twelve months after the onset of MI, their vital status was determined by analyzing data from electronic medical records of patients. Univariate and multivariate regression analyses were performed to determine the independent predictors of mortality. Results and discussion. Multivariate regression analysis could establish that left ventricular ejection fraction <50% (p=0.045) and platelet-to-lymphocyte ratio >122 (p=0.028) were statistically significantly associated with mortality in able-bodied patients with NSTEMI. The area under the ROC curve for the resulting risk model was 0.85; the sensitivity and specificity were 71.4% and 96.2%, respectively. Conclusion. The investigation has yielded an original post-hospital mortality prediction model using routine clinical parameters in able-bodied patients with NSTEMI. To stratify patients who are at a high risk of death, it may be necessary to take into account the left ventricular ejection fraction and the value of a platelet-to-lymphocyte ratio.

Objective. To analyze the frequency and date of onset of a secondary noncardioembolic ischemic stroke (IS) over a three-year period according to a patients gender and the presence of diabetes mellitus (DM). Subjects and methods. The cohort observational study covered 206 patients who had experienced a first noncardioembolic IS. The clinical and metabolic parameters were studied in the participants, as well as the frequency and date of onset of a secondary IS were assessed using the Cutler-Ederer and Kaplan-Meier methods according to gender and DM. Results. The analysis of the frequency and date of onset of a second noncardioembolic IS over a three-year period showed an increase in the risk of this pathology in both male patients and type 2 diabetes (T2DM) ones. Conclusion. Male patients and T2DM ones are at a high risk for a secondary noncardioembolic IS.

Orthopedic treatment with fixed structures leads to changes in microcirculation in the periodontal tissues of the supporting teeth. The rate of hemodynamic recovery largely depends on the general somatic state. This is due to the fact that patients with arterial hypertension the vasomotor activity of microvessels is reduced with an increase in the tone of the resistive link of the microvasculature, but in contrast to them, the balance of blood flow regulation mechanisms is characteristic for healthy people. Against the background of the balneological based on extraction from silt medical dirt treatment of patients with arterial hypertension, the processes of microcirculatory bed regeneration are accelerated. Determining the dependence of changes in periodontal microcirculation indicators on supporting teeth during an prosthodontic treatment using fixed constructions for patients with arterial hypertension with the use of balneological product based on extraction from silt medical dirt was the aim of this work. Under the supervision were 120 patients who applied for dental care, aged 22 to 65 years. Prosthodontic treatment was with fixed constructions. Dynamic observations using Laser Doppler Fluometry (LDF), carried out in the region of the roots of the abutment teeth before treatment and preparation of the design on days 3 and 7. The presence of arterial hypertension in patients was reflected in a change in the rate of restoration of microcirculation indicators. It was noted that with the use of the balneological product based on extraction from silt medical dirt in patients with arterial hypertension, the values of these indicators were close to those of people which were without this pathology, the indicates of effectiveness of the using this product in prosthodontic treatment.

One of the pressing problems of modern healthcare is a steady increase in the proportion of chronic non-communicable diseases (CNCDs) that are most commonly caused by an improper lifestyle. Timely identification of risk factors contributing to the development of CNCDs will be able to preserve and considerably augment the health of each person and the general population. For effective screening of risk factors for CNCDs, preventive medical examination programs have been introduced into practical health care. Screening programs make it possible to detect diseases at earlier stages and, accordingly, to use a wider range of therapy options, which eventually enhances treatment efficiency and reduces the risks of possible adverse consequences. One of the possible options for the widespread introduction of screening programs is telemedicine. The advantages of the latter include reducing the number of medical errors, saving the time of a physician and a patient, enhancing the effectiveness of medical and preventive establishments, high-quality diagnosis and prevention of diseases, regardless of the patients area of residence. The use of telemedicine technologies became especially relevant during the COVID-19 pandemic. The forced cancellation of full-time visits to the physician, the reprofiling of hospitals, and implemented lockdowns served as an impetus for the development of telemedicine in both Russia and foreign countries. Telemedicine under pandemic conditions makes it possible to closely monitor the patient without the need for movement around the city and for a direct physical contact, which ultimately assists in reducing the spread of infection.

In our country, when with a radical change in the socio-economic living conditions of the population has occurred since Perestroika (restructuring), there is a long-felt need for correct information about the vector of movement of the epidemiological situation, including the parameters of attitudes towards health and the prevention of diseases. An analysis of these long-term monitoring data will make it possible to predict the population’s response to different prevention programs, to preliminarily estimate the amount of necessary preventive care in the population, to take into account certain material costs that will be required to implement certain prevention measures, and to evaluate the effectiveness of an intervention. Objective: to determine trends in attitudes towards the prevention of diseases among 25-64-year-old women during 20-year population monitoring. Subjects and methods. One-stage epidemiological studies were conducted on representative samples among able-bodied women in 1996 and 2016. At cardiac screenings, the WHO knowledge and attitude towards one’s health questionnaire was completed by the women in the presence of an interviewer to determine the parameters of attitudes towards the prevention of diseases. Results. According to the twenty-year monitoring of the open population of a medium-sized urbanized Siberian city, it showed an increase in the positive attitude towards the prevention of diseases among women, mainly those at young ages. There were positive trends in the opinion of young and middle-aged women regarding the need for prevention measures. Conclusion. The revealed positive trends in a more positive attitude towards the problems of prevention among women over twenty years of monitoring the population create favorable conditions for the work of a preventive service of practical health care, which should be focused just on young and middle-aged able-bodied women as a category as most promising and susceptible to lifestyle changes.