Vol 22, No 4 (2016)

Articles
The competence of physicians of medical organizations of pediatric profile in the field of ethical legal issues
Shmeleva I.A., Konovalov O.E., Polunina N.V.
Abstract
The implementation of rights of under age patients in medical institutions to considerable extent is determined by the level of awareness of pediatricians about ethical legal issues related to children and adolescents. The article presents the results of survey of 239 pediatricians about rights of patients and duties of physicians. It is established that respondents are insufficiently informed about ethical legal issues and apply untimely knowledge about legal acts concerning rights of children-patients in their practice. It is established that awareness about ethical legal issues was higher among pediatricians with professional experience less than 10 years since disciplines of biomedical ethics and medical law were included into the program of prediploma training of pediatricians only in last decade. The direct relationship between competence of pediatricians in ethical legal issues and qualification was determined. The most of respondents are convinced in importance of advanced education in ethical and legal issues. It is necessary to include sections intended to increasing of legal competence of pediatricians.
Medical Journal of the Russian Federation. 2016;22(4):172-176
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The laparoscopic trans-abdominal pre-peritoneal hernioplasty in case of inguino-scrotal hernia
Sazhin A.V., Klimiashvili A.D., Ivakhov G.B., Kotchiay E.
Abstract
The laparoscopic trans-abdominal pre-peritoneal hernioplasty is an effective technique of treatment of uncomplicated hernia. However, application of this technique at complicated forms (inguinal-scrotal, repeatedly relapsing, strangulated hernias) continues to be a point at issue. The treatment of inguinal-scrotal hernia requires from surgeon availability of considerable experience independently of selected technique. The study was carried out to evaluate reliability and effectiveness of application of trans-abdominal pre-peritoneal hernioplasty under inguinal-scrotal hernia. In municipal clinical hospital № 4 8 operations of hernioplasty was implemented using trans-abdominal pre-peritoneal hernioplasty from 2014 to 2015. The technical intra-operational characteristics of techniques were analyzed. The evaluation of intra-operational and post-operational complications in early post-operational period and after 3 and 6 months after operation was implemented. All hernias were primary and onesided ones and were operated by the same surgeon. The average duration of operation made up to 93.5 min. In no cases the conversion was needed. No severe intra-operational complications were detected. In no case chronic pain and relapsing were detected. The total rate of post-operative complications made up to 12.5%. All patients were satisfied with operation in 3 and 6 months after discharge from the hospital. According the results of study, trans-abdominal pre-peritoneal hernioplasty is an effective technique of treatment of inguinal-scrotal hernias comparative with results of treatment of primary uncomplicated hernias.
Medical Journal of the Russian Federation. 2016;22(4):177-179
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The approaches to early diagnostic and correction of nutritive disorders under arterial hypertension combined with chronic obstructive lungs disease
Shpagina L.A., Gerasimenko O.N., Sukhaterina N.A., Shpagin I.S.
Abstract
The complex evaluation of food status of patients with arterial hypertension and chronic obstructive disease of lungs was implemented. The patients with combination of arterial hypertension and chronic obstructive disease of lungs are characterized by expressed anomalies of body composition (visceral obesity, surplus of total and extracellular fluid, protein-energy deficiency), dyslipidemia (increasing of level of cholesterol of low density lipoproteins, index of atherogenicity and hypertriglycer-inemia), disorders of protein metabolism (decreasing of total protein and pre-albumin) and adipocytokine status (increasing of concentration of leptin and resistin of blood against the background of decreasing of content of adiponeсtin). The mentioned alterations can promote increasing of cardiovascular risk in patients of this phenotype. The patients received protein formula for enteric nutrition during 21 day in combination with standard therapy. Whereupon, the indices of food status were re-evaluated. In dynamics, amelioration of indices of protein and fat metabolism was established. Hence, it appropriates to prescribe to patients with combination of arterial hypertension and chronic obstructive disease of lungs nutritive support with higher protein products for enteric nutrition.
Medical Journal of the Russian Federation. 2016;22(4):180-184
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The analysis of sensomotor disorders in late recovery and residual periods after ischemic stroke
Damulin I.V., Ekusheva E.V.
Abstract
The study was carried out to investigate clinical and neuro-physiological characteristics of sensomotor disorders in patients at different time periods after hemispheric ischemic stroke. The sampling of 133 patients with ischemic stroke in right hemisphere and left hemisphere were examined in late recovering and residual period (58 and 75 patients accordingly). The trans-cranial magnetic stimulation, abdominal reflexes and sensomotor induced potentials were implemented. It is demonstrated that in patients even in one year after stroke processes of functional rehabilitation of various degree of expression continue to be present. The constancy and degree of manifestation of sensomotor disorders and compensatory possibilities as well are determined by afferent component of post-stroke deficiency that supposes long-term effect for broadening possibilities of neuro-rehabilitation of patients after stroke.
Medical Journal of the Russian Federation. 2016;22(4):184-189
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The impact of oxidative stress on state of insulin secretion and insulin-binding activity of blood cells under diabetes mellitus and its complications in children
Mikaelyan N.P., Gurina A.E., Smirnov V.V., Mikaelyan A.V., Terentyev A.A.
Abstract
The study of condition of carbohydrate and lipid metabolism in 137 children and adolescents suffering of diabetes mellitus type I demonstrated progressing decrease of residual insulin secretion and insulin-binding activity of lymphocytes and erythrocytes against the background of metabolic disorders. This is the risk factor for severe course of disease with fast development of diabetic complications. The persistent disorder of carbohydrate and lipid metabolism, higher level of overoxidation of lipids with disorder of activity of enzymes of antioxidant defense and reliable decreasing of insulin-binding activity of blood cells testify presence of oxidative stress in children. The metabolic disorders, presence of residual insulin secretion and oxidative stress are to be taking into account for prevention of deterioration of condition of patient with progressing course of disease. These processes determine application of adequate dosages of insulin and necessity of application of effective remedies with antioxidant activity.
Medical Journal of the Russian Federation. 2016;22(4):189-193
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The rationale application of donor material: original ten years experience, possible ways of development and literature data
Oganesyan O.G., Yakovleva S.S., Kharlampidi M.P., Grdikanyan A.A.
Abstract
Lately, layer-wise keratoplasty became the first operation of choice in case of pathology of cornea. In view of satisfying results of endothelial surgery similar operations are implemented at earlier stages that increases need in donor tissue. With increasing of life span of population, also increases number of patients in need of transplantation of cornea. The number of intact cadaver cornea decreases because of stable increase of surgical interventions on front segment of eye. The present article presents original ten years experience concerning optimization of application of donor tissue and indicate on possibilities of further increasing of number of applied keratoplasties. From 2009 to 2015 in the Helmholtz Moscow research institute of eyes diseases 652 transplantations of cornea were implemented in various modifications: straight-through keratoplasty, transplantation of Descemet's membrane with endothelium (DMEK), deep front layer-wise keratoplasty, endokeratoplasty (DSEK) with various modes of transplant formation and 23 frontal layer-wise keratoplasties. In transplantation were also used eyes of donors with radial keratotomy, after laser keratomileusis and with artificial intra-ocular lens. To implement 652 operations 528 cadaver eyes with average age 41 ± 32,5 years (varying from 21 to 87 years) were required. The number of transplantations increased approximately on 50% at potential up to 75%. The lamellar surgery permits using corneal donor tissue with altered frontal surface and to increase number of transplantations of cornea. The renunciation of application of corneal donor tissue with altered frontal surface is inexpedient.
Medical Journal of the Russian Federation. 2016;22(4):193-197
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The specifics of radiologic characteristic of clinical forms of tuberculosis
Smetanina E.A., Smetanin A.G., Stakhanov V.A., Romenskiy V.V.
Abstract
The article presents the results of analysis of medical histories and roentgenologic archive (rontgenograms, linear tomograms, photofluorograms, multispiral computer tomography data) of 85 patients with tuberculosis of organs of thoracic cavity from one of departments of hospital of anti-tuberculosis dispensary of Barnaul. To specify roentgenologic characteristics of clinical forms of tuberculosis the comparative analysis was implemented concerning description of results of roentgenologic analysis comprised by roentgenologists and authors of article. The hyper-diagnostic of clinical forms “disseminated tuberculosis of lungs” and “infiltrative tuberculosis of lungs” was established. The discrepancy between roentgenologic syndromes and clinical forms of tuberculosis was revealed. The underestimation of significance of emphasis of leading roentgenologic syndrome for formulation of clinical form of tuberculosis is emphasized.
Medical Journal of the Russian Federation. 2016;22(4):198-202
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The effectiveness and safety of pharmacotherapy against the background of application of Gliquidone
Titov D.S., Pravkin S.K.
Abstract
The study was carried out to investigate using rabbits in vivo effect of Gliquidone on functional activity of protein-carrier of glycoprotein-P (P-gp, ABCB1-protein). The activity of P-gp was evaluated according pharmacokinetics of its marker substrate - Fexofenadine after single endogastric introduction. The application of Gliquidone in dosage of 10 mg per 1 kg of body mass during 14 days resulted in no alteration of concentration of Fexofenadine, period of its partial ejection, area under pharmacokinetic curve “concentration-time” from zero to last point of blood sampling, area under pharmacokinetic curve “concentration-time” from zero to infinity and also time of holding of marker substrate, total clearance and absorption coefficient. All this testifies absence of effect of Gliquidone on functional activity of protein-carrier at the level of integral organism. No alterations of pharmacokinetic parameters of Fexofenadine at the 5th day of cessation of Gliquidone were observed.
Medical Journal of the Russian Federation. 2016;22(4):203-206
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The effect of educational programs on effectiveness of treatment of arterial hypertension at out-patient stage of medical care rendering
Melekhov A.V., Emelina E.I., Andreeva O.Y., Gendlin G.E., Sokolovskaya L.V.
Abstract
The increasing of effectiveness of treatment of arterial hypertension is a key issue of prevention of complications of this disease. The level of target arterial pressure is achieved far from all patients treated because of arterial pressure. The article presents data concerning 55 individuals with office systolic arterial pressure higher than 140 mm of mercury column who in spite of hypotensive therapy prescribed by physician, demonstrated no achievement of target values of arterial pressure. Out of this group, 24 patients were acquainted with educational program including an hour lecture concerning arterial hypertension, techniques of self-control of arterial pressure, effect of non-pharmaceutical modes of treatment and role of patients themselves in therapy of this diseases. The educational program was ignored by 31 patient. All patients at the start and the completion of examination were measured office arterial pressure, monitored day arterial pressure. Also evaluation of compliance to indicated hypotensive medicinal therapy was carried out. At the second control visit after 1-3 months, in patients who attended the lecture, significant decreasing of arterial pressure was established according both office measurement and data of indices of systolic arterial pressure. Moreover, the same patients developed compliance to applied treatment. No such effects were observed in 31 patients who ignored lecture mentioned above. It is assumed that the important part of activities concerning treatment of patients with arterial hypertension from the very beginning of interaction with physician is to become increasing of awareness of patients about disease, modes of its control, importance of non-medicinal measures, regular pharmacotherapy attended by physician. It is appropriate to actively implement these measures in practical health care considering expressed clinical and social economical effectiveness of educational programs for patients with arterial hypertension.
Medical Journal of the Russian Federation. 2016;22(4):207-212
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The differential diagnostic of anemias associated with iron metabolism
Andreichev N.A., Andreicheva E.N.
Abstract
The iron-deficiency conditions continue to be an actual problem all over the world being present in half of population of the terrestrial globe. The development of iron deficiency often depends on gender and age. In females specific role is played by hypermenorrhea and repeated pregnancies (iron deficiency and iron-deficiency anemia are found 6 times more often in females than in males). The anemia of chronic diseases by it prevalence takes second place after iron-deficiency anemia. The prevalence of anemia of chronic diseases in elder and senile age varies within range 2,9-61% in males and 3,3-41% in females. In young and mature age anemia of chronic diseases more often occurs in females. There are anemias when content of iron in organism and its resources are within limits of norm or higher - sideroahrestical anemias. The percentage of them in structure of hypochromic anemias is smallish. The diagnostic and differential diagnostic of anemias related to iron metabolism. The anemias are diverse according to clinical hematological characteristics. At selection of diagnostic schemes, treatment of anemias differs on leading pathogenic mechanism. However, to facilitate diagnostic and differential diagnostic the color indicator and morphological classifications are considered. The differentiated diagnostic of anemias is based on data of clinical, laboratory and instrumental analysis. The blood analysis under anemia is to take into account indices of Hb, size of erythrocytes, their saturation with Hb, average volume of erythrocytes, and average content of hemoglobin in erythrocytes, amount of reticulocytes and other cells permitting judging about character and activity of erythropoiesis. The article presents algorithm of examination of patient under hypochromic and microcytic anemia, diagnostic and differentiated diagnostic of acute post-hemorrhagic anemia, anemia of chronic course, iron-deficiency anemia, anemia of chronic diseases, sideroahrestical anemia, iron-saturated anemia due to leaden intoxication, inherent iron-saturated anemia of pharmaceutical genesis, thyroprival anemia and thalassemia.
Medical Journal of the Russian Federation. 2016;22(4):213-221
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The cascade stomach in girl 11 years old
Artamonov R.G., Alieva E.I., Glazunova L.V., Polyakov M.V.
Abstract
The article presents observation of case of cascade stomach being accompanied with number of dyspeptic phenomena and abdominal pain in girl of 11 years old.
Medical Journal of the Russian Federation. 2016;22(4):222-224
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