Vol 23, No 6 (2017)

Articles
THE LEGAL PROBLEMS OF IMPLEMENTATION OF CLUSTER POLICY IN HEALTH CARE
Mokhov A.A.
Abstract
The cluster policy is a component of new social economic policy implementing in the Russian Federation. In last years, it became to be applied and in health care too. The implementation of this type of policy requires following purely juridical standards since they create corresponding normative legal base for development and functioning of medical clusters. Nowadays, the actual legislation concerning medical clusters is at its initial stage of elaboration. Тhe further elaboration of legislation on medical clusters is required to develop national and regional medical clusters.
Medical Journal of the Russian Federation. 2017;23(6):284-287
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THE WORKING TIME SPENDING OF PHYSICIANS-SPECIALISTS FOR PROFESSIONAL ACTIVITIES RELATED TO APPLICATION OF ULTRASOUND EXAMINATIONS
Starodubov V.I., Ivanova M.A., Lyutsko V.V., Popova N.M., Tolmachev D.A.
Abstract
The photo time-keeping monitoring of working of 50 physicians of ultrasound diagnostic was carried out in 20 pilot territories with consideration for modern technical possibilities. The substantiation of the study was based on point 3 of the regulations of development and authorization of type labor standards, approved by enactment of the Government of the Russian Federation of November 11 2002 № 804 (legislation corpus of the Russian Federation, 2002, № 46, article 4583) and point 19 of the plan of actions («road map») «The alterations in sectors of social sphere directed to increasing of efficiency of health care», approved by the enactment of the government of the Russian Federation of December 28 2012 № 2599-p (legislation corpus of the Russian Federation, 2013, № 2, article 130; № 45, article 5863; 2014, № 19, article 2468). The results of study testify the necessity of development of normative documentation related to establishment of standards of load of endoscopy physicians concerning increasing of time spend to implementation of curative diagnostic examinations.
Medical Journal of the Russian Federation. 2017;23(6):288-291
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THE REGIONAL FEATURES OF MOTIVATION OF BLOOD DONORSHIP IN THE REPUBLIC OF KAZAKHSTAN
Burkitbaiev Z.K., Abdrakhmanova S.A., Skorikova S.V., Zhiburt E.B.
Abstract
The blood donorship is an integral part of modern medicine. Nowadays, it is very important to develop gratuitous and regular donorship and formation in population, especially in the youth, deliberate attitude to donorship and revival of noble traditions of charity, humanism and moral values. The article presents analysis of regional characteristics of dynamics of blood donorship in the Republic of Kazakhstan. The condition of annually increasing need in blood and its preparations creates a necessity in studying means of incoming of blood to the blood service. The analysis of reports concerning functioning of blood service in the regions of the Republic of Kazakhstan demonstrated that during 2012-2015 percentage of gratuitous donations increased from 47.7% to 54.9%. The percentage of donations of donors-relatives decreased from 36.4% to 34.5% and paid donations decreased from 15.9% to 10.8% as well. The obtained data testifies that in regions of the country nowadays a main impulsive cause for participating in blood donorship is gratuitous support of patients.
Medical Journal of the Russian Federation. 2017;23(6):292-294
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THE ANALYSIS OF PERINATAL LOSSES UNDER DELIVERY IN WOMEN AGED 34 YEARS AND OLDER IN VARIOUS REGIONS OF AZERBAYDZHAN
Mamedova S.N.
Abstract
The article presents the results of delivery in women older than 34 years. The obtained data testifies that on the whole in the Republic of Azerbaydzhan percentage of delivery in women older than 34 years factually has no difference with such in similar countries and amounts to 5-6 cases per 100 deliveries correspondingly. The analysis of perinatal losses during deliveries in women older than 34 years demonstrated that only in every second region of the Republic of Azerbaydzhan there is a statistical confirmation of correlation dependence between percentage of deliveries in women older than 34 years and perinatal losses. The significant differences are established depending on regions both in prevalence of deliveries in women older than 34 years and availability of perinatal losses. This occurrence requires further investigation of causes and development of measures of their elimination.The purpose. To evaluate significance of inter-regional differences of prevalence of deliveries in women older than 34 years among cases of terminated pregnancy in period of gestation after 22 weeks for health of mother and child.Materials and methods. The study was carried out using retrospective algorithm in obstetric institutions of cities of republican subordination. The object of observation was formed using complete inclusion of all cases of termination of pregnancy in of gestation after 22 full weeks during 2012-2014. The percentage of delivery in the age older than 34 years was determined. The results. In totality, 5.8±0.07 cases of delivery at 35 ages and older go to 100 terminated cases of pregnancy in period of gestation after 22 full weeks. In district and municipal obstetric institutions, a value of this indicator varied in the range from 0.3±0.06% to 18.5±0.53%. In totality, level of perinatal losses made up to 1.8±0.04%. In regional obstetric institutions, the level of perinatal losses varied in the range from 0,1±0.04% to 3.7±0.16% (p < 0,01).Conclusions. In Azerbaydzhan, the inter-regional differences in prevalence of delivery at the age 44 years and older are significant (percentage of deliveries at the age 34 years and older varies in the range from 0,3 to 18,5%). The increasing of risk of perinatal losses under delivery at the age 34 years and older has no unequivocal confirmation. In Azerbaydzhan, in most of the municipal and district obstetric institutions (8 out of 15) deliveries in women older than 34 years have no association with increased level of perinatal losses.
Medical Journal of the Russian Federation. 2017;23(6):295-297
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THE T-CELL IMMUNITY IN CHILDREN WITH MEGALOTHYMUS
Vaganov P.D., Nikonova M.F., Yanovskaya E.Y., Mandzhieva E.T., Donetskova A.D.
Abstract
The indices of T-cell immunity are decreased in children of early age with megalothymus: content of T-cells (CD3+), Т-helpers (СD4+ Т-cells), cytotoxic Т-lymphocytes (СD8+ Т-cells), regulatory Т-cells (CD4+CD25hi) and also activated Т-lymphocytes (CD4+CD25lo и CD3+HLA-DR+). The increasing of expression of alterations was observed as degree of megalothymus was progressing. The only exclusion were regulatory T-cells. Their level was decreased under megalothymus degree I and II and was closer to indices of age standard under megalothymus degree III. Also, it was demonstrated that capacity of T-cells to differentiation to cytokine-producing cells type Th1 and Th2 increases as far as increases expression of megalothymus. However, this process remains within framework inherent to comparison group. The T-lymphopenia under megalothymus is conjugated with decreasing of emigration of T-cells from thymus to peripheral section of immune system. These alterations bring on deficiency of T-cell chain of immune system and can favor manifestation of its incapacity especially in conditions of increased load under effect of pathogens.
Medical Journal of the Russian Federation. 2017;23(6):298-302
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THE PARTIAL DISCEMETOREXIS WITHOUT TRANSPLANTATION IN CASE OF ENDOTHELIAL DYSTROPHY OF CORNEA
Oganesyan O.G., Grdikanyan A.A., Yakovleva S.S., Getadaryan V.R.
Abstract
During the last 20 years, the penetrating keratoplasty gave in its leading place to selective lamellar keratoplasty when pathologically altered layers of cornea are selectively replaced, including endothelium. The main technical task of all procedures of endothelial keratoplasty is an obligatory complete or almost complete post-operative adjacency of endothelial transplant to stroma of recipient. However, there are publications concerning resorption of edema in case of separation of endothelial transplant and even at its absence. The purpose of study. To analyze, on the basis of limited clinical observations, the results of partial discemetorexis (5.25 mm) without transplantation in patients with endothelial dystrophy of cornea (Fuchs).The materials and methods. The study was implemented concerning maximal correcting visual acuity, central thickness of cornea, density of endothelial cells and optical density of cornea, before, in one day, in one week, in 1, 3 and every 6 months after operation. The study covered 6 patients with Fuchs dystrophy (average age 63 ± 6,5 years) operated in 2015-2016 with period of observation neither less than 6 months. The visual acuity before operation in average made up to 0,32 ± 017 mkm, average central thickness of cornea - 677 ± 76 mkm. The native crystalline lens was present in 2 patients. The study was supported by ethical committee of the Helmholtz Moscow research institute of eyes diseases. The results. The resorption of edema of cornea occurred in 2 patients (33%), visual acuity increased from 0.45 to 0.6. In different periods density of endothelial cells varied from 549 to 689 kl/mm2. The central thickness of cornea decreased from 613 ± 33 mkm to 553 ± 15 mkm in 12 months after operation. Conclusion. The discemetorexis (5.25 mm) is more often efficient in case of availability of native crystalline lens, at earlier stages of dystrophy independently of patient's age. The discemetorexis ensures lower indices of maximal correcting visual acuity and density of endothelial cells and higher values of central thickness of cornea in comparison with DMEK. The indices of central thickness of cornea and optical density of cornea are exposed to fluctuations in different periods after discemetorexis (5.25 mm).
Medical Journal of the Russian Federation. 2017;23(6):302-307
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THE ALTERATION OF COMPOSITION OF FATTY ACIDS AND INSULIN-BINDING ACTIVITY OF CELLS IN CONDITIONS OF OXIDATIVE STRESS UNDER EXPERIMENTAL DIABETES MELLITUS
Mikaelyan N.P., Gurina A.E., Terentev A.A., Mikaelyan A.A.
Abstract
The parallel study of effect of experimental diabetes mellitus on the level of lipids and composition of fatty acids in blood and homogenates of liver and insulin-binding activity of cells in conditions of oxidative stress demonstrated that in rats already at early period of development of diabetes, alongside with hyperlipoproteinemia, hypertriglyceridemia and hypercholesterolemia significant alterations are marked in structure of fatty acids and homogenates of liver. These alterations are accompanied by peroxide oxidation of lipids and decreasing of activity of enzymes-antioxidants and also by decreasing of insulin-binding activity of cells. Under experimental diabetes mellitus, a significant increasing of level of saturated fatty acids, especially palmitic fatty acid results in decreasing of levels of mono-unsaturated fatty acids (at the expense of oleic fatty acid) that significantly differs corresponding specter in patients with diabetes. The increasing of concentration of eicosapentaenoic and docosahexaenoic acids is accompanied by decreasing of total content of fatty acid Omega-3 at the expense of alfa-linoleic fatty acid. At that, the level of fatty acid Omega-6 reliably decreases both in erythrocytes and homogenates of liver. The results of study also testify that already at early stages of development of diabetes mellitus alterations in pool of fatty acids of erythrocytes and homogenates of liver are similar (with slight differences) and in all analyzed tissues disorder of metabolism of fatty acids has an anti-sclerotic direction.
Medical Journal of the Russian Federation. 2017;23(6):308-311
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THE CHARACTERISTICS OF SECRETION OF ADIPONECTIN AND ITS RELATIONSHIP WITH PARTICULAR INDICESOF METABOLISM IN MALES OF ABLE-BODIED AGE IN CASE OF OBESITY
Karataeva O.V.
Abstract
The sampling consisted of 79 examined males of able-bodied age. The arterial hypertension stage I and II was established in 58% of them; obesity of various degree of severity was diagnosed in 63% of them; metabolic syndrome according criteria ATP-III was noted in 46.8% of examined patients. The general clinical and anthropometric examination was carried out. The laboratory analyses included estimation of lipidogram, fasting glycaemia and also hormones adiponectin and insulin with following calculation of index of insulin resistance HOMA-IR (Homeostasis Model Assessment of Insulin Resistance). The study was organized to investigate effecting of obesity on secretion of adiponectin and its relationship with indices of lipidogram and level of insulin resistance. The comparative analysis of groups with and absence of obesity established no significant difference in level of adiponectin and indices of lipidogram. the significant differences were established in the levels of basal insulin hence in value of index NOMA-IR that points to hyperinsulinemia and expressed insulin resistance in patients with obesity. The patients were separated in two groups depending on presence of manifestations of metabolic syndrome: with metabolically healthy obesity and metabolically complicated obesity. The analysis established a significant decreasing of level of adiponectin in the group of metabolically complicated obesity accompanied by insulin resistance, dyslipidemia and increased level of glycaemia. The study established no effect of degree of obesity on decreasing of level of adiponectin. The significant differences between levels of adiponectin in comparison between group without obesity and group of metabolically healthy obesity. The correlation analysis in group with obesity demonstrated back-coupling between level of adiponectin and content of total cholesterol, low density lipoproteins and coefficient of atherogenicity. The comparison of groups according median of adiponectin established significant differences in rate of development of metabolic syndrome and value of coefficient of atherogenicity.
Medical Journal of the Russian Federation. 2017;23(6):312-315
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THE CLINICAL AND PSYCHO-SOCIAL CHARACTERISTIC OF PATIENTS IN PLASTIC SURGERY
Petrova N.N., Kalakutsky N.V., Palatina O.M.
Abstract
Nowadays, the standards of rendering of specialized psychiatric care to patients of plastic surgery are still to be determined. The broadening of knowledge about clinical, psycho-social characteristics of patients of reconstructive and plastic surgery will assist to determine risk groups on mental disorders and to specify algorithms of management of these patients. The study covered 44 examined patients underwent plastic operations in area of face and neck. The clinical and psychometric techniques (Hamilton depression scale, Hospital Anxiety and Depression Scale) were applied. The patients of aesthetic surgery are characterized by higher level of social functioning. However, in the past mental disorders were diagnosed among them more frequently. At that, the patients of reconstructive and aesthetic surgery received treatment of mental disorders in 33.3% and 46.2% correspondingly. They visited psychiatrist on rare occasions. The mental pathology, more often of neurotic level, was diagnosed in 52.4% of cases in the group of reconstructive surgery and in 81.6% of cases in the group of aesthetic surgery. The patients of reconstructive surgery differed by higher prevalence of severe stress and reactive conditions, better criticism and hypochondria tendencies. Subjectively, the patients with deep affections of face and neck tissues psychologically considered as a most difficult year the first one after first treatment by plastic surgeons. The patients of aesthetic surgery are characterized by dysmorphophobia and personality disorders. In both groups in more than 50% of all cases a depressive symptomatic was detected. In the group of reconstructive surgery, the structure of depressive syndrome characterized by superficial sleep, locomotion anxiety. At the same time, the group of aesthetic surgery demonstrated more strikingly vegetative and mental components of anxiety.
Medical Journal of the Russian Federation. 2017;23(6):315-320
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THE COMPLEX ASPECTS OF MENTAL HEALTH OF PATIENTS WITH ONCOLOGIC PATHOLOGY
Berezantsev A.Y.
Abstract
The article considers issues of mental health of patients with oncologic pathology from position of bio-psychosocial approach and in the context of psycho-oncology, an actual direction of practical medicine. The prevalence of marginal mental disorders in this contingent of female patients is demonstrated on the example of women with oncologic diseases of reproductive system. The psychotherapeutic approaches to their correction are outlined. The original view on ratio of pathogenic factors effecting mental health of patients with oncologic pathology at various stages of medical care support. The genuine point of view on functional diagnosis of patient with oncologic disorder including somatic, clinical psychological and social components. The conclusions are made concerning necessity in timely modern psychosocial and psychotherapeutic care of the given contingent of patients.
Medical Journal of the Russian Federation. 2017;23(6):321-326
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THE EROSIVE ULCEROUS LESIONS OF UPPER PART OF GASTROINTESTINAL TRACT IN PATIENTS WITH ISCHEMIC HEART DISEASE: TREATMENT AND PREVENTION
Luzina E.V., Lareva N.V., Zhilina A.A., Zhigzhitova E.B., Ustinova E.E.
Abstract
The erosive ulcerous affections of gastrointestinal tract in patients with cardiovascular diseases occur frequently and are conditioned by both ischemia of organs of digestion against the background of reduced cardiac output and intake of low doses of acetylsalicylic acid combined with anti-coagulants. The bleeding can be the first and the only manifestation of gastroduodenal pathology. The treatment and prevention of aspirin-induced gastropathy provides for implementation of eradication of Helicobacter pylori infection, application of cyto-protectors (Misoprostol or Bismuthate tripotassium dicitrate), long-term using of inhibitors of proton pump. Out of them Pantoprazole has a certain advantage at the expense low risk of medicinal interactions, good clinical efficiency and anti-inflammatory effect.
Medical Journal of the Russian Federation. 2017;23(6):327-330
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THE PHENOMENON OF «SECOND HIT» AFTER OPERATIONS OF OSTEOSYNTHESIS IN CASE OF POLY-TRAUMA
Shapkin Y.G., Seliverstov P.A., Skripal E.A.
Abstract
In case of poly-trauma the early operations of osteosynthesis under fractures of long bones, unstable fractures of pelvis and backbone bones being an operational trauma, can provoke progression of inflammatory reaction, development of systemic complications and poly-organ inadequacy i.e. causing a «second hit» effect. The pathophysiologic mechanisms of «second hit» phenomenon are complicated and they are implementing by means of modulation of immune response. The risk of development of the given phenomenon depends on period of implementation and method of osteosynthesis, severity of injuries and condition, age, concomitant pathology of patient, presence of chest trauma and craniocerebral trauma. The study of pathophysiology of «second hit» phenomenon is perspective for development and optimization of clinical concepts of treatment of patients with poly-trauma and skeletal damages.
Medical Journal of the Russian Federation. 2017;23(6):331-336
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