Vol 18, No 2 (2021)

Nowadays the necessity of implementation of new learning technologies in medical education is considered more and more actively. These technologies allow to move from the teacher-centered approach, which is based on the directive style of learning programs mainly because they are overloaded by lectures, to the student-centered approach which suggests more active educational technologies, such as problem-based learning. The principal ground of education in medicine is aimed mainly at receiving a new information but not at development of practical skills so the compliance between the educational and professional activities, knowledge and skills becomes the essential divergence instead. The experience obtained in different countries allows consider the problem-based learning as the most effective educational technology. It's main principle is a self-directed learning via active group work and supportive, stimulative and facilitative activity of a teacher. In these circumstances the acceptance of new knowledge becomes easier the students this process has internal stimuli while the proper group process supports the carrying out this motive. Key words of this approach are “find, create, master”. These principles are fulfilled in the creation of skills which are necessary for the successful practice. Among the skills to be developed here are hard - skills and especially soft - skills, related to a creativity, competence in communication, cooperation in a team, cognitive flexibility, the ability to cope the emotional arousal in the work etc. The effectiveness of a problem-based learning helps to solve the tasks, related to the medical staff education and training and could be essentially increased while using the new information technologies. The active learning makes the process of acceptance and mastering of knowledge and skills more individually based. The paper presents the reasons for the advanced implementation of the problem-oriented learning into the structure of the postgraduate medical studies. The psychological aspects of this process, methods and stages are described. The role of a teacher in this process and the core aspects of the carrying out of the problem-oriented learning are analyzed.

The introduction of simultaneous operations into medical practice allows patients to experience preoperative stress, anesthesia, the postoperative period and rehabilitation once. Carrying out these operations involves the synchronous correction of diseases of the cardiovascular system, oncological, gynecological and other pathologies. Simultaneous operations have good long-term results and high economic efficiency too.

The article presents the results of the medical examination of schoolchildren aged 9-10 years living in the Altai Republic. Anthropometric measurements assessing the level of schoolchildren physical development were carried out. The study revealed a low level of schoolchildren physical development in the presented age group, underweight in children of both sexes being more prominent in females. At the beginning of the academic year, children were characterized by an asthenic body type. At the end of the year, the parameters characterizing the body type were within the recommended values. The causes of the low level of physical development may be the special characteristics of the climate and geographical zone where the studied children live, the diet and the lack of physical activity which is necessary for the normal body development.

Despite an active search and an abundance of scattered recommendations for the prevention of incisional ventral hernias, there is still no consensus on many issues. Discussions continue about the use of a continuous or interrupted suture of the aponeurosis, the prophylactic use of a mesh endoprosthesis during the closure of abdominal wall incisions. The generally accepted methods of prevention include the use of monofilament non-absorbable synthetic materials when suturing the aponeurosis using the "small byte" technique. The first experience with a new prevention method, such as laparotomy with umbilical dissection, shows good results and requires further study.

Currently, the problem of determining the professional suitability of vehicle drivers is very relevant. This is related to the need to develop and implement effective methods of psychophysiological diagnostics of the condition of drivers. The study involved 32 trolleybus drivers with at least a year of experience in their specialty and age at the time of inclusion in the study 26-59 years. Based on the data obtained, a diagnostic technique has been developed to identify the degree of development of the most significant psychophysiological qualities of trolleybus drivers. This express-test can be used at the stage of professional selection of drivers of passenger vehicles working in a large city.

Our study revealed the correlations between parameters that reflect changes in the systemic regulation of physiological functions during abnormal occlusion accompanied by disturbances in postural control. Estimating the heart rate variability, studying the posture (by means of computer optical topography), and performing the tests for activity of the autonomic nervous system showed that a normal functional state is characterized by coordinated activity of the postural control apparatus, occlusion of dentition, and other physiological systems. By contrast, the predominance of sympathetic autonomic regulation and anomaly of occlusion in the form of distal occlusion are is accompanied by the certain postural disorders (scoliosis of the 1st - 2nd degree in the frontal plane). Orthodontic treatment was followed by a decrease in activity of the sympathetic nervous system for heart rate regulation, which illustrates an increase in the adaptability of cardiovascular functions. These data are promising for an improvement of instrumental procedures for functional diagnostics in physiology and dentistry.

The use of biologically active enantiomers instead of racemic forms is currently a promising approach to improving the properties of known drugs. In such derivatives of GABA as phenibut and baclofen, the pharmacological activity is determined by the (R)-isomer. The potential for the possible clinical use of tolibut is limited by a narrow spectrum of therapeutic action. One of the ways to expand it may be the approach of isolating and studying the active enantiomer. The sedative, anxiolytic, nootropic, antihypoxic effects, as well as the toxicity of the (R)-isomer and racemate of tolibut were evaluated. The performed study showed that the (R)-isomer of tolibut has a more pronounced muscle relaxant, antihypoxic effect, exhibits less pronounced anxiolytic activity and less toxicity compared to racemate.

The aim of the study was to assess the dynamics of structural changes in the follicular apparatus and the hemomicrocirculatory bed of the thyroid gland in rats with cerebral hypoperfusion in rats with different levels of learning ability under prolonged exposure to physical exertion. Materials and methods: using classical histological stains, the state of the follicular and interfollicular epithelium, as well as perifollicular hemocapillaries in Wistar rats after bilateral ligation of the common carotid arteries was investigated, separately for animals with high and low test rates in the Morris water maze. The thyroid gland was studied 1, 6, 8, 8, 14, 28, 35, 60 and 90 days after surgery (comparison group), as well as when it was combined with 15 minutes of physical activity (experimental group). Results and discussion: changes in isolated cerebral hypoperfusion are characterized by periodicity - when a short-term increase in organ activity is replaced by its decrease. Also, results were obtained on a greater amplitude of changes in the studied parameters and a later growth of signs of organ activity in a subgroup with a high level of cognitive abilities. A single physical activity leads to a greater increase in the activity of the thyroid gland during cerebral hypoperfusion, which may have a positive value, based on the ability of its hormones to stimulate the neuroprotective mechanisms of astrocytes and shift the vector of differentiation of progenitor cells towards neurons. Conclusions: physical activity against the background of cerebral hypoperfusion leads to a restart of the adaptive-compensatory syndrome, which, in turn, is accompanied by an increase in the activity of the thyroid epithelium in the subgroup with a high level of cognitive abilities after 3 weeks, associated with a decrease in mortality.

The results prospective study of accommodation in 114 patients with hyperopia (114 eyes) before and after FemtoLASIK were analyzed. According to the data of a prospective study after FemtoLASIK, the 114 patients were diagnosed with false myopization syndrome in 42,1 % of cases, which was caused by accommodation disorders pre-op. The following data were revealed pre-op: habitually excessive accommodation stress (HEAS) - 22,8 %, weakness of accommodation - 38,6 %, HEAS in combination with weakness of accommodation - 24,6 %. A significant improvement in accommodation was noted after FemtoLASIK: HEAS was detected only in 4.8% of cases and HEAS in combination with weak accommodation in 9,5% of cases, a decrease in the severity of asthenopia.

The article presents a rare clinical case of trichobezoar. The article describes the difficulties of diagnostic search when a child was treated for anemia by a hematologist for 4 years. The diagnosis was made already against the background of the developed complication.

Acute hematogenous osteomyelitis (AHO) is a severe disease of childhood and leads to disability in 70-87 % of cases. Despite the achievements of modern science, research methods are not always able to diagnose CSO in children in time. The number of scientific works devoted to the early diagnosis of CSO in children based on the use of morphological and functional characteristics of bone tissue is limited. The material for the study was a biopsy of bone tissue and red bone marrow obtained after osteoperforation in children with CSO. After preliminary processing of the biopsy, histological and immuno-histochemical studies were performed, followed by an assessment of the prognostic value of the data obtained. The study revealed histological changes in bone tissue characteristic of the intramedullary and extramedullary phases of CSO, IHC indicators of an increase in the population of cytotoxic T-lymphocytes in the red bone marrow, indicating the development of a severe inflammatory process.

In hypertension, the administration of several single-component antihypertensive drugs from different groups increases the choice of pharmacotherapy options. Conducted a quantitative assessment of these options at various stages of intensification of antihypertensive therapy. The international nonproprietary name, trade name and dosage of the drugs were taken into account. The methods of combinatorics were used for the calculation. At each stage of the intensification, the number of possible combinations of drugs increased significantly, which could eventually reach 1 834 555 464. The obtained results revealed the problem of choosing rational antihypertensive therapy during its intensification, which is the justification for the development of a specialized decision support system.

The aim of this study was to asses hepatoxicity of riamilovir with repeated administration on the animal model. Materials and methods. Twenty non-linear guinea pigs were randomized into 4 groups: control and three experimental, receiving 64 days of daily riamilovir orally in doses of 48, 96, 144 mg/kg. Biochemical profile: ALT, AST, GGT, total protein, total and direct bilirubins, albumin, cholesterol, triglycerides: on 0, 33 and 65 days from the start of the experiment. Results. A significant decrease of serum albumin and cholesterol levels was found only in group 2 and there were no statistically significant changes of other indicators. Conclusion. The data obtained indicate afunctional liver synthetic function changes without signs of hepatobiliary and hepatocellular damage.

The article presents the results of a survey according to the "Methodology for determining stress resistance and social adaptation of Holmes and Rage" 28 men and 33 women who underwent inpatient treatment in the cardiology department of (SBIHC RA) Adygea republican clinical hospital with myocardial infarction (MI) and hypertension complicated by the crisis (HCC). Men showed the dynamics of the growth of HCC was revealed after 61 years, while in the subgroup up to 61 years, MI prevailed. Women subgroups' results were opposite. Significant stress load was found both in male subgroups, especially under 61 years, and in female subgroups. The criteria for the selection of patients into high and moderate risk groups for subsequent psychological correction are identified. Recommendations are given on the inclusion of psychological correction in the general rehabilitation program for patients with an acute cardiac event during the period of hospital treatment and dispensary observation at the outpatient-polyclinic level.

Good pharmacovigilance practices have been introduced for continuous and updated exchange of information on drug safety. The pharmacovigilance system provides continuous monitoring of medicines, which can reduce morbidity, mortality and costs to health care providers. The purpose of this study was to analyze the structure and information of spontaneous messages received by the Pharmacovigilance Center in the Yaroslavl Region in 2018-2020. The work was divided into 2 stages: collection of information and analytical stage. According to the Federal Service for Surveillance in Healthcare, today antibacterial drugs for systemic use occupy a leading position in the Pharmacovigilance database, which is also confirmed by the data of our study. Antibiotic use has been reported in more than 70 % of COVID-19 cases. Inappropriate antibiotic treatment for COVID-19 patients can lead to preventable complications, including increased bacterial resistance.

The article discusses a clinical case of diagnosing secondary antiphospholipid syndrome (APS) in a young patient. The multiple organ symptoms and the need for additional special laboratory research methods make it difficult to make this diagnosis. APS is diagnosed with one clinical (thrombosis or pregnancy complication) and one serological criterion (lupus anticoagulant, antibodies to cardiolipin or p2-glycoprotein I). Patients with APS should be under long-term dispensary supervision to prevent recurrence of thrombosis and their prevention., it is necessary to control the activity of the underlying disease, timely detection and treatment of concomitant pathology, and the impact on corrected risk factors for thrombosis with secondary APS.