Vol 43, No 2 (2024)

BACKGROUND: The involvement of civilian medical institutions in medical care in military conflicts and counter-terrorism operations has become an important area of the medical support system. Modern methods of surgical navigation make possible minimal invasive, effective and safe removing foreign bodies from soft tissues. Clear understanding of injuries’ character allows better planning of procedures.

AIM: Improving the results of treatment of military personnel with fragment wounds by taking into account the character of injury and the use of ultrasound control during removing soft tissue foreign bodies at the stage of specialized surgical care.

MATERIAL AND METHODS: Data from 253 case histories who were treated at the State Budgetary Institution RO “Central City Hospital named Semashko”. Indications for the removal of fragments included the size of the fragment over 7 mm, localization near to large vessels and nerve trunks, and an acute purulent process. The patients were been randomized to two groups. Group I (control) included 118 patients in whom surgery was been performed in the traditional way. Group II (main) included 135 patients in whom procedures were performed with ultrasound navigation. The research methods are ultrasound, X-ray, clinical, and statistical.

RESULTS: In 164 patients (64.8%), the wounds were of an isolated nature, where fragments were localized in various anatomical areas. 89 patients (35.2%) had combined shrapnel wounds. Of the 118 patients in group I, in whom surgery was performed in the traditional way, 65 patients (55.1%) underwent surgery under local anesthesia, 53 (44.9%) — under general anesthesia (anesthesia is always general). In 135 patients of group II, operations were performed by only one surgeon under local anesthesia. The duration of surgery, surgery invasion and wound infections rate were significantly lower in group II.

CONCLUSION: The part of isolated fragment wounds is 64.8%, combined — 35.2%. The use of ultrasound navigation during surgery can significantly improve the effectiveness of surgical treatment of patients with fragmentation wounds: reduce the invasiveness and duration of surgery, blood loss, and the rate of wound infectious complications.

BACKGROUND: The state of the hemostatic system in patients with chronic heart failure (CHF) remains an insufficiently studied problem.

PURPOSE OF THE STUDY: to present the results of an original study of the coagulation system of patients with CHF using an integral technique — low-frequency piеzothromboelastography (LPTEG).

MATERIAL AND METHODS: The study involved 90 patients with CHF due to hypertension and coronary artery disease aged 50–75 years. The subjects were divided into groups with CHF I–IIa (n = 30), CHF stages IIb–III (n = 60). All patients underwent a study of the hemostasis system using classical (coagulogram) and integral (NPTEG) methods before prescribing antiplatelet and anticoagulant therapy. The comparison group consisted of healthy patients of the same age group without CHF (n = 30).

RESULTS: In patients with CHF, a general blood test revealed a statistically significant decrease in the number of platelets (group 1 — 215; group 2 — 185) compared to the control group — 241. When analyzing the coagulogram, a decrease in the levels of prothrombin (group 1 — 89; group 2 — 86; control group 105), antithrombin-III (group — 76.5; group 2 — 73; control group — 91) and increased INR (group 1 — 1.03; group 2 — 1.12; control group 1.01) in patients in groups with CHF compared to the control group (p < 0.05). When using the NPTEG method in patients with CHF, a decrease in indicators characterizing the rate of clot polymerization (intensity of clot polymerization) and clot density (maximum amplitude) was determined when compared with the control group (p < 0.05).

CONCLUSION: In patients with CHF, changes in the hemostatic system are determined, characterized by a tendency to hypocoagulation, the frequency a severity of which increases with the progression of the stage of the disease.

BACKGROUND: Assessing social efficiency currently plays a key role in improving the organization of medical care to citizens. Satisfaction with medical care provided is an indicator of the availability of medical care and the effectiveness of healthcare in general.

AIM: To assess the social effectiveness of medical care using the method of remote monitoring of blood pressure in cardiac patients based on the results of remote monitoring.

MATERIALS AND METHODS: The study materials included data from an anonymous sociological survey of 200 patients who were under dispensary observation and had a history of periods of deterioration in the functional state of the cardiological profile. The questionnaire offered to patients contained six establishing questions, each of which was distributed on a scale balanced from extreme positive to extreme negative assessment.

RESULTS AND DISCUSSION: Before conducting remote monitoring, the level of awareness of patients about their own health status, preventive measures, and the use of devices for remote transmission of blood pressure data from the patient to the doctor was investigated. Subsequently, to increase patient awareness, additional information materials on the procedure for interaction be-tween patients and medical workers, as well as about risk factors for the development of cardiovascular diseases and complications from them.

The sociological survey was conducted to summarize the results of remote monitoring of patients’ blood pressure and was aimed at studying patients’ opinions on changes in the organization of medical care provided in outpatient settings.

CONCLUSION: The data obtained showed that, in general, the degree of achievement of social results after remote blood pressure monitoring increased by 61.0%. Undoubtedly, such an increase in patient satisfaction was achieved as a result of the redistribution of responsibilities between doctors and nurses, as well as a result of well-established participatory interaction between medical workers and patients in terms of remote monitoring of dispensary groups of cardiac patients, instruction in the method of measuring blood pressure and monitoring it indicators in electronic form.

BACKGROUND: The article provides an analysis of the prescriptions of a group of medications used for the prevention and treatment of dementia associated with central nervous system damage. During the period of gerontogenesis, irreversible changes occur in the human body, associated with the somatic state and mental processes in the CNS. According to the ICD-11 classification, this type of pathology is defined as neurocognitive disorders (6D80-86).

PURPOSE OF THE STUDY: Analysis of the prescription of drugs for the treatment of dementia in patients with disorders caused by neurocognitive changes due to the aging process.

MATERIALS AND METHODS: In the course of the study, the following were used: content analysis, observation method, documentary, systematic, statistical and other methods of analyzing drug prescriptions. The research base include the gerontological departments of the Sverdlovsk Regional Psychiatric Hospital. Medical documentation with the specified medications prescribed to patients aged 60 years and older with a psychiatric history.

RESULTS AND DISCUSSION: A trend has been established towards a decrease in the number of prescriptions of drugs No. 1–3, 7 (Galantamine, Memantine, Akineton and Vinpocetine, respectively) and an increase in No. 4–6 (aminophenylbutyric acid, rivastigmine, piracetam). The experts prefer drugs with nootropic effects (57% of the entire sample), which are used along with anticholinergics (14%) and anticholinesterase drugs (29%).

CONCLUSION: According to the results of the analysis, a high level of prescriptions by doctors of specialized departments have medicines numbered No. 4, 5, and 6 (aminophenylbutyric acid, rivastigmine, piracetam).

The rapid spread of overgrowth of plants of the genus Hogweed, associated with their use as an agricultural fodder crop, is currently a serious problem for the Russian Federation. This process has a negative impact on the biodiversity of the vegetation cover, destroying natural ecosystems and causing significant economic damage. However, the active spread of hogweeds on the territory of the Russian Federation would not be so catastrophic if it were not for their aggressive properties: in contact with the skin, plant sap causes phytophotodermitis, which is a burn similar to thermal burns of I, II and III degrees. The article considers qualitative and quantitative composition of the main biologically active substances of hogweeds sap and shows that the biologically active substances causing phytophotodermatitis are furanocoumarins. It has been established that the pronounced photosensitizing activity of furanocoumarins is determined by the presence of a furan ring at positions 6,7 and 7,8 of coumarin. Such compounds include psoralen and its main derivatives: xanthotoxin, bergapten, bergamotin, imperatorin, isopimpinellin and angelicin (isopsoralen) and its main derivatives: sfondin, pimpinellin, isobergapten. Substitution of furan ring condensed with coumarin ring as well as change of its position leads to loss of photosensitizing activity. It was determined that the activity of plant sap of the genus Hogweed is in direct dependence on such factors as qualitative and quantitative content of furanocoumarins in the plant sap, the amount of sap and the area of the skin lesion zone, the time of contact of the affected skin areas with the plant sap, the intensity of ultraviolet irradiation and the time of its effect on the affected areas, as well as the peculiarities of each person (e.g., age, skin phototype). The methods of standard therapy of three clinical forms of phytophotodermatitis were analyzed. It was found that currently no specific clinical recommendations for the diagnostics and treatment of phytophotodermatitis resulting from contact with the sap of hogweeds. At the end of the article, the conclusion is formulated that one of current and promising tasks of pharmaceutical technology may be the development of drugs used in the treatment of burns caused by the sap of plants of the genus Hogweed, taking into account the mechanism of action of furanocoumarins.

The number of diving descents in the world is steadily growing, as is the complexity of the work performed under conditions of increased environmental pressure. Also, in order to increase efficiency and expand the range of tasks performed, the intensity, depth of dives and the time divers spend in hyperbaric conditions are increasing. These factors contribute to an increase in the number of diving pathologies, including damage to the skeletal bones of dysbarogenic genesis. X-ray diagnostic methods used during annual medical examinations of divers do not always allow the detection of dysbarogenic changes in the bones; in addition, the clinical manifestations of this pathology do not have obvious specificity. In this regard, it can be assumed that the occurrence of this pathology among divers has not been reliably established to date. This article is devoted to a review of the literature on the possibilities of radiodiagnosis of dysbarogenic changes in skeletal bones in specialists whose work involves being in conditions of high environmental pressure. The article highlights the results of a literature review of English-language and Russian-language publications presented in the databases of PubMed and scientific electronic libraries of Russia (eLIBRARY.RU and CYBERLENINKA.RU). In order to determine the optimal methods of radiation diagnostics, the etiological and pathogenetic aspects of the development of dysbarogenic degenerative and necrotic changes in the bones of the skeleton, as well as the experience of scientists in determining the corresponding radiation semiotics, were analyzed. Considering that the worst manifestation of bone pathology of dysbarogenic origin is dysbaric (aseptic) osteonecrosis, we studied the literature on the issues of its clinical and instrumental diagnosis. One of the directions in scientific research was the work of authors exploring the possibilities of early instrumental diagnosis of changes in bone tissue, in particular the possibilities of magnetic resonance imaging in the diagnosis of dysbaric osteonecrosis. In addition, data on modern x-ray methods were analyzed, which may be promising as a screening diagnosis of dysbarogenic degenerative and necrotic changes in the bones of the skeleton.

BACKGROUND: One of the tools for ensuring the quality of medical care and medical services is licensing procedures for admission to medical activities, which include licensing. Licensing is indicated as a mandatory condition for carrying out medical activities in the list of types of activities for which licenses are required (clause 46 of Article 12 of the Federal Law “On Licensing of Certain Types of Activities”). Since life and health are the most important universal human values and are legally enshrined at the level of the Constitution of the Russian Federation, the study of the healthcare sector, including from the point of view of legal support for procedures for admitting individuals and legal entities to medical activities, is of exceptional scientific and practical interest. It should be noted that the institution of licensing of medical activities is one of the legal institutions that is constantly undergoing legislative changes, which allows us to speak about the relevance and relevance of this issue. Issues of licensing medical activities quite often come to the attention of researchers, however, due to the dynamic changes in the current legislation on the issue under study and the presence of quite extensive judicial practice, they require additional research in order to resolve problematic issues that arise in practice.

OBJECTIVE OF THE STUDY: based on an analysis of the regulatory framework for licensing medical activities, to identify problematic procedural issues and determine ways to improve the current legislation regulating the provision of medical care and medical services.

MATERIALS AND METHODS: Using the method of expert assessments, an analysis was carried out of the regulatory framework of the Russian Federation regulating legal relations during the procedure for licensing medical activities by organizations of the public and private healthcare system.

RESULTS: Licensing as an institution of law is complex in terms of the legal relations it generates, combining at its core the legal norms of two broad branches of law — administrative and civil. At the same time, licensing is a mandatory criterion for the functioning of a medical organization and includes a number of requirements for such organizations. Despite the extensive regulatory framework on the issue under study, licensing requirements contain a number of problematic aspects that create obstacles for licensees and license applicants and require legislative approval. In this regard, the authors have proposed ways to resolve existing contradictions by making specific proposals to change the current legislation. The proposed optimization of the licensing procedure for all participants in this process, as well as minimizing the risks arising from these legal relations, according to the authors, fully meets the objectives of ensuring the rights of citizens to high-quality and safe medical care.