Journal «MEDICINA» 3/2016

The article analyses a number of demographic indicators: population, birth rate, death rate, natural decrease (and increase) of population, age structure, the factor of demographic burden, life expectancy at birth, average age of the rural population of the Russian Federation for years 2005-2014. Studied is the total incidence by classes of diseases among Russian rural population in years 2010-2014. Comparison of demographic indicators and the total incidence of diseases among the rural and urban population in Russia is conducted. Situation for the provision of hospital and primary health care in rural areas over the past 10 years is demonstrated. Cadres of rural medical organizations are analyzed.

Key words: the rural population, demographic indicators, total incidence, inpatient care, primary health care, doctor, nurse

In the third part of the article the author formulates proposals on the priority steps to streamline the situation in the national healthcare, which can be implemented in 2016.

Key words: health, healthy lifestyle, healthcare costs, budget financing, compulsory health insurance

The article is devoted to Academician Alexander A. Yaroslavsky, who made a significant contribution to the development of the national railway medicine. Described in detail are fruitful and multifaceted activities of Alexander A. Yaroslavsky in the Ministry of Railways health organization branch.

Key words: railway medicine, public health organization

Selective laser trabeculoplasty (SLT) is one of the methods to reduce IOP in primary open-angle glaucoma (POAG) treatment. In some cases, SLT is ineffective and insufficient for various reasons and there is a need to perform surgical treatment. Currently, the main methods of surgical treatment for glaucoma in our hospital are non-penetrating deep sclerectomy (NPDS) and micro invasive NPDS.

Practical assessment of glaucoma surgical treatment clinical outcomes in patients undergone SLT, these results compared with the patients treated surgically without previous laser interventions, an attempt to ascertain the presence or absence of the influence of previous SLT on the results of surgical treatment seems to be relevant.

61 patients (65 eyes) with POAG were examined. The patients were divided into two groups. Group I included 28 patients (30 eyes) who underwent antiglaucomatous surgery followed selective laser trabeculoplasty. Group II included 33 patients (35 eyes) who underwent antiglaucomatous surgery without any previous laser interventions. By the end of the follow-up IOP (P°) level in group I was 13.20±0.71 mm Hg, in group II – 16.06±0.86.

The analysis of the POAG surgical treatment outcomes in the group of patients with previously performed SLT and in the group of patients without any laser interventions didn’t show significant difference in the main values. SLT does not have a negative effect on surgery in POAG in the following period irrespective of the periods between interventions.

Key words: primary open-angle glaucoma, selective laser trabeculoplasty, intraocular pressure, micro invasive non-penetrating deep sclerectomy, non-penetrating deep sclerectomy

Gestational process, against the background of pyelonephritis, is characterized by increased risk of complications for mother and fetus. The aim of this study was to detect correlation of hemodynamic changes in the system mother-placenta-fetus with the level of nuclear index of intoxication in pregnant women with different forms of uncomplicated pyelonephritis. The study established the existence of mixed correlation between the value of nuclear index of intoxication in pregnant women with different forms of uncomplicated pyelonephritis and blood flow parameters in the system mother-placenta-fetus.

Key words: pregnancy, pyelonephritis, nuclear index of intoxication, uterine-placental circulation, correlation analysis

Author presents modern views on the physiological and therapeutic and prophylactic effects of hypoxia and hypercapnia action. General conclusions are formulated concerning the human body adaptation to conditions of low partial pressure of oxygen in the alveolar air, according to which specific adaptation component is a series of structural and functional changes aimed at improving the oxygen tissue supply, and non-specific adaptation of the component is to activate the mechanisms of cellular and humoral immunity, detoxification cytochrome P-450, antioxidant systems. It is shown that the lack of scientific evidence on the comparative effectiveness of these potentially promising methods to optimize the state of representatives of the various socio-professional groups, the timing of the application and its duration determines the relevance of applied research of physiological and therapeutic and prophylactic effects of hypoxia and hypercapnia.

Key words: hypoxia, hypercapnia, hypoxia physiological effects, physiological effects of hypercapnia, hypoxia, therapeutic and preventive effects, the therapeutic and prophylactic effects of hypercapnia

The article discusses the possibility of introducing a new model of preventive and consultative psychological assistance aimed at detecting and preventing the development of the burnout syndrome of employees in "helping" professions. On the whole, implementation of the program allows to address a wide sector of the population, as well as significantly reduce the economic and time costs for the provision of psychological services.

Key words: stress, emotional burnout, psychological prevention, adaptation

The progress of medicine and ophthalmology, in particular, are largely determined by the research intensity and technological processes of diagnosis and treatment. Modern ophthalmological clinic can be fully operational and develop only applying the latest IT-technologies. At the present stage, all surgical and diagnostic equipment can exchange digital information, systematize it and organize in a database; all operations and manipulations require strict health and economic accounting, control and analysis. In 1988, Kaluga branch of «IRTC «Eye Microsurgery» was created as an ophthalmic medical complex, where wide use of computer technology was originally planned. A distinctive feature is the unification of economic and medical subsystems into a single information space, full availability of all necessary information from any workstation. The opening of the clinic branches in the regions, introduction of mobile structures required the creation of a distributed interregional system. Currently, medical information system of the clinic is an integral part and instrument of the therapeutic process, scientific and economic activities, and the operational part of the data on more than 330000 patients exceeds 7 GB. Information system of Kaluga branch of «IRTC «Eye Microsurgery» allows to automate most optimal and cost-effective the vast majority of the challenges facing the ophthalmologic clinic.

Key words: medical information system, ophthalmic clinic, database management system Oracle

In young men with arterial hypertension (AH) reduced tolerance to physical stress and psychological change adaptation was observed. The use of outpatient physical rehabilitation showed a significant increase in exercise tolerance, positive dynamics of mental health and increase self-esteem levels in patients with hypertension, compared with the group with isolated anti-hypertensive therapy. The effect of physical rehabilitation is preserved in the long term, but the effect of the correction tends to decrease, which proves the need for regular physical training.

Key words: arterial hypertension, psychological health, tolerance to physical activities

Abstract. First metabolomic studies were conducted in patients being in critical condition on admission in the resuscitation department (during the initial 24-72 hours), to determine prognostic significance of the levels of a wide variety of low molecular weight substances in relation to 28-day survival. In this study, we determined levels of 32 amino acids in the blood plasma of 62 patients being in a critical condition (CC) in the first 6 hours on admission to the intensive care unit (ICU) by the method of high performance liquid chromatography - mass spectrometry. In retrospect, we allocated two groups of ICU patients in accordance with 28-day survival rate: Group 1 (n = 25) - survivors, Group 2 (n = 37) - deceased. Aminograms were compared in groups of patients, and analyzed by using classical methods of statistical analysis (software package Statistica 12) and meta-data mining (Data Mining Statistica 12 applications). Results: 1) Initial aminograms of the blood plasma are different in groups of patients who subsequently died and survived within 28-day period. 2) Accounting of aminogram parameters in predicting probable outcomes increase the accuracy of its determination. 3) The most significant predictors of adverse course of the pathological process in patients being in critical condition in amino acid composition of the blood plasma are the following: changes, compared to the reference values of citrulline level/odds ratio (OR) = 15.3; predictive test - 0.89; specificity - 0.88), and decreased levels of glutamic acid (OR = 5.0; predictability - 0.82; specificity - 0.84). Conclusions. More rapid inclusion of patients in the study revealed earlier pathogenetic mechanisms leading to the adverse outcome of the pathological process in patients being in critical condition.

Key words: patients in critical condition, metabolites, amino acids, prediction

The study evaluates results of the perfluororganic compounds (PFOC) use as an immediate intraoperative tool, and as tamponade agent for vitreal cavity during surgical treatment of retinopathy of prematurity (ROP). The study group was 11 patients (17 eyes) aged 7-12 weeks (post-conceptual age 36-42 weeks) with different stages of retinopathy of prematurity. Given the high activity of the pathological process and the risk of a total retinal detachment, all patients were performed 3-port vitrectomy with the use of PFOC as immediate intraoperative tool, and as tamponade agent for vitreal cavity during surgical treatment of retinopathy of prematurity. In 9 cases when the operation was completed replacing PFOS with the air, long term outcomes in 6 cases were full retina attachment, in 3 cases minor folds of the retina persisted at the former shaft of extra retinal proliferation. In cases of short-term tamponade PFOC 5 eyes demonstrated full retina attachment, ruptures were blocked, pigmented coagulates were observed, additional laser photocoagulation was not performed. In 2 cases, where PFOC tamponade lasted for 2 weeks, under the second stage of the intervention (replacement with silicone oil or gas-air mixture) negative manifestations were identified in the form of PFOC in the vitreal cavity. Based on the results of the study it can be concluded that the use of PFOC as an intraoperative guide in surgical treatment of severe progressive forms of PH is an effective method which greatly facilitates the key stages of intervention, enhances safety and assists in stabilization of the pathological process, helping to achieve the proper anatomical proportions of the eyeball. Short-term tamponade with PFOC is advisable in cases of retinal ruptures, contributing to their effective blocking by laser photocoagulation and provides attachment of the retina without the use of silicone oil tamponade. A longer stay of PFOC in vitreal cavity is impractical due to intensification of the inflammation and ineffectiveness of vitreal intervention.

Key words: retinopathy of prematurity, vitreous surgery, perfluororganic compounds (PFOC)

The article is reported on preclinical changes in the functional state of the myocardium in patients with neurocirculatory asthenia males with hypercholesterolemia according to the electrocardiogram dispersion mapping.

Key words: neurocirculatory asthenia, hypercholesterolemia, dispersion mapping ECG

PURPOSE: to study bleb characteristics dynamics after post-trabeculectomy adjuvant ranibizumab injection.

METHODS: 90 patients (90 eyes) with primary open-angle glaucoma who underwent trabeculectomy were randomized into 3 groups of 30 each: group I was injected with 0.05 ml (0.5 mg) subconjunctival ranibizumab into the bleb area on day 2 after the surgery, group II – on day 7, patients in the Control group received no postoperative injections.

Tonometry and bleb characteristics according to the parameters of vascularization, corkscrew vessels, encapsulation and microcysts (Wurzburg bleb classification score) were assessed in the postoperative period on the following day after the surgery, as well as on weeks 1, 2 and 1, 3, 6 and 12 months after the injection in groups I and II and after the surgery – in the Control group. Bleb hyperemia was measured by means of specially designed software "Hyperemia-3". Complex ophthalmological examination including visometry, perimetry, and retinal tomography was conducted before trabeculectomy and 6 and 12 months after.

RESULTS. Intraocular pressure compensation according to the individual IOP scale without hypotensive therapy in Group I was observed 16% more often than in the Control group. With additional hypotensive therapy – 13% more often. Group II showed a 6% more often compensation without hypotensive therapy and an equal compensation rate when hypotensive therapy was needed.

Bleb characteristics dynamics according to all WBCS criteria as well as Hyperemia index showed a corresponding pattern: their mean values in both injection groups were higher than those in the Control group. Comparative analysis between injections on days 2 and 7 revealed a statistically significant differences in vascularization and corkscrew vessels (p<0.001) and encapsulation, (p=0.03) in favour of earlier injections.

Total WBCS score revealed a similar pattern: on week 1 mean difference between the groups equaled 1.47 (Group I vs. Control) and 1.0 (Group II vs. Control) points. By week 2 mean difference reached 1.67 and 1.37 points correspondingly, by month 1 – 0.73 and 0.70 points, by month 3 – 0.4 points in both groups, by month 6 the difference lowered to 0.47 and 0.27 points, and by the end of the follow-up period it equaled 0.87 and 0.44 points.

Hyperemia index analysis showed a significant bleb hyperemia decrease after adjuvant ranibizumab, starting from the first day after the injection and reaching as much as 20% in difference with the Control group.

CONCLUSION: Subconjunctival ranibizumab injections (0.05 ml, 0.5 mg) into the bleb area help stabilize postoperative hypotensive effect, enhance bleb characteristics and subdue postoperative hyperemia. Injections on day 2 were superior in efficacy and had a more pronounced hypotensive effect to those on day 7.

Key words: glaucoma, trabeculectomy, wound healing, VEGF inhibitors, renibizumab, bleb, WBCS

The paper presents the diagnostic criteria of ICD-10 for major morbid conditions associated with the use of nicotine. Authors consider health and social consequences of tobacco use by means of pipes and hookahs, harm associated with passive smoking, use of electronic cigarettes and smokeless forms of tobacco. Principal tools for the diagnosis of the degree of dependence syndrome and readiness to quit, as well as modern treatment methods are presented.

Key words: Tobacco dependence, tobacco use, nicotine dependence, electronic cigarettes, passive smoking, nicotine replacement therapy, Fagerstrom test

Aim. To develop a non-contact photoluminescent diagnostic method for the fibrous tunic of the eye.

Methods. Mechanical stress of eye fibrous tunic equal to 50 mmHg was induced in a deepithelized rabbit eye. In these conditions a Flurolog-3 spectrophotometer (Jobin-Yvon, France) was used to measure cornea and sclera photoluminescence excitation spectra in with 250, 350 and 450 nm wavelengths and photoluminescence excitation spectra within the 300-425 nm wavelength range. Cross- and co-polarized photoluminescence spectra induced with linearly polarized light with 450 nm wavelength were also acquired.

Results. Maximal corneal photoluminescence excited at 350nm wavelength approaches 450nm. Meanwhile, photoluminescence spectrum can be presented as two bars: pyridine nucleotide with its maximum at 460-470nm and glycated collagen at 430-440nm. Epithelium contribution is shown to be substantial. The difference of photoluminescence spectra with and without epithelium is defined by luminescence of riboflavin that has two absorption bands with maximums at 450 and 365nm. Corneal luminescence spectrum excited at 450nm wavelength has a maximum nearing 540nm, that coincides with the spectrum of fluorophores localized in epithelium and endothelium. Luminescence spectrum excited at 250nm wavelength corresponds with the spectrum of tryptophane, that is present in the intraocular lens.

Corneal photoluminescence induced with polarized light is partly polarized with degree of polarization equaling 0.2-0.35 and dependent on luminescence wavelength.

Conclusion. Corneal photoluminescence yield is maximal at 330-350nm excitation light wavelength. Eye photoluminescence induced with linearly polarized light is partly polarized. The degree of corneal photoluminescence polarization induced with linearly polarized light can be calculated to assess the physiological state of the eye.

Key words: cornea, sclera, eye fibrous tunic, luminescence, polarization, elasto-optic effect, collagen