Journal «MEDICINA» 3/2017

The article is devoted to the research and evaluation of the physician’s rights to target limited use of medical images for professional purposes.

Key words: physician's right to use the patient's medical images for professional purposes, physician's rights, medical images, medical law, medicine, health care

The article analyzes normative legal documents regulating the work of in-patient social service institutions for elderly age and disabled citizens. The main indexes of the activity of in-patient social service institutions for elderly age and disabled citizens in the Russian Federation for 2002-2016 have been studied (according to the data from Ministry of Labor and Social Protection of the Russian Federation). For 15 years, the number of in-patient social service institutions increased by 11,6%, the number of beds by 8,5%, the number of residents is 13,4%. The study determined the rate of growth of boarding houses of the general type, psychoneurological boarding, houses of mercy, gerontological and social-improving centers for elderly age and disabled citizens. The number of elderly and disabled on the waiting lists for admission to in-patient institutions of social service decreased by 29,5%. At the same time, there is an increase in the proportion of elderly age and disabled citizens being on the waiting list to be placed in these institutions for more than one year, from 33,1 to 45,0%.

Key words: elderly age citizens, disabled citizens, in-patient institutions of social service

The article deals with the prediction of the risk of developing of bronchial asthma among children of 5 years old and younger with a prolonged recurrent cough and/or wheezing attacks (Broncho-obstructive syndrome). There was developed a model of predicting the disease using binary logistic regression. The prediction is based on the anamnestic principle with the allocation of peri-, intra- and early postnatal predictors of the disease. Using the developed model on a separate group of children showed its high prognostic significance.

Key words: bronchial asthma, prediction tool, logistic regression, children of early age

Aim. To study the spectral states of polarization of the luminescence of the fibrous membranes of the eye ex vivo stimulated by linearly polarized light as a function of intraocular pressure. To study the changes in the structure of the collagen matrix of the cornea and sclera of the eye under mechanical stresses with the help of a confocal microscope and generation of a second harmonic. To evaluate the correlation of mechanical and structural changes in tissues with the polarization of luminescence.

Methods. In the experiments, rabbit eyes were used. The eyeball was fixed in a special holder, equipped with a system for setting and maintaining intraocular pressure. The photoluminescence spectra of the eyes were recorded with the help of the Jobin-Yvon Flurolog-3 spectrophotometer under excitation by linearly polarized radiation of a He-Cd laser with a wavelength of 325 nm. At the entrance to the spectrophotometer, Glan's prism was installed. A laser scanning microscope LSM-710-NLO (Carl Zeiss, Germany) was used to study the collagen matrix of the eye cornea. For the analysis of optical images, a one-dimensional wavelet analysis was used, a mathematical apparatus used to process signals of various nature and structures.

Results. Luminescence of the eye cornea, excited on the eyeball by linearly polarized radiation, is partially polarized, and the integrated intensity of the luminescence spectrum depends on the intraocular pressure. The degree of polarization of the luminescence is spectrally dependent, it can have a linear or parabolic form with a minimum near the maximum of the luminescence spectrum. The form of the spectrum of the degree of polarization depends on the position of the stimulating ray on the cornea of the eye, which may be due to parasitic luminescence of other eye tissues, such as the iris, vitreous, lens. The spectrum of the degree of polarization is sensitive to intraocular pressure. Any significant change in the structure of the collagen matrix of the cornea with intraocular pressure changes by visual examination with laser scanning microscopy could not be detected. One-dimensional wavelet analysis for the analysis of optical images makes it possible to reveal spectra of inhomogeneities in optical structures with an increase in intraocular pressure to 23, 45 and 76 mm Hg.

Conclusion. Luminescence of the eye cornea, excited on the eyeball by linearly polarized radiation, is partially polarized, and the integrated intensity of the luminescence spectrum depends on the intraocular pressure. With the help of laser scanning microscopy any significant changes in the structure of the collagen matrix of the cornea with the change in intraocular pressure could not be detected. One-dimensional wavelet analysis of optical images makes it possible to reveal spectra of inhomogeneities in optical structures with an increase in intraocular pressure to 23, 45 and 76 mm Hg.

Key words: cornea, sclera, eye fibrous tunic, luminescence, polarization, elasto-optic effect, collagen, laser scanning microscopy, wavelet analysis

The aim of this review is to study feasibility of near-field resonance microwave tomography as a new diagnostic tool for estimation of pathological scars parameters. Data about modern classification, etiology, pathogenesis and formation stages of skin scars are systemized. Technologies of pathological scars study are discussed. Special features and advantages of near-field resonance microwave tomography for the stated application, based on understanding of method’s physical principles, are shown.

Key words: microwave probing, skin, wound, burn

With the goal to achieve a qualitatively new rehabilitation results and health improvement of disabled people in the Saki resort, using a systematic approach, systematic and analytical methods for conducting field examination and mathematical modeling, the territorial resort occupancy has been evaluated within the administrative boundaries and characteristics of the functional structure of sanatoria named after N.N. Burdenkov in Saki were identified. To determine today's needs for treatment and rehabilitation of spinal patients we evaluated resort of Yevpatoriya and Saki as the climatic balneological spa. The last point is a good reason to develop them as «medical tourism» centers and use in complex rehabilitation.

Key words: resort, spa resources, spa facilities, infrastructure, health spa, organization of service system

Prosthetic technology for adults and children with acquired and congenital upper limb defects has developed considerably lately. Modern prosthesis are complicated and expensive devices. So the demands for the objective assessment of their effectiveness and helpfulness became more and more intense. Assessment should be based on International Classification of Function and Disability and consider impairment, disability, handicap and health-related quality of life. Then, these tools should be valid and reliable. Outcomes of prosthesis users can be performance-based or self-reported. This review covered prosthetic-specific measures for adult and pediatric upper limb prosthesis users. Potentially suitable standardized generic outcome measures are also listed. Evaluative outcome measure concern arm structure and functional abilities, activity of daily living and social participation, as well as quality of life in adult or child with limb defects. Finally, summarized outcome measurements data for adult and children with upper limb deficiency and prosthesises, based on international recommendations, are presented.

Key words: prosthesis, upper limb, assessment, outcome measures

Purpose of the study: To conduct a retrospective analysis of glaucoma suspects with different periods of observation. Material and methods. We analyzed 300 patients diagnosed with suspected glaucoma in the primary supervision in 2010, whose case histories were monitored until December 2016. The largest group included patients examined once or twice within 1 month (40%), from 2 to 24 months – 29%, from 3 to 5-6 years – 31%. Results. In the initial examination, terminal or advanced glaucoma was detected in one eye in 121 patients (43%). Transition from suspected glaucoma to the primary open-angle glaucoma, which was diagnosed only in the presence of GON occurred in 10 patients in the study group observed from 2 to 24 months (11.5%), in 6 patients in the study group observed up to 3-4 years (17%) and in 19 patients observed up to 5-6 years (33%). At the same time, in 30% of patients with long-term observation marked negative dynamics of optic disc parameters occurred which was not always accompanied by the negative dynamics of the central visual field. Conclusion. Suspected glaucoma may be diagnosed only as a result of 2-3 month study of an eye to exclude GON. A slow transition of patients with suspected glaucoma to the group with true glaucoma in most cases allows conducting a long-standing strategy of prevention of blindness from glaucoma using a full diagnostic examination, depending on the age of the patient.

Key words: ophthalmology, glaucoma, suspected glaucoma, GON, computed perimetry, HRT-study

The article analyzes the data published in recent years concerning application of cell technologies in treatment of patients with arthronosos. Author examines the sources of multipotent cells, delivery methods and main pathological conditions they were used under. The conclusion is drawn on the absence of convincing data on advantages of a particular method of cell delivery to the affected area. To confirm the safety of this therapy longer observation periods are required. Issues concerning the best source of stromal cells, technique of their harvesting and processing, dosage, cell transport to the affected area, influence of various physical factors remain unsolved. The problem of explicit indications for the cell therapy use continues to be relevant.

Key words: multipotent mesenchymal stem cells (MMSC), cell technology, joint, articular cartilage

Purpose of the article is to analyze provision of the high-technological medical care (HTMC) for patients with vitreoretinal pathology in the Kaluga branch of S. Fyodorov Eye microsurgery clinics during 2014-2016, define existing problems and development prospects. During 2014-2016, the total number of vitreoretinal surgery operations performed in the Kaluga branch of S. Fyodorov Eye microsurgery clinics «Eye microsurgery» for all funding sources were 8 319. The branch has the state of the art equipment, which allows to perform any vitreoretinal surgeries. Patients from almost all regions of the Russian Federation come to the branch for HTMC in vitreoretinal pathology. There was 75.6% patients from another region during the period. Surgery for the patients with vitreoretinal pathology is funded by means of federal budget, mandatory medical insurance fund and other sources. Executed volume of HTMC for the patients with retinal and vitreous diseases allowed to analyze quantitative and qualitative indicators, reveal existing problems, and to identify solutions for some of them. Generally, the separation of HTMC in the system of state guarantees has provided the availability of the high level ophthalmic care to the patients with vitreoretinal pathology. However, there are a number of organizational issues that require resolution at the federal level.

Key words: high-technological medical care, ophthalmology, vitreoretinal pathology

The experience in medical provision of participants of 16th FINA World Masters Championships in Kazan is presented as well as results of the implementation of conceptual approach to health care in international sports competitions. During the period of the event 820 requests for medical aid were recorded, of which the proportion of athletes was 48,9%. The frequency of referrals of athletes ranged 90,9 to 375,0 per 1000 athletes of appropriate age, with the highest values in the age groups 85 years and older and 65-74 years (375,0 and 204,0 per 1000 athletes, respectively). These statistics will be used for organizing medical support in water sports competitions.

Key words: medical services, 16th FINA World Masters Championships

The problem of surgical treatment of rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR) is far from being solved, since about 20% of surgeries end with the absence of retinal attachment and 40-60% require the repeated intervention. Functional outcomes often do not correspond to the successful anatomical result and leave much to be desired. Purpose. To perform the comparative analysis of the surgical methods of treating rhegmatogenous retinal detachment complicated by vitreoretinal proliferation. Material and methods. 207 eyes (207 patients) were examined and divided into 2 groups. In group I (181 eyes) the endovitreal intervention with circular retinotomy was performed, in group II (26 eyes) the combined intervention was performed (episcleral + the endovitreal inrervention). Results and conclusion. Surgical treatment of RRD complicated by PVR is possible using both methods (endovitreal intervention with retinotomy or circular episcleral sealing). The criterion for choosing the method is the pathological process localization. The improvement of functional results was noted in both groups (no statistically significant difference between groups), but remained at a low level (0.09±0.01). The anatomical results appeared to be higher in group I (the differences between groups were statictically significant (t=2.250; p=0.04)).

Key words: ophthalmology, rhegmatogenous retinal detachment, proliferative vitreoretinopathy, circular retinotomy, combined surgical treatment

The results of a yearly monitoring of the conditions of 94 patients who underwent plastic surgery of the alveolar bone of the upper jaw during perforation of the maxillary sinus are presented. The choice of the method of plastic closure of oro-antral perforations depends on the size of the defect of the bone tissue, the dimensions of which must be determined by means of computed tomography. The use of combinations of osteoplastic materials of various origins and new methods of bone plasticity allows to achieve accelerated recovery of patients, to prevent postoperative complications and their relapse.

Key words: sinusitis, oro-antral anastomosis, biomaterials, plastic

It's known that anemia syndrome makes heavy the course and prognosis of different diseases because of body's oxygen transfer system damage. The article presents data on anemia prevalence in medical hospital patients and anemia composition and shows that most often case is anemia of chronic diseases, also high comorbidity in anemia groups is underlined. The possibilities of optimization of anemia syndrome diagnosis and management are presented.

Key words: iron deficiency, iron deficiency anemia, anemia of inflammation, comorbidity

The problem of assessment of the state of health of prisoners has great social value for society. The correct assessment of the importance of this or that pathology in population of convicts is a key element, the defining volume of necessary intervention, directed to preservation and promotion of health of prisoners. Purpose. The analysis of the disability adjusted life years (DALY) owing to violations of health for 2006-2016 considered as the integrated indicator characterizing the state of health of prisoners of the Volga federal district. Materials and methods. The state of prisoner’s health was estimated on the basis of these departmental reports, using the World Health Organization's recommended method for determining disability adjusted life years (DALY). Results. The DALY of prisoners in the Volga federal district increased from 348,0‰ (men – 347,7‰, women – 373,5‰) in 2016 to 414,5‰ (men – 406,1‰, women – 481,3‰) in 2016. The value of DALY prisoners was 26,8% higher than that of the population (332,1‰). The contribution to the DALY structure of the loss of life years due to premature mortality in 2016 among all prisoners during the period increased from 28,3% in 2006 (men – 29,7%, women – 13,2%) to 35,1 % in 2016 (men – 36,6%, women – 21,7%), which is more than 3 times higher than the similar indicator of the population of the country (12,0%). The sex and age structure of DALY has been established in which the leading place for the causes of loss of life as a result of a health disorder belong to: some infectious and parasitic diseases, mainly represented by HIV and tuberculosis, occupy the top line of the rating in the age groups 20-34 and 35-59 years; circulatory system diseases are the main cause of loss of life years in the age group of 60 years or more; in the age group of 14-19 years, the most relevant class are diseases of the respiratory system. Conclusions. The obtained data confirm existence of a tendency to deterioration in the state of health of prisoners of the Volga Federal District during 2006-2016. The leading reasons of disability adjusted life years as a result of violation of health became: tuberculosis, HIV infection, sharp respiratory infections of airways and complete suicides.

Key words: disability adjusted life years, DALY, prisoners, health assessment

Evolution of the life is a natural result of constant changes in the gene pool. The latter circumstance leads to reorganization of the genes, caused not only by point mutations, but also by a violation of metabolic processes in the organism, which contribute to the appearance of new characters from the evolutionary point of view. The molecular mechanisms of this process are connected and depend directly on the features of the DNA structure proposed by D. Watson and F. Crick. At the present time, a new model for the structural organization of DNA is proposed, based on a mathematical pattern known as the Fibonacci number series. According to the latter, polymerization in the framework of the DNA chain leads to the formation of different types of dimers. The presence of different types of dimers determines the possibilities for the participation of the organism in the processes of evolution.

Key words: variability, evolution, genome, dimer, DNA molecule

Relevance. The prevalence of alcohol abuse in the Russian Federation is extremely relevant. An active alcohol policy aimed at reducing alcohol consumption among the population including young people is currently implemented in the country at the state level. However, there were no representative studies devoted to alcohol consumption among young people aged 18-34 in the context of assessing the quantitative indices of alcohol consumption depending on socio-demographic and cultural features. Aim and targets. To study the prevalence, the quantitative characteristics of alcohol consumption, the types of alcoholic beverages, the age of first experience of alcohol use, the influence of the main demographic characteristics in transition into adulthood among young people aged 18-34 in Moscow. Methodology. Questioning by specially trained interviewers of young people aged 18-34 sampled on the basis of a multi-stage stratification. Results. The prevalence of alcohol use during the last 12 months for men and women as a whole was 77.1%, for men – 80.7%, for women – 73.4%. The most common alcoholic beverage was beer – it was consumed by 57.2% of respondents, wine – 52.6%, strong alcohol – 47.8% and low-alcohol energy drinks – 11.3%. The average age of the first experience in drinking alcohol is 16.4 years (for men 16.1 years, for women 16.8 years). The average age of the first intoxication in life is 17.2 years (for men 16.1 years, for women 17.6 years). The frequency of alcohol use during the last 12 months among men is on average 72 days per year, for women – 25 days. Among all respondents for the last 12 months 23.6% did not drink alcohol («abstainers»), 68.7% – classified as «low drinkers», 4.2% – «moderate drinkers», 3.5% were attributed to the category of «heavy drinkers.» On average, one respondent using alcohol consumes 14.9 grams of pure alcohol per day, a male 24.1 grams, and a female 5.1 grams. The amount of alcohol consumed increases with growing up. Reduction of alcohol consumption was observed after 27 years in men and after 31 years in women. Conclusions. Consumption of alcohol in Moscow remains high despite the measures taken by the government. It was revealed a cohort of young people identified as «moderate drinkers (4.2%) and» heavy drinkers «(3.5%). for whom the development of preventive interventions is necessary.

Key words: alcohol, gender, age, Moscow