Journal «MEDICINA» 4/2017

The aim of this work was to study the frequency of paroxysmal arrhythmias in adolescents. For this purpose, an epidemiological clinical and electrocardiographic examination was carried out for 1242 adolescents aged 14 to 18 years in St. Petersburg, including ECG registration, medical examination, and a targeted interview for palpitation attacks not related to emotional or physical stress. In cases of suspected paroxysmal arrhythmia were performed transesophageal electrostimulation of the heart. Paroxysmal arrhythmias were found in 0.24% of adolescents – 0.08% of cases were associated with Wolff-Parkinson-White syndrome, 0.08% of cases with sick sinus syndrome and 0.08% of cases were idiopathic. Timely diagnosis of paroxysmal arrhythmias is important, especially nowadays in connection with the development of cardiosurgical methods of arrhythmia treatment.

Key words: paroxysmal tachycardia, Wolff-Parkinson-White syndrome, atrial fibrillation

Use of highly concentrated ethyl esters of polyunsaturated fatty acids after myocardial infarction and in patients with heart failure was associated with lower mortality. The goal of this analysis was to perform cost-utility analysis of the use of highly concentrated ethyl esters of polyunsaturated fatty acids after myocardial infarction (applying Markov model) and to find whether its use in some group of patients leads to decrease in budget costs. It was shown that use of highly con-centrated ethyl esters of polyunsaturated fatty acids after myocardial infarction leads to increase in quality-adjusted life expectancy on 0.5 QALY, with incre-mental cost-effectiveness ratio of 105 thousand rubles, and net monetary benefit of 780.5 thousand rubles. In the patient subpopulation that receives highly concen-trated ethyl esters of polyunsaturated fatty acids for arrhythmia prevention after coronary artery bypass the budget cost actually decrease, depending on denomina-tor used – on 6-50%.

Key words: myocardial infarction, cardiovascular mortality, polyunsaturated fatty acids, cost-utility analysis, quality-adjusted life years (QALY)

There is considerable unevenness in the patient's access to different types of medical care both within countries and between countries. The article considers the impact of medical tourism on decrease of the effects of this non-uniformity. A review of the status and prospects of the global medical tourism development is carried out. The state of medical tourism in Russia is analyzed. We have considered the impact of medical tourism on the role of the patient in the treatment process. It is shown that medical tourism makes it necessary to adjust the concept of modern health care, opening up new ways to fight the spatial non-uniformity of development of medicine. Thus, medical tourism contributes to the increase of health care level of the population. It is noted that, in addition to reducing the spatial non-uniformity of provision of population with qualitative health care services medical tourism contributes to interstate competition between health care systems under conditions of contemporary global economic competition and, thereby, improving their quality, making the medicine to develop more rapidly. It is shown that Russia lags behind many countries of the world in the level of medical tourism development. At the same time, there is an urgent need for its accelerated development, related to the size of the territory and the existing differences in the quality of health care, both among regions and as compared to other countries. We have demonstrated that medical tourism expands the degree of patient participation in the treatment process. It allows the patient to be an active participant in the process by choosing the medical services of required quality out of the entire global range of options.

Key words: healthcare disparities; health services accessibility; medical tourism; quality of health care; health care costs; patient participation; philosophical overview

Purpose. To examine macular zone using OCT-angiography followed endovitreal intervention with regard to rhegmatogenous retinal detachment. Material and methods. The study included 26 patients (36 eyes) divided into two groups: main and control. The main group consisted of 16 patients (16 eyes) operated on for rhegmatogenous retinal detachment. All the main group patients underwent endovitreal intervention regarding rhegmatogenous retinal detachment using standard technique 25g. The silicone oil and gas tamponade was performed as the last stage of surgical intervention. The control group included healthy subjects (10 people – 20 eyes) of the same age without any ophthalmopathology. Macular zone was examined using spectral domain optical coherence tomography on RTVue XR Avanti (Optovue, Inc., Fremont, CA). Scanning size was 3x3 mm. Scan protocol AngioVue Angio retina 3.0 was used. All measurements were performed in the foveal area (1 mm in circumference) and parafovea – the region between foveal border and a circumference 3 mm in diameter round the center. Macular zone examination by angio-OCT method according to the above-mentioned protocol was performed in a month followed endovitreal intervention. Results. The most significant indices, which distinguish patients after surgery (main group) from healthy subjects (control group) were found to be data of vascular density of macular microcirculatory channel of the retina in all areas and sectors. Conclusion. The investigation performed showed the importance and high informativity of optical coherence tomography – angiography when assessing macular zone after endovitreal intervention as regards rhegmatogenous retinal detachment.

Key words: optical coherence tomography – angiography, rhegmatogenous retinal detachment, endovitreal intervention, relative density of macular microcirculatory channel, retinal thickness of macular zone

The article presents clinical characteristics of 137 patients with arterial hypertension (AH), send for the consultation with cardiologist by the local therapist. Analyzed are the completeness of the survey of this group (identification of risk factors, target organ damage, associated clinical disease) and appropriate therapy. Authors come to the conclusion that most patients with hypertension, had no indications for consultation and did not meet the existing level of cardiovascular risk determining the treatment.

Key words: arterial hypertension, clinical characteristics, risk factors, subclinical organ damage

Abstract. The aim of study was to analyze pregnancy outcomes in diabetes mellitus women with respect to insulin injection method (insulin pump or pen). The material of study was 52 case reports of labor in women with diabetes in anamnesis. Glycosylated hemoglobin (HbA1c) was at target level in 88% women using pump during pregnancy and only in 18,5% in women using pen (p<0,0001). Mean term of childbirth in the first group was 39,2±0,6 weeks (full-term pregnancy) vs. 36,4±0,6 weeks in the second group (premature birth), р<0,001. Newborns of first group had birth weight 3 278±153 grams, while this parameter in the second group was 3 810±157 grams (р<0,0001). Newborns from the first group were healthy in 92,6% of cases but only 40,8% of second group children were healthy (р=0,0001). Thus, using pump insulin therapy improves delivery outcomes in women with diabetes compared with insulin pens.

Key words: diabetes mellitus, pregnancy, insulin pump

Purpose. To assess the outcomes of combined laser treatment in patients with primary mixed glaucoma. The study group included 26 patients (30 eyes) with primary mixed glaucoma and 1 month to 5 years follow-up. The mean follow-up was 30.30±2.90 months. Male – 16 (61.5%), female – 10 (38.5%). According to the stages, the patients were divided in the following way: stage I – 13 eyes (43.3%), stage II – 9 eyes (30%), stage III – 8 eyes (26.7%). The age varied from 63 to 84 years old (the mean age was 70.04±1.22 years). During the first stage all patients underwent laser iridectomy in the superior segment according to the standard method (at 10 to 2 o’clock) with a pulse energy 2.6-3.2 MJ and the number of pulses 3-9. The second stage included selective laser trabeculoplasty (SLT) by the standard method on the laser unit Selecta, the radiation source of which was a q-switched Nd:YAG laser of double frequency. The radiation wavelength – 532 nm, pulse duration 3 ns, single pulse energy 0.6 – 1.3 MJ, the light spot size was 400 microns. 50-60 pulses were applied to the trabecular area in the lower segment of the anterior chamber angle along the arc 180 degrees. The mean time between the stages was 2.58±0.51 months. The mean IOP values (P0) preoperatively (the first stage – laser iridectomy) were 20.67±0.69 mm Hg. The average number of hypotensive medications used prior to laser treatment was 2.12±0.13. The visual acuity before treatment was 0.733±0.044. The mean visual field (MD index) before treatment was 7.92±1.46 dB. After the first stage (laser iridectomy) and prior to the second one (SLT) IOP was 17.59±0.35 mm Hg. By the end of the follow-up (after laser iridectomy and SLT) the IOP level was 12.86±0.44 mm Hg. The average number of hypotensive medications during the last examination was 1.12±0.17. The mean visual field (MD index) before treatment was 7.92±1.46 dB, after treatment – 8.02±1.41 (the differences were not significant (enough Z=-0.17, p=0.861)). Visual acuity before treatment was 0.733±0.044, by the end of the follow-up – 0.621±0.055 (the differences were not significant (enough Z=-0.32, p=0.187)). When analyzing the hypotensive regimen the tendency towards its weakening was noted during the whole follow-up period. We managed to achieve the target IOP in 23 cases (76.7%). The repeated SLT was required in four patients in terms of 6 months to 1 year. Three patients were referred for hypotensive surgery in the period 1-3 years. The two-stage laser intervention in treating primary combined glaucoma allows achieving IOP normalization at the expense of the anterior chamber angle broadening with the following influence on the trabecula by means of selective trabeculoplasty in the majority of patients with different stages of the disease.

Key words: ophthalmology, primary mixed glaucoma, laser iridectomy, selective laser trabeculoplasty, intraocular pressure, anterior angle chamber, trabecular apparatus

The paper examines studies conducted to assess the validity, reliability, and sensitivity of a 9-peg test for children with cerebral palsy. Twenty 5-7 years old healthy children and 20 children with cerebral palsy participated in the survey. To confirm the substantial validity, a comparative analysis of the test time for healthy children and children with cerebral palsy was carried out, the dependence of the test time on the severity of the motor defect of the upper limbs was evaluated. The severity of the defect was assessed according to the scale of functioning of the upper limbs for children with cerebral palsy MAKS. Retest reliability of the test was determined by comparing the results obtained by the same researcher during repeated testing. To confirm the sensitivity of the test, the time of the test was compared in children in groups with different severity of cerebral palsy before and after rehabilitation. A test with 9 pegs can be used as a tool for evaluating fine motor skills in children with cerebral palsy, is informatively accessible and easy to perform.

Key words: infantile cerebral palsy, evaluation, test with 9 pegs, validation

The article proves the expediency of the establishment of pharmacy institutions in the adapted premises authorized to manufacture «ex tempore» medicines for emergency medical assistance to the population in emergency situations.

Key words: manufacturing «ex tempore», emergency situation, emergency medical care