Journal «MEDICINA» 1/2018

The article, based on factual materials, considers the problem of crimes, resulting from improper performance by medics of their professional duties. The shortcomings of criminal statistics that do not allow creating an integral picture of the situation in the area developing in the country are analyzed, difficulties are noted with the identification of such crimes and the bringing of the perpetrators to criminal liability. The analysis of separate sentences in respect of doctors, through the fault of which the patients were killed, is given. The conclusion is made that the existing criminal legislation does not correspond to the objective needs of protecting the rights of the patient, and proposals are made to improve the effectiveness of forensic medical examinations in criminal cases on professional crimes of medical workers.

Key words: crimes with serious consequences, medical workers, crime statistics, medical error, forensic medical examination

The purpose of this study was to assess the severity of the burnout syndrome components among health care professionals. 53 persons were included in the study: 23 doctors and 30 persons with specialized secondary medical education. Estimation of parameters of burnout syndrome was made using the Russian version of the questionnaire "Professional burnout" ("PB") by N. Vodopyanova and E. Starchenkova. In the result of the study it was found that the burnout syndrome develops regardless of age and professional experience of health care worker. A higher level of emotional exhaustion in women compared to men was detected. Professional achievements in men are evaluated as more successful, compared to women. The obtained results can be useful in the system of the development of psychologic prevention measures aimed at the preservation and maintenance of health in medical personnel.

Key words: emotional burnout syndrome, rehabilitation, health care, stress

Introduction. In various clinical recommendations, jozamycin and azithromycin are indicated along with doxycycline as the drugs of choice in urogenital chlamydia. However, given the experience of clinical trials, meeting the requirements of evidence-based medicine, such recommendations raise a number of questions that require at least clarifications. Aim of the study. Evaluate the evidence base for the effectiveness of the use of various macrolide antibiotics in the treatment of urogenital infections. Material and methods. A profound temporal analysis of the clinical results of use, pharmacokinetic, pharmacological properties, the mechanism of resistance of macrolides, administered in the treatment of urogenital infection, was performed. Results of the study and their discussion. The weak points of josamycin compared with azithromycin are marked: the shortest half-life, the absence of two peak concentrations in the blood, less pronounced anti-inflammatory effect, the lack of sub-MPK effect and compliance. It is pointed out that the inclusion of josamycin into federal clinical guidelines for the treatment of various forms of urogenital pathology, including pregnant women, is a wrong choice, since the evidence base for the effectiveness and safety of azithromycin is much broader. Conclusion. The results suggest a greater commercial interest in the promotion of josamycin in the pharmaceutical market, as there are no convincing clinical evidence and pharmacokinetic justifications for its large-scale application.

Key words: macrolides, azithromycin, josamycin, pharmacokinetics, treatment

Introduction. According to the International Diabetes Federation (Diabetes Federation), the number of patients with diabetes mellitus (DM) is progressively increasing. About 7 million new cases of diabetes are diagnosed every year and annually 3.8 million people die from diabetes related causes. Diabetes is an independent risk factor for cardiovascular diseases and it is also the leading cause of death in patients with type 2 diabetes. Prevention and treatment of late complications of diabetes, including diabetic foot syndrome (DFS), is one of the most important problems of endocrinology. Purpose of the study. Analysis of the main methods of anesthesia in order to choose the one that will have the minimal impact on the cardiovascular, endocrine, respiratory and other body systems. Anesthesiologic support in this complex category of patients should be directed not only to relief of severe pain syndrome during the perioperative period, but also to improvement in trophism of tissues, as the pain supports spasm and microcirculation disorders. The choice of safe anesthetic method for patients in this group will reduce the risk of developing certain complications. Material and methods. Authors performed search and study of information regarding the topic: "Anesthesiologic methods for patients with DFS and critical ischemia of the lower limbs" in the main medical and biological databases. Each method was examined, and the most optimal alternatives were identified. Results. Epidural and conductive anesthesia seem like the most rational alternatives as these two methods not only guarantee a high-quality intraoperative anesthesia, but they also can be used for a long-term pain relief. These types of anesthesia have minimal effect on the cardiovascular system. Also, epidural and conductive anesthesia have an influence on the pathogenetic mechanisms of the disease. Conclusions. All patients with DFS and critical ischemia of the lower extremities of course can be placed under conduction anesthesia. Considering trophic effects, it is preferable to use prolonged blockade of peripheral nerves, by catheterization. Because of the mandatory use of antiaggregant therapy, epidural anesthesia is not recommended for in these patients.

Key words: diabetic foot, conduction anesthesia, epidural anesthesia, spinal anesthesia, critical limb ischemia, transcutaneous oxygen tension, microcirculation

Purpose. To consider the organizational and informational aspects of high-technology medical care in Kaluga branch of «Eye Microsurgery». Material and methods. Kaluga branch of «Eye Microsurgery» is among the medical institutions providing high-tech medical care to the patients with different ophthalmopathologies. A subsystem of the high-tech medical care coupons accounting was introduced within own medical information system of the branch to optimize work with the state monitoring subsystem of high-tech medical care providing. Results. Analysis of the data showed that in Kaluga branch of «Eye Microsurgery» all kinds of high-tech medical care by «ophthalmology» profile are performed. The significant part of high-tech medical care is the most difficult vitreoretinal surgery, as well as high-tech medical care to children with retinopathy of prematurity (every fifth treated patient by high-tech medical care is a child). Patients from all regions of Russia come to the branch for high-tech medical care. Own branch medical information system allowed to organize the optimal interaction with the state monitoring subsystem of high-tech medical care providing, to establish internal accounting of patients receiving high-tech medical care, to optimize the workflow. Occasionally occurring unusual situations in the absence of the relevant regulations resolve promptly, so that every patient could receive the full volume of necessary medical care at a high level. Conclusion. The allocation of high-tech medical care in the system of state guarantees significantly increases the volume of its ophthalmological care that uses modern micro-invasive, resource-intensive treatment methods, and to incorporate into clinical practice the latest treatment methods. However, despite the overall successful operation of the Federal program for high-tech medical care providing there are a number of organizational issues that require further developmental work and correction.

Key words: high-tech ophthalmological care, ophthalmology, the state monitoring subsystem of high-tech medical care providing, medical information system

The aim of the study is to analyze the course of pregnancy and childbirth in pregnant women with arrhythmias based on register data. Material and methods. The study included 3214 pregnant women admitted to the city of Tula Regional Perinatal Center from January 1, 2014 to December 31, 2014. The data were copied from the patients records and entered in the previously developed form of information collection with the purpose of forming the register. Results and discussion. Of the total number of women included in the register, a group of 691 (21.4%) patients with cardiovascular diseases was identified, among whom 116 (16.8%) had arrhythmias. Sinus tachycardia was registered in 77% of women with arrhythmias. More than 40% of patients with arrhythmias were overweight or obese, 35.14% – arterial hypertension, 25.68% – endocrine diseases (gestational diabetes, hypothyroidism). Conclusions. The data of the register made it possible to establish the prevalence of cardiac rhythm disturbances in real clinical practice, and to determine the relationship of arrhythmias to another pathology of pregnancy and childbirth. It was determined that complications of newborns are registered in more than half of cases (52.7%) in women with arrhythmias, and the chance to detect arterial hypertension in these women will be significantly high (OR = 2.893 at p<0.05).

Key words: registry, pregnant women, arrhythmias in pregnancy, complications of newborns

Introduction. The study of accommodation ability in children has traditionally been of great interest for many years. In clinical practice, the subjective methods of accommodation research are the most common. Clinical availability of Righton Speedy–i accommodograph provided the opportunity to assess the accommodative function. Purpose. To study the accommodation peculiarities in amblyopic and fellow eyes in children and teenagers with anisohypermetropic amblyopia using computed accommodography. Material and methods. The present study is based on the analysis of the clinical and functional status of 96 patients (192 eyes) with anisohypermetropic amblyopia. Besides the general clinical methods of examination, all patients underwent accommodography. The power of accommodative response (AR), the frequency of accommodative microfluctuations (AMFs) and accommodogram stability were evaluated. Results and discussion. While examining we revealed the significantly higher accommodative response values of the amblyopic eye in comparison with the fellow one, the frequency of AMFs varied within 49-55 mfs/min, corresponding to normal values. The were no any significant differences between groups of amblyopic and fellow eyes. Histograms were not stable and were characterized by the presence of “prolapses”, connected with the absence of ciliary muscle contraction in response to accommodative stimulus. Conclusions. AR values of amblyopic and fellow eyes differ significantly. There were no any significant differences between amblyopic and fellow eyes. The presence of “prolapses” is linked with the absence of ciliary muscle contraction and is not an instrument error. The difference between the number of “prolapses” in the histograms of amblyopic and fellow eyes was significant.

Key words: accommodation, accommodography, anisometropia, hypermetropia, amblyopia

A description of the clinical case is given in a 68-year-old patient with elevated erythrocyte sedimentation rate (ESR). The process of diagnostic search is presented with the verification of the clinical diagnosis – multiple myeloma.

Key words: elevated ESR, multiple myeloma

Introduction. Significant sanitary losses due to infectious morbidity of military personnel seriously affect its fighting capabiliy and sometimes make combat missions impossible to perform. Purpose. The work aims to define the principles and content of the organization of preventive antiepidemic disinfection measures among the population and military personnel in the combat zone in order to prevent of infectious diseases outbreaks and hotbeds, the specifics of conduct of such measures, organizational and managerial basis for improving the activities of antiepidemic service as part of the national security system. Matherial and methods. A review of scientific literature on the infectious morbidity specifics in relation to military personnel participating in military actions in the XVIII-XX centuries is presented. Results and discussion. In this article the questions of the infectious morbidity features and the implementation of preventive anti-epidemic and sanitary aid to the civilians and military im the area of local armed conflict are considered. The most important factors determining the specific features of health and epidemiological support for the population and military personnel in emergency situations of a military nature are identified. The role of disinfection units in the implementation of preventive measures and the specifics of their conduct to prevent epidemic complications in the territories is determined. Conclusions. To ensure national security, the epidemic welfare of the population and military personnel, the scientific justification for improving the legislative and regulatory framework is a strategic issue, along with staffing of anti-epidemic structures, introducing constructive changes in legislation regarding their functioning in peacetime, effective work in the war zone in order to prevent outbreaks and the emergence of foci of infectious diseases.

Key words: disinfection service, disaster medicine service, military medical service, military operations, sanitary-epidemic state, epidemic complications

The article systemizes data on a new medical science field - biocrystallomics in experimental and clinical combustiology. Research in the area is based on the complex study of human and animals’ crystallogenic and initiated properties of any biological substrata by special methodology and methods system. Potential spheres of biocrystallomics methods use in clinical combustiology are shown. There are burn disease complications diagnostics, pharmacotherapy choice and its effectiveness monitoring, burn results prognosing etc. Possibilities of biocrystallomics methods use as metabolic status estimation instrument at burn experimental modeling are demonstrated.

Key words: biocrystallomics, combustiology, metabolism, diagnostics, biocrystallization