Journal «MEDICINA» 2/2018

The article analyzes the main principles of reforming higher education systems in European countries associated with the creation of a single global market of educational services and ensuring the free cross-border movement of skilled labor. Russia's accession to the Bologna process in September 2003 so far raises disputes and doubts about the expediency of total submission to European educational standards. This is particularly evident in the health education system, the reform of which has not been completed to date.

Key words: professional education reform, Bologna process, medical education reform in Russia

The review is dedicated to a wide range of femtosecond laser applications in corneal surgery. It focuses on refractive surgery, featuring a detailed account of femtoLASIK advantages and specific postoperative complications, refractive lenticule Extraction (ReLEx) and its SMILE modification (small incision lenticule extraction), as well as corneal inlays use for presbyopia correction. The review also recounts femtosecond laser use in keratoplasty (PKP, DALK, DSAEK): its vantage points, limitations and postoperative prognosis.

Key words: Femtosecond laser, Refractive surgery, Corneal surgery, femtoLASIK, SMILE, Penetrating keratoplasty, PKP, DALK, DSAEK

Recent experimental and clinical data about role of pineal and extrapineal melatonin for physiology and pathology of the liver are reviewed. Melatonin is involved in the control of the basic physiological functions of the liver, providing a modulating effect. The results of experimental studies indicate the presence of a distinct hepatoprotective effect of the hormone in various types of organ pathology. This allows one to assume the possibility of using melatonin in clinical settings for the prevention and treatment of various hepatic diseases.

Key words: melatonin, liver physiology and pathology

The author draws attention to certain aspects of the problem of the modern chronic patient. A person, becoming sick, does not cease to be an individual person, an active subject of life. With the advent of chronic disease, a new social situation of development arises, containing the possibility of provoking a situationally conditioned crisis of personality development, the appearance of new symptom complexes, forming the phenomenon of modern medicine - a chronic patient. The relevance of the problem is growing particularly since the increased life expectancy, «modernization» of lifestyle associated with the rise of risk factors for many chronic diseases and the improved life-saving possibility in previously terminal cases change the structure of morbidity facing healthcare system. The main idea of the proposed concepts of disease-burden analysis in world healthcare systems presents an attempt of qualitative integrated assessment of health conditions while taking in consideration various social roles at different ages and their measurements over time. In-depth causes of the crisis of health changes in a globalizing world can be understood using the new knowledge in medicine and other sciences.

Key words: modern medicine, chronic patient

The article is dedicated to clinic, assessment of activity and diagnostic of patients suffering from nonspecific aortoarteritis. There are modern current criteria of diagnostic, and activity in Takayasu's disease patients are presented.

Key words: Takayasu's disease, nonspecific aortoarteritis

In the present review, the main etiopathogenetic mechanisms of the development of chronic polypous rhinosinusitis (HPRS) are considered. The interrelationship of some neurotrophic factors and sensory neuropeptides capable of causing neurogenic inflammation is established. As a result, the amount and volume of the polypositively altered mucosa of the nasal cavity and upper respiratory tract is increased. The article gives a general idea of HPRS, its etiology, pathogenesis and the supporting factors. Data on ways of and methods of treatment of HPRS are also given.

Key words: chronic polypous rhinosinusitis (HPRS), neurotransmitters, sensory neuropeptides, neurotrophic factors, Vidic nerve

The results of the study of the prevalence of wandering atrial pacemaker (MAP) and ectopic supraventricular rhythms in adolescents based on the population-based clinical and electrocardiographic examination of 1242 adolescents aged 14-18 are presented. In the study, the expediency of the allocation of two groups of ectopic atrial arrhythmias is justified – arrhythmias associated with the manifestation of activity of the lower atrial centers of automatism (LACA) and arrhythmias associated with the manifestation of the activity of medium-atrial centers of automatism (MACA). ECG criteria for these two types of arrhythmias are proposed. Arrhythmias associated with the manifestation of activity of MACA (MAP to the middle divisions of the right atrium, middle atrial rhythm) were found in 26.4% of adolescents and were not associated with any diseases. Arrhythmias associated with the manifestation of the activity of the LACA (MAP to the lower parts of right atrium, lower atrial rhythm and complexes) were detected only in 12 adolescents (0.97%) – 5 of them are deemed healthy; one teenager is diagnosed with mild myocarditis; in the remaining 6 adolescents, no organic diseases of the cardiovascular system were detected, but chronic tonsillitis or other concomitant diseases were detected. Atrioventricular junctional escape complexes were found in 1 teenager actively engaged in sports. It is recommended in the analysis of ECG of adolescents to evaluate arrhythmias associated with the manifestation of activity of MACA, as a variant of the norm; arrhythmias associated with the manifestation of LACA as "borderline" conditions requiring additional examination.

Key words: wandering atrial pacemaker, ectopic atrial rhythms, adolescent electrocardiogram

In an experimental study, 60 animals were used. Depending on the amount of thiamine in the diet, the animals were divided into following 3 research groups (20 each): control group I – with a normal diet; group II – thiamine was completely absent in the diet, products containing vitamin B₁ were excluded; group III – in the diet, foods rich in vitamin B₁ predominated. To evaluate the results, artificial impact was applied by hot air flow with noise, an "open field" installation, an "elevated cross-shaped labyrinth" installation. In the course of the experiments, it was found that a decrease in daily thiamine negatively affects cognitive abilities, the resistance of the organism to a stress factor decreases.

Key words: oxidative stress, psychoemotional stress, pyrimidine derivatives, thiamine, vitamine B₁

The aim of the study was to estimate the features of dehydration structurization of the cystic fluid in a wide range of bullous dermatoses. To achieve this goal the cystic fluid was collected in patients with Duhring herpetiformis dermatitis (n=13), pemphigus (n=15), shingles (n=17), eczema (n=18), allergic contact dermatitis (n=10), bullous pemphigoid (n=4), phytophotodermatitis (n=6) and other diseases associated with blistering. All samples of biological fluid were studied by teziocrystalloscopy using our own system of semi-quantitative parameters. Assessment of crystallogenic properties of cystic fluid allowed demonstration of qualitative and quantitative differences in morphostructure of cystic fluid facies, making it possible to assume differential diagnostic value of the study of biological substrate in patients with bullous dermatoses.

Key words: biocrystallomics, dermatology, crystallogenic properties, cystic fluid

Satisfaction of the population with the quality of medical care is one of the key indicators of the effectiveness of medical organizations and territorial bodies of state power. The article gives a brief overview of the normative documents regulating the management of the quality of medical care and conduct of sociological surveys of patients. Evaluation of patient satisfaction with the quality of clinics is carried out in many ways, including questionnaires. The purpose of the study is to analyze the opinions of hospital patients about the quality of treatment, comfort and services, satisfaction with medical care in general. The results are based on about 17 thousand patient’s questionnaires entered into the information system (IC) of the clinic, covering a 3-year period. We describe the survey process at different stages of treatment in the clinic. The questionnaires included questions about the organization of medical care, professionalism and human qualities of the staff, the level of information support, the quality of rehabilitation care and medical nutrition, the quality of medical care in general, the possibility of personal referral for treatment in the clinic in the future and possible recommendations to contact the center for relatives. The methods included automated processing of responses to 13 questions that has been exported from IP in the form of Excel files. The results of the study showed a high survey coverage of patients treated in the hospital – 84.43%. According to the results of the survey, up to 48.39% of patients waited to be hospitalized in the admission department from 1 to 3 hours. Most of the respondents stated that the price and quality of paid services were adequate. The satisfaction of patients with most aspects of the clinic's work was 97.5-99.7%. In general, all respondents are satisfied with the quality of medical care, 99% of patients are ready to refer to the clinic again if necessary and advise their relatives to be treated there. The study identified areas for improvement of work. A number of organizational measures have been taken to optimize the activity of the admission department, the medical rehabilitation department, improve patient information support, hospital conditions, comfort and service. The obtained results indicate the correct vector of development of the institution. The survey is an important tool for feedback from patients, meeting their needs and wishes, making management decisions and evaluating the results of actions to improve the quality of work.

Key words: survey of patients, satisfaction with medical care, quality of clinic's work