Journal «MEDICINA» 3/2018

The aim is to study the volume of performed diagnostic tests in the day hospitals of the Russian Federation for 2003-2017. Material and methods. To conduct the study the data on the number of patients discharged from day hospitals by classes of disease according to the statistical observation form № 14ds «Information on the activities of day hospitals of medical organizations» were analyzed. Types of the performed diagnostic tests in day hospitals environment were determined according to the form of Federal statistical observation № 30 «Information about the medical organization» for 2003-2017. Statistical and analytical methods were used. Result and discussion. In the Russian Federation the main causes of treatment in day hospitals of medical organizations that provide assistance in outpatient and inpatient settings were diseases of the circulatory system, diseases of the musculoskeletal system and connective tissue, neoplasm, diseases of the nervous system. For 15 years, there has been an increase in the number of discharged patients from day hospitals per 1000 population by 1,8 times, including those undergoing treatment for neoplasms – by 7,0 times, diseases of the endocrine system, eating disorders and metabolic disorders – by 4,1 times, the eyes and its subordinate apparatus – by 2,5 times, diseases of the circulatory system – by 2,4 times. In 2003-2017, the number of diagnostic tests increased in day hospitals (magnetic resonance imaging – 4,2 times, laboratory – 2,8 times, ultrasound - 1,8 times, functional – 1,8 times, x-ray diagnostics - 14,2%, endoscopic - 10,8%). Conclusions. During the study period in the country the increase in the number of discharged patients from day hospitals and the volume of diagnostic studies performed by them was observed.

Key words: day hospital, patient, diagnostic studies

A comparative analysis of the principles and methods of treatment of drug addiction used in Europe and in the Russian Federation, based on the study of foreign and domestic scholarly publications is presented. Approaches to drug treatment are based on following general principles: examination, evaluation, diagnosis and treatment planning. This activity is conducted according to Treatment Standards and Clinical Recommendations developed by leading specialists of the respective countries, taking into account the evidence level of the effectiveness of treatment methods and ethical norms. Unlike the world practice, in Russia there is a state addiction service that provides free territorial-based treatment to addicted patients. The implementation of methods and ways of treatment in Russia coincides with the international standards of respective methods and ways of treatment of drug use disorders, recommended by UNODC and WHO. Those include awareness raising in the population at different levels: surveys, short-term interventions and referral to inpatient care, outpatient and rehabilitation. The main differences in European and Russian approaches are in the field of the intervention measures aimed at reducing the negative consequences of drug use, the so-called harm reduction measures, including substitution maintenance therapy.

Key words: principles, methods, treatment, drug addiction, prevalence

The emergence of laser scanning retina tomograph (HRT) in the mid-90th of XX century, using in the technological development the best achievements of the previous decades, enabled the ophthalmologists to examine the optic disc at the micron level. It was established that changes in the disc and peripapillary retina might occur long before the detection of pathological alterations in the central visual field. Although optical coherence tomography has made significant progress in terms of retinal study, its superiority in respect of analyzing the disc parameters remains uncertain. This issue will be the subject of our next article.

Key words: ophthalmology, glaucoma, optic disc, disc parameters, HRT, methods of optic disc examination

The article summarizes the critique of Russian healthcare system considering other countries healthcare experience as well. It’s being stressed that healthcare reforms in post-communist Russia are guided by the World Bank’s consultants, together with the fact that Russia is a member of WTO. It’s being argumented, that healthcare reforms in Russia are performed according to the policies of the aforecited organizations who are the real actors, upon which the reforms should be judged, but not the national government. From the perspective of that really sovereign actor Russian health care reforms lose their evidently inconsistent character, their means and methods become concordant with the aim, which is maximal privatization of healthcare. Conclusion confirms the opinion of Russian community of healthcare professionals that the country needs to reestablish its previous budget model of healthcare organization.

Key words: types of healthcare organizations, WTO, World bank, insurance companies, DRG, copayments, GDP

The goal of the study – to reorganize the medical personnel management system in the region. The methodology – economics and mathematical modelling. The result – optimization of medical personnel management at the regional level (Republic of Crimea).

Key words: region, model, matrix, human recourses, medical personnel, management system

Spearman rank correlation analysis was performed between the body mass index and the structural and functional parameters of the heart in 210 women (age 18-24 years) with idiopathic arterial hypotension (SBP 90-98 mmHg). Statistically significant relationships between the body mass index and the size of the heart cavities, the thickness of their walls, and the contractility of the heart were revealed. The results of the study indicate a direct correlation between the parameters of the heart and body mass index (weight and height) in young women with idiopathic arterial hypotension.

Key words: women, arterial hypotension, heart, body mass index

The article presents the results of study of pathomorphological features of the granulomas structure with acute and chronic inflammation. Studied were 112 granulomas, sampled after the removal of the teeth in individuals of different age groups, mainly up to 50 years (88,6%). In 95 granulomas neural elements were investigated, in 17 – a morphological and histochemical studies were performed. It is established that dystrophic processes in acute inflammation of the periapical tissue are characterized by a decrease in the content of glycogen, and pathological changes of the nervous elements of granulomas are concomitant with protein dystrophy and a violation of the tinctorial properties of axially-cylindrical part of the nerve fibers. Neural elements in the long-existing granulomas are characterized by severe degenerative and destructive processes as well as phenomena of reactive growth and hyperplasia of nerve fibers. The data obtained permit us to adjust both the tactic of surgical intervention and the tactics of active transapical therapy.

Key words: inflammation, granuloma, nerve fibers

Currently, children's respiratory diseases, accompanied by bronchial obstruction syndrome, rank at one of the first places in the structure of respiratory diseases. Bronchopulmonary dysplasia (BPD) is an acquired chronic obstructive pulmonary disease developing because of respiratory distress syndrome in premature infants and/or artificial lung ventilation (ALV), accompanied by hypoxemia and bronchial hyperreactivity. The maximum incidence of BPD is observed in children with very low birth weight, who required ALV [4,6,7]. There are three distinguished severity degrees of bronchopulmonary dysplasia: light, medium, heavy. When determining the severity of BPD is not enough to consider only data on the duration of oxygen support, it is also necessary to take into account the infant’s bodyweight at birth, the presence of comorbidities and complications. The development of BPD is facilitated by many factors: immaturity of pulmonary tissue, surfactant deficiency, exposure to high concentrations of oxygen during ALV, pulmonary edema, aspiration syndrome, shunt from left to right with an open aortic duct [9,10,13,15]. Predisposing factors are bacterial pneumonia, intrauterine infection, pulmonary edema, fetal hypoxia [10,11]. Currently, there is a marked increase in the development of bronchopulmonary dysplasia due to the growing number of premature infants. Early diagnosis of bronchopulmonary dysplasia, timely treatment at an early stage, the correct management tactics of such cases reduces the risk of complications of the disease [5,8,14,17]. At present, the problem of assessing the survival rate of children with very low birth weight, the frequency of bronchopulmonary dysplasia, and the algorithm of patient management remains highly relevant [11,19]. There is no accurate data on the quality of life and long-term effects after bronchopulmonary dysplasia, reliable prognostic data and the outcome of BPD [20,21]. The article presents results of clinical and instrumental research of respiratory organs of children with a history of bronchopulmonary dysplasia. Comprehensive clinical and functional evaluation of lung respiratory functions in children from 3 to 10 years after BPD of varying severity is given, based on body plethysmography, CT, spirography. Methods of prevention of bronchopulmonary dysplasia, causing chronic lung diseases, are proposed.

Key words: extremely low birth weight, premature births, respiratory distress syndrome, bronchopulmonary dysplasia, bronchial asthma, bronchitis, pneumofibrosis

Clinical practice lacks studies on association of low level of physical activity with the development of cardiovascular diseases (CVD), as well as the problem of early diagnosis of risk factors for chronic diseases in patients considering themselves healthy. Purpose. To study the evidence of cardiovascular risk in outpatients depending on their physical activity and the presence of suboptimal health status. Material and methods. An observational descriptive study conducted from 2016 to 2018 surveyed 358 people (155 men and 203 women aged 18 to 60 years) considering themselves healthy and/or not seeking medical attention for the last 3 months. The main CVD risk factors were studied, and individual cardiovascular risk was determined applying the SCORE scale. The level of physical activity was determined by IPAQ questionnaire of physical activity. The presence of suboptimal health status was identified by the international questionnaire SHSQ-25. Data processing was performed in Microsoft Excel 2010 and Statistica 10.0 and evaluated for the normal distribution using the calculation of Pearson's criterion χ2. Results. The interrelation of CVD risk factors with body mass index, indicators of total cholesterol, blood pressure, blood glucose and family history were revealed. Values of CVD risk factors indicators were significantly different in all groups of patients with different levels of physical activity. Differences in physical activity and suboptimal status were determined in the low-risk group of CVD. Discussion. Significant data on the study of physical activity at low cardiovascular risk in patients considering themselves healthy were obtained for practical medicine. The importance of studying the suboptimal status in patients with low cardiovascular risk is proven. Conclusion. For the prevention of cardiovascular diseases in outpatients considering themselves healthy, it is necessary to take into account the level of physical activity and the presence of suboptimal health status.

Key words: Cardiovascular diseases, physical activity, suboptimal status

The article is a scientific review of the monograph by Sharabrin E.G., Mukhin A.S., Medvedev A.P., Ivanova Y.A., Fedorova S.A. "Tactics of endovascular treatment for thrombosis of the infarct-responsible artery."

Key words: endovascular treatment tactics, acute coronary syndrome, coronary artery thrombosis

The article presents a method for assessing the diagnostic effectiveness of immunochromatographic analysis in hardware-software execution during chemical-toxicological studies and establishing the level of "cutoff" with the probability of detection of synthetic cathinones in persons directed to medical examination of establishment intoxications. New immunochromatographic test systems at the stage of screening can detect synthetic cathinones in the urine in the range from 20 ng/ml. The overall accuracy of the test was 92.3%. Therefore, to confirm a positive result obtained during screening, on the second stage of chemical-toxicological researches, it is necessary to have a reliable method for detecting analytes in the urine when they are found at low concentrations. Such methods include gas chromatography with mass-selective detection (GC-MS).

Key words: synthetic cathinones, immunochromatographic analysis, sensitivity, specificity, ROC-analysis