Journal «MEDICINA» 2/2019

The article assesses association of VKORC1 C1173T genetic polymorphisms and haemostatic indicators in patients with permanent atrial fibrillation. We enrolled in the study 235 patients with coronary artery disease and permanent atrial fibrillation (mean age 66.5±8.3 years). We show that in patients with permanent atrial fibrillation genotype CC VKORC1 is associated with increasing of thrombin activatable fibrinolysis concentration more than 210% and soluble fibrin monomer complexes more than 11 mg%.

Key words: genetic polymorphisms, vitamin K epoxide reductase subunit 1, thrombin activatable fibrinolysis inhibitor, atrial fibrillation

The aim of the study. To analyze the indicators characterizing the work of day hospitals and hospitals at home in Russia for 1990-2017 years, to formulate proposals for improving the filling of statistical reporting on their work. Material and methods. The normative legal documents regulating the organization of activities of day hospitals and hospitals at home, management of reporting documentation were studied. Analysis of the work of day hospitals and hospitals at home in medical organizations was conducted according to the forms of sectoral statistical observation № 14ds «Information on the activities of day hospitals medical organizations» for 2002-2017 years; Federal statistical observation № 47 «Information about the network and activities of health organizations» for 1990-2001 and 2014-2017. The methods used: content analysis, analytical, statistical. Results and discussion. The assessment of work of day hospitals and hospitals at home in the Russian Federation for 28 years showed growth: number of beds in day hospitals of the hospital organizations and of the polyclinics – more than 13,0 times respectively; provision with beds of day hospitals of the hospital organizations – from 0,4 to 6,5 per 10 thousand of the population, day hospitals of polyclinics – from 0,8 to 10,6 per 10 thousand of the population; number of the treated patients in day hospitals of the hospital organizations – by 36,0 times, in day hospitals of polyclinics – 13,2 times, in hospitals at home – 2,45 times; the number of treated patients per 1000 population in day hospitals of hospital organizations increased from 0,6 to 20,7, in day hospitals of polyclinics – from 2,6 to 34,7, in hospitals at home – from 0,9 to 2,2. During 2000-2017, the average duration of treatment in day hospitals: hospital organizations decreased by 2,9 days, polyclinics – by 0,7 days, in hospitals at home – by 1,4 days. Management of reporting documentation on work of day hospitals and hospitals at home was studied. It was established that additions and changes were made to the form of sectoral statistical observation № 14ds, which are not approved by regulatory documents and are not specified in the instructions for its completion and make it difficult to analyze the activities of day hospitals and hospitals at home. Conclusions. In the Russian Federation, for 28 years, an increase in the performance of day hospitals and hospitals at home in medical organizations has been noted. In 2017, in the subjects of the Russian Federation, the difference in indicators provision with beds of day hospitals of the hospital organization and polyclinics differed by 6,0 times (from 5,5 per 10 thousand population in the Republic of Dagestan to 32,9 in the Ivanovo region) and the number of patients treated in day hospitals and hospitals at home per 1000 population – by 5,9 times (from 15,2 in the Republic of Dagestan to 90,6 in the Magadan Region). Proposals to improve the filling of statistical reporting on the work of day hospitals and hospitals at home in medical organizations are formulated.

Key words: day hospital, hospital at home, reporting documentation

The aim of the study is to evaluate the principal indicators for morbidity rate of the musculoskeletal system illnesses in children due to traumas, poisonings and some other external causes in the period 2011-2017 to improve the statistical recording of abovementioned pathologies. Material and methods. Authors performed analysis of primary and general morbidity (per 100000 of the population) of the musculoskeletal system and connective tissue diseases due to traumas, poisonings and some other external causes in 0-14- and 15-17-years old children based on the data from the Ministry of Health of the Russian Federation for the period 2011-2017. Results and discussion. A positive trend in morbidity rate decrease of the musculoskeletal system diseases in child population of Russian Federation in 2011-2017 was identified. Primary morbidity in 0-14 years old children decreased by 19,2% and general morbidity – by 2,4%. In 15-17 years old adolescents primary morbidity decreased by 7,0% and general morbidity – by 0,8%. In Astrakhan region authors observed increase in primary morbidity by 4,0% in 0-14 years old children and by 49,2% in 15-17 years old adolescents. General morbidity increased by 18,2% in 0-14 years old children and by 25,8% in 15-17 years old adolescents. Discrepancy between primary morbidity and general morbidity dynamics indicates drawbacks in the statistics on the pathology. Sufficiently high number (up to 30%) of «other» illnesses, especially in Astrakhan region, indicates drawbacks in official medical statistics. The increase of nationwide primary and general morbidity rates due to traumas and poisonings in 15-17 years old adolescents necessitates further development of the prevention activities and provision of traumatological aid. Statistics on the pathology needs improvement, applying state of the art information technologies.

Key words: analysis, morbidity, children, traumas, diseases, musculoskeletal system

Since 1997 many clinical cases have been described in foreign literature indicating that the antianginal drug nicorandil can cause gastrointestinal (GI) ulcerations, as well as ulcerations outside the GI tract. Relatively recently data have been presented that in a randomized, double-blind, placebo-controlled IONA trial (Impact of Nicorandil in Angina), the main results of which had been published in 2002, nicorandil had significantly increased the risk of GI ulcerations. The paper discusses in detailed examples how these foreign data are presented in Russian publications.

Key words: nicorandil, ulceration, translation equivalence

The term «preperimetric glaucoma» first appeared in foreign literature at the end of the 20th century. Previous experience in analyzing the optic disc was mainly based on ophthalmoscopy, photography and stereophotography, planimetry and other difficult methods of investigation in glaucoma. The emergence of modern more accurate diagnostic methods allowed for the first time separating qualitative (subjective) and quantitative (objective) criteria for assessing the optic disc and the adjacent retina. It took years before ophthalmologists began to comprehend the meaning of the term and its role in glaucoma. This issue is the subject of this literature review, sources are presented in chronological order.

Key words: ophthalmology, preperimetric glaucoma, optic disc

The problem of cerebral ischemic stroke (IS) is of extreme medical and social importance due to the significant frequency of its development, high percentage of resulting disability and mortality. Thrombolytic therapy (TLT) is currently the only possibility of highly effective intervention, allowing to restore blood flow in the affected vessel and prevent irreversible changes in brain tissue. To evaluate the effectiveness of TLT by recombinant tissue plasminogene activator (rt-PA) Alteplase* (Alteplase*), a retrospective analysis of 103 case histories of patients in the acute period of IS receiving TLT in the first 4.5 hours was carried out. The evaluation considered the data of neurological examination on the NIHSS score scale: at admission, 1 hour after the start of thrombolytic administration and a day after, as well as the frequency of detection of hemorrhagic transformation (HT) on brain tomography. To compare the average values of quantitative traits in the two groups, the Student's t-test was used in case of normal distribution (verified by Kolmogorov-Smirnov test). When comparing frequencies and fractions, statistical differences were established by calculating Pearson's Chi-square (χ²). For each studied parameter we calculated: M-mean, SD-standard deviation, presented in the text as M ± SD (with normal distribution of variables). In all statistical analysis procedures, the achieved level of significance was calculated (p=0.05). Confidence intervals (CI) were constructed for the confidence probability p=95%. When assessing the neurological status on the NIHSS scale, the mean score for admission was 13.72±4.96 CI [13.43-13.96], p=0.227, and 24 h after TLT – 9.91±6.95 CI [9.67-10.21], p=0.141. The data of two dependent samples were processed using Student's t-test, p<0.001. As a result, statistically significant differences in the dynamics of neurological status were revealed. On average, the positive effect of TLT was observed in 38.1% of patients, and complications in the form of HT in 17.6%. It should be emphasized that TLT was performed in a much smaller number of patients than the recommended indicator. This is primarily due to the large number of contraindications and low hospitalization of patients during the «therapeutic window». TLT is an effective and safe method of reperfusion tera-FDI of the acute period of IS. However, despite the positive experience, there is still a high risk of HT, which is the leading cause of deaths.

Key words: ischemic stroke, thrombolytic therapy, recombinant fabric activator of a plasminogen, hemorrhagic transformation

The efficiency of implantation of Ahmed glaucoma valve (AGV) is considered at secondary neovascular refractory glaucoma for patients with diabetes mellitus. The material gives a general idea about development of glaucoma and is not a substitution for studying of specialized literature. The priority is given to research of an avascular macular zone (FAZ) of a retina, applying angio-OCT, before and after the implantation of AGV. In patients with diabetes mellitus and numerous surgical treatments by neovascular glaucoma the operation of choice is implantation of AGV.

Key words: Ahmed glaucoma valve (AGV), refractory neovascular glaucoma, avascular zone of a retina, proliferative diabetic retinopathy

Purpose of the study. Study of the characteristics of severity and severity of chronic venous diseases (CVD) in men with arterial hypertension (AH). Material and methods. The object of study – men with hypertension 30-50 years of age. Subject of research – the severity of CVD symptoms. Type of research – single-step (cross-sectional), non-randomized. The study included 74 people with hypertension and 41 men with normal blood pressure. The severity of symptoms and the severity of CVD were determined by the VCSS scale. Results. In hypertension, episodic, not requiring analgesics, pain was recorded in 57% of patients and evening malnour swelling in 28% of men, which is 1.8 and 4 times more often than in men without hypertension. Conclusion. In working-age men with hypertension, more pronounced manifestations of CVD were recorded more often than in men with normal blood pressure. Symptoms of chronic bronchitis in patients with hypertension are moderate, and patients do not resort to additional medical intervention – the use of analgesics and compression therapy.

Key words: arterial hypertension, chronic venous diseases, men

Тhe most important resource of the Russian Federation are rural areas, small cities with uneven level of socio-economic development. The strategy of sustainable development of rural areas in Russian Federation until 2020 is aimed at increasing the quality and standard of living of the rural population, including boosting the level of health care for local population. Chronic non-communicable diseases (NCD) are the leading mortality cause in the population: more than 90% of fatal outcomes, of which 56% are cardiovascular diseases (CVD). Use of remote electrocardiography (RECG) in the organization of medical-diagnostic process in rural areas helped to increase the availability of the service for population and increased by 18% the coverage of electrocardiographic examination method, while greatly reducing the time of processing the results of ECG analysis. In the rural area, remote communication of registration, analysis and archived ECG between district units with the Central district hospital (CRH) was established, allowing for coordination of the actions of the paramedic, working directly at the patient's bedside. Automatic interpretation of ECG compared with the clinical status of the patient allows to reveal the presence of emergency pathology. Organization of simultaneous DECG operation at many rural medical posts led to the explicit economic effect, reducing costs of prophylactic medical checkups of population, diagnostics of emergency conditions, training of functional diagnostics specialists, cutting down processing time for RECG results.

Key words: Remote electrocardiography, cardiovascular diseases, attached rural population, medical and preventive institutions

Purpose. To detect the presence of the primary corneal alterations typical for keratoconus, with the further determination of the optimal tactics of managing and treating children, using the conventional methods of diagnosis. Methods. 20 patients (28 eyes), aged 14-18 years were examined. Patients were split into three groups depending on the stage of keratoconus. All patients underwent projection scanning topography (Pentacam, Oculus, Germany) besides the routine examinations. An elevation map of the anterior and posterior corneal surface was evaluated. The follow-ups were 6, 12, 18 and 24 months. Results. In 100% of patients of group I the constant indices of visual acuity, keratometry and pachymetry were observed within the whole follow-up period. The patients of this group underwent further monitoring. In patients of group II the negative dynamics was noted in 70% (7 eyes) of cases. This group of patients underwent stabilizing treatment (UV crosslinking). After the therapy in all 7 cases the process was stabilized. In all patients of group III the negative dynamics was noted within the whole follow-up. All patients underwent stabilizing treatment. In 86% (6 eyes) of cases the stabilization wasn’t achieved, the patients were recommended to undergo keratoplasty. Conclusion. The obtained results show the importance of the early detection of keratoconus, monitoring and consequently timely necessary treatment to achieve the maximum effect.

Key words: keratoconus, projection scanning topography, crosslinking