Journal «MEDICINA» 1/2020

The object of the study is established system of attitudes in the legal sector to the unlawful professional medical activities associated with the infliction of death by negligence. The subject of the study are relations between the professional level of a doctor, his conformity with the requirements for the implementation of medical activities in case of patient’s death by negligence. Death by negligence cases are analyzed from the standpoint of judicial and law enforcement practice. The purpose of the study, as set out in the article, is to consider the contradiction between the causes of deprivation of the right to engage in medical activity and confirmation of medical professional compliance. The methodological basis of the research are analysis, comparative method, method of systematic approach. A comprehensive and systematic study of the problems of unlawful medical activity in modern society has made it possible to formulate some legal constructs minimizing the number of medical errors by making changes to the current legislation and to build legal patterns of repetition of crimes committed by doctors. The author proposes to match the objective relationships between causing death by negligence and professional compliance. It is proposed to carry out extraordinary medical accreditation of persons to whom such a penalty as deprivation of the right to engage in medical activities is applied. Formulating conclusions, the author admits the inadmissibility of re-violation of bioethical principles, such as «do no harm», by convicted doctors returning to the profession after the end of the sentence. In this connection, the unscheduled accreditation of a doctor, after serving a sentence in the form of deprivation of the right to engage in medical activities, is fair both from the point of view of professional knowledge check and building trust between the patient and the doctor concerning the latter professional skills. The general trend to minimize incompetent medical care, should, in the author's view, result in revision of some provisions on the management of the list of practitioners in the database for health institutions, as well as re-checking the professional level of a doctor.

Key words: medicine, practice, death, negligence, harm, error, doctor, criminal case, trial, court

Binocular vision provides the perception of the object as a whole due to the fusion. The weakness of fusion mechanisms can cause the asthenopic complaints, decreased work capacity and limitations in professional activities. The main qualitative characteristic of binocular vision is deep, stereoscopic vision. The change of fusion reserves in children, depending on the degree of myopia and the method of correction is insufficiently studied. The article presents a comparative analysis of the fusion reserves in children with mild and average myopia in association with spectacle and orthokeratological correction. The study included 140 patients, divided into 4 groups of 35 people: group I included patients with mild myopia in association with spectacle correction; group II – average degree of myopia in association with spectacle correction; group III – mild myopia in association with orthokeratological correction; group IV – average degree of myopia in association with orthokeratological correction. In these groups fusion-positive and fusion-negative reserves were determined using synoptophore (synoptiscope L-2510HB). The improvement of fusion reserves was noted as a result of wearing orthokeratological lenses in patients with mild and average degree of myopia, which was accompanied by the improvement in the quality of vision and decrease in asthenopic complaints.

Key words: myopia, fusion reserves, binocular vision, orthokeratological correction, spectacle correction

The review describes intestinal microbiota as a complicated system, that has great impact on regulation of homeostasis in human body, attention is paid to factors, capable of disturbing it. Symbiosis between microbiota and host and disturbing is a subject for discussion, essential for understanding of homeostasis regulation. Changes in mircobiota quality and quantity (dysbacteriosis) lead to leaky gut syndrome formation. Prolonged and stable disturbances, related to onset of this newly described syndrome, nowadays are described as etiopathogenetic steppingstone for many well-known diseases, especially with unclear etiology and pathogenesis. Scientists investigate interaction between microbiota and host searching for new methods for microbiota influence on host. That’s why, estimation of intestinal microbiota may be used for diagnostic purposes, helping to determine risks of pathology onset to perform prevention measures, or it may reflect possible stage of existing disease and become the possible target in treatment of many outcomes.

Key words: microbiota, dysbacteriosis, leaky gut syndrome

A clinical case of a 50-year-old patient with diabetes mellitus type 2 with associated pathologies and their complications is described. The stages of diagnosis with verification of the data are considered, the tactics of the pharmacotherapy performed are analyzed.

Key words: ischemic stroke, diabetes mellitus, hypertension, comorbidity

In this article we discussed the mechanisms of infection with SARS-CoV-2, intercellular interactions and ways of infection transmission. We considered the epidemiology of COVID-19 and covered in detail the prospects of involving other organs and systems other than the respiratory system in maintaining the viral load. Problems of immune protection of the human body during infection with SARS-CoV-2 have been identified. Clinical parallels with progenitor viruses, namely SARS-CoV-1 and MERS-CoV, have been drawn. Risk factors for SARS-CoV-2 infection were identified, which allow predicting the course and probable outcomes of COVID-19.

Key words: SARS-CoV-2, COVID-19, angiotensin converting enzyme 2, angiotensin 1-7, transmembrane protease, serine 2, target cell, type 2 alveocyte

Purpose: Myopia is the main cause of visual impairment in the world. The analysis of its causes and anatomical characteristics of an eyeball is a challenging task for prognosis of ametropia progression especially in children. The aim of our study is an assessment and analysis of anatomical and refractive characteristics of an eyeball in children with myopic refraction. Material and methods: We observed 248 (496 eye) children with myopia dividing them into two age groups: younger school age 7-12 years (168 eyes) and older school age 13-18 years (244 eyes)). Control group – 21 emmetropic children: 11 (n=22) 7-12 years of age and 10 children (n=20) 13-18 years of age. We performed standard ophthalmological investigation: sciascopy with medical cycloplegia, ophthalmometry, measurement of the eye size (optical biometry). We calculated theoretical refraction for each child and compared it with his (her) actual refraction. Results: In the group of younger children we found prevalence of slight and moderate myopia. We found axial type of myopia (increase of an eye size) in 70% of cases and mixed type (increase of an eye size as to corneal refraction) in 20,5% and in 9,5% refractive type of myopia (eye size is normal but corneal refraction is increased). We found extreme increase of an eyeball in 29% of children from the group of axial myopia. Also, we found in them the theoretical (calculated) refraction is much higher than the real one (due to the lower corneal refraction compared to control group and other myopic children). In the older children we found double increase of high myopia compared to younger. The incidence of myopia in girls was higher compared to boys in the older children. In older group we found axial type of myopia in 64% of cases and mixed type in 36%. As well we see decrease of number of older children with pathological increase of an eyeball (20%). Conclusion: In children we see age-related increase of myopic refraction in connection with the eyeball size increase. In schoolchildren we see prevalence of axial myopia (70% in yonger age and 64% in older) but with the age one can see increase of mixed type of myopia (up to 36% compared to 20 in younger children)

Key words: myopia, axial size of an eyeball, corneal refraction, eyeball characteristics

The article examines the current state of the branch, legal issues of providing cosmetic services, legal responsibility for providing cosmetic services, analyzes the judicial practice of settling the disputes associated with dissatisfaction with the result of cosmetic services, and suggests measures to prevent legal conflicts.

Key words: cosmetology services, legislation, legal liability, conflict

Introduction. The indicators of economic damage caused by infectious diseases in 2018 increased by 1.6% compared to the previous year. Community-acquired pneumonia accounts for a significant percentage of the total number of infectious diseases and is often associated with a complicated course of influenza and acute respiratory viral infections. Purpose of the research. The present study was conducted with the aim of clinical and economic assessment of the feasibility of using gamma-interferon as part of complex treatment of community-acquired pneumonia. Materials and methods of the research. The study was based on the results of the open randomized study evaluating the effect of the drug Ingaron® (lyophilisate for the preparation of a solution for intramuscular and subcutaneous administration of 100,000 IU, manufactured by SPP «Pharmaclon» Ltd., Russia) on the effectiveness of antibiotic therapy and antibiotic resistance in patients with community-acquired pneumonia, which included 114 patients hospitalized for clinical reasons. Patients in the study group received gamma-interferon with antibacterial therapy; patients in the control group received only standard antibacterial therapy. The analysis of cost-utility and analysis of the impact on the budget were conducted. Results of the research and discussion. An improvement in the quality of life was revealed due to the earlier return to full health and the earlier cessation of intoxication. The strategy of prescribing gamma-interferon led to a reduction in health system costs by an average of 5629 rubles and an increase in quality of life by 0.3 days or 0.0008 QALY. The total economic gain from the appointment of gamma-interferon at 6231 rubles per patient consists of the direct gain described above and the monetary estimate of the gain in quality of life made on the basis of the willingness to pay threshold. When prescribing gamma-interferon for the treatment of community-acquired pneumonia in adults, the maximum budget savings can amount to 602 million rubles. Conclusions. Clinical and economic evaluation of the feasibility of using gamma-interferon as part of the complex treatment of community-acquired pneumonia at the hospital stage of medical care has revealed a positive impact on the quality of life and cost reduction of budgetary funds.

Key words: interferon gamma, community-acquired pneumonia, QALY, pharmacoeconomics

The aim of the study was to conduct a systematic review and meta-analysis of the role of the following risk factors for central serous chorioretinopathy: the use of steroid and non-steroidal anti-inflammatory drugs, psychopharmacological drugs, obstructive sleep apnea syndrome, coronary heart disease, autoimmune diseases, arterial hypertension, Helicobacter pylori infection, tobacco smoking. Methods: A literature search was conducted in English and Russian using electronic databases PubMed, Web of Science, Сochrane Library, E-library. Links from found studies were also analyzed. Selected articles were published during the period from June 1986 to June 5, 2019. The odds ratio (OR) with a confidence interval of 95% (CI) were calculated. Results: In accordance with the inclusion criteria, 25 trials were selected (21 trials – case – control studies and 4 cohort), involving 32747 patients with diagnosed central serous chorioretinopathy and 129980 people without it. According to the results of a meta-analysis, the risk factors for the disease were: the use of steroid drugs (OR 3.60; 95% CI 2.13-6.08); coronary heart disease (OR 1.39; 95% CI 1.11-1.74); the presence of an autoimmune disease (OR 2.35; 95% CI 1.09-5.05); arterial hypertension (OR 1.59; 95% CI 1.13-2.24); Helicobacter pylori infection (OR 2.45; 95% CI 1.56-3.85). The association of central serous chorioretinopathy with tobacco smoking (OR 1.43; 95% CI 0.75-2.73), obstructive sleep apnea syndrome (OR 1.82; 95% CI 0.70-4.75), and the use of non-steroidal anti-inflammatory drugs (OR 0.96; 95% CI 0.83-1.11), the use of psychopharmacological drugs (OR 1.52; 95% CI 0.91-2.53) have not been demonstrated. Conclusions: The most likely risk factors for central serous chorioretinopathy are diseases and conditions associated with the presence of endothelial dysfunction, such as arterial hypertension, ischemic hard disase, autoimmune diseases, and the use of steroid drugs.

Key words: central serous chorioretinopathy, systematic review, meta-analysis, risk factors, corticosteroids, coronary heart disease, arterial hypertension

Nowadays, there is no doubt that the study of the features of the blood supply to the choroidal melanoma (CM) using doppler ultrasound imaging examinations is not only of diagnostic significance, but also determines the choice of therapeutic tactics and allows predicting the course of the tumor process. Purpose. To study the diagnostic capabilities of doppler ultrasound imaging examinations in assessing the blood supply to small and medium sized choroidal melanomas. Material and methods. 73 patients (73 eyes): 39 men and 34 women, average age 59.27 + 1.64 years. The mean tumor thickness was 2.71 ± 0.15, the average base diameter was 9.12 ± 0.132. All patients based on metric characteristics of tumors were split into 2 groups. Group I («small» CM) consisted of patients with tumor prominence from 0.6 mm to 3.0 mm (n = 42), Group II («medium» CM) from 3.1 to 5 mm (n = 31). All patients underwent ultrasound examination with an expert-grade ultrasound scanner PHILIPS Affinity 50 (Philips Ultrasound, USA) using a linear high-frequency broadband sensor L15-7io using the color Doppler mapping mode, during which the characteristics of intratumor blood flow were evaluated. Results. The method of ultrasound scan allowed to determine the intratumoral blood flow in 77% of cases, and the reliability of its identification was higher in the group of «medium» CM. It was found that about half (47%) of CM were represented by the hypervascular type of vascularization and significantly more often (68%) were found in the group of «medium» CM. The absence of signs of intrinsic vascularization was diagnosed in 17 of 42 patients (40%) only in the group of «small» CM. In the course of studying the frequency of identification of the number of feeding vessels, it was found that several feeding vessels (75%) were significantly more often detected in tumors and this type of blood supply was more characteristic for medium-sized of choroidal melanoma (p<0.05). Conclusion. In the study of the blood supply to choroidal melanoma, a significant role is given to doppler ultrasound imaging examinations, which allows non-invasive imaging with high degree of information and reliability to visualize intratumoral vessels and determine the nature of blood flow, mainly with medium-sized choroidal melanomas.

Key words: Choroidal melanoma, doppler ultrasound imaging examinations, ophthalmic oncology, hemodynamic of choroid melanoma, choroidal tumor`s