Journal «MEDICINA» 2/2020

Regional drugs injection is а promising method of partial optic atrophy treatment. The therapy involves the introduction of drugs into the microcirculation region on the side of the affected organ, in the area corresponding to the topographic projection of the lymph node. Purpose: To evaluate the effectiveness of treatment of partial optic atrophy of various origins using regional combination therapy. Material and Methods: Complex therapy was applied in hospital environment of The S. Fyodorov Eye Microsurgery Federal State Institution in treatment of 38 patients (38 eyes) with partial optic atrophy of various origins. The patients were divided into two groups: group I (27 eyes), diagnosed with partial optic atrophy of glaucomatous origin, group II (11 eyes), diagnosed with partial optic atrophy of mixed genesis. Before and after treatment, all the patients passed standard ophthalmological examination, as well as optical coherence tomography (OCT).The parameters of the optic disk were assessed using Cirrus 5000 retinal tomograph by Carl Zeiss Meditecinc (Germany). Results: After 12 months of complex treatment, administered 2 times a year and included injections in the pterygopalatine fossa and submastoid region, in patients of group I the following indices were registered: an increase in visual acuity by 0.1-0.2, a decrease in relative scotoma number by13%, stability of the nerve fiber layer thickness and excavation of the optic disc. Total visual field expanded up to 220-335. After 12 months of treatment, administered 2 times a year in patients of group II the following indices were registered: an increase in visual acuity by 0.1-0.3, a decrease in relative scotoma number by 9%, stability of the nerve fiber layer thickness and excavation of the optic disc. The total visual field after treatment expanded up to 310-450. Conclusion: the application of complex therapy in treatment of patients with partial optic atrophy of various origins has positive effect on visual function.

Key words: combination therapy, glaucoma neuroopticopathy, partial atrophy, optic nerve

The article discusses in detail three fairly stable myths about drug interactions of macrolide antibiotic josamycin, which have become widespread in Russian literature over three decades since the drug product was introduced in Russia: 1) josamycin does not affect the metabolism of other drugs; 2) josamycin has a negligible effect on the metabolism of other drugs; 3) josamycin rarely interacts with other drugs.

Key words: Josamycin, drug interactions

The search for new methods for identifying the pathogen in biological material, including microscopic, remains relevant. The study of ultrastructural changes of microorganisms as a result of exposure to various groups of antibiotics is important, because the morphology of the bacterial cell varies considerably depending on the conditions of cultivation. The purpose of the study: 1. To identify the nature of changes in the ultrastructure of preserved bacterial cells of S. aureus, cultivated in the presence of antibiotics. 2. To determine the viability of that part of the population of S. aureus, which remained exposed to suppressive concentrations of antibacterial drugs. 3. To determine whether the ultrastructural changes of the reference strain S. aureus ATCC 25923 in the proposed conditions completely reflect the nature of these changes for strains isolated from clinical material. Materials and methods. Three strains of S. aureus isolated from biological material and the reference strain S. aureus ATCC 25923 were used to investigate the S. aureus ultrastructure. The analysis was carried out on the basis of data obtained using scanning electron microscopy (SEM). In the process of sample preparation, the technique of imprinting bacteria from agarized nutrient medium was applied. Results and conclusions. The most common feature for the strains of clinical isolates of S. aureus was the formation of a large number of bacterial cells of a specific disc-shaped form in zones of influence of bacteriostatic antibiotics. In terms of the use of bactericidal drugs, part of the population remained spherical, the other part had irregular contours. Changes in the size of bacterial cells in growth suppression zones were multidirectional. Cultivation of bacteria under conditions of exposure to suppressive concentrations of antibacterial drugs stimulated the production of exocellular matrix. The ultrastructural changes of phenotypic variability of the reference strain S. aureus ATCC 25923 did not fully correspond to changes in the morphology of the bacterial cells of the strains of clinical isolates. The viability of bacteria remaining in the zones of growth suppression has been confirmed in all cases of antibiotic exposure, except gentamicin. Thus, the study revealed the nature of changes in the ultrastructure of S. aureus as manifestations of phenotypic variability of microorganisms in response to the presence of antibacterial drugs with different mechanisms of action.

Key words: ultrastructure of S. aureus, antibacterial drugs, scanning electron microscopy, phenotypic variability of S. aureus, biofilm

Due to its rapid development, telemonitoring technologies in the field of healthcare significantly outstripped the possibilities of implementation in real practice. Therefore, there is a need for the active development of this area of prevention and treatment of chronic patients, identifying emerging problems and finding possible solutions. The aim of this work was to assess the status and development prospects of monitoring of patient health in residential settings and analyze the problems of its inclusion in the existing health care system. Based on the analysis of scientific publications and expert assessments, the existing at-home telemonitoring systems, the main pathologies observed, and the organization of medical care for chronic patients under remote monitoring are examined. It was shown that the on-line treatment of monitored patients in the current health care system is very difficult due to its unpreparedness for the introduction of such technologies and the undeveloped concept of clinical and economic efficiency of their use. The article proposes to carry out special training of patients on effective participation in the process of remote monitoring, and it is also proposed to provide in the treatment and prevention institutions the position of a consultant (general practitioner, with an appropriately equipped workstation) for conducting remote patient consultations.

Key words: chronic diseases, telemonitoring, home monitoring, teleconsultation, telemonitoring systems, healthcare organization

In the structure of medical rehabilitation, the demand for restorative technologies with healing natural factors is steadily increasing. Rational exploitation of natural resources provides the core of the resort and recreation and sanatorium branches. Rehabilitation measures in the complex of sanatorium-resort therapy are optimally balanced and effective. A potential part of recovery techniques is the healing properties of climate, mineral water, natural heat carriers, etc. The Voronezh region is rich in reserves of mineral waters, brines and therapeutic mud in the operational waiting phase. Deposits of various clays are available everywhere. Argillotherapy developed based on gray clay (kaolinite) incision «Strelitsa Middle» at Latnoe settlement. Comparison is made of clinical effectiveness and economic effect of argillotherapy gray clay (kaolinite) in the complex of rehabilitation programs among patients of different ages in conditions local health resort.

Key words: sanatorium-resort organizations, rehabilitation, natural balneoresources, argillotherapy, analysis

Type I Diabetes Mellitus (DM) is among the most common endocrinological diseases for adolescents. The purpose was to study the level of autoantibodies (AAT) to NMDA receptors and Type 2 dopamine receptors (DAR2) in children with varying severity of Type I Diabetes. We examined 38 children and adolescents aged 2 to 17 years. In order to determine the levels of AAT to NMDA receptors and dopamine receptors (DR2) in blood serum, we applied the enzyme-linked immunosorbent assay (ELISA). We found higher levels of AAT to NMDA receptors and dopamine receptors (DAR2) in children with chronic Type I Diabetes against the background of diabetic ketoacidosis (DKA), as compared to children with the diabetes onset or compensation of the disease. The increased levels of AAT to NMDA and dopamine receptors (DAR2) were found in children and adolescents against the background of a long history of the disease and frequent hospitalization to the intensive care unit.

Key words: Diabetes Mellitus Type I, NMDA receptors, dopamine receptors, autoantibodies

Aim of the study: Assessment of the influence of potential risk factors on the development of central serous chorioretinopathy in a large industrial city. Materials and Methods: Case-control study of persons aged 18 years and older. The study group included 100 patients with central serous chorioretinopathy, confirmed by optical coherence tomography, and controls – 100 patients without central serous chorioretinopathy. The groups are comparable in gender and age. Interviewing of patients was carried out according to the developed questionnaire, including 33 questions. One-way and multivariate analysis of the results using logistic regression was carried out. Statistical data processing was carried out using Microsoft Office Excel 2010, Jamovi programs, R – Studio statistical package, OpenEpi online calculators (http://www.openepi.com). Results: The following risk factors for CSC were identified: taking corticosteroid drugs in the last year – OR 13.5; 95% CI 3.4-53.2 and the presence of arterial hypertension – OR 8.3; 95% CI 1.3-54.1. Intake of antihypertensive drugs and psychotropic drugs from the group of anxiolytics were statistically significant factors in the «prevention» of the development of CSC (OR 0.1; 95% CI 0.02-0.9 and OR 0.01; 95% CI 0.0003− 0.5), respectively. The presence of myopia also proved to be a protective factor for CSC –OR 0.3; 95% CI 0.14-0.8. Conclusion: In a case-control study, significant risk factors for CSC for the population of a large industrial city were arterial hypertension and the use of corticosteroid drugs. The presence of myopia is associated with a lower incidence of CSC.

Key words: central serous chorioretinopathy, epidemiology, risk factors, case control, arterial hypertension, corticosteroids

Background. The Russian and international community is concerned about the growing incidence of measles. This is typical for highly developed and developing countries and has an impact on the epidemic situation in Russia. Purpose of research: to study the main results of the activities carried out by the Rospotrebnadzor administration in the Tver region to improve the state of the environment and protect the population of the Tver region from measles infection. Material and methods. The results of implementation of measures to reduce the impact of risk factors of measles on the health of the population of the Tver region in 2017-2019 were analyzed. Analyzed indicators are: the incidence of measles per 100 thousand population; coverage of preventive vaccinations to prevent the spread of measles among controlled individuals (%); results of serological monitoring of the state of collective immunity against measles in indicator population groups by a passive hemagglutination reaction method with a protective titer of 1:10 or more (absolute number, %); comparative assessment of changes in indicators of the number of measles seronegative persons in indicator groups of the population (%). Results and discussion. A set of measures aimed at preventing the incidence of measles is being implemented in the Tver region. To do this, the population is immunized against measles every year. In 2017 38,881 people were vaccinated, in 2018 – 35,476 and in 2019 – 42,347 people. This led to the fact that in 2017 in the Tver region there were no cases of measles. In 2018 the incidence of measles was 0.23 per 100 thousand population (3 cases) and in 2019 – 0.86 per 100 thousand population (11 cases). All cases of measles were imported from foreign countries and various regions of Russia. The situation in the incidence of measles in the Tver region is much better than in the Russian Federation and the Central Federal District of Russia. This is facilitated by a consistently high vaccination coverage of adults and children. Vaccination coverage of children aged two years in 2019 amounted to 98.2%, at the age of 6 years – 94.4% and adults 18-35 years old – 99.7%. If during seromonitoring an increase in the specific gravity of seronegative persons was detected, then their vaccination was carried out as planned. Conclusion. The implementation on a regular basis by the Office of Rospotrebnadzor in the Tver region of a set of effective measures aimed at combating measles helps prevent the incidence of measles infection in the population of the Tver region.

Key words: habitat, measles, incidence, vaccination, collective immunity, serological monitoring

The article provides an analysis of the reform of the structure of national health care for the period from 2010 to 2020 and an assessment of the development of public-private partnership in the system of mandatory medical insurance. The analysis was conducted before the beginning of the pandemic on the date of 15.01.2020.

Key words: healthcare organization, public-private partnership in healthcare, compulsory medical insurance system, private healthcare, non-governmental medical organization

Retrospective diagnosis of disease of Lukerya, female protagonist of the story is Turgenev's «Living relic» from «A Sportsman's Sketches» series. The aim of the study is to clarify the diagnosis. Based on the acute onset of the disease, due to injury, the presence of «bronze» skin pigmentation, pronounced adynamia, exhaustion, Addison's disease is diagnosed. Given the detailed literary characteristics of the disease, it is proposed to name Addison's disease as «Addison–Turgenev's disease» and «Lukerya's disease».

Key words: Turgenev, the story «Living relics», Lukerya, Addison's disease, scleroderma