Journal «MEDICINA» 4/2020

The aim. To conduct a comparative analysis of the composition of patients in day hospitals and in-home health care by medical organizations providing outpatient care by age groups and classes of diseases in the Russian Federation for 2011-2019, to submit proposals for making additions to the report form. Material and methods. The data from the report form of sectoral statistical observation № 14ds «Information on the activities of day hospitals of medical organizations» on the composition of patients treated in day hospitals and in-home health care by medical organizations providing outpatient care, by age and classes of diseases for 2011-2019 were analyzed. Since 2019, the report form has provided consolidated information on the work of day hospitals and in-home health care. Based on the results of the performed in-depth study, a separate composition of patients in day hospitals and in in-home health care in the Russian Federation is presented, which makes it possible to compare data for 9 years. The methods used: statistical, analytical. Results and discussion. In the process of studying the age structure of patients in day hospitals and in in-home health care in the Russian Federation for 2011-2019, the growth of the proportion of treated persons older than working age was determined: in day hospitals from 33,4 to 49,4%, in in-home health care – from 57,1 to 64,4%. For 9 years, the greatest increase was noted in the proportion of adult patients treated in day hospitals for neoplasms, diseases of the endocrine system, nutritional disorders and metabolic disorders; in in-home health care – for diseases of the nervous system, mental disorders and behavioral disorders; the proportion of children treated in day hospitals – for diseases of the nervous system, musculoskeletal system and connective tissues, in in-home health care – with respiratory diseases. The report documentation combines data on the performance of day hospitals and in-home health care of medical organizations providing outpatient care, which does not allow for their comparative analysis with previous years. Conclusions. In 2019, more than half of the patients treated in day hospitals and in in-home health care were older than working age. There are differences in the distribution of treated adults and children in day hospitals and in in-home health care. The main causes for treatment of adult patients in day hospitals were diseases of the circulatory system (34,4%), musculoskeletal system and connective tissue (12,9%), neoplasms (12,9%); in in-home health care – diseases of the circulatory system (65,4%), musculoskeletal system and connective tissues (11,8%); children in day hospitals – diseases of the nervous system (29,5%), respiratory organs (27,2%), digestion (12,4%), in in-home health care – diseases of the respiratory organs (90,5%). Supplements for inclusion in the reporting documentation concerning the activities of day hospitals and in-home health care of medical organizations that provide treatment on an outpatient basis are proposed.

Key words: adult patient, child, age, class of diseases, day hospital, in-home health care, reporting form

The most important problem of non-steroid anti-inflammatory drugs (NSAIDs) is a high risk of ulcerogenicity. It is possible to reduce it by the increase in gastric mucosa concentrations of gastroprotective NO. New NSAIDs Amtolmetin guacil (AMG) was registered in Russia in 2013. It is positioned as an effective medicine with gastroprotective action. AMG stimulates capsaicinoid receptors and accumulates NO in the stomach. However, the data on the effectiveness and safety of AMG are few. During its metabolism highly ulcerogenic Tolmetin is formed. The purpose of our research was to study the anti-inflammatory, analgesic and ulcerogenic effect of AMG after intragastric administration. The research was carried out on white nonlinear mice and rats of both sexes. Our study showed that AMG effectively reduced the severity of carrageenan edema of the rat's paw and reduced the number of acetic cramps in mice. Gastric mucosa of most animals was without pathological changes, single shallow erosions without infiltration were found in 32% of animals after administration during 4 days of AMG to rats at a dose of 200 mg/kg once a day. Diclofenac in the same conditions at a dose of 10 mg/kg caused deep defects in 75% of rats. AMG showed pronounced analgesic and anti-inflammatory effect. Our results also confirmed the advantage of AMG compared to diclofenac in its effect on the gastric mucosa.

Key words: non-steroidal anti-inflammatory drugs, amtolmetin guacil, ulcerogenicity, gastrotoxicity, diclofenac

Pruritus associated with chronic kidney disease, also known as uremic pruritus, is a common and underestimated clinical condition that occurs in over 60% of patients treated with programmed hemodialysis. Moderate to severe itching develops in 20-40% of patients. It often leads to a decrease in the quality of life, sleep disturbances, depression, and an increased risk of infection and death. The pathogenesis of pruritus remains unclear. It is believed to be a multifactorial process in which metabolic disturbances, immune dysregulations, hormonal imbalances, systemic inflammation, and increased levels of parathyroid hormone, histamine, calcium and magnesium salts play an important role. However, there are currently no unified approaches to the treatment of uremic pruritus, and off-label treatment is not effective enough and is associated with side effects, which requires further search for new pharmaceutical possibilities.

Key words: pruritus, uremia, hemodialysis, etiology and pathogenesis of pruritus, T-helpers, μ-receptor agonists, substance P, neurotransmitters, cytokines, neurotransmitters, chronic kidney disease, capsaicin, histamine, bradykinin, pruriceptors, pruritogens

Type I Diabetes Mellitus (DM) is among the most common endocrinological diseases in adolescents. The purpose of this study was to research the level of autoantibodies (AAT) to NMDA receptors and Type 2 dopamine receptors (DAR2) in children with varying severity condition 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

Background. In the Arkhangelsk region, the global trends in the spread of type 2 diabetes mellitus persist. At the beginning of 2019, 47 thousand patients with diabetes mellitus were registered in the region. In view of this, it is of interest to assess the demographic contour of this category of patients on the territory of the subject of the federation. Aim: To assess the prevalence of type 2 diabetes mellitus in the Arkhangelsk region. Materials and methods: The object of the study is a depersonalized database of the Federal register of patients with diabetes mellitus living on the territory of the Arkhangelsk region and having an established diagnosis of type 2 diabetes mellitus (DM type 2), complicated by nephropathy, retinopathy, existing cholesterol metabolism disorders and not using insulin. Results: According to the data obtained, most of the patients with type 2 diabetes live in cities (Arkhangelsk, Severodvinsk, Kotlas). The majority of patients are in the age segment over 50 years old, with 68.59% of cases of the disease occurring in women.

Key words: type 2 diabetes mellitus, demographic contour of disease prevalence, Federal register of patients with diabetes, gender composition, age composition

Two cases of acute porphyria are presented. Acute porphyria is a rare disease, a pathology associated with hereditary or acquired abnormalities of the biosynthesis of heme. The main features distinguishing these nosological forms are: the prevalence of precursors of porphyrins among laboratory-defined metabolites, rapid clinical progression of the disease; the absence of a correct diagnosis or late diagnosis resulting in life threatening neurological disorders. The main diagnostic difficulties are related to a non-specific character of clinical signs of acute intermittent porphyria, the clinical signs mimic a large range of somatic conditions, including emergency conditions. Certain difficulties for doctors are caused by the orphan nature of porphyria, clinical polymorphism, the difficulty to obtain pathogenetic drugs in medical institution for treatment of the disease in the Russian Federation.

Key words: acute porphyria, difficulty of diagnosis, heme arginate