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REVIEWS
ORGANIZATION OF HEALTHCARE
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UDC 616(051.2)(091)’’2008/2018’’
DOI: 10.20969/VSKM.2018.11(1). 7-16
AMIROV NAIL B., ORCID ID: orcid.org/0000-0003-0009-9103; SCOPUS Author ID: 7005357664, D. Med. Sci., professor of the Department of general medical practice № 1 of Kazan State Medical University, Chief editor of the journal «The Bulletin of Contemporary Clinical Medicine», Russia, 420012, Kazan, Butlerov str., 49, e-mail: namirov@mail.ru
VIZEL ALEXANDER A., D. Med. Sci., professor, Head of the Department of phthisiopulmonology of Kazan State Medical University, chief freelance pulmonologist of the Ministry of Health of Tatarstan Republic, deputy editor of the journal «The Bulletin of Contemporary Clinical Medicine», Russia, 420012, Kazan, Butlerov str., 49, e-mail: lordara@inbox.ru
DAMINOVA MARIA A., C. Med. Sci., assistant of professor of the Department of pediatrics and neonatology of Kazan State Medical Academy — Branch of Russian Medical Academy of Postgraduate Education, scientific secretary of the journal «The Bulletin of Contemporary Clinical Medicine», Russia, 420012, Kazan, Butlerov str., 36, tel. + 7-917-262-47-79, e-mail: daminova-maria@yandex.ru
AMIROVA RENATA N., expert physician, Head of the Department of foreign claims of «SOGAZ», Chief of the Department of contracts and advertising of the journal «The Bulletin of Contemporary Clinical Medicine», Russia, Kazan, tel. +7-903-307-99-47, e-mail: renata1980@mail.ru
SHAYMURATOV RUSTEM I., assistant of professor of the Department of phthisiopulmonology of Kazan State Medical University, Head of the Department of IT and Web of the journal «The Bulletin of Contemporary Clinical Medicine», Russia, 420012, Kazan, Butlerov str., 49, e-mail: russtem@gmail.com
ZIGANSHINA ARINA A., postgraduate student of the Department of advanced pediatrics with the course of outpatient pediatrics of Kazan State Medical University, International relations manager of the journal «The Bulletin of Contemporary Clinical Medicine», Russia, 420012, Kazan, Butlerov str., 49, e-mail: arina.ksmu@gmail.com
AMIRKHANOVA SURIYA V., C. Soc. Sci., editor of the journal «The Bulletin of Contemporary Clinical Medicine», e-mail: 17suria@gmail.com
Abstract. Aim. To analyze the activity of the mass media — the journal «The Bulletin of Contemporary Clinical Medicine» for a 10-year period from the date of its foundation in 2008 till present. Material and methods. Analysis of all issues of the journal «The Bulletin of Contemporary Clinical Medicine» published during the studied period, including enclosures and issues of the journal dedicated to conferences and congresses and reprints, has been performed. All documents and resources related to the journal have been studied, including the journal’s website, e-library and cyberleninka platforms. The study of the journal materials included the recommendations of the National Bibliographic Database of Scientific Citation (RSCI), the Higher Attestation Commission under the Ministry of Education and Science of the Russian Federation, the Association of Scientific Editors and Publishers, Scopus and Web of Science database experts. Results and discussion. During the period under review more than 1 500 scientific works were published in the main sections of the journal. Those are «Original study» (clinical and fundamental publications), «Reviews», «Clinical lectures», «Public Health», «Notes on practical experience», «Experimental studies — clinical medicine», «Clinical case» and others. Scientists from various regions and 84 sities of the Russian Federation prevailed among the authors. The growth in number of publications and authors from distant 14 countries (Argentina, Germany, Spain, Italy, the Netherlands, the USA, etc.) and from near abroad (Azerbaijan, Belarus, Kazakhstan, Uzbekistan, Ukraine, etc.) has been noted. According to the RSCI data for 2016 published on e-library platform, the impact factor of the journal grew significantly and has reached: a 2-year impact factor including citations from all sources = 0,643 and 5-year impact factor = 0,486. According to SCIENCE INDEX indicators the journal ranks 47 out of 513 ones related to «Medicine and Health». In the general ranking of scientific journals it takes 347 place out of 3,472 journals, with the journal index in the rating = 1,196. At the same time, the annual positive tendency of the Impact Factor index of the journal has been noted. Conclusion. The journal «The Bulletin of Contemporary Clinical Medicine» is a highly significant, intensively developing mass media related to «Medicine and Health». Development strategy of the journal has been assessed as positive. Financial support remains as a problem of the journal.
Key words: medicine and health, medical journal, peer-reviewed journal.
For reference: Amirov NB, Vizel AA, Daminova MA, Amirova RN, Shaimuratov RI, Ziganshina AA, Amirkhanova SV. Activity and development analysis of medical scientific-practical journal «The Bulletin of Contemporary Clinical Medicine» for 10 years (from 2008 to 2018). The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 7-16. DOI: 10.20969/ VSKM.2018.11(1). 7-16.
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AUDITORY THRESHOLD RAISING DEPENDENCE ON PRODUCTION RISK FACTORS IN AIR CREW MEMBERS
UDC 613.693:616.28-008.185-07
DOI: 10.20969/VSKM.2018.11(1). 17-22
ADENINSKAYA ELENA E., C. Med. Sci., Head of Research Center for occupational diseases and occupational health of civil aviation of Central Clinical Hospital of civil aviation, Russia, 125367, Moscow, Ivankovskoye highway, 7, tel.+7-916-845-50-45, e-mail: loruna@gmail.com
SIMONOVA NADEZHDA I., D. Med. Sci., professor, Head of Science school of Klin Institute of professional safety and working conditions, Russia, 141607, Moscow region, Klin, Dzerzhinsky str., 6, e-mail: simonovani@yandex.ru
SAVELYEV ANATOLY A., D. Biol. Sci., professor of the Department of environmental system modeling of Kazan (Privolzhsky) Federal University, Russia, 420008, Kazan, Kremlevskaya str., 18, e-mail: anatoly.saveliev.aka.saa@gmail.com
MUKHARAMOVA SVETLANA S., C. Biol. Sci., associate professor of the Department of environmental system modeling of Kazan (Privolzhsky) Federal University, Russia, 420008, Kazan, Kremlevskaya str., 18, e-mail: smukhara@gmail.com
Abstract. Aim. Evidence-based approaches for assessment the dependence of raising hearing threshold on operating production factors and the reasons for it in conventional frequency range in members of civil aviation crews have been developed. Material and methods. Analysis of 1420 audiograms from current air crew members of the Russian Federation operating at 120 airlines of the country flying on 56 types of aircraft was carried out. When constructing models of linear regression the deviation of the audibility threshold from the median age norm obtained with tone threshold audiometry was taken as a dependent variable. As the independent variables, the total duration of service in flying profession, the total flight time and noise level in the cockpit of the aircraft were considered. Results and discussion. The results obtained from the members of civil aviation air crews in the Russian Federation confirm that the level of industrial noise equal to 80 dB is the minimal level of impact that does not lead to an increased risk of hearing loss. Typical occupational disease development in the hearing organ such as audiometric changes are similar to the noise effects on workers from the other economy sectors (machine building, mining, construction, etc.). It appears as a «typical wave» at frequencies of 3 and 4 kHz, which fully corresponds with all international studies with a high level of significance. Conclusion. It was established that aircraft noise causes rising of the hearing thresholds at the frequencies of 3 and 4 kHz in air crew members, with the dependence occurring at a noise level of 80 dBA increasing accordingly with the noise level. The increase in hearing thresholds in the area of high frequency perception does not depend on flight duration (p=0,2; 0,5; 0,9) and slightly depends only on the duration of service (for a record of more than 20—25 years the dependence disappears due to prevalence of age-related changes). The increase in auditory thresholds at frequencies of 1, 2, 6 and 8 kHz does not depend on the effect of aircraft noise. The rumor among air crew members in the speech frequency range worsens with increasing flight time, with the dependence becoming significant with a flight time of about 15,000 hours and increasing correspondingly (p<0,001).
Key words: sensor neural hearing loss, noise induced hearing loss, industrial noise.
For reference: Adeninskaya EE, Simonova NI, Saveliev AA, Muharamova SS. Auditory threshold raising dependence on production risk factors in air crew members. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 17-22. DOI: 10.20969/VSKM.2018.11(1). 17-22.
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INFARCTION-LIKE MYOCARDITIS: CHALLENGES AND SOLUTIONS IN DIAGNOSIS
UDC [616.127-002.1-039:616.127-005.8]-079.4
DOI: 10.20969/VSKM.2018.11(1). 23-29
GAIFULLINA RAUSHANIYA F., C. Med. Sci., associate professor, Head of the Department of fundamental basis of clinical medicine of the Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, Karl Marx str., 74, e-mail: rushana78@mail.ru
KIM ZULFIYA F., C. Med. Sci., associate professor of the Department of internal medicine № 2 of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49
AMIROV NAIL B., ORCID ID: orcid.org/0000-0003-0009-9103; SCOPUS Author ID: 7005357664, D. Med. Sci., professor of the Department of general medical practice № 1 of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: namirov@mail.ru
ABDRAKHMANOVA ALSU I., C. Med. Sci., associate professor of the Department of fundamental basis of clinical medicine of the Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, Karl Marx str., 74
KHAIBULLINA SVETLANA F., D. Med. Sci., leading researcher of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, Kremlevskaya str., 18
RIZVANOV ALBERT A., D. Biol. Sci., chief researcher of Institute of biology and fundamental medicine of Kazan Federal University, Russia, 420012, Kazan, Kremlevskaya str., 18
Abstract. Aim. The aim of the study is to demonstrate the importance of compleх diagnostics with cytokine and mast cell role assessment in differential diagnosis of acute myocarditis with infarction-like clinical picture and acute myocardial infarction. Material and methods. As an example of myocarditis with infarction-like clinical picture was the patient, 31 years old, who referred for medical care because of pressing and compressing pain behind the breastbone radiating to the left shoulder, under the left scapula and to the lower jaw. On electrocardiogram — infarction-like changes. Laboratory data: troponin I was 5,85 ng/ml, creatinephosphokynase — 34,5, myoglobin — 80,8. The serum level of 13 cytokines (IL-18, IL-1ra, IL-1a, IL-2Ra, IL-12p40, CTACK, M-CSF, HGF, LIF, MIG, b-NGF SCGF, SDF-1a) differed from such in healthy people, while other cytokines were within the normal range. According to the results of myocardium scintigraphy the changes typical for acute myocarditis were revealed. Results and discussion. Infarction-like electrocardiographic changes identified by cardiologist should not be considered uniquely in favor of coronary heart disease. Only complete diagnostics provide accurate diagnosis of myocarditis with infarction-like clinical picture. The levels of growth factors SCGF and b-NGF, chemokines MIG and CTACK, cytokines IL-18 and LIF, regulating inflammation, were higher in our patient comparing to the mean values in control group. Conclusion. Different diseases may occur under the guise of an acute myocardial infarction. Severe chest pain, angina-like attacks were the main symptoms at the time of admission to the hospital. Our data may indicate that the pain can be developed from the interaction of mast cells with nociceptors during myocarditis attack. Thus, a detailed study of cytokine and mast cell role in pathogenesis of myocarditis will allow improving our understanding of the disease pathogenesis and mechanisms of pain symptoms initiation in these patients.
Key words: myocardial infarction, acute myocarditis, coronary heart disease, cytokines.
For reference: Gaifullina RF, Kim ZF, Amirov NB, Abdrakhmanova AI, Khaibullina SF, Rizvanov AA. Infarction-like myocarditis: challenges and solutions in diagnosis. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 23-29. DOI: 10.20969/VSKM.2018.11(1).23-29.
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MICROVASCULAR STATUS CHANGES IN PATIENTS WITH PRIMARY HYPOTHYROIDISM
UDC 616.441-008.64-07:616.16-008.1-073
DOI: 10.20969/VSKM.2018.11(1).29-33
KULABUKHOVA IRINA S., assistant of professor of the Department of internal medicine of Kuban State Medical University, Russia, 350063, Krasnodar, Sedin str., 4, tel. 8-918-324-07-21, e-mail: irina.kulabuhova@yandex.ru
ELISEYEVA LUDMILA N., D. Med. Sci., professor, Head of the Department of internal medicine of Kuban State Medical University, Russia, 350063, Krasnodar, Sedin str., 4, tel. 8-918-437-59-23, e-mail: yeliseyeva@mail.ru
ORANSKIY SERGEY P., C. Med. Sci., associate professor of the Department of internal medicine of Kuban State Medical University, Russia, 350063, Krasnodar, Sedin str., 4, tel. 8-918-367-10-67, e-mail: s_oransky@inbox.ru
KHUAKO MARIETT SH., C. Med. Sci., physician of the Department of clinical ultrasound of Kuban Regional Hospital № 1, Russia, 350000, Krasnodar, 1 May str., 167, tel. 8-918-440-84-03, e-mail: mariiet@yandex.ru
BUTAEVA SVETLANA V., Head of the Department of endocrinology of Kuban Regional Hospital № 1, Russia, 350000, Krasnodar, 1 May str., 167, tel. 8-918-464-93-49, e-mail: sv_butaeva@yandex.ru
Abstract. Aim. The changes in microvascular status in patients with compensated and decompensated primary hypothyroidism have been compared. Material and methods. The study included 53 patients with primary hypothyroidism (15 — with compensation and 38 — with decompensation). 20 healthy persons have been enrolled into control group. Microvascular status assessment was performed with laser Doppler flowmetry using LAKK-01 laser capillary blood flow analyzer (LAZMA, Russia). Results and discussion. The decrease of the key integral microcirculation index in patients from both groups was established. Blood flow amplitude parameters (Aα, ALF, ACF, AHF) as well as myogenic and neurogenic tone and intravascular resistance indicators demonstrated vasospastic reaction predominance. Reliable relationship between the recorded values of microcirculatory bed parameters and the state of thyroid status compensation was obtained. The most pronounced changes were noted in patients at the stage of decompensation. The changes in peripheral blood flow are less pronounced in patients at the stage of compensation, but they do not reach control values. Conclusion. There are micro-vascular status violations in patients with primary hypothyroidism with predominant vasospastic reactions more pronounced at decompensated hypothyroidism, which are not completely eliminated against the background of adequate therapy with L-thyroxine.
Key words: primary hypothyroidism, microcirculation, microvascular status.
For reference: Kulabuhova IS, Yeliseyeva LN, Oranskiy SP, Khuako MS, Butaeva SV. Microvascular status changes in patients with primary hypothyroidism. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 29-33. DOI: 10.20969/VSKM.2018.11(1).29-33.
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RESULTS OF RECONSTRUCTIVE SURGERY IN PATIENTS WITH POST-BURN SCAR ESOPHAGEAL STRICTURES
UDC [616.329-007.271-02:616.329-001.37]-089.844-06
DOI: 10.20969/VSKM.2018.11(1).33-38
NIZAMKHODZHAEV ZAYNIDDIN M., D. Med. Sci., professor, Head of the Department of surgery of the esophagus and stomach, Academician V. Vakhidov RSCS, Uzbekistan, Tashkent, tel. +998-90-348-64-57, e-mail: docligay73@rambler.ru
LIGAY RUSLAN E., C. Med. Sci., senior researcher of the Department of surgery of the esophagus and stomach, Academician V. Vakhidov RSCS, Uzbekistan, Tashkent, tel. +998-90-348-64-57, e-mail: docligay73@rambler.ru
SHAGAZATOV DANIYAR B., С. Med. Sci., resident physician, Academician V. Vahidov RSCS, Uzbekistan, Tashkent, tel. +998-71-277-26-80
KHADZHIBAEV ZHAMSHID A., junior researcher of the Department of surgery of the esophagus and stomach, Academician V. Vakhidov RSCS, Uzbekistan, Tashkent, tel. +998-90-348-64-57
TSOY ALEXEY O., junior researcher of the Department of surgery of the esophagus and stomach, Academician V. Vakhidov RSCS, Uzbekistan, Tashkent, tel. +998-90-348-64-57, e-mail: alexey_tsoy@mail.ru
NIGMATULLIN ELNAR I., 3rd year student of master program of Tashkent Medical Academy, Uzbekistan, Tashkent, tel. +998-90-372-24-77, e-mail: etoyaek@mail.ru
Abstract. Aim. The results of surgical treatment in patients with post-burn cicatricial strictures of the esophagus have been studied. Material and methods. 150 reconstructive surgeries on esophagus in patients with post-burn scarring stricture of the esophagus have been performed in the department of surgery of the esophagus and stomach at RSCS named after Academician V. Vahidov for the period from 1991 to 2015. 51 patients were men (34%), 99 — women (66%) aged 14 to 68 years. The chemicals used were following: vinegar essence — in 105 patients (70%), alkali — in 20 (13,3%), concentrated potassium permanganate solution — in 1 (0,7%), sulfuric acid — in 14 (9,3%), hydrochloric acid — in 2 (1,3%) and unidentified chemical reagent — in 8 (5,3%) patients. Post-burn scarring stricture of the esophagus number distribution was following: single stricture — 25 patients (16,7%) and multiple lesions — 125 (83,3%) patients. Results and discussion. The article presents 24-year experience of surgical treatment of 150 patients with post-burn cicatricial strictures of the esophagus. The indications for various embodiments of reconstructive surgeries, such as: extirpation of esophagus and shunt intervention, have been considered. We have studied the main groups of postsurgical complications after the surgeries on the esophagus, divided into specific, bronchopulmonary, purulent inflammation, thromboembolic and bleeding. The frequency and causes of death after the reconstructive surgeries on the esophagus in patients with post-burn scarring stricture of the esophagus have been determined. Conclusion. The choice of surgical treatment of the post-burn cicatricial strictures of the esophagus has to be individual. The most serious postsurgical complications are specific and directly related to technique of intervention. The main causes of death are specific and bronchopulmonary complications.
Key words: surgical treatment, esophagocoloplasty, dysphagia, chemical burns, scar stricture.
For reference: Nizamkhodzhaev ZM. Ligay RE., Shagazatov DB., Khadzhibaev ZhA., TsoyAO., Nigmatullin EI. Results of reconstructive surgery in patients with post-burn scar esophageal strictures. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 33-38. DOI: 10.20969/VSKM.2018.11(1).33-38.
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7. Nizamhodzhaev ZM, Ligaj RE, Shagazatov DB, Abdullaev DS, Hadzhibaev DA. Principy lechenija sochetannyh postozhogovyh rubcovyh striktur pishhevoda i zheludka [The principles of treatment of combined post-burn scarring stricture of the esophagus and stomach]. Vestnik jeksperimental’noj i klinicheskoj hirurgii [Bulletin of Experimental and Clinical Surgery]. 2012; 5 (4): 662-666.
8. Chernousov AF, Chernookov AI, Chernousov FA, Oganesjan AV. Lechenie bol’nyh s ozhogovoj strikturoj pishhevoda, oslozhnennoj svishhom [Treatment of patients with burn strictures of the esophagus complicated by fistula]. Hirurgija: nauchno-prakticheskij zhurnal imeni NI Pirogova [Surgery: Scientific and practical journal them NI Pirogov]. 2005; 4: 4-8.
9. Zaripov LR. Sovremennye aspekty lechenija rubcovyh striktur pishhevoda [Modern aspects of treatment of cicatricial esophageal strictures]. Grudnaja i serdechnososudistaja hirurgija: dvuhmesjachnyj nauchnoprakticheskij zhurnal [Thoracic and cardiovascular surgery: a two-month scientific journal]. 2006; 3: 35-39.
UDC 616.147-005.6-084:617.58-001.45-058.65
DOI: 10.20969/VSKM.2018.11(1).38-44
NIKOLAEV KONSTANTIN N., C. Med. Sci., assistant of the Head of Central Military Clinical Hospital of the National Guard forces of the Russian Federation for scientific and methodological work, faculty member, the branch of the Military Medical Academy named after S.Kirov, Russia, 143915, Moscow region, Balashikha, md. Nikolsko-Arkhangelskiy, Vishnyakovskoe highway, ow.101, e-mail: gvkg-tezis@mail.ru
ZUBRITSKY VLADISLAV F., D. Med. Sci., professor, Chief surgeon of Ministry of Internal Affairs of Russia, Head of the Department of surgery of Institute of Medical and Social Technologies, Russia, 119049, Moscow, Zhitnaya str., 12a
KOLTOVICH ALEXEY P., D. Med. Sci., Chief physician-surgeon of Central Clinical Hospital of the Ministry of Internal Affairs of the Russian Federation, Russia, 123060, Moscow, Narodnoe opolchenie str., 35
IVCHENKO DMITRY R., C. Med. Sci., Chief surgeon of the Department of medical support of Federal Service of the National Guard forces of the Russian Federation, Russia, 111250, Moscow, Krasnokazarmennaya str., 9a
AKIMOV ANDREY V., C. Med. Sci., Head of the Department of vascular surgery of Central Military Clinical Hospital of the National Guard forces of the Russian Federation, Russia, 143915, Moscow region, Balashikha, md. Nikolsko-Arkhangelskiy, Vishnyakovskoe highway, ow.101
GOLUBOV EVGENIY A., the acting Head of the Department of cardiovascular surgery of Central Military Clinical Hospital of the National Guard forces of Russian Federation, Russia, 143915, Moscow region, Balashikha, md. Nikolsko-Arkhangelskiy, Vishnyakovskoe highway, ow.101
DVORTSEVOY SERGEY N., C. Med. Sci., Head of the Department of ultrasound diagnostics of Central Military Clinical Hospital of the National Guard forces of the Russian Federation, Russia, 143915, Moscow region, Balashikha, md. Nikolsko-Arkhangelskiy, Vishnyakovskoe highway, ow.101
KAPUSTIN SERGEY I., D. Biol. Sci., Head of biochemical laboratory of Russian Research Institute of Hematology and Transfusiology of the Federal Medical Biological Agency, Russia, 191024, St. Petersburg, 2-nd Sovetskaya str., 16
Abstract. The issue of vein thromboembolic complication (VTE) prevention in injured is an urgent problem of military medicine. The course of thrombotic process is asymptomatic in the most cases. It manifests as a clinical picture of pulmonary artery thromboembolism, which is the cause of death in some military personnel. Aim. To analyze and to improve the methods of VTE prevention in injured with lower limb gunshot fractures and traumatic amputations. Material and methods. Analysis of the results of treatment of 298 injured with lower limb surgical trauma being hospitalized in the Central Military Clinical Hospital of the National Guard forces of the Russian Federation and in the Central Clinical Hospital of the Ministry of Internal Affairs of the Russian Federation from 2000 to 2017 was conducted. Effectiveness of VTE prevention methods and allelic polymorphism of genes associated with the process of thrombus formation were studied. Results and discussion. It has been established that vein thrombosis is being developed in 38,5% of injured with lower extremity gunshot fractures. Haemostasis system errors occur on the 1st day after being wounded and remain for 35 days. Conducting VTE prevention in wounded according to developed method allowed reducing the number of vein thromboses up to 16%. Vein thrombosis was diagnosed in 70% of the wounded with blood coagulation system genetic defects. Conclusion.The injured with gunshot fractures of long tubular bones of the lower limbs require VTE prevention at all stages of treatment. The definition of hereditary thrombophilia in wounded can be applied in order to predict the VTE development.
Key words: thrombosis, wound, limbs, thrombophilia, trauma.
For reference: Nikolaev KN, Zubritsky VF, Koltovich AP, Ivchenko DR, Akimov AV, Golubov EA, Dvortsevoi SN, Kapustin SI. A Differentiated approach to vein thromboembolic complication prevention in military low-extremity firearm injury. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 38-44. DOI: 10.20969/VSKM.2018.11(1).38-44.
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5. Nacional’nyj standart Rossijskoj Federacii GOST R 56377- 2015: Klinicheskie rekomendacii (protokoly lechenija) «Profilaktika trombojembolicheskih sindromov» [The national standard of the Russian Federation GOST R 56377-2015: Clinical recommendations (protocols of treatment) «Prevention of thromboembolic syndromes»]. Moskva [Moscow]: Standartinform. 2015; 46 p.
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8: 25-30. 8. Dvortsevoy SN, Zubarev AR. Ul’trazvukovaja diagnostika tromboza ven nizhnih konechnostej v ostrom periode minno-vzryvnoj travmy [Ultrasonic diagnostics of vein thrombosis of lower limbs in the acute period of mineblast injury]. Ul’trazvukovaja i funkcional’naja diagnostika [Ultrasound and functional diagnostics]. 2010; 3: 51-56.
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15. Barinov VE, Lobastov KV, Schastlivcev IV, Caplin SN, Laberko LA, Brehov EI, Bojarincev VV. Prediktory razvitija venoznyh trombojembolicheskih oslozhnenij u operirovannyh pacientov iz gruppy vysokogo riska [Predictors of venous thromboembolic complications in operated patients at high risk]. Flebologija [Phlebology]. 2014; 1: 21–30.
TELOMER LENGTH IN PATIENTS OF DIFFERENT AGE WITH CORONARY HEART DISEASE
UDC 616.12-005.4-053-07:576.316.24
DOI: 10.20969/VSKM.2018.11(1).44-49
OSTANINA JULIA O., assistant of professor of the Department of pharmacology, clinical pharmacology and evidence-based medicine of Novosibirsk State Medical University, Russia, 630091, Novosibirsk, Krasniy ave., 52, e-mail: julia679@yandex.ru
YAKHONTOV DAVYD A., D. Med. Sci., professor of the Department of internal medicine, hematology and transfusiology of Novosibirsk State Medical University, Russia, 630091, Novosibirsk, Krasniy ave., 52, e-mail: mich99@mail.ru
Abstract. Aim. Telomere relative length has been assessed, correlation between telomere relative length and independent predictors that affect telomere relative length reduction has been identified in coronary heart disease patients of different age. Material and methods. 106 patients (men) with I—III class stable angina pectoris including 59 young and middle-aged ones (52 [46,5; 55] years) — group 1 and 47 elderly persons (64 [62; 67] years, p<0,001) — group 2, have participated in the study. Patient history, coronary angiography findings, metabolic parameters, coronary and brachiocephalic arteries ultrasound results, matrix metalloproteinase-9 (MMP-9), interleukin 6, 8, 10, telomere relative length and vessel stiffness have been assessed. Results and discussion. Telomere relative length was comparable in both groups of patients with stable angina pectoris (p=0,058) as well as the frequency of its reduction (p=0,844). Negative correlation was revealed between telomere relative length and left ventricle myocardial mass index (r = –0.345; p=0,034), creatinine level (r = –0,335; p=0,014) and ankle brachial index (r = –0,308; p=0,033) in young and middle age patients with coronary heart disease. In elderly patients telomere relative length negatively correlated with waist circumference (r = –0,34; p=0,033), body mass index (r = –0,324; p=0,039), systolic (r = –0,355; p=0,023) and diastolic (r = –0,324; p=0,039) blood pressure as well as with history of hypertension (r = –0,389; p=0,012). Various age dependant telomere relative length predictors were revealed by multidimensional regression analysis. Conclusion. Considering the fact that telomere relative length is a typical feature of early vascular aging syndrome, it is possible to assume frequent presence of this syndrome in coronary heart disease patients of young and middle age. Proceeding from revealed clinical features and metabolic disorders, it is necessary to talk about the multifactor nature of vascular aging and about the early debut of coronary heart disease in young and middle-aged persons.
Key words: arterial stiffness, coronary heart disease, vascular aging, matrix metalloproteinase-9, telomere.
For reference: Ostanina JO, Yakhontov DA. Telomer length in patients of different age with coronary heart disease. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 44-49. DOI: 10.20969/VSKM.2018.11(1).44-49.
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15. Arakelyan VS, Barbarash OL, Bolotova EV et al. Nacional’nye rekomendacii po vedeniyu pacientov s sosudistoj arterial’noj patologiej (Rossijskij coglasitel’nyj dokument): CHast’ 1. Perifericheskie arterii [National recommendations for management of patients with vascular arterial pathology (the Russian agreement): Part 1. Peripheral arteries]. Moskva: Izdatelstvovo NCSSKH imeni AN Bakuleva RAMN [Moscow: Publishing House NTSTSH them AN Bakuleva RAMS]. 2010; 176 p.
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17. Strazhesko ID, Tkacheva ON, Akasheva DU et al. Vzaimosvyaz’ mezhdu faktorami riska serdechnososudistyh zabolevanij i dlinoj telomer lejkocitov [The relationship between risk factors for cardiovascular disease and telomere length of leukocytes]. Kardiovaskulyarnaya terapiya i profilaktika [Cardiovascular therapy and prevention]. 2016; 15 (3): 52-57.
THE QUESTION OF EARLY VIRAL HEPATITIS A DIAGNOSIS
UDC 616.36-002-022-053.2-07:616.152.72-074
DOI: 10.20969/VSKM.2018.11(1).49-52
PROVOTOROV VLADIMIR YA., D. Med. Sci., professor of the Department of infectious diseases and epidemiology of Kursk State Medical University, Russia, Kursk, Sumscaya str., 45g
KISELEVA VICTORIA V., C. Med. Sci., associate professor, Head of the Department of infectious diseases and epidemiology of Kursk State Medical University, Russia, Kursk, Sumscaya str., 45g
BELOKONOVA LYUDMILA V., C. Med. Sci., associate professor of the Department of infectious diseases and epidemiology of Kursk State Medical University, Russia, Kursk, Sumscaya str., 45g e-mail: Ludmila2611@yandex.ru
Abstract. Aim. The features of the change in serum iron content in the early stage of viral hepatitis A were evaluated. Material and methods. During the period of the incidence of viral hepatitis A 85 patients have referred for outpatient care presenting an infectious toxic syndrome with a preliminary diagnosis of acute respiratory viralinfection. The mean age of the examinees was (10±5,4) years. Exclusion criteria were severe concomitant inner organ diseases. Results and discussion. In 67 (79%) of 85 patients serum iron level was below normal with the average of (11,4—0,6) mol/l. The level of bilirubin and ALT were within normal limits. These patients were subsequently diagnosed with acute respiratory viral infection. In 18 (21%) patients serum iron level was higher than normal along with an increase in the iron concentration in this group of patients ALT level was also above normal with the average of (305,4±1,3) U/l and the liver pigment function was not disturbed. Later these patients were diagnosed with viral hepatitis A. Conclusion. Even the minimal values of serum iron ions in prodrome period of viral hepatitis A significantly exceed the maximal values of the control group, which can serve as one of the criteria for early viral hepatitis A diagnosis.
Key words: viral hepatitis A, serum iron, differential diagnosis, acute respiratory viral infection.
For reference: Provotorov VYa, Kiseleva VV, Belokonova LV. The question of early viral hepatitis A diagnosis. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 49-52. DOI: 10.20969/VSKM.2018.11(1).49-52.
REFERENCES
1. Karetkina GN. Virusnyj gepatit A: sovremennye osobennosti kliniki, diagnostiki i profilaktiki [Viral hepatitis A: the modern features of the clinic, diagnostics and prevention]. Lechashhij vrach [Treating doctor]. 2010; 10: 21- 24.
2. Klimova EA. Virusnyj gepatit A: sovremennoe sostojanie problemy [Viral hepatitis A: current state of the problem]. Farmateka [Pharmateca]. 2010; 2: 46-49.
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4. Pokrovskij VI, Zhebrun AB. Virusnye gepatity v Rossijskoj Federacii: analiticheskij obzor [Viral hepatitis in the Russian Federation: analytical review]. Sankt-Peterburg: FBUN NIIJeM imeni Pastera [St Petersburg: Pasteur Institute]. 2011; 116 p.
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6. Habarov AA, Novikov DA, Budko EV, Odinchenko LV. Biologicheskoe dejstvie himicheskih jelementov: zhelezo; Fiziologicheskie, farmakodinamicheskie i toksicheskie priznaki [Biological effects of chemical elements: iron; Physiological, pharmacodynamic and toxic signs]. Kursk: KGMY [KGMU]. 2014; 114 p.
UDC 343.828:004.9(470.41)
DOI: 10.20969/VSKM.2018.11(1).52-57
TIMERZYANOV MARAT I., C. Med. Sci., associate professor of the Department of epidemiology and evidence-based medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: Marat.Timerzyanov@tatar.ru
POLUNINA NATALIYA V., D. Med. Sci., professor, Head of the Department of public health, healthcare and health economics Pirogov Russian National Research Medical University, Russia, 117997, Moscow, Ostrovitianov str., 1
MILUSHKINA OLGA YU., D. Med. Sci., associate professor, Head of the Department of hygiene of Pirogov Russian National Research Medical University, Russia, 117997, Moscow, Ostrovitianov str., 1
MALEYEV MIKHAIL V., C. Phys.-Math. Sci., Head of the Department of patent and invention of Republican Clinical Hospital, Russia, 420064, Kazan, Orenburgskiy trakt, 138
Abstract. Aim. Risk factor analysis and assessment for the impact of sanitary and hygienic working conditions on the incidence among convicts employed at production at corrections department of the Russian Federation for the Republic of Tatarstan has been performed. The algorithm of comprehensive incidence assessment in convicts has been developed. Processing of received data has been robotized. Similar approach has been applied in convict nutrition assessment. Material and methods. A set of statistical research methods such as probabilistic approach, computational diagnostic method, differential informativity coefficient calculation has been applied for selected factors. Instrumental physical and chemical factor measurements at production environment were made. Coefficient of differential informative factors has allowed determining the odds ratios for each of the presented factors. Results and discussion. The automatic software modules «Working conditions» and «Nutrition» have been developed and tested to robotize processing of information obtained from questioning of convicts employed at production at corrections department of the Russian Federation for the Republic of Tatarstan. Conclusion. Limited data processing period allows monitoring morbidity in working convicts, identifying unfavorable trends that affect the increase in morbidity, and making timely adjustments. The ability to analyze the incidence in convicts in selected region in general and in terms of institutions. Developed method of incidence assessment in convicts has been introduced to all institutions of the penal system on the territory of the Republic of Tatarstan.
Key words: sanitary and hygienic working conditions for convicts, hygienic assessments of labor factors in the working environment, odds ratio, algorithm for integrated assessment of the incidence in convicts.
For reference: Timerzyanov MI, Polunina NV, Milushkina OYu, Maleyev MV. Program modules «Working conditions» and «nutrition» as a tool of analysis of the influence of sanitary and hygienic working conditions on morbidity in convicts employed at production at corrections department of the Russian Federation for the Republic of Tatarstan. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 52-57. DOI: 10.20969/VSKM.2018.11(1).52-57.
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RABEPRAZOLE TABLET CORE COMPOSITION AND ENTERIC COAT APPLICATION TECHNOLOGY RESEARCH
UDC 615.243.4.014.21:615.453.6.014.64
DOI: 10.20969/VSKM.2018.11(1).57-63
CHUVASHOVA DINARA P., postgraduate student of Kazan State Medical University, leading engineer-technologist of the Department of research of «Tatkhimpharmpreparaty», Russia, 420091, Kazan, Belomorskaya str., 260
EGOROVA SVETLANA N., D. Pharm. Sci., professor, Head of the Department of pharmacy of the faculty of advanced learning and professional specialist training of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, tel. 8(843)521-44-96, e-mail: svetlana.egorova@kazangmu.ru
ANISIMOV ALEXANDER N., C. Techn. Sci., deputy chief executive officer for development of «Tatkhimpharmpreparaty», Russia, 420091, Kazan, Belomorskaya str., 260 Abstract. Aim. Theoretical and experimental basis of intestine-soluble shell composition and its application technology on rabeprazole core tablets has been investigated. Material and methods. The main object of composition development and coating technology in the study was 20 mg rabeprazole core tablets and conventional film shells widely used in pharmaceutical technology. Results and discussion. Full factorial experiment method has been applied in order to investigate technologic factor contribution to the process of intestine-soluble shell application on rabeprazol tablet core. The following optimal experimental mode has been chosen for Huttin Unitab-0,5-TJ rig: inlet air volume — 70—90%, inlet air temperature — 60—65°С, product temperature 38—41°С, roller pump rpm from 3,1 to 4,7%. The result was yellow rabeprazole tablets with brownish tinge (20 mg dosage) with uniform shell. Tablet surface was slightly rough without chips. The optimal shell composition for 20 mg rabeprazole tablet core is separative layer Opadry® YS-1-7027 White («Colorcon») with applied Acryl-EZE® Yellow («Colorcon») enteric shell + macrogol plasticizer (polyethylene glycol) 6000. Conclusion. The composition and technology has been developed for 20 mg rabeprazole tablets with enteric shell on the tablet core coated with separative layer.
Key words: rabeprazole, tablet, enteric coat.
For reference: Chuvashova DP, Egorova SN, Anisimov AN. Rabeprazole tablet core composition and enteric coat application technology research. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 57-63. DOI: 10.20969/ VSKM.2018.11(1).57-63.
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RUPTURE OF THE RENAL ARTERY IN PREGNANT — RARE CLINICAL OBSERVATION
UDC 618.3-06:616.136.7-007.64
DOI: 10.20969/VSKM.2018.11(1).64-68
CHIKAEV VYACHESLAV F., D. Med. Sci., professor of the Department of traumatology, orthopedics and emergency surgery of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: prof.chikaev@gmail.com
GALYAUTDINOV FARID SH., D. Med. Sci., deputy chief physician for surgery of City Clinical Hospital № 7, Russia, 420000, Kazan, Chuykov str., 54
DEVLIKAMOV RADIK SH., autopsist of City Clinical Hospital № 7, Russia, 420000,Kazan, Chuykov str., 54
BUKUSHKINA VICTORIA A., VI year student of pediatric faculty of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49
FATYKHOV LENAR Z., VI year student of the faculty of general medicine of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49
Abstract. Aim. Clinical case of spontaneous rupture of the renal artery aneurysm in a pregnant woman in the 3rd trimester was presented. Material and methods. A complex examination was carried out. The features of the clinical course and provision of medical care in City Clinical Hospital № 7 at Kazan to a pregnant woman aged 29 years with a rupture of the aneurysm of the renal artery were revealed. Results and discussion. The patient has been admitted with a diagnosis of intercostal neuralgia on the left. Considering proteinuria and leukocyturia in urinalysis, the patient with a diagnosis of acute pyelonephritis in pregnancy was hospitalized to internal medicine ward. 5 hours after hospitalization the patient’s condition has worsened. The pain in the abdomen has increased, cold sweat, weakness and dyspnea have appeared. After the repeated ultrasound examination of the abdominal cavity and after the consultation (gynecologist, surgeon, and critical care physician) she was diagnosed with subtotal placental abruption, antenatal fetal death. The patient was taken to operation room in critical condition: blood pressure — 50/20 mmHg. Hemodynamics was maintained by the administration of norepinephrine 0,3 μg/kg/min via syringe intravenous dispenser. After laparotomy, dead fetus extraction and contraction of the uterus an extensive retroperitoneal hematoma was revealed. The surgery was continued by a team of surgeons and a vascular surgeon. When revising the retroperitoneal space, intensive arterial bleeding was detected in the area of the kidneys’ gate. The cause was damage to the renal artery at the kidneys gate. Nephrectomy was performed according to vital indications. Histological examination of the removed kidney revealed a rupture of the aneurysm of the renal artery. Infusion therapy was performed during the surgery in the amount of 8879 ml, including: erythrocyte mass — 2489 and fresh frozen plasma — 1890 ml. In the postoperative period the patient developed acute renal failure and hepatic insufficiency on the 1st day. Complex intensive conservative therapy was conducted in intensive care unit. As a result of ongoing therapy on the 10th day the biochemical parameters of blood have normalized. The patient was discharged on the 21st day of hospitalization in a satisfactory condition. On the 2nd day after discharge the patient developed acute calculous cholecystitis, on the 14th day — an acute strangulation adhesive commissural obstruction with necrotic ileum and gangrene of the gallbladder site. The surgery consisted of laparotomy, viscerolysis, resection of the ileum with a thin-intestinal anastomosis and cholecystectomy. She was discharged on the 10th day in a satisfactory condition. In remote terms the patient’s condition remained satisfactory. Conclusion. The clinical observation indicates that the aneurysm of the renal artery in women is a life-threatening condition. The rupture of the aneurysm of the renal artery in pregnant women leads to severe bleeding with antenatal fetal death, to development of unforeseen complications and disruptions of the compensatory capabilities of the body.
Key words: aneurysm, renal artery, rupture, pregnancy.
For reference: Chikayev VF, Galyautdinov FSh, Devlikamov RSh, Bukushkina VA, Fatykhov LZ. Rupture of the renal artery in pregnant — rare clinical observation. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 64-68. DOI: 10.20969/VSKM.2018.11(1).64-68.
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UDC 616.24-036.12-085.217.22(048.8)
DOI: 10.20969/VSKM.2018.11 (1).70-78
PUXEDDU ERMANNO, pneumologist, assistant of professor of the Department of respiratory medicine, of the Department of systems medicine of University of Rome Tor Vergata, Rome, Italy, University Hospital Tor Vergata, Via Montpellier, 1, Italy, 00133, Rome, e-mail: ERMANNOPUX@libero.it ORA JOSUEL, pneumologist of University Hospital Tor Vergata, Via Montpellier, 1, Italy, 00133, Rome, e-mail: josuel78@gmail.com
CALZETTA LUIGINO, D. Med. Sci., research worker of the laboratory of respiratory clinical pharmacology of the Department of systems medicine of University of Rome Tor Vergata, Via Montpellier 1, Italy, 00133, Rome, e-mail: luigino.calzetta@uniroma2.it
CAZZOLA MARIO, honorary professor of respiratory medicine, the Department of systems medicine of University of Rome Tor Vergata, Via Montpellier, 1, Italy, 00133, Rome, e-mail: mario.cazzola@uniroma2.it
Abstract. Aim. The treatment of chronic obstructive pulmonary disease (COPD) is generally based on the assumption of drug combinations in which β2 -agonists are commonly included. Ultra-LABAs were developed to induce a greater adherence to the treatment as a result of the simplification of treatment with the reduction of the daily dose to be taken. Material and methods. We analyzed the current literature data on β2 -adrenergic agonists. The potential positioning of ultra-LABAs in the treatment of COPD and their cardiovascular safety is discussed according to the new information on the topics. Results and discussion. The novel fixed-dose combinations of ultra-LABAs with LAMAs and/or ICSs are examined, as well as the novel ultra-LABAs under clinical development and the ultra-LABAs in preclinical development. Conclusion. The huge interest in developing new ultra-LABAs has apparently declined progressively in recent times. Nevertheless, ultra-LABAs are considered a fundamental component of the combinations with other classes of drugs (LAMAs and ICSs) that are central for treating COPD and now are administered on oncedaily basis.
Key words: cardiovascular safety, combination therapy, COPD, monotherapy, ultra-LABAs.
For reference: Puxeddu E, Ora J, Calzetta L, Cazzola M. Progress and prospects for long-acting β2 -agonists in the treatment of chronic obstructive pulmonary discase. The Bulletin of Contemporary Clinical Medicine. 2018; 11 (1): 70-78. DOI: 10.20969/VSKM.2018.11(1).70-78.
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HUMAN RESOURCE MANAGEMENT STRATEGY IN REGIONAL CHILDREN’S HOSPITAL
UDC 614.25:005.95/.96:616-053.2-082.6(470.41-25)
DOI: 10.20969/VSKM.2018.11(1).79-85
VAFIN ADEL YU., C. Med. Sci., Head of the Department of health management of Kazan State Medical University, Russia, 420012, Kazan, Butlerov str., 49, e-mail: Adel.Vafin@tatar.ru
FAKHRUTDINOVA ELENA V., D. Econ. Sci., Head of the Department of human resource management of Kazan (Volga region) Federal University, Russia, 420008, Kazan, Kremlevskaya str., 18, e-mail: efahr@mail.ru
SHAVALIEV RAFAEL F., C. Med. Sci., Head physician of Children’s Republican Clinical Hospital, Russia, 420138, Kazan, Orenburgskiy trakt, 140, e-mail: Rafael.Shavaliev@tatar.ru
KULIKOV OLEG V., C. Med. Sci., deputy Head physician of organizational and methodical work of Children’s Republican Clinical Hospital, Russia, 420138, Kazan, Orenburgskiy trakt, 140, e-mail: Oleg.Kulikov@tatar.ru
Abstract. Aim. This work is dedicated to development of human resource management strategy in Children’s Republican Clinical Hospital of Ministry of Health of the Republic of Tatarstan based on the implementation of the principles of process management using strategic management tools. The relevance of the study is the transition to a new stage of the institution development resulting from completed implementation of modernization regional program, structural changes in the organization, as well as from the radical factor changes in near and far surroundings. Material and methods. The key role and significant part of human resource management strategy in the hierarchy of big medical company policies are clearly demonstrated. Major attention is paid to the possibility of using strategic management tools for human resource management strategy development. Moreover, analysis of human resource strategy in Children’s Republican Clinical Hospital has been performed. It included mission and values of the organization, value chain analysis, human resource analysis, environmental analysis of Children’s Republican Clinical Hospital, organization stakeholders’ analysis matrix of the SWOT-analysis. Results and discussion. The results of the strategic process in the field of personnel management are typical for big public clinic. It is necessary to create a holistic process-oriented model of staff remuneration using the following tools: balanced scorecard, an effective strategy of participation (kaizen), lean manufacturing, mentoring, «effective contract» motivational trainings and other financial and non-financial rewards. Conclusion. An important condition for management development at the workplace level is a clear regulation of the personnel management processes at each stage: activity planning — recruiting — employment contract signing — introduction to the position — continuous training — evaluation of the results of work — personnel development.
Key words: human resource management, strategic management, Children’s Republican Clinical Hospital of Ministry of Health of the Republic of Tatarstan, value chain.
For reference: Vafin AU, Fakhrutdinova EV, Shavaliev RF, Kulikov OV. Human resource management strategy in regional children’s hospital. The Bulletin of Contemporary Clinical Medicine. 2018; 11(1): 79-85. DOI: 10.20969/ VSKM.2018.11(1).79-85.
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